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ImportanceAlthough child mortality trends have decreased worldwide, deaths among children younger than 5 years of age remain high and disproportionately circumscribed to sub-Saharan Africa and Southern Asia. Tailored and innovative approaches are needed to increase access, coverage, and quality of child health care services to reduce mortality, but an understanding of health system deficiencies that may have the greatest impact on mortality among children younger than 5 years is lacking.ObjectiveTo investigate which health care and public health improvements could have prevented the most stillbirths and deaths in children younger than 5 years using data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network.Design, Setting, and ParticipantsThis cross-sectional study used longitudinal, population-based, and mortality surveillance data collected by CHAMPS to understand preventable causes of death. Overall, 3390 eligible deaths across all 7 CHAMPS sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) between December 9, 2016, and December 31, 2021 (1190 stillbirths, 1340 neonatal deaths, 860 infant and child deaths), were included. Deaths were investigated using minimally invasive tissue sampling (MITS), a postmortem approach using biopsy needles for sampling key organs and fluids.Main Outcomes and MeasuresFor each death, an expert multidisciplinary panel reviewed case data to determine the plausible pathway and causes of death. If the death was deemed preventable, the panel identified which of 10 predetermined health system gaps could have prevented the death. The health system improvements that could have prevented the most deaths were evaluated for each age group: stillbirths, neonatal deaths (aged ResultsOf 3390 deaths, 1505 (44.4%) were female and 1880 (55.5%) were male; sex was not recorded for 5 deaths. Of all deaths, 3045 (89.8%) occurred in a healthcare facility and 344 (11.9%) in the community. Overall, 2607 (76.9%) were deemed potentially preventable: 883 of 1190 stillbirths (74.2%), 1010 of 1340 neonatal deaths (75.4%), and 714 of 860 infant and child deaths (83.0%). Recommended measures to prevent deaths were improvements in antenatal and obstetric care (recommended for 588 of 1190 stillbirths [49.4%], 496 of 1340 neonatal deaths [37.0%]), clinical management and quality of care (stillbirths, 280 [23.5%]; neonates, 498 [37.2%]; infants and children, 393 of 860 [45.7%]), health-seeking behavior (infants and children, 237 [27.6%]), and health education (infants and children, 262 [30.5%]).Conclusions and RelevanceIn this cross-sectional study, interventions prioritizing antenatal, intrapartum, and postnatal care could have prevented the most deaths among children younger than 5 years because 75% of deaths among children younger than 5 were stillbirths and neonatal deaths. Measures to reduce mortality in this population should prioritize improving existing systems, such as better access to antenatal care, implementation of standardized clinical protocols, and public education campaigns.

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

Insecticide resistance is one of the primary threats to the recent gains in malaria control. This is especially true in Guinea, where long-lasting insecticidal nets are currently the primary vector control intervention. To better inform the national malaria control program on the current status of insecticide resistance in Guinea, resistance bioassays were conducted, using Anopheles gambiae s.l. Giles, in three sites. Molecular analyses were also done on An. gambiae s.l. to determine the species and find whether the target-site mutations kdr and Ace1R were present. Susceptibility tests revealed resistance to DDT and pyrethroids, although mosquitoes were susceptible to deltamethrin in two of the three sites tested. Mosquitoes were susceptible to bendiocarb, except in Kissidougou, Guinea. The kdr-west mutation was widespread and the frequency was 60% or more in all sites. However, the Ace1R mutation was present in low levels. Insecticide susceptibility should continue to be monitored in Guinea to ensure insecticide-based vector control methods remain effective.

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.

