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The Pica syndrome is an eating disorder characterized by an excessive or abnormal desire to consume a non-nourishing substance which can be relatively harmless, or potentially harmful for the health. It is a rare affection secondary to the accumulation of diverse nature foreign bodies inside the digestive tract and more especially at the stomach level. Gastro-intestinal localization is the most frequent, and can remain long time asymptomatic. Treatment is surgical. We report 3 cases of digestive complication of Pica syndrome. The first one was operated for gastric perforation due to nail (53 nails, a pin and bands of tape recorder cassette ingested), the second one for trichobezoar and the last had a subocclusion by pieces of granite.

BACKGROUND In a country where radiotherapy (RT) is not available, advocacy based on the relevance of surgery + adjuvant RT in locoregional control and survival is needed. AIM To evaluate the impact of surgery with RT on local control and survival compared to surgery alone in breast cancer (BC). METHODS AND RESULTS Between 2007 and 2016, 210 patients with BC were retrospectively reviewed, of which 90 patients underwent surgery with RT (group 1) and 120 patients' surgery (group 2). There were several treatment combinations, including surgery combined with neoadjuvant chemotherapy [ACT], RT, and ACT. The results showed 88 (41.9%) cases of relapse, including 31 (34.4%) (group 1) and 57 (47.5%) (group 2) (p = .046). Recurrence occurred after a mean time of 1.5 years in group 1 versus 0.66 years in group 2 (p = .006). The 5-year overall and BC-specific survivals were 49.5% and 62.5%, respectively. The 5-year survival was 60.0% (group 1) and 40.0% (group 2) (p

Objectifs : Déterminer la séroprévalence des infections transmissibles par transfusion de produits sanguin labiles chez les donneurs de sang à l'hôpital Nianankoro Fomba de Ségou. Patients et Méthodes : Il s'agissait d'une étude rétrospective, descriptive effectuée chez les donneurs de sang de Janvier à Décembre 2016 à l'unité de la banque de sang de l'hôpital Nianankoro Fomba de Ségou. Les tests rapides ont été utilisés pour le dépistage des infections recommandées par l'OMS. Résultats : 3941 donneurs ont été colligés. L'âge moyen était de 31,21± 8,7 ans (Extrêmes : 18-60 ans). Le sex- ratio M/F était de 15,63. Les donneurs familiaux et les nouveaux donneurs de sang prédominaient avec respectivement 91,4% et 81%. La séroprévalence du VIH, de l'hépatite B, de l'hépatite C, et de la syphilis était respectivement de 5,30% ; 11% ; 2,40% et 5,40%. La séroprévalence du VIH, de l'hépatite B, de l'hépatite C et de la Syphilis était plus élevée chez les primo-donneurs de sang avec respectivement ; 4,62%, 9,69%, 2,11% et 4,69%. Conclusions : La séroprévalence du VIH, de l'hépatite B, de l'hépatite C et la syphilis est élevée chez les donneurs familiaux et les primo- donneurs d'où l'importance de fidéliser les donneurs bénévoles de sang

To analyze risk factors for the development of chronic gastritis in Conakry, Guinea, and to provide a basis for its prevention and control. A case group of patients who had a gastroscopy and a gastroscopy report at the Sino-German Friendship Hospital in Conakry from January 2019 to January 2020 was selected, while a control group of 107 patients with chronic lung diseases and other chronic diseases of the digestive system were selected. Factor logistic regression analysis of risk factors. The results show that chronic gastritis affects people aged 11 to 95 y, with the highest proportion of patients aged 18 to 30 y, 80 % of whom live in rural areas. The main risk factors for gastritis in the Conakry region of Guinea were a history of digestive problems, smoking for more than 10 y, fast eating, eating hot food at least once a week, and eating moldy food at least once a week. Protective factors against gastritis in Guinea Conakry are: regular diet. The adjusted population-attributable risk for the main risk factors for gastritis were a history of digestive problems 61.19 %, eating too fast 23.59 %, smoking for more than 10 y 26.60 %, eating hot food at least once a week 24.76 % and eating mouldy food at least once a week 6.87 %. The combined population-attributable risk for these factors was 79.07 %. A history of digestive disease, a smoking history of more than 10 y, fast food intake, hot food at least once a week and moldy food at least once a week were risk factors for the development of chronic gastritis in Guinea Conakry, and regular diet was a protective factor against the development of chronic gastritis in young and middle-aged patients in Guinea Conakry.

Angioimmunoblastic T-cell lymphoma (AITL) is a rare hematologic malignancy recognized in the WHO 2016 classification as a clinical and histological entity. It is a very poorly described disease in Africa due to its rarity and diagnostic difficulties, particularly differential diagnosis with tuberculosis. Here, we report a 57-year-old man who presented with fever, weight loss, and lymphadenopathies. The diagnosis of tuberculosis was carried out based on lymph node fine needle aspiration showing the image of tuberculous adenitis and CT images in favor of necrotic lymphadenopathies. The presence of autoantibodies and the failure of tuberculosis treatment led us to perform a biopsy with immunostaining that confirmed pathological features of AITL. The patient was treated by CHOP-based chemotherapy, and complete remission was achieved. This case highlights the difficulty of recognizing AITL and the importance of considering other potential differential diagnoses of tuberculosis in the endemic region.

PURPOSE To assess the impact of the Ebola virus disease outbreak (EVDO) on cancer management at the surgical oncology unit of Donka National Hospital. METHODS This was a retrospective and comparative analysis of cancer consultation and care data before (2012-2013), during (2014-2015), and after (2016-2017) the EVDO. The number of cancer occurrences, referral mode, origin, main activities (consultations, surgery, chemotherapy), and access of radiotherapy were analyzed. The Mann-Whitney U test with independent samples used was considered as significant if P was ≤ .05. RESULTS From 2012 to 2017, 4,977 patients were admitted, including 2,254 with cancer. The variations observed were a decrease in consultations by 2.3% during the EVDO versus an increase by 46.9% after the outbreak ( P < .001). We found decreases of 0.7% and 12.5% during and increases of 253.8% and 15.4% after the EVDO from level 1 and 2 and from level 3 health facilities, respectively ( P < .001). A total of 251 surgeries were performed, and 1,463 received chemotherapy. There was 5.2% more chemotherapy use during and 33.7% more after the EVDO ( P < .001). The number of surgeries increased by 35.8% and decreased by 40.0% during and after the EVDO, respectively ( P < .001). We evacuated 36 patients for radiotherapy, which reflected a decrease of 42.1% and 45.5% during and after the EVDO ( P < .001). CONCLUSION Cancer management slowed down during the EVDO. This change requires organization of the fight against cancer through the institutionalization and decentralization of its management.

To analyze surgical complications and their impact on the prognosis of operated breast cancer patients. This was a retrospective cohort study of breast cancer patients who underwent radical breast cancer surgery (RBS) or conservative breast cancer surgery (CBS) with axillary lymph node dissection. The oncological surgery unit of Donka National Hospital served as a framework for this study from January 2007 to December 2016. A total of one hundred and thirteen patients, including 111 women and 2 men were operated during the study period. The cancer was stage III in 92 (81.1%) cases. RBS was performed in 103 (91.1%) patients and CBS in 10 (8.9%) patients. Of the patients, 92.5% had neoadjuvant chemotherapy, 68.5% had adjuvant chemotherapy, 33.6% had adjuvant radiotherapy and 39.8% hormone therapy. Surgery was complicated by intraoperative hemorrhage in 2 (2.1%) cases. Early postoperative complications included pain 47 (50%), seroma 14 (14.9%), delayed healing 13 (13.8%), hematoma 9 (9.6%), infection 2 (2.1%) and embolism 2 (2.1%). Late complications includedrelapse in 59 (52.2%), brachial pain in 23 (20.4%), lymphedema in 19 (16.8%) and shoulder movement limitations in 8 (7.1%). There was 27.1% of relapsesoccurred in patients with lymphedema versus 5.7% in the absence of lymphedema (p=0.002). The overall mortality was 59 (52.2%), including 4 (3.5%) postoperative cases. Operative pain, seroma, lymphedema and recurrence were the most common complications. This study showed that the high risk of death was related to the occurrence of relapse, more commonly seen in patients with lymphoedema.

