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Introduction: RA©sultats: Conclusion: Pain is a frequent reason for medical consultation particularly among persons infected with HIV. In Mali very little work has been conducted on pain in HIV hence the aim of this work. The aims for this study were to determine the knowledge of medical staff dedicated to the management of HIV about pain to determine the frequency of pain in HIV and assess its impact on their quality of life. We conducted a descriptive study from June to August 2013. Medical staffs from departments of internal medicine and infectious diseases and hospitalized patients infected by HIV were included. We obtained verbal consent from patients before inclusion. A total of 50 health workers were interviewed including 29 physicians (doctors) 11 nurses and 9 students in medical theses. In practice they do not systematically evaluate pain (40%). When evaluating EVA and EVS were the main methods used. Prescription analgesic was not correct in 53.9% of cases. The prevalence of pain was 92.9% among hospitalized patients infected by HIV. Pain was level I (32.7%) II (48.1%) and III (19.2%). The majority of patients had a low CD4 count (73.3% had a CD4 below 200/mm3) with level 3 (60.7%) and 4 (25%) of WHO. The pain was acute (53.8%) and permanent or chronic (57.7%) in general. Impacts of pain were cognitive and motor. The high frequency of pain and its impact on the quality of life HIV require its systematic research and care at every visit. It is necessary to recycle the health staff on the assessment of pain and the correct prescription of analgesic.

We conduct a longitudinal descriptive study in the department of infectious diseases to CHU of Point G during 18 months. It concerned adult patients referred from another care center. All the patients underwent systematic clinical examination and complementary exploration. Our sample was 352 HIV+ patients, with a mean age of 37.8 ± 9.8 years and a sex ratio (M/F)=0.94 shared among patients receiving ARV treatment (ART-s) and not (n-ART). Delay of reference was 5 ± 4.4 days. All patients benefited from clinical and paraclinical examinations. In both groups patients were mostly from level II. On admission, 132 cases were ART-s (38%). The main reasons for consultation were mainly fever [87.9%, p

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

Le but principal de cette etude etait d’evaluer les aspects epidemiologiques et semiologiques des troubles fonctionnels intestinaux (TFI) dans les centres de sante de reference de Bamako. Il s’agissait d’une etude transversale menee de juin 2006 a novembre 2006. Pendant la periode d’etude, 104 patients ont repondu aux criteres d’inclusion sur 487 patients, soit une frequence de 21,35 % de la population examinee. L’âge moyen etait de 30,5 ± 11,5 ans, la tranche d’âge de 16–26 ans predominait avec 45,2 %. Le sex-ratio etait de 0,5 en faveur des femmes. Les signes fonctionnels les plus frequemment retrouves ont ete la douleur abdominale (97,1 %), le meteorisme/ballonnement abdominal (51,9 %) et la constipation (45,2 %). Un absenteisme frequent etait rapporte par 65,8 % des patients. Les TFI peuvent etre consideres comme un probleme de sante publique. Les couts du traitement et des explorations et les absences frequentes au travail constituent les veritables problemes socio-economiques.

Resume Objectif Etudier entre 1996 et 2006, l’evolution des schemas therapeutiques et du profil clinique et immunologique des patients infectes par le VIH au debut du traitement antiretroviral (TARV) en Afrique de l’Ouest. Cadre et methode Les donnees issues de 12 centres cliniques adultes (IeDEA West Africa reseau collaboratif de prise en charge de l’infection a VIH) de cinq pays (Benin, Cote d’Ivoire, Senegal, Gambie, Mali) ont ete mises en commun et analysees. Les patients âges de 16 ans et plus dont le sexe, la date de naissance et la date d’initiation du TARV etaient connus ont ete inclus dans cette etude. Resultats Quatorze mille quatre-cent-quatre-vingt-seize patients avaient debute un TARV entre 1996–2006 avec 55 % des patients l’ayant debute entre 2005–2006. La proportion de femmes etait de 46 % en 1996–2000 et de 63 % en 2005–2006. L’âge median a la mise sous traitement etait constant : 35 ans chez les femmes et 40 ans chez les hommes. La proportion de patients qui ont debute le TARV avec un taux de CD4 inferieur a 200 cellules/μl etait de 54 % en 1996–2000 et de 64 % en 2005–2006. Les combinaisons therapeutiques les plus prescrites etaient : AZT/3TC (ou d4T/DDI)/IDV (27 %) en 1996–2000 ; d4T (ou AZT)/3TC/EFV (59 %) en 2003–2004 ; et d4T/3TC/NVP (49 %) en 2005–2006. Les traitements de premiere ligne recommandes par l’OMS etaient debutes dans 83 % de cas en 2005–2006. Conclusion De nouvelles approches pour debuter un TARV plus precocement doivent etre developpees pour ameliorer la survie des patients sous TARV.