The closure anomalies of the peritoneal-vaginal canal include several clinical entities, which are at the origin of various symptomatology.To study the anatomo-clinical and therapeutic aspects of pathologies of the peritoneal-vaginal canal.This was a prospective study from January 1During the study period, 2,699 children were treated in pediatric surgery, of which 150 cases of pathology of the peritoneal-vaginal canal had a hospital frequency of 5.5%. The average age was 3.25 ± 9.63 years. The sex ratio was 14. The reason for consultation was intermittent or permanent inguinal or inguino-scrotal swelling in all children. The pathology was discovered by the parents during the pushing efforts in 46.7%. Inguino-scrotal swelling was found on physical examination in 40% of cases. The right side was reached in 60% of the cases. Hernia accounted for 80.6% of these pathologies. We recorded 31 cases of strangulation and 11 cases of craze. Immediate operative follow-up was simple in 92% of patients. This rate was 96% after 6 months.Pathologies of the peritoneal-vaginal canal are very common in pediatric surgical practice. The first place of these pathologies is occupied by hernia. They preferentially affect male infants.Les anomalies de fermeture du canal péritonéo-vaginal (CPV) regroupent plusieurs entités cliniques qui sont à l'origine d'une symptomatologie variée.étudier les aspects anatomo-cliniques et thérapeutiques des pathologies du canal péritonéo-vaginal.il s'agissait d'une étude prospective du 1er Janvier au 31 Décembre 2015 réalisée dans le service de chirurgie pédiatrique du CHU Gabriel Touré. Elle a porté sur tous les enfants de 0-15 ans présentant une pathologie du canal péritonéo-vaginal opérés dans le service pendant la période d'étude. N'ont pas fait partie de cette étude, les cas non opérés et ou non vus pendant la période d'études.Durant la période d'étude 2699 enfants ont été pris en charge en chirurgie pédiatrique dont 150 cas de pathologies du canal péritonéo-vaginal soit une fréquence hospitalière de 5,5%. L'âge moyen était de 3,25± 9,63 ans. Le sexe ratio était de 14. Le motif de consultation était la tuméfaction inguinale ou inguino-scrotale intermittente ou permanente chez tous les enfants. La pathologie a été découverte par les parents lors des efforts de poussées dans 46,7%. La tuméfaction inguino-scrotale a été retrouvée à l'examen physique dans 40% des cas. Le côté droit était atteint dans 60% des cas. La hernie a représenté 80,6% de ces pathologies. Nous avons enregistré 31 cas d'étranglement et 11 cas d'engouement. Les suites opératoires immédiates ont été simples chez 92% des patients. Ce taux était de 96% après 6 mois.Les pathologies du CPV sont très fréquentes dans la pratique chirurgicale pédiatrique. La première place de ces pathologies est occupée par la hernie. Elles touchent préférentiellement les nourrissons de sexe masculin.

Assessing the use of high-dose fluconazol monotherapy (1200mg or 800mg) in the treatment and prognosis of HIV-associated cryptococcal meningitis in Ivory Coast.A retrospective study carried out from August 2008 to August 2011 based on patients charts suffering from CM in the Abidjan Tropicals and Infectious Disease Unit. Mortality rate and associated factors were analyzed.Forty-six cases of cryptococcal meningitis (2.5% of hospitalizations) were included. The sex-ratio was of 1.2. The median age was 40.5 [35-47] years. The symptomatology was subacute (93.5%). The main clinical symptoms were syndrome of pure meningeal irritation (65%), fever (100%); 35% of patients had encephalomeningits. Twenty-one (45.7%) was ART-naïve patients. Fluconazole 1200mg was prescribed to 29 (63%) patients. Therapeutic lumbar punctures were performed in 42 (91.3) patients. The mortality rate was 50%. Significant predictors of mortality were encephalomeningitis and therapeutic lumbar puncture.Cryptococcal meningitis associated mortality remains high despite the use of high-dose fluconazole monotherapy. Therapeutic lumbar punctures help to improving the prognosis.

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.

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.

In Mauritania, epidemiological data estimate national HIV prevalence to less than 1%. Our study is the first joint survey on HIV/AIDS conducted among prisoners in Mauritania. It is a cross-sectional survey with anonymity and informed consent. The study covered a sample of 296 prisoners enrolled in a population of 706 prisoners held in Nouakchott. The sex ratio was 14.6. The refusal rate of blood sample was 4.7%. HIV prevalence in the sample was 3.9%. 53.37% of prisoners knew the concept of seropositivity but only 7.4% had a perfect knowledge of the ways of HIV transmission untainted by false beliefs. The results showed that 99% of prisoners knew that the condom is a means of protection against HIV infection, but they also showed many false beliefs about protection against HIV in the majority of prisoners. Indeed, 98.49% of respondents said they protected themselves by avoiding sex with strangers and 94.97% of them thought that sex with young girls or virgins are protection against HIV. Nearly one quarter of the prisoners did not have a good perception of risk of contracting HIV in prison although homosexual relations between prisoners have been reported. This study showed that prisoners in Mauritania are a vulnerable group to HIV because the prevalence of HIV in this group was higher than the national prevalence and this sub-population was unfamiliar with the disease and adopt risk behaviors.

Chemotherapy for human African trypanosomiasis (HAT), or sleeping sickness, is unreliable because of resistance, refraction and toxic and adverse side-effects. Using a long-term experimental model of HAT with involvement of the central nervous system (CNS), we tested the ability of a megazol and suramin combination treatment to eliminate CNS trypanosomes. This consisted of 20 mg suramin per kg body weight administered intraperitoneally (i.p.), followed 24 h later by 4 daily doses (80 mg/kg) of megazol given either i.p. or per os. One week post-treatment, neurological disorders had disappeared. One of 15 mice relapsed in each application group at 81 and 98 days after treatment, respectively. At six months, no signs of relapse were seen in remaining mice, indicating that this chemotherapy regimen was curative. Immunohistochemical (astrocytosis) and histological (inflammatory lesions) examinations of brain tissues showed that animals returned to normal from 2 months post-treatment. These results suggest that the megazol-suramin combination reversed the CNS pathology in this model.