Background: Data on Severe cutaneous drug reactions (CADRs) are not common among in sub-Saharan Africa children. The purpose of this study was to document the clinical, etiological and evolutionary aspects of Severe CDRs in children hospitalized at the dermatology department of university hospitals of Conakry. Material and Methods: Retrospective study, conducted from 1 January 2000 to 31 December 2014. Were included all children aged 0-17 years hospitalized for severe CARDs. The data collected were Socio-demographic, clinical, para-clinical and evolution variables. The data was entered and analyzed using the Excel 8.0 software. Results: During a study period, 4437 patients of all ages was hospitalized in dermatology department. 35 patients were included with an average age of 11.3 years and a sex ratio of 1.5. The main clinical patterns were: Stevens Johnson syndrome 37.14% (13/35) Lyell syndrome 25.71 % and generalized bullous fixed eruption 22.85%. The drug was identified as 32 patients (91.42%): Sulfadoxine–Pyriméthamine 40.62%, cotrimoxazole 21.85%, nevirapin 12.5%, ampicillin 6.25%, traditional Pharmacopoeia 6.25% and griseofulin 3.12%. It was taken following self-medication in 14 patients, including a parental initiative in 9 patients. 7 patients had a history of drug allergy and 4 were HIV positive. We recorded 5 deaths. Conclusion: Our study confirms the rarity of severe CADRs in children. The importance of the sulfadoxine-pyrimethamine in the occurrence of severe CADRs in children is the particularity of our series.

Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever (EHF), is often a severe and fatal disease. The objective of this study is to identify the psychological and social problems as well as the needs of people cured of Ebola. This work is a prospective, cross-sectional, descriptive study done within a period of three months, from 16 November 2014 to 15 February 2015. The population of this research consists of those who were infected by and cured of Ebola; they were 18 years and above and were both males and females. They have received treatment at Donka (CET) and are members of those affected and healed in Guinea (A.PE.GU.AEG); they were in Conakry during the study period and gave their consent to participate in our study. Of a total of 72 members, 55 (76.39%) met the inclusion criteria of this study. The average age was 29.9 ± 11.33 years [18-66 years] with a male predominance, sex ratio = 1.2. The average duration of isolation was 16 days with extremes of 6 and 25 days. The main psychological disorders experienced by people healed of Ebola are: fear, 85.45%; revivability, 43.64%; nightmare, 63.64%; stress, 56.36%; anxiety, 49.10%; insomnia, 45.45%; withdrawal, 43.63%; insomnia, 45.45%; distrust, 41.82%; discouragement, 41.82%; and those that want to die, 41.82%. On the social level, stigmatization from the neighborhood was 90.91% and distrust 58.18%. This study shows that people infected by and cured of Ebola suffer many psychological and behavioral disorders. Stigma and distrust are the major social problems. Key words: Ebola, psychosocial lived, Donka, Conakry.

Resume Introduction La prison constitue un facteur de risque de l’emergence de la tuberculose multiresistante (TB-MR). Le but de ce travail etait d’etudier la TB-MR dans un centre carceral noir africain. Materiel et methodes Il s’agissait d’une etude prospective, descriptive et observationnelle de janvier a decembre 2016 a la maison centrale d’arret pour homme, Bamako. La population d’etude etait composee de detenus tuberculeux. La suspicion de la TB-MR est faite devant un cas reste positif au 2e mois de traitement de 1re ligne ou en contact avec un cas de TB-MR. Les registres de depistage et de traitement de la tuberculose nous ont servi de support verificatif des donnees. La comparaison des taux est faite par le logiciel SAS 9,3, seuil de signification a 5 %. Resultats Parmi 1622 detenus, 21 cas de tuberculose pulmonaire ont ete notifies (1,29 %), soit une incidence annuelle de 13 cas/1000 detenus, il s’agissait de 16 cas de tuberculose a microscopie positive (TPM + ) et cinq cas de tuberculose a microscopie negative. L’âge moyen etait de 28 ± 7 ans avec des extremes de 18 et 46 ans. La tranche d’âge 18–30 ans etait la plus representee (66,7 %), pour la plupart des sans-emplois (47,6 %). On a trouve une association negative entre la notion de tabagisme et la profession dans la survenue de la tuberculose (OR = 0,036, [IC95 % : 0,03–0,04], p = 0,03) ; et 60 % des tabagiques ont ete observant au traitement (OR = 1,667, [IC95 % : 1,13–2,56], p = 0,092). Sur les 21 cas de tuberculose notifies, un cas confirme de TB-MR a ete depiste (4,7 %) a un delai long. Sur la cohorte du 1er semestre 2016, on notait un taux de guerison de 87,5 % (7/8 cas TPM + ). L’evolution du cas TB-MR confirme en traitement actuellement (regime de 21 mois) a ete emaillee de nombreuses sequelles pulmonaires et auditives a sept mois de traitement de 2e ligne. Conclusion Il s’agissait du 1er cas de TB-MR depiste dans une prison du Mali. De diagnostic tardif l’evolution est emaillee de sequelles et d’effets secondaires. Un engagement gouvernemental, de partenariat et un financement soutenu devraient etre necessaires afin de faciliter l’amelioration de la lutte antituberculeuse dans les prisons.

Introduction :The psoriasis is one of the inflammatory dermatoses with unknown etiology, with chronic evolution having episodic appearance and disappearance. Its prevalence in HIV patients varied from 2% to 5% in most of the times. Objective of this study was to describe the demographic, clinical and therapeutic characteristics of psoriasis patients infected with HIV. Methods: It is a descriptive retrospective study done from January 2003 to December 2013 based on the information from the hospital card of hospitalized patients and outpatients taken care in the department of Dermatology-STD for psoriasis at the University hospital center in Donka Conakry. We included all the cases of psoriasis associated with HIV infection diagnosed from clinical and paraclinical elements. Results: We recorded 23 (24.73%) cases of psoriasis associated with HIV infection among 93 patients observed for psoriasis in which there are 4 cases of psoriasis vulgaris, 10 cases of erythrodermic psoriasis and 9 cases of arthropathic form among these numbers. We had 7 women and 16 men. The medium age of our patients was 44.5 ± 12 years [27 - 62 years]. The delayed duration time of consultation varied from 30 to more than 180 days. The psoriasis was the circumstance of the discovery of the HIV infection among 55% of cases. The pruritus was the functional sign which is the most frequent in 20 cases among 23 cases and 71.4% of cases were accompanied with pain. Family history was found in 7.10% of cases. Anxiety was the dominant factor cause in 42% and the infection 38%. The cutaneous alteration was noted in all patients; 92.9% of patients had nails alteration and intertrigineous association in 78.6% of cases. The clinical forms found were psoriasis vulgaris 4/23 cases, arthropathic psoriasis 9/23 cases, erythrodermic psoriasis 10/23. More than half (13/23) cases of our patients were diagnosed stage III of the classification of WHO. The complicated forms like erythrodermic and arthropathic psoriasis were frequent in patients whose total CD4 red co-morbidity was tuberculosis (9 cases). The use of traditional therapeutic means was noted in 50% of cases. The local treatment was based on dermocorticoid and keratolylic drugs. The general treatment received by all patients was antiretroviral medication and Methotrexate. Discussion: Our results are of course not representing all the cases of psoriasis in Guinea but it gives us an idea of the importance of HIV and psoriasis association and the influence of immunodepression inducted by HIV during the evolution of psoriasis. The demographic, clinical and therapeutic characteristics described in our patients were near those reported by more authors. Conclusion: HIV-associated psoriasis does not appear to be familial. Serious clinical forms occur in highly immunocompromised patients.