Le but de notre etude etait d’etudier les aspects anatomo-cliniques des gastrites chroniques. Notre etude transversale s’est deroulee dans les centres d’endoscopie de l’hopital du Point «G» et de la Clinique du Farako. Tous les malades ont subi un examen clinique soigneux.

Le but principal de notre travail etait d’etudier les aspects epidemiologiques, cliniques et evolutifs des cancers colorectaux (CCR) en milieu hospitalier.

Notre etude retrospective avait pour objectifs de determiner la frequence de la tuberculose peritoneale, d’en decrire les manifestations cliniques, laparoscopiques et les caracteristiques du liquide d’ascite. Ont ete inclus dans cette etude les dossiers des malades presentant a la laparoscopie des granulations et/ou des nodules peritoneaux. Dans tous les cas, l’examen anatomo-pathologique de ces lesions avait confirme le diagnostic de tuberculose peritoneale. 26 dossiers repondaient aux criteres d’inclusion (10 hommes et 16 femmes). La tuberculose peritoneale representait 4,13 % de l’ensemble des cas de tuberculose. L’âge moyen a ete de 37,7 ±15 ans avec des extremes a 12 et 65 ans. Les signes cliniques ont ete domines par l’ascite (88,5 %) des cas, l’amaigrissement (53,8 %), l’anorexie (53,8 %), la douleur abdominale (42,2 %), l’asthenie (42,3 %) et la fievre (42,3 %). L’association des granulations aux nodules a ete l’anomalie laparoscopique la plus frequente: 80,76 % (21/26). L’examen direct avec la coloration de Ziehl Neelson et la culture du bacille de Koch (BK) sur milieu de Lowenstein ont ete positifs respectivement dans 50 % (3/6) et 60 % (3/5) des cas. En Afrique, la laparoscopie demeure un examen de choix dans le diagnostic de la tuberculose peritoneale. Elle a permis la mise en evidence de granulations: lesions classiques, mais aussi de nodules peritoneaux pouvant faire discuter des metastases peritoneales. The objectives of our retrospective study were to determine peritoneal tuberculosis frequency, to describe its laparoscopic and clinical manifestations and the characteristics of the ascitis fluid. The included patients recorded forms were those presenting granulations and/or peritoneal nodules at laparoscopy. In all cases, the anatomical and pathological examination of these lesions confirmed the diagnosis of peritoneal tuberculosis. Twenty-six patients were included in the study: 10 men and 16 women. Peritoneal tuberculosis occurred in 4.13 % of the tuberculosis total case. The mean age was 37.7 ±15 years from 12 to 65 years. The most important clinical signs were ascitis (88.5 %), weight loss (53,8 %), anorexia (53.8 %), abdominal pain (42.2 %), asthenia (42.3 %) and fever (42.3 %). The association of granulations and nodules was the most laparoscopically frequent abnormality: 80.76 % (21/26). The direct examination with Ziehl Neelson coloration and the bacillus of Koch (BK) culture in Lowenstein media were positive in 50 % (3/6) et 60 % (3/5) respectively. In Africa, laparoscopy remains an examination of choice for the diagnostic of peritoneal tuberculosis. It allows the discovery of granulations: classical lesions but also peritoneal nodules that could be discussed as peritoneal metastasis.