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.

The aim of this study was to describe the characteristics and trends in the number of patients presenting with breast diseases (BD), their evolution in time, and the referral route.We reviewed all patients with breast disease who consulted at the Unit of Surgical Oncology of Donka from May 2007 to December 2009, examining the distribution of breast diseases. The numbers of women diagnosed with breast cancers was analysed with respect to time and referral source.There was a progressive increase in the number of patients presenting with breast diseases from year to year: 66 cases in 2007, 134 in 2008 and 227 in 2009. Of 423 patients with breast disease, 184 (43.5%) were diagnosed with breast cancer: 178 women and 6 men. Moreover, the percentage with breast cancer varied significantly according to referral route (p10-3); 56.0% among patients referred by health professionals and 22.3% in women who self-referred. Mean age at diagnosis of breast cancer was 48 years (n=178), 52.2% were post-menopausal. Women with breast cancer had on average 4.7 full term pregnancies. The tumor was considered aggressive in 62.9% of women because of the rapidity of its evolution. Early stage at diagnosis was made only for 4.3% of the cases. The hormone receptor were positive in 4 of 13 cases (30.7%), and the Cerb2 oncogene was over expressed in 8 of 11 cases (72.7%).A better organisation of the consultation services in a unit of oncology in a developing country can allow a better sorting and a good orientation of the patients and thus allow the early detection of the breast cancer. This requires adequate awareness of the population, a better involvement and adequate training of the health professionals dedicated to the tasks. The study of the Cerb2's expression and the hormone receptor are to be considered for better understanding the aggressiveness of the breast cancer found in our practice.

Our objectives were to determine the frequency of non-resecable gastric cancers, to analyse its clinical, and therapeutic aspects, and to assess patients follow-up.Our retrospective study has been from 1st January 2008 to 31st December 2009. It included all patients operated or not having non-resecable gastric cancers at general surgery at CHU Gabriel TOUREWe have recorded 305 cases of advanced gastric cancers, accounting for 71.4% of gastric cancers (n=425), 47.8% of digestive cancers (n=766) and 2.2% of hospitalisations. The sex ratio was 1.6 in men favour; the average age was 57 } 12 with extremes of 25 and 90. The average evolution delay was 15.5 months with extremes of 5 and 7, and standard deviation 19.2. 14 patients have been admitted in an emergency context. (8 cases of gastric perforation related peritonitis, 6 cases d’haematemesis). The main found signs were: epigastric tumours 187 (61.3%) cases, lower limbs oedema 105 (34.4%) cases, ascitis 105(34.4%) cases, hepatomegaly 68(22.3%), lymphadenopathy ≪ ganglions de Troisier ≫21(7%), ≪ ecailles de Brumer ≫ (= Brumer’s scales) from rectal touch 17(6%) cases More than half of patients have been classified ASA 4.105(34.4%) ASA 5, and 74(24.2%) ASA . The tumour location was antrum in 260(85.2%) cases Cardiac orifice in 17(5.5%) cases, fundus i n 11(3.6%), the gastric linitis in 17(5,5%) cases. The imaging has found the ascitis in 119(39%) cases, the hepatic metastases in 54(17.7%) cases, pulmonary in 36(19%) cases, pancreatic 5(1.6%) cases, splenic in 4(1.3%), and ovarian in 3(1%) cases 105(34.4%) patients had no surgery, 4(1.3%) had chemotherapy, and 200(65 %) had surgery. The mortality rate was at 16.5% and the one year survival at 15.5%.

The foreign bodies of the oesophagus see each other at any age. They are more frequent at the child's than at the adult. The cutting foreign bodies can constitute an urgency because of the risk of oesophagienne perforing or bleeding.Bring report the epidemiological and clinical profile of the foreign bodies of the oesophagus in our practice, and underline the difficulties of coverage(care) at the adult.A forward-looking study was realized of April, 2007 in Mars 2009 in the service ENT of the University hospital (CHU) Gabriel TOURE of Bamako concerning 26 grown-up patients presenting a foreign body of the oesophagus.Both sexes are affected in a equivalent way. The average age was of 32 years with extremes of 15 years and 65 years. The patients from 31 to 45 years old were the most touched. The false tooth was the foreign body most frequently met (58 %). Three patients presented complications has type of oesophagienne perforing (2) and of oeso-trachéale fistula (1) the outcome of which was fatal afterward. The oesophagoscopie in the stiff tube under general anesthesia allowed to extract 92 % of the foreign bodies.The foreign body of the oesophagus is a pathology so frequent at the adult and the diagnosis is mostly evident. Among the foreign bodies, false teeth raised problems of therapeutic coverage. The prevention passes by the regular medical supervision of false teeth, the training formation of the staff, the improvement of the technical trayp, and a good education of the patient.