Introduction: Dermatological manifestations during HIV infection play a diagnostic and prognostic role. They are observed in 83% - 98% of patients at the late stage of AIDS and 58% - 75% at an early stage of AIDS. The objective of this study was to determine the prevalence of skin diseases in HIV in children, describes the demographic profile and identify key dermatoses. Material and methods: This was a prospective study of descriptive kind conducted from August 25, 2009 to February 25, 2010. It involved children infected with HIV followed in pediatric services at the University Hospital of Conakry. All children were examined by an experienced dermatologist. The diagnosis of dermatosis was made according to the clinical signs. The stages of HIV infection were determined according to the WHO classification. Each child received retroviral serology rapid tests according to national algorithm. Results: Among 119 HIV-positive children 65 showed mucocutaneous manifestations, there are 34 girls and 31 boys, all HIV-1 infected with 66.16% in stage III disease. The average age was 7 years, ranging from 11 months to 15 years. 66.15% of the children were from married mothers and more than half of the mothers were illiterate. They were all positive for HIV1. Oral candidiasis (38.46%), prurigo (29.23%) and molluscum contagiosum (7.69%) were the most common skin diseases; 52.31% had at least two associated dermatoses. The candidiasis-prurigo combination (26.47%) was the most common. Dermatosis was often associated with other conditions: malaria (30.76%), pulmonary tuberculosis (25.61%) and malnutrition (12.30%). Discussion: With 65 cases diagnosed in six months our study shows that skin diseases are common in HIV among children in Guinea. The prevalence and socio-demographic characteristics are close to those reported by sub saharian and North African authors. A special feature of the study is that most mothers are illiterate and are infected with HIV, which would have favored the contamination of these children. Conclusion: In Sub-Saharan Africa where the rate of pediatric HIV infection is increasing, it is important to identify the mucocutaneous manifestations for optimal care.

Introduction: Scleroderma is a generalized condition of the connective tissue, arterioles and micro-vessels characterized by tissue fibrosis, vascular obliteration and abnormal humoral and cellular immune responses. The aim of this study was to describe the epidemiological, clinical, therapeutic and evolutionary aspects of scleroderma at the Department of Dermatology-Venerology at Donka National Hospital. Methods: This was a descriptive cross-sectional study with a retrospective collection of data for a period of 11 years, from January 1, 2000, to December 31, 2010, covering all inpatient records of Scleroderma in the service. Results: We collected 17 cases of scleroderma out of 3289, a frequency of 0.04%. The average age of patients was 33.33 years with extremes of 10 and 60 years. A female predominance was noted with a sex ratio M/F of 0.13. Cutaneous induration was the main symptom associated with the phenomenon of Raynaud, and disorders of pigmentation. The extra-skin manifestations were mainly dominated by gastrointestinal involvement (32%), pulmonary involvement (24%), cardiac (20%), articular (20%) and renal (12%) involvement. The systemic form was the most common (99.45%). Corticotherapy was the most prescribed treatment (24.59%). Clinical improvement was noted in (93.2%) of the cases. Conclusion: Scleroderma, although rare, deserves special attention at all levels for early diagnosis.

La thrombolyse intraveineuse (TIV) par activateur tissulaire du plasminogene recombinant (rt-PA) est recommandee pour la prise en charge d’accident vasculaire cerebral (AVC) ischemique aigu. Nous avons evalue la faisabilite et la securite du traitement dans un contexte d’absence d’unite neurovasculaire. Nous avons mene une etude retrospective a partir des donnees informatisees de tous les patients ayant beneficie d’un traitement par TIVau centre hospitalier de Cayenne entre avril 2014 et avril 2016. Les criteres de selection sont bases sur les resultats des etudes NINDS et ECASS III, hormis quelques situations discutables telles que l’âge >80 ans, la presence d’epilepsie, etc. Les differents delais entre le debut des symptomes d’AVC, l’arrivee aux urgences et le traitement par rt-PA ont ete calcules. Le score NIHSS (National Institute of Health Stroke Scale) a ete utilise a l’admission, puis pour l’evaluation des resultats cliniques 24 heures apres la TIV et avant la sortie, ainsi que le mRs a la sortie. L’IRM cerebrale a ete l’imagerie de choix a l’entree et a 24 heures postthrombolyse. Mais, dans certains cas, le scanner cerebral avec ou sans produit de contraste a aussi ete utilise. Quarante-huit patients victimes d’AVC ischemiques aigus ont ete inclus avec une predominance masculine de 37 sur 48 soit 77 % et un âge moyen de 64 ans. Le temps ecoule entre la survenue de l’AVC au traitement rt-PA etait de 202 min soit 3h22 et le delai de l’arrivee aux urgences jusqu’au debut de la TIV est de 110 min (1h50). Vingt-six patients ont presente une recuperation clinique precoce avec une diminution du score NIHSS de quatre points a 24 heures, parmi lesquels 18 ont poursuivi leur amelioration jusqu’a la sortie. L’hemorragie intracerebrale post-TIV a ete observee chez trois patients, tous asymptomatiques. Le nombre total de deces etait de cinq patients soit 10 % dont trois avec une occlusion de l’artere cerebrale moyenne avec echec a la TIV, aggravation et deces, par defaut d’acces a la thrombectomie. Conclusion: Notre etude, realisee sur un petit echantillon, demontre que la TIV d’AVC ischemique aigu est aussi faisable avec moins de risque en cas de necessite et en absence d’unite neurovasculaire. Mais, ceci n’est realisable qu’en presence de praticiens competents et formes dans la prise en charge de la pathologie neurovasculaire.

Resume Objectif Evaluer l’utilisation de fortes doses de fluconazole en monotherapie (1200 mg ou 800 mg) dans le traitement de la cryptococcose neuromeningee au cours du sida. Patients et methodes Etude retrospective menee d’aout 2008 a aout 2011 a partir des dossiers de patients atteints de cryptococcose neuromeningee dans le service des maladies infectieuses et tropicales d’Abidjan. La letalite et les facteurs associes ont ete analyses. Resultats Quarante-six cas de cryptococcose neuromeningee (2,5 % des hospitalisations) ont ete inclus. Le sex-ratio etait de 1,2. L’âge median etait de 40,5 [35–47] ans. La symptomatologie etait subaigue (93,5 %). Les principaux symptomes cliniques etaient le syndrome meninge pur (65 %), la fievre (100 %) ; 35 % des patients presentaient une meningo-encephalite. Vingt et un patients (45,7 %) etaient naifs d’antiretroviraux. Le fluconazole 1200 mg a ete prescrit chez 29 (63 %) patients. La ponction lombaire soustractive a ete effectuee chez 42 (91,3 %) patients. La letalite etait de 50 %. Les facteurs predictifs de la mortalite etaient la meningo-encephalite et les ponctions lombaires soustractives. Conclusion La letalite de la cryptococcose neuromeningee reste elevee malgre l’utilisation de fortes doses de fluconazole en monotherapie. Les ponctions lombaires soustractives contribuent a l’amelioration du pronostic.

Anthrax disease is an anthropozoonosis caused by a Gram-positive bacterium, Bacillus anthracis. Our objective was to describe the epidemiological, clinical and therapeutic features of the 2014 epidemic in Koubia prefecture. This retrospective study examined all of the anthrax cases reported in Fafaya, Koubia Prefecture. In March and April 2014, there were 39 cases of human anthrax reported, for an incidence of 1.135%. The mean age was 20.9 (± 18.3) with a sex ratio of 2.54 (28/11) in favor of men. Seventy-six percent (23/39) were single. More than one half were students (53.8%). The main clinical signs were fever in 71, 8% (n = 28 /), papules 59% (n = 23), vesicles of 59% (n = 23) Digestive and cutaneous signs represented 35.9 % and 64.1% respectively; 35% had ingested contaminated meat and 17.95% were in direct contact with a sick animal. We didn't find any correlation between the mode of infection and onset of signs. The fatality rate was 28.21%. The 2014 epidemic of anthrax disease in the Koubia prefecture was marked by a high incidence and lethality. Clinical manifestations were cutaneaous and digestive. These results may serve further interventions to fight against anthrax disease. They should mainly focus on an awareness of peasants, surveillance and vaccination of cattle. Other studies seem to be necessary.