Le but de cette etude etait d’etudier les caracteres non histologiques des ulceres malins. Nous avons effectue de janvier 1986 a decembre 1998 (soit 12 ans), une etude retrospective de dossiers de malades vus en endoscopie digestive haute dans le centre d’endoscopie de l’hopital du point « G ». Tous les malades ayant un ulcere gastrique avec un examen histo-pathologique ont ete inclus. Parmi les 914 ulceres gastriques diagnostiques, 241 ont ete biopsies sur lesquels 34 etaient malins soit 15,88 % (34/241). L’âge moyen des malades ayant un ulcere malin etait de 53,50 ± 3,15 ans. 76,47 % de ces ulceres avaient un diametre compris entre 10 et 110 mm. Les ulceres dont le diametre depassait 110 mm etaient tous malins. Les ulceres malins etaient situes sur la face anterieure de l’antre dans 67,64% des cas, dans 94,10% des cas, le fond sale etait necrotique et hemorragique; leurs contours etaient arrondis dans 82,36 % des cas. Ils etaient creusants dans 97,50 % des cas, durs dans 100 % des cas, avec un bourrelet epais dans 70,50 % des cas. La lesion histologique a ete exclusivement l’adenocarcinome gastrique: 100 % des cas. En l’absence d’examen anatomo-pathologique, les ulceres gastriques repondant a cette description doivent etre referes au chirurgien. The goal of this survey was to describe the non-histological characteristics of malignant ulcer. We conducted a retrospective survey of patients submitted to an endoscopic examination of the upper digestive tract in the endoscopy unit of the hospital “Point G” from January 1986 to December 1998 (12 years). Subjects with gastric ulcer and histopathological exam were included. A biopsy was performed on 241 of the 914 subjects with gastric ulcer. Of the 214 subjects who had biopsy and histological exam, 34 (15,88 %) were diagnosed with malignant ulcer. The mean age of subjects with malignant ulcer was of 53,50 ± 3,15 years. 76,47 % of these malignant ulcers have a diameter of 10 to 110 mm and all cases of ulcer with a diameter over 110 mm were malignant. The malignant ulcers were located on the anterior face of the stomach in 67,64 % of cases, the bottom was soiled with necrosis and hemorrhage in 94,10 % of cases. The contours of the malignant ulcers were of rounded shape in 82,36 % of cases, excavated in 97,50 %, hard in 100 %, with a thick pad in 70,50 %. The type of histolological lesions in all cases (100 %) was gastric adenocarcinoma. In the absence of anatomopathological exam, cases of gastric ulcers with the above characteristics should be referred to the surgeon.

Le but principal de ce travail etait d’etudier les cancers de l’œsophage en milieu hospitaller. Notre etude, prospective cas-temoins s’est deroulee de decembre 1997 a decembre 1999 dans les hopitaux du Point G et de Gabriel Toure de Bamako et a la Clinique Farako. Tous les patients presentant une tumeur maligne histologiquement confirmee ont ete colliges. Les temoins ont ete constitues par des patients ayant une endoscopie digestive normale et ne presentant pas de signe evoquant un cancer d’un autre siege. Une enquete sur le mode de vie des deux groupes a ete realisee. En deux ans, nous avons collige 27 patients presentant un aspect macroscopique de tumeur maligne de l’œsophage, dont 16 cas ont ete confirmes par l’histologie. Ces cancers ont represente 0,2% de l’ensemble des endoscopies digestives hautes et 16% des cancers du tube digestif. Lesex-ratio a ete de 0,5 en faveur des femmes. L’âge moyen des cancereux a ete de 59,4 ans ± 7,4. Les couches socioprofessionnelles les plus representees ont ete les menageres avec 68,7% et les cultivateurs avec 31,3% (p=10−8 et 210−2). La consommation frequente de poissons fumes, de to avec potasse, de viande conservee naturellement et de tabac a chiquer etait significativement associee aux cancers de l’œsophage (p

Resume Objectif : L’insuffisance des services d’anatomie pathologique et leur concentration dans les seuls centres hospitaliers en pays d’endemie tuberculeuse, peuvent retarder le diagnostic de tuberculose ganglionnaire. Cette etude examinait la rentabilite de la ponction a l’aiguille fine (PAF) des ganglions lymphatiques dans le diagnostic des adenopathies mycobacteriennes de l’adulte a Bamako, Mali. Population : Cinquante-et-un patients d’âge moyen = 33,03 ± 11,45 ans etaient recrutes de juin 1997 a avril 1999. Resultats : La bacilloscopie des produits de PAF du ganglion etait positive chez 29 malades sur 45. Elle n'etait pas moins fructueuse que celle des crachats. Ces resultats bacilloscopiques concordants avec ceux de la cytologie dans 61,9 % des cas etaient rendus dans un delai plus court que ceux de l’histologie du ganglion et a un cout moindre. Conclusion : La pratique de la PAF des ganglions lymphatiques dans toutes les structures sanitaires des pays a forte endemie mycobacterienne et de VIH semble interessante.