This prospective survey was conducted from February to December 2014 about the use ceftriaxone (ceftriaz) for antibioprophylaxy concerning 300 patients by the surgery staff in the Gabriel Toure Teaching Hospital in Mali. The quantity of drug used was based on the weight of the patient. One dose was administrated in intravenous at the anesthesiology induction time. For more than 2 hours of intervention time, 4 (1.3%) patients received a second dose. The majority of cases (189, 63%) were out of emergency (emergency cases—111, 37%). The mean age was 41.6 years (range: 3 - 95 years). The patients were classed Altmeir II 203 (67.7%) and Altmeir I 97 (32.3%). The NNISS score 0 concerned 101 (33.6%) and NNISS 1 in 180 (60%) patients. The factors of risky were anemia (38; 12.7%), diabetes (6; 2%), and HIV (3; 1%). The mean of intervention duration was 56.8 ± 27.5 minutes. Four cases of intervention site infection were encountered caused by Pseudomonas aeruginosa in 2 patients; Escherichia coli (1 case), and Staphylococcus aureus (1 case). Conclusion: Antibioprohylaxy is not the only way to prevent infections but it stays necessary. The respect of hygien and aseptic measures should be used to reduce the rate of intervention site infection.

Severe drug reactions are defined as mucocutaneous complications secondary to systemic admin- istration of drugs likely to be life threatening. Our work was designed to determine the evolutio- nary epidemiological and etiological characteristics of severe drug reactions to the Department of Dermatology Venereology, at Donka Teaching Hospital. A prospective descriptive study of all cases of severe drug reactions received at the Department of Dermatology Venereology of the Donka Teaching Hospital was conducted over a period of two years, from June 2009 to May 31, 2011. We identified 22 Stevens-Johnson syndrome, 13 Toxic Epidermal Necrolysis, 1 Stevens-Johnson syn- drome Border Toxic Epidermal Necrolysis, 1 Drug Rash with Eosinophilia and Systemic Symptoms and 2 Acute generalized exanthematous pustulosis among 481 hospitalized patients, of whom 50 had consulted for drug reactions, that is to say, a frequence of 10.40%. The Stevens-Johnson syn- drome accounted for 44%, the Stevens-Johnson syndrome Border Toxic Epidermal Necrolysis 2%, Toxic Epidermal Necrolysis 26%, Drug Rash with Eosinophilia and Systemic Symptoms 2% and Acute generalized exanthematous pustulosis 4% of drug reaction. The female sex was predomi- nant (28 women vs. 11 men), that is to say 71.59% vs. 26.21 with a sex ratio of 2.55. The average age of our patients was 29.72 years; the range of ages 21 - 40 years was the most affected (51.28%) followed by 0 - 20 years (33.33%). The lethality rate was 9.09% (2/22) in the Stevens-Johnson syndrome and 53.85% (7/13) in the Toxic Epidermal Necrolysis. HIV infection was found in 17.95% (7/26) of our patients and 71.42% (5/7) of the deceased. The drug accountability was established in 79.48%; the most commonly implicated drugs in the Toxic Epidermal Necrolysis were sulfona- mides followed by ARVs (nevirapine) and anti TB (isoniazid); in the SJS sulfonamides followed by salts of quinine and anti TB, the only case of DRESS was due to quinine. No drug was found in 20.52% (8 cases). HIV infection remains a poor prognostic factor. Our study shows the scarcity of Drug Rash with Eosinophilia and Systemic Symptoms and Acute generalized exanthematous pustulosis in our service. * Corresponding author.

Les sarcomes de la tete et du cou sont des cancers otorhinolaryngologiques (ORL) rares et histologiquement tres heterogenes. Nous rapportons une observation de sarcomes de l’enfant a localisation ORL au centre hospitalo-universitaire de Conakry. L’etude a concerne une enfant de quatre ans, sans antecedents particuliers, qui presentait depuis huit mois une tumeur parotidienne droite d’installation progressive. Apres une biopsie et une cytoponction qui n’ont pas permis de poser le diagnostic, nous avons realise une exerese chirurgicale complete, en monobloc de la tumeur. L’etude anatomopathologique couplee a l’immunohistochimie ont permis de poser le diagnostic de sarcome fusocellulaire de bas grade. En l’absence de traitement complementaire, la patiente est decedee dans un tableau de metastases pulmonaires. Les sarcomes de la tete et du cou sont tres agressifs et de mauvais pronostic etant donne leur potentiel important d’extension locoregionale, de metastases a distance et de recidive tumorale.

In urban areas in Nouakchott, diarrheal diseases present a major public health problem, especially for children and adolescents. In August, 2008, a cross-sectional survey of 300 households in two adjacent districts of the city sought to study correlations between diarrheal disease and environmental health. The results show that 87 children of all ages had about 139 episodes of diarrhea, for an average prevalence of 14.8% that varied by age (23.6% in children younger than 5 years and 9.7% among children aged 5 to 14 years) and area (16.8% in Tevragh-Zeina and 28.3% in Sebkha). The univariate analysis indicates that 52% of the diarrhea risk was due to precarious basic hygiene. Studies of the specific causes of diarrheal diseases to help improve their treatment are necessary to supplement these epidemiological results.

Resume Objectifs Evaluer la prevalence du bronchospasme induit par l’exercice chez des sportifs vivant en climat tropical humide. Methodes Cette enquete prospective, realisee a Abidjan en septembre 2001, a concerne 108 sportifs de competition. Apres un questionnaire relatif a l’asthme et a l’atopie, chaque sportif a subi un test de provocation bronchique a l’effort. La temperature et l’hygrometrie ont ete enregistrees. Le critere de positivite du test etait une chute du volume expiratoire maximal seconde superieur ou egal a 10 % et/ou du debit expiratoire de pointe superieur ou egal a 15 %. Resultats La temperature ambiante et l’hygrometrie moyennes etaient respectivement de 30,1 ± 1,6 °C et 82,6 ± 6,3 %. Selon le questionnaire, 13 % des sportifs etaient asthmatiques ou avaient des symptomes d’asthme et 36,1 % avaient des symptomes d’atopie. Selon les chutes post-exercices du volume expiratoire maximal seconde, du debit expiratoire de pointe, du volume expiratoire maximal seconde et/ou du debit expiratoire de pointe, les prevalences du bronchospasme induit par l’exercice etaient respectivement de 22,2 %, 35,2 % et 42,6 %. Ces chutes survenaient surtout entre la premiere et la 15 e minute apres l’effort. Conclusion Les resultats de la presente etude n’etaient pas en faveur de l’hypothese selon laquelle l’inhalation d’air chaud et humide protegeait contre la survenue de bronchospasme.

Approximately 20 000 new cases of Hodgkin lymphoma are diagnosed each year in North America and Europe. However in Africa, the incidence of this condition is almost unknown. While publications from western countries and the rest of world are numerous in the literature, few data from Africa about this malignancy are available. The aim of this retro and prospective, unicentric study over 3 years is to describe the epidemiologic, pathologic, clinical and therapeutic aspects of children treated for Hodgkin lymphoma in our paediatric oncology unit of Gabriel-Toure Hospital, Bamako (Mali). From January 2005 to December 2007, all children under 18 years of age, with histologically proven Hodgkin lymphoma, not previously treated by chemotherapy and HIV negative, were included in this study. Informed consent was obtained from parents. The treatment protocol was the GFAOP (Groupe franco-africain d’oncologie pediatrique) Hodgkin lymphoma treatment protocol: COPP/ABV (Cyclophosphamid, Vincristin, Prednisone, Procarbazin, Adriamycine, bleomycin and vinblastine). During the study period, 217 cancer cases were diagnosed in our centre. Of these cases, 7 were Hodgkin Lymphoma (0.04%). The average age was 11.7 years. The sex-ratio was 6/1 in favor of boys. 6.71% (5/7) of the patients were stage IIB and 28.6 % (2/7) of the patients were stage IIIB of the Ann-Arbor classification. Histologically, there were 42.8% cases of sclero-nodular subtype, 28.6% of lymphocyte-rich subtype, 14.3 % of mixed cellularity and 14.3% of lymphocyte depleted subtype. After 4 years follow-up, 5 patients (71.4 %) were alive, and 2 patients (28.6 %) had died from drug toxicity. Hodgkin lymphoma is a relatively rare condition in African children which can be cured. Broader multicentric studies are needed for more accurate data on this malignancy.

Ce travail presente les resultats de l’enquete comportementale et serologique sur le virus de l’immunodeficience humaine (VIH/sida) realisee de decembre 2007 a decembre 2008 chez les consultants pour infections sexuellement transmissibles (IST), consideres comme a risque d’infection a VIH. En Mauritanie, la derniere enquete de seroprevalence chez les consultants IST remonte a l’annee 1995, elle etait alors estimee a 0,9 %. L’objectif etait de determiner la seroprevalence du VIH et de la syphilis et de recueillir des informations sur les connaissances et les comportements sexuels a risque de ces patients. Deux cent vingt-quatre consultants IST ont ete recrutes sur un an, sans predominance de sexe, et avec une majorite d’adultes jeunes. Les seroprevalences relevees sont respectivement de 9 % pour le VIH et de 10%pour la syphilis. Le preservatif est peu utilise par ces patients, meme lors de rapports occasionnels. Ils constituent egalement un groupe a risque d’infection de VIH et de syphilis en raison de leurs comportements et de leur faible niveau de connaissance.

Jadis toute contusion abdominale avec hemoperitoine etait justiciable d’un acte chirurgical. Mais depuis plus de deux decennies, avec l’avenement de l’echographie et de la tomodensitometrie, l’option non operatoire est de plus en plus preconisee. Les objectifs de notre etude etaient de determiner la frequence du traitement non operatoire (TNO) de l’hemoperitoine dans les traumatismes abdominaux fermes, d’identifier les etiologies avec les mecanismes de survenue, de decrire les signes cliniques, paracliniques et de determiner les indications du TNO. Il s’agissait d’une etude retrospective, descriptive, realisee de janvier 1999 a decembre 2008 en chirurgie generale au CHU Gabriel-Toure de Bamako (Mali). Ont ete inclus tous les patients admis pour traumatismes fermes de l’abdomen (TFA) avec hemoperitoine confirme par la clinique, la paraclinique et hemodynamiquement stables, en l’absence de lesion intestinale. Les cas de contusion abdominale avec instabilite hemodynamique ou une lesion intestinale associee ont ete exclus de l’etude. Nous avons collige 405 cas de TFA avec 270 cas d’hemoperitoine associes. Le TNO a porte sur l’expectative armee avec une surveillance clinique et paraclinique repetee. L’etude a porte sur 73 patients, dont 50 hommes (68,5 %) et 23 femmes (31,5 %) avec un sex-ratio de 2,26. La moyenne d’âge a ete de 20,53 ans. Les eleves etaient les plus exposes avec 40 cas (54,8 %). Le TNO a represente 18 % des TFA et 0,3 % de nos hospitalisations durant la periode d’etude (n = 23 887). Cinquante-six patients (76,8 %) ont ete admis avant les six premieres heures apres le traumatisme. La pâleur conjonctivale et l’hypotension arterielle ont ete retrouvees respectivement chez 26 (36 %) et huit (11 %) des patients. Nous avons observe une stabilite hemodynamique chez 65 malades (89 %) a l’admission et huit cas (11 %) d’instabilite ayant repondu favorablement a une reanimation initiale. Les accidents de la voie publique (AVP) 44 cas (60,3 %) et les chutes 14 cas (19,2 %) etaient les principales etiologies. L’hemoperitoine etait de faible abondance 36 cas (49,3 %), de moyenne abondance 34 cas (46,6 %) et de grande abondance trois cas (4,1 %). L’ASP a ete realise chez tous les patients (100 %) et n’a pas retrouve de pneumoperitoine. A l’echographie, la rate a ete l’organe le plus lese 21 cas (28,8 %) contre dix cas (13,7 %) pour le foie et trois cas (4,1 %) pour le rein. Sept patients (9,6 %) ont pu beneficier du scanner, dont trois cas de lesions spleniques de grade II, deux cas de lesions hepatiques de grade II, un cas de lesion renale de grade II. Six malades (8,2 %) ont ete transfuses. Les suites ont ete simples dans 66 cas (90,4 %), et l’echec therapeutique a ete observe chez sept patients (9,6 %) operes secondairement. La mortalite a ete nulle. Le sejour moyen hospitalier etait de 7,8 jours. Actuellement, le TNO peut etre preconise chez tout patient hemodynamiquement stable en l’absence d’une lesion intestinale associee. Il permet de limiter le nombre de laparotomies blanches et les risques lies a l’acte chirurgical.

Le diagnostic des cancers abdominaux de l’adulte est tardif. Nous avons determine la frequence hospitaliere et analyse les aspects diagnostiques et therapeutiques. Notre etude retrospective a dure de janvier 1999 a decembre 2004. Elle a concerne les patients âges de plus de 14 ans, traites en chirurgie generale du CHU Gabriel-Toure pour une tumeur abdominale maligne confirmee par l’histologie ou la cytologie. Les tumeurs de l’œsophage et les tumeurs non confirmees ont ete exclues. Nous avons collige 152 dossiers de tumeurs malignes de l’abdomen. L’âge moyen des malades a ete de 54,4 ± 14 ans. La serie comprenait 86 hommes et 66 femmes. Les tumeurs siegeaient: sur l’estomac chez 90 malades (59,2 %), le pancreas chez 22, le colon chez 17, le rectum chez 14, l’ovaire chez cinq et le foie chez quatre malades. Le sejour hospitalier a dure en moyenne 24 jours. Les signes cliniques retrouves ont ete la douleur abdominale dans 78,9 %, les vomissements 81 fois (53,3 %) et une masse abdominale dans 17,8 %. Cent dixsept malades etaient operables. Trente-cinq ont beneficie d’une intervention a visee curative, 72 a visee palliative, 45 etaient inoperables. L’histologie a revele 90 % d’adenocarcinomes. La morbidite et la mortalite postoperatoires ont ete de 6 et 7,7 %. La survie globale a cinq ans a ete de 6 % (sept malades). Le cout moyen du traitement chirurgical a ete de 158 745 F CFA.

Un sondage sérologique sur la fasciolose a été réalisé en Guinée sur des sérums issus de la sérothèque du Laboratoire de diagnostic vétérinaire de la Direction nationale des services vétérinaires. Au total, 480 sérums provenant de bovins N’Dama ont été sélectionnés par randomisation et analysés par la technique de dosage immuno-enzymatique (Elisa). Les résultats obtenus ont mis en évidence la présence d’anticorps de douves chez 44,1 p. 100 des bovins, avec un taux de 35,5 p. 100 dans la région Ouest de la Guinée et de 55,5 p. 100 dans la région Est. Les bovins de tous les âges ont été séropositifs avec des taux variant de 27,8 à 44,5 p. 100.