Le but principal de notre etude etait d'evaluer la prevalence des signes endoscopiques de la cirrhose et d'en preciser la performance diagnostique pour celle-ci. L'etude prospective s'est deroulee de janvier 1997 a fevrier 1999 dans les hopitaux nationaux du Point «G» et Gabriel Toure de Bamako (Mali). Les criteres diagnostiques de la cirrhose etaient l'examen histologique ou l'association d'un gros foie a bord inferieur tranchant, d'un taux de prothrombine bas et d'un aspect echographique ou laparoscopique de cirrhose. Les hepatopathies chroniques sans cirrhose, prises comme temoins ont toutes ete histologiquement prouvees. Au terme de l'etude, 116 patients ont ete inclus dont 56 cas de cirrhose et 60 hepatopathies non cirrhotiques. Les varices œsophagiennes, la gastropathie d'HTP et les erosions etaient significativement plus frequentes dans le groupe cirrhose. Huit variables etaient significativement differentes entre les 2 groupes et ont ete incluses dans une analyse discriminante: l'antigene HBs, les varices œsophagiennes, les erosions et l'ictere avaient une valeur predictive independante avec une performance diagnostique de 89% pour la cirrhose. Notre etude, dont l'originalite est un diagnostic de reference reposant sur la laparoscopie, confirme que les signes endoscopiques ont une valeur independante dans le diagnostic de cirrhose.

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Schistosoma haematobium-related morbidity was studied in the perennial irrigation area of Office du Niger and the small reservoirs area of Plateau Dogon in Mali. Questionnaire, clinical, parasitologic, and ultrasound examination data were collected from 1,041 individuals at the baseline survey in 1991; 705 were re-examined one year after treatment. At baseline, the overall prevalence of S. haematobium infection was 55.2%; half of those infected had no clinical symptoms and 30% had pathologic lesions. Both infection and morbidity were more frequent in children than in adults, with a peak prevalence at 7-14 years of age. The rates of lesions were more than twice as high in those heavily infected as in lightly infected individuals. Reagent strip testing for microhematuria was more sensitive in detecting individuals with pathologic lesions than in detecting individuals with infection. One year after treatment with praziquantel, more than 80% of the urinary tract lesions had cleared. It is concluded that S. haematobium-related morbidity is frequent in Mali, but passive case detection for treatment would not cover a great deal of early stages of the disease; active intervention using reagent strip testing for microhematuria at the most peripheral levels would be an efficient system for morbidity control and monitoring of control operations.

L’incidence de la tuberculose est elevee en Afrique. Le traitement fait appel a des molecules pourvoyeuses de neuropathies douloureuses susceptibles d’avoir un impact negatif sur la qualite de vie et sur l’observance du traitement. L’objectif de ce travail est d’etudier la douleur neuropathique due aux antituberculeux chez les patients non infectes par le virus de l’immunodeficience humaine (VIH). Methode. Il s’agit d’une etude prospective realisee dans le service de pneumo-phtisiologie du centre hospitalier universitaire (CHU) de Point G, au Mali. Ont ete inclus les malades sous antituberculeux ayant une serologie VIH negative, et qui n’avaient pas d’autre cause de douleur neuropathique. Le diagnostic s’est fait sur la base du questionnaire DN4 (pour « douleurs neuropathiques en quatre questions »), et l’evaluation a l’aide de l’EVA (echelle visuelle analogique) et du test Lattinen. Resultats. Pendant l’etude, 423 sujets furent admis, dont 103 (24,4 %) cas de tuberculose. Quatre-vingt patients repondaient aux criteres d’inclusion. Le sex-ratio (H/F) etait de 2,5. La moyenne d’âge etait de 39 ans avec des extremes de 13 et 80 ans. Sous traitement, treize patients presenterent une neuropathie douloureuse soit 16 %. Les sensations de brulure plantaire furent le mode revelateur, associees ou non a une paresthesie, chez dix patients sur treize. Un traitement associant amitriptyline, vitamine B6 et kinesitherapie fut initie chez tous les patients, avec succes apres deux mois. Conclusion. La douleur survient independamment de l’âge, du sexe et du regime antituberculeux – s’il contient de l’isoniazide. L’interruption ou la modification des protocoles n’est pas necessaire. Dans notre contexte, au vu des difficultes d’identification des acetyleurs lents, un traitement systematique par vitamine B6 merite d’etre discute.