Resume Les perforations typhiques restent une cause frequente de peritonite dans les pays en developpement. Nos objectifs ont ete de determiner la frequence hospitaliere, de decrire les signes cliniques et paracliniques, d’analyser les suites operatoires. Nous avons realise une etude retrospective qui a porte sur une periode de dix ans (janvier 1999–decembre 2008) dans les services de chirurgie generale et pediatrique du CHU Gabriel-Toure. Elle a porte sur tous les malades operes pour peritonite par perforation typhique. Nous avons collige 385 perforations typhiques, soit 32,5 % des peritonites toute cause confondue. C’etait 136 femmes (35,4 %) et 249 hommes (64,6%), l’âgemoyen a ete de 15,2 ± 11,6 ans (2–65 ans). Deux cent cinquante patients (64,93 %) avaient entre 2 et 15 ans, 64 malades (16,62 %) avaient deja ete traites pour fievre typhoide. Le sejour hospitalier a dure en moyenne 18,4 jours (ET = 6,5). La radiographie de l’abdomen sans preparation realisee chez 221 avait une sensibilite de 70,59 %, la sensibilite du Widal a ete de 82 %. Les organes perfores etaient les suivants: ileon 367 (95,32 %); colon 9 (2,34 %) et vesicule biliaire 9 (2,34 %). L’excision-suture a ete realisee 273 fois, 44 resections-anastomoses en un temps, 54 ileostomies, neuf cholecystectomies et cinq hemicolectomies droites avec ileostomies. La mortalite a ete de 8,33 % et la morbidite de 21,56 % (61 abces de parois, huit fistules digestives, sept peritonites postoperatoires, sept eviscerations postoperatoires). Les suites n’ont pas ete influencees par la technique operatoire.

Resume Objectifs Determiner la frequence des infections nosocomiales, identifier leurs facteurs de risque et determiner les germes en cause et leurs sensibilites. Materiel et methodes Il s’agissait d’une etude prospective realisee de 1er janvier au 31 decembre 2007 sur tous les patients hospitalises dans le service de chirurgie pediatrique pendant au moins 48 heures. Les enfants dont l’hospitalisation etait inferieure a 48 heures et les patients perdus de vue n’ont pas ete inclus. L’infection nosocomiale a ete identifiee selon les criteres definis par Center for Disease Control (CDC) d’Atlanta. Resultats La frequence etait de 7,4 %. L’âge moyen de nos patients etait de 8,7 ans. Le sex-ratio etait de 1,66 en faveur des garcons. Le mode de recrutement, le score de National Nosocomial Infection Surveillance System (NNISS), la classification d’Altemeier, le mode d’intervention et la duree d’hospitalisation ont ete des facteurs determinants dans la survenue des infections nosocomiales, avec p

In Bamako, Mali, where surveillance revealed a high incidence of Haemophilus influenzae type b (Hib) invasive disease, Hib conjugate vaccine was introduced into the Expanded Program on Immunization and the impact assessed. Annual confirmed Hib hospitalizations for infants 0-11 months of age fell from 175/10 5 to 44/10 5 ( P < 0.001); among infants 6-7 months of age Hib hospitalizations fell from 377/10 5 to 69/10 5 , (82% decrease, P < 0.001). Invasive Streptococcus pneumoniae hospitalizations remained unchanged. In a baseline serosurvey, only 3/200 infants 6-7 months of age (1.5%) had protective anti-polyribosylribitol phosphate (PRP) titers ≥ 0.15 μg/mL and 1(0.5%) had ≥ 1.0 μg/mL . In serosurveys 18 and 30 months after vaccine introduction, 168/201 (84%) and 184/200 (92%) infants, respectively, had titers ≥ 0.15 μg/mL and 141/201 (70%) and 163/200 (82%) had titers ≥ 1.0 μg/mL. Introduction of Hib vaccine led to rises in anti-PRP seroprevalence, significant reductions in Hib disease, and all-cause hospitalizations, whereas S. pneumoniae disease remained unchanged.

Resume Introduction Les dermohypodermites bacteriennes sont frequentes et potentiellement graves. Certains facteurs de risques ou aggravants ont deja ete mis en evidence (œdeme, breches cutanees, anti-inflammatoires). En Afrique, l’utilisation frequente de dermocorticoides pour depigmenter la peau pourrait etre un facteur de risque supplementaire. Malades et methode Une etude retrospective sur une periode de 4 ans et 6 mois (1er juillet 1999 au 31 decembre 2003) a ete menee dans le but d’analyser les caracteristiques epidemiologiques, cliniques et therapeutiques des dermohypodermites bacteriennes rencontrees en milieu hospitalier au CHU Donka (Conakry, Guinee). Resultats Deux cent quarante-quatre malades (188 femmes et 56 hommes) ont ete hospitalises pour une dermohypodermite bacterienne. L’âge moyen etait de 38 ans. Les localisations de la dermohypodermite bacterienne etaient : le membre inferieur, la jambe et le pied, les cuisses, les fesses, les membres superieurs. Un antecedent d’erysipele, un ethylisme chronique, une prise d’anti-inflammatoire non steroidien, ou un etat d’obesite, un lymphœdeme ont ete releves. Les dermohypodermites bacteriennes necrosantes et les fasciites necrosantes ont ete observees chez 31 malades. Ces formes necrosantes etaient associees plus souvent a la prise d’anti-inflammatoires non steroidiens, 90 p. 100 contre 25 p. 100 pour les infections non necrosees (OR = 27, IC 95 = 8-94), au retard de la mise en route du traitement adapte, a l’utilisation des medicaments traditionnels. Discussion Cette etude montre en Guinee la preponderance feminine de la population atteinte de dermohypodermite bacterienne. Ceci est peut-etre lie a l’atrophie cutanee chez les femmes utilisatrices de produits depigmentants (une fragilite cutanee qui facilite les effractions constituant ainsi des portes d’entree). La prise d’anti-inflammatoires non steroidiens est frequente dans notre serie, mais beaucoup plus dans le groupe des infections necrosantes, posant la question du role potentiellement aggravant de ces medicaments.

INTRODUCTION: Several neurological complications are associated with cerebral malaria (CM). However, few long-term data from childhood survivors have been published. METHODS: A cross-sectional study was carried out in Mali among children followed from 1999 to 2002 after serious and complicated malaria. Our aim was to evaluate the persistent neurological sequelae associated with CM. RESULTS: This study concerned 101 subjects who had had CM. Mean age was 5.6+/-3.6 years. Twenty-eight children presented persistent neurological sequelae (27.7p.cent). Among them eight (7.9p.cent) children had developed these sequelae just after CM and 20 (19.8p.cent) a few months later: headaches, mental retardation, speech delay, bucco-facial dyspraxia, diplegia and frontal syndrome (one case each), dystonia (two cases), epilepsy (five cases) and behavior and attention disorders (15 cases). CONCLUSIONS: In this study, we show that neurological signs due to CM can persist in the long run. Long-term follow-up and proper management after CM are essential.

L'objectif était de déterminer la prévalence de l'infection à VIH chez les patientes atteintes de cancer du sein et de comparer les caractéristiques anatomocliques et thérapeutiques de ces cancers du sein par rapports aux patientes non infectées par le VIH. Il s'agissait d'une étude rétrospective et analytique comparant les dossiers de patientes atteintes de cancers du sein histologiquement confirmés, infectées ou non par le VIH à l'unité de chirurgie oncologique de Donka, CHU de Conakry, de 2007 à 2012. Nous avons colligé 278 patientes présentant un cancer du sein dont 14 (5,0%) infectées par le VIH et 264 (95,0%) non infectées par le VIH. Les différences observées entre ces deux groupes de patientes étaient respectivement: âge médian (36,8 vs 49,0 ans), la ménopause (21,4% vs 53,4%), le nombre des patientes traitées (50,0% contre 77,1%) et la survenue de décès (78,6% vs 50,8%). Aucune différence n'a été notée dans la présentation clinique, histologique et le retard de consultation. Dans notre étude, la prévalence de l'infection à VIH chez les patients atteints de cancer du sein est élevée. L'âge jeune des patients, la faible accessibilité au traitement et la mortalité élevée doivent être confirmés par une étude sur un échantillon plus large.

Aim. To determine the prevalence of HIV infection among patients seen at the surgical oncology unit of Donka (Conakry, Guinea).Method. We conducted a retrospective and descriptive study of HIV infection in cancer patients from May 2007 to December 2012. Social characteristics (age, gender, marital status, and education) and immune status (HIV type, CD4 count) were reviewed.Results. Out of 2598 cancer patients, 54 (2.1%) tested positive for HIV. There were 11 (20.4%) defining AIDS and 43 (79.6%) nondefining AIDS cancers. The most frequent cancers were breast (14) (26.0%), non-Hodgkin lymphoma (6) (11.1%), liver (6) (11.1%), eye and annexes (6) (11.1%), and cervical cancer (5) (9.3%). These patients were female in 34 (63.0%) and had a median age of 39 years and body mass index was 20,3 Kg/m2. They were unschooled in 40 (74.1%) and married in 35 (64.8%). CD4 count showed a median of 317 cells/mL. Antiretroviral treatment was performed in 40 (74.1%).Conclusion. HIV prevalence is higher in patients in our unit of surgical oncology. Breast cancer was the most common in this association. A national survey of a large sample is needed to determine the true prevalence and impact of HIV on cancer prognosis.

Resume But Analyser les attitudes des communautes guineennes et ivoiriennes susceptibles d'induire un retard a la consultation dans le cadre de malformations apparentes. Patients et methodes Du 1 er janvier 2000 au 31 decembre 2002, nous avons realise une enquete dans les services de chirurgie pediatrique du CHU de Donka (Conakry) et des CHU de Cocody, Treichville et Yopougon (Abidjan). Cent deux enfants atteints de malformations apparentes ont ete recenses. Les variables etudiees etaient l'âge, le sexe, l'ethnie, le niveau socio-economique, la religion, la reaction de l'entourage vis-a-vis de l'enfant porteur de malformation et le niveau d'instruction des parents. Resultats L'âge moyen au moment de la premiere consultation etait de 17 mois. Le sexe masculin etait predominant (sex-ratio = 1,5). Soixante-seize pour cent des enfants porteurs de malformations apparentes a la naissance ont ete vus pour la premiere fois a un âge compris entre 1 et 30 mois et 24 % a un âge egal ou superieur a 30 mois. Les malformations orthopediques ont ete les plus frequemment rencontrees (44 %). Certaines croyances ont negativement influence le delai de la consultation et les relations entre les 2 parents. Le bas niveau socio-economique etait determinant dans le retard a la consultation (54 %). Discussion L'âge moyen a la consultation est tardif, fait communement rapporte dans les pays en voie de developpement. Ce retard est du a la pauvrete, a l'ignorance, a des conditions socioculturelles et a des convictions religieuses particulieres. La naissance d'un enfant porteur de malformation dans les communautes Malinke, Akan et Krou peut etre interpretee comme une malediction divine ou une sorcellerie. Les malformations neurologiques ont entraine le plus grand pourcentage de reactions negatives de la part de l'entourage des malades. Conclusion Les causes du retard a la consultation des enfants porteurs de malformations apparentes dans les communautes guineennes et ivoiriennes etaient le bas niveau socio-economique, l'ignorance, le milieu socioculturel et les considerations religieuses. L'information et la sensibilisation sur les realites propres aux pays en voie de developpement amelioreraient l'acceptation de ces enfants et le desir de leur apporter les soins adequats. L'instauration d'une couverture sociale ameliorerait la prise en charge des enfants porteurs de malformations.

BACKGROUND Population-based, bacteriologically confirmed disease burden data aid decision makers in African countries pondering whether to introduce Haemophilus influenzae type b (Hib) immunization for infants. METHODS A bacteriology laboratory was established in Hopital Gabriel Toure, serving Bamako, Mali. Children age 0-15 years with fever > or =39 degrees C or syndromes compatible with invasive bacterial disease (meningitis, etc.) were eligible. From 2 to 5 mL of blood or relevant body fluid were inoculated into Bactec Ped Plus/F medium for automated culture; body fluids were also inoculated directly onto solid media. Hib was confirmed by standard microbiologic techniques and antibiograms generated by disk diffusion. RESULTS From June 1, 2002 to May 31, 2004, 3592 (87.8%) of 4092 children admitted to Hopital Gabriel Toure with high fever or suspected invasive bacterial disease were cultured, including 1745 who were 0-11 months old, 1132 who were 1-4 years old and 715 who were 5-15 years old. Hib was isolated from 207 Bamako children, 81 from blood alone and 124 from cerebrospinal fluid (with or without positive blood culture). Of 207 cases 204 (98.5%) occurred in children younger than age 5 years (annual incidence, 45.2/10) and 159 (77%) in infants age 0-11 months (annual incidence, 158.4/10). Peak incidence (370.0 cases/10) and 12 of 21 Hib deaths occurred in 6- to 7-month-olds. Of the Hib isolates, 11.1% were resistant to ampicillin, 32% to chloramphenicol and 0.5% to ceftriaxone. CONCLUSIONS The substantial burden of invasive Hib disease documented in Bamako has prompted the Malian government to introduce routine infant immunization with Hib conjugate.

The predominant manifestations of severe malaria in African children are cerebral malaria (CM) and severe malarial anemia (SMA). As a first step toward a family-based approach to identify the environmental and genetic pathways that contribute to severe malaria, we tested whether it aggregates within families.Family history of severe malaria was explored during face-to-face interviews with parents. Logistic regression was used to determine whether CM and SMA aggregate within individuals and within families. The pattern of familial aggregation was then expressed as familial odds ratios that were adjusted for relevant risk factors.This study was of 2811 inhabitants of Bamako, Mali, clustered in 407 nuclear families. The probands were 136 children with severe malaria and 271 healthy children from the community. Within-person association of CM and SMA was significant (odds ratio, 6.15 [95% confidence interval (CI), 2.62-14.41]). Over a lifetime, with each additional affected relative, the odds of a person contracting CM increased by 1.98 times (95% CI, 1.59-2.45), and the odds of having SMA increased by 1.91 times (95% CI, 1.05-3.47). Over a lifetime, for a child whose sibling had a history of CM, the odds of having CM were 2.49 times greater (95% CI, 1.51-4.10) than the odds for a child whose sibling had no such history; for a child whose sibling had a history of SMA, the odds of having SMA were 4.92 times greater (95% CI, 1.21-19.9) than the odds for a child whose sibling had no such history.Our data suggest strong familial aggregation of CM and SMA.

Resume Vingt-quatre pour cent de la population gabonaise est porteuse du trait drepanocytaire, 1 a 3 % est homozygote. La prise en charge de ces patients doit suivre des protocoles bien definis qui prennent en compte le handicap cause par les episodes de douleur severe. Objectif. – Evaluer l'efficacite du traitement par paliers d'analgesiques dans les crises douloureuses drepanocytaires. Patients et methodes. – Il s'agit d'une etude prospective et descriptive realisee sur la base de questionnaires, de fevrier 2000 a mars 2001. Nous avons inclus dans cette etude les enfants drepanocytaires ayant presente des crises douloureuses avant ou pendant leur hospitalisation. L'evaluation de la douleur etait faite selon les echelles DEGR et EVA. Les antalgiques utilises etaient ceux du protocole par paliers d'analgesiques de l'Organisation mondiale de la sante. L'intensite de la douleur et le delai de sedation qui ont permis d'evaluer l'efficacite de ce protocole ont ete mesures avant l'administration du traitement, deux heures et 24 heures apres. Resultats. – Soixante enfants ont ete inclus. Toutes les categories sociales etaient representees. Le niveau scolaire etait variable. Cinquante-six pour cent des patients avaient eu leur premiere crise avant l'âge d'un an. Trente et un pour cent avaient une crise annuelle, 20 % une crise mensuelle. Les douleurs etaient articulaires dans 35 % des cas et osteo-articulaires dans 15 % des cas. La crise douloureuse a ete calmee dans 81,6 % des cas par les medicaments du palier I. Le passage au palier II est intervenu dans 18,3 % des cas restants. Conclusion. – Le traitement de la douleur par paliers d'analgesiques selon les recommandations de l'OMS est efficace dans la crise douloureuse drepanocytaire. La mise en place des medicaments du palier I a fait ceder la douleur chez 81,6 % des patients dans un delai relativement court. Il n'a pas ete possible d'avoir acces au palier III.