Background As access to antiretroviral drugs increases in developing countries, it will become increasingly important to monitor the emergence of resistance and to define the molecular pathways involved to identify optimal therapeutic regimens. Methods We performed genotypic resistance testing on plasma obtained from 101 HIV-infected treatment-naive individuals from Mali. Genotyping was carried out using the Virco protocols and HXB2 was used as the reference strain. Results CRF02_AG was the most common subtype, present in 71.3% of our patient population. Other subtypes included B, C, G, CRF06_CPX, CRF09_CPX, CRF01_AE, A2/CRF16_A2D, A1 and CRF13_CPX. A total of 9.9% [95% confidence interval (CI) 6.9–12.9%] of patients had at least one resistance mutation. The prevalences of mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 5% (95% CI 0.7–9.2%), 6% (95% CI 1.3–10.6%) and 0%, respectively. The most frequent mutations were T215A/Y for NRTIs and K103N/T for NNRTIs. One patient harboured three NRTI resistance mutations and one NNRTI mutation. This is the first reported case of multi-drug-resistant viral transmission in Mali. Polymorphisms at protease codons 10I/V and 33F potentially associated with resistance were observed in 18.8% and 1% of patients, respectively. Several polymorphisms in the C-terminal domain of reverse transcriptase were observed: A371V (in 63.4% of patients), G335D (76.2%), E399D (10.9%) and G333E (1%). Conclusion Primary resistance was seen in 9.9% of subjects, which is higher than previously reported in Mali. Taking into consideration other polymorphisms in protease such as L10I/V and 33F, primary resistance could reach 28.7% (95% CI 19.9–37.5%). Our study reflects the need to monitor the evolution of resistance on a regular basis and trends of transmitted resistance.

Eighteen patients hospitalized with intestinal parasitic infections associated with diarrhea and dehydration completed a study of nitazoxanide in the treatment of Cryptosporidium parvum and other intestinal parasitic infections. Seventeen of the 18 patients were positive for human immunodeficiency virus. Twelve patients were diagnosed with clinical Stage 4 acquired immunodeficiency syndrome (AIDS) according to the 1990 World Health Organization proposed clinical classification system and cryptosporidiosis. Nitazoxanide (500 mg tablets) were administered orally, one tablet twice a day for seven consecutive days. Cryptosporidium parvum oocysts were eradicated or reduced by more than 95% in seven of the 12 Stage 4 AIDS patients who completed the study based upon two post-treatment fecal examinations conducted on days 7 and 14 following the initiation of treatment. The elimination or reduction of C. parvum oocysts was associated with a complete resolution of diarrhea in four of the seven patients. The test drug was also effective against cases of Isospora belli, Entamoeba histolytica, Giardia lamblia, Ascaris lumbricoides, Enterobius vermicularis, Hymenolepis nana, and Dicrocoelium dentriticum. Treatment with nitazoxanide was well tolerated by the patients. There were no abnormalities in blood chemistry or hematology data that were considered to be attributable to nitazoxanide therapy. Transient episodes of vomiting were observed in four patients, all with Stage 4 AIDS and cryptosporidiosis, which resolved spontaneously without discontinuation of treatment and were not considered to be related to administration of nitazoxanide.The effectiveness of nitazoxanide in the treatment of Cryptosporidium parvum and other intestinal parasitic diseases was assessed in 18 patients hospitalized at Point G. National Hospital in Bamako, Mali, with parasite-related diarrhea, dehydration, and weight loss. 17 of the 18 patients were infected with HIV, and 12 of these had progressed to clinical stage 4 AIDS. 500 mg tablets of nitazoxanide were administered twice a day for 7 days. After completion of treatment, Cryptosporidium parvum oocysts were eradicated or reduced by more than 95% in 7 of the stage 4 AIDS patients; diarrhea was completely resolved in 4 of these patients. Nitazoxanide was also effective against other parasites common in AIDS patients, including Entamoeba histolytica, Giardia lamblia, and Isospora belli. The test drug was well tolerated by all recipients, with no blood chemistry abnormalities.