Background: Prevention of invasive pneumococcal disease (IPD) in children is a global public health priority, and determination of the most common serotypes is crucial for vaccine development and implementation. Methods: We performed prospective surveillance for IPD in hospitalized children in Bamako, Mali. All febrile children and others suspected to have invasive bacterial disease had an admission blood culture and cultures of additional anatomic sites when indicated. Standard microbiologic methods were used to identify, serotype and determine antibiograms for pneumococcal isolates. Results: Of 2049 children enrolled, 106 (5%) had an IPD, including 47 cases of meningitis and 44 bacteremic pneumonias. The incidence was highest in infants (84/100,000/year). The overall IPD case fatality rate was 24%. Only 2 of 96 isolates were nonsusceptible to penicillin. The serotypes isolated were 5 (54%), 2 (14%), 7F (10%), 19F (8%), 6A/B (3%), 9V (3%), 1 (2%) and 14 (1%). Conclusions: IPD is common and frequently fatal among hospitalized children in Mali, but surprisingly little resistance has occurred. Notably, 91% of the serotypes causing IPD in Bamako children are found in the 11-valent pneumococcal conjugate vaccine.

The aim of this case-control study was to identify epidemiological risk factors for severe malaria among children living in Bamako, a malaria-endemic area. For this, 260 healthy community controls were matched to 130 patients with severe malaria. Conditional multiple logistic regression analysis indicated that all examined independent factors associated with severe malaria are directly related to characteristics of the child's mother, with the exception of the child's own yellow fever vaccination history (odds ratio (OR): 1.93, 95% confidence intervals (CI(95%)) [1.10-3.37]). The following characteristics were all associated with a decreased risk of severe malaria in the child: maternal education (OR: 0.52, CI(95%) [0.31-0.86]), the mother's adequate knowledge about malaria (OR: 0.46, 95% CI(95%) [0.25-0.86]), her use of mosquito bed nets (OR: 0.53, CI(95%) [0.30-0.92]) and breast-feeding for at least 2 years (OR: 0.57, CI(95%) [0.33-0.94]). Conversely, chronic maternal disease (OR: ?3.16, CI(95%) [1.31-7.61]) was associated with an increased risk of severe malaria. These findings strongly support the hypothesis that maternal factors are central to the development of severe malaria in children. Programmes aiming to improve both maternal health and maternal education may reduce the incidence of severe malaria in children and should therefore be advocated in Bamako and in areas with similar epidemiological patterns for malaria.

Animal models of Human African Trypanosomiasis (HAT) have been developed to understand the pathogenic mechanisms leading to the passage into the neurological phase, most of them referring to histological aspects but not clinical or behavioral data. Our study aimed at defining simple clinical and/or behavioral markers of the passage between the hemolymphatic phase and the meningo-encephalitic stage of the disease. Sprague-Dawley rats (n=24) were infected with Trypanosoma brucei brucei AnTat 1.1E. Food intake and body weight were measured daily from the day of infection until death. Hematocrit was measured twice a week. Behavioral disturbances were evaluated through an Open-field test. A sudden weight loss occurred on the twelfth day after infection, due to a significant drop of food intake starting two days before. The rats developed an anemic state shown by the hematocrit measurements. The Open-field test showed them to be less active and reactive as soon as the second week after infestation. A complementary histological study observed trypanosomes and inflammatory cells in the choroid plexus at the same period. These results are in favor of central nervous system functional disturbances. The observed weight loss is discussed as being a parameter of the entry in the meningo-encephalitic phase. The rat model reproduces neurological symptoms observed in the human disease and may prove to be useful for further neurohistological and therapeutic studies.

Introduction: The aim of this study was therefore to provide a detailed description of the dermatological conditions presented by prisoners and to determine their determining factors in the largest

Objectives The objectives of this study were to determine the frequency of perforations and to describe the clinical, diagnostic and therapeutic aspects of traumatic perforations of intra-abdominal hollow organs in the general paediatric surgery unit of Gabriel-Toure teaching hospital.

We conducted an evaluation study on the GenoType MTBDRplus assay's ability to detect mutations conferring resistance to rifampin and isoniazid directly from sputum taken from 120 smear positive pulmonary patients from tuberculosis (TB) centers in Cote d'Ivoire. The sputum was decontaminated by N-acetyl-l-cysteine (NALC) and comparatively analyzed with the MTBDRplus assay version 2.0 and the mycobacterial growth indicator tube (MGIT) 960 automated drug susceptibility testing (MGIT-DST). The Gene-Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay was performed for 21 sputa with absence of hybridization for at least one rpoB wild-type probes. Four and seven, respectively, discordant and concordant results were also analyzed. The mutations in the rpoB gene were 21 (17.5%), 20 (16.7%), 7 (5.8%), and 10 (8.3%), respectively, for D516V, H526Y, H526D, and S531L. S315T mutation in katG gene associated or not with mutation in promoter of inhA was detected in 76 (63.3%) of the sputum. Compared to MGIT-DST, the sensitivity and specificity of the MTBDRplus for rifampin resistance detection were 100% (75-100%) and 73.2% (61.3-84%), respectively. For isoniazid resistance detection, the sensitivity and specificity were, respectively, 95% (90-‌99) and 95.1% (88.5-100%). Interpretation of 16 sputa without hybridization of rpoB wild-type probe 8 compared to those obtained with MGIT-DST and GeneXpert MTB/RIF was discordant and concordant, respectively, for 11 and 5.

Summary: Purpose: Cerebral malaria (CM) is suspected to be a potential cause of epilepsy in tropical areas, but little information is available. The purpose of this study was to evaluate the role of CM in epilepsy among children in Mali. Methods: An exposed–nonexposed study was performed to identify children who had epilepsy after malaria in the 0- to 15-year age group. The exposure factor was CM defined according to World Health Organization (WHO) criteria, and the nonexposure factor was symptomatic malaria without the characteristics of CM (NCM). All the children underwent a screening questionnaire and were examined by a medical physician. After the screening phase, a specialist in neuropediatrics examined the children suspected to have epilepsy. EEG and computed tomography (CT) scans were performed in some of these patients. Results: In total, 101 subjects who had had CM and 222 who had had NCM were included. Fifty-four children (CM, 34; NCM, 20) were suspected to have epilepsy, and six were confirmed (CM, five; NCM, one). The incidence rate was 17.0 per 1000 person-years in the CM group and 1.8 per 1000 person-year in the NCM group; thus the relative risk (RR) was 9.4 [95% confidence interval (CI), 1.3–80.3; p = 0.02]. After adjustment on age and duration of follow-up, the RR was 14.3 (95% CI, 1.6–132.0; p = 0.01). Conclusions: The risk of sequelar epilepsy is significantly higher in the CM group compared with the NCM group. A reevaluation of this cohort should be carried out later to search for temporal epilepsy that appeared after age 10 years.

In 1978 in the city of Alma Ata of the former Soviet Union, the World Health Organization declared its intention to provide health for all by the year 2000. In the third world, this was to be achieved through the integration of traditional and modern medicine. In the case of Senegal, the prescription was ahistorical. It did not take into account several centuries of integration in all areas, including health care. The central argument here is that four centuries of activity have made integration an historical fact for the peoples of Senegambia. The results of that integration are manifested in the inadequacies of the current health care system which evolved through the contestations of various political economic polities for control of the Senegambian region

A six-month prospective surveillance study of postoperative surgical site infections (SSIs) was undertaken between January and June 2010 in paediatric patients aged15 years, in the University Hospital Gabriel Touré, Mali. SSI was documented in 43 out of 352 children (12.2%). SSIs were significantly more common after emergency operations, in patients with a National Nosocomial Infection Surveillance System (NNISS) score of 2 or 3, and in patients operated on by trainee rather than by experienced surgeons. Children with anaemia or malnutrition were significantly more likely to develop infection postoperatively. Patients' sex, duration of preoperative stay and the number of patients in the hospital room were not considered as risk factors for infection (P0.05).