The admission of a patient in intensive care justified by the severity of the disease, is a stressful situation for his heirs. A fair and understandable information is a major component of the process quality of care.Evaluate the practice of informing families of patients and their satisfaction in intensive care unit.We conducted a prospective study of 90 families of patients. The demographics of family representatives, and satisfaction data were collected.The majority of parents were aged between 20-40. The sex ratio was 2.9 for men. The siblings had accounted for 23 parents whether 25,6%. In 46 cases whether 51%, the relatives of families were satisfied with information received. 57.8% did not have good information on the risks of treatment complications. The lack of explanation about the evolution of the disease remained a major concern for 36 families. 69 of parents whether 76.7% felt that the frequency of visits was satisfactory. In our series no contradiction has been recorded in the information provided in 87 (96.7%) parents of patients. 80 (88.9%) of parents of patients showed the courtesy of staff at the reception. 54 relatives of patients whether 60% said they could not have been involved in the therapeutic management of the patient. 41 parents of patients whether 45.6% do not differentiate between the role of different caregivers. 45 parents felt uncomfortable.Despite the lack of normative information , most family members of patients were very satisfied with the information they were provided. Efforts to improve the satisfaction of families go through identifying the needs of the latter and effective communication strategy.

Diabetes complications constitute the 2nd cause of amputations after the sequels of traditional treatment for traumatism of the members with negative functional, aesthetic and psychological effect. The aims of this study were to determine the prevalence of the amputations consecutive to the complications of the diabetes, and describe the operating suites and the type of used equipment.20 cases of amputations consecutive to the complications of the diabetes (ACCD), from October 1st, 2006 to September 30th, 2007 in Nianankoro Fomba hospital of Segou.The frequency was of all the amputations with mean age of 57 years and sex-Ratio 1, 87. A history of high blood pressure was found in 18 cases (90%), the notion of addiction to smoking in 4 cases (20%). 7 (35%) patients had a body mass index included between 25 and 30 kg/m2 and 15 (75%) were of typical diabetes II. The average duration of evolution was included between 5 and 9 years. The leg and the foot was the most frequent seats 15 cases (75%). The state 5 of Wagner was the most frequent 12 cases (60%), and a glycaemia included between 3 and 4.99 g/l in 12 cases (60 %). The staphylococcus was the most frequently found germ in our taking, 12 cases (60%). The leg was the level of amputation the most frequent 35% (7 cases). 15 (75%) patients had a favourable evolution. We recorded 5 cases (15%) of death. The crutch was the locomotion's apparatus the most used in 11 cases (55%)An earlier management of diabetes will avoid these complications.

The incisional hernia is a frequent complication of the opened abdominal surgery. The objectives of this study were to determine the hospital frequency and the favoritizing factors, to analyze the therapeutic aspects.We realized a retrospective study from January, 1999 to December, 2005 in the services of general and paediatric surgery of teaching hospital Gabriel Touré. It concerned 45 cases of incisional hernia. The hernias of the abdominal wall, the abdominal and traumatic hernia were not retained.The frequency was 0.52%; the average age of our patients was 37.8 years with a sex ratio of 2 in favour of the woman. The average delay of consultation was of 59 months with extremes going from 2 to 11 months. Favoritizing factors found were the parietal suppuration to 13 (28.8%) patients and the multiple interventions to 8 (17.8%) patients. The average dimension of the hernia was 9.5 cms ± 3.8 with extremes going from 5 to 14 cms. The 45 patients benefited from the cure of the hernia according to Mayo. We didn't lost any patient. 2 parietal suppurations happened post-operatively.Incisional hernia treatment consists for Mayo's method or prosthesis. The laparoscopic surgery can reduce complications.

Evaluate the care of burn sequel of the hand in the services of orthopaedic trauma and paediatric in the teaching hospital Gabriel Touré.It was about a longitudinal and prospective study lasting from Jun 2006 to January 2008 in all the children aged from 0 to 14 years with burn sequel of the hand admitted and treated in the services of orthopaedic- trauma and paediatric surgery of Gabriel Touré. Patients with an incomplete file or lost during the study were not included.In 20 months we brought together 40 cases of burn sequel of hand. The mean age of the patients was 8.5 years. There were 18 boys and 22 girls. The sex-ratio was 1.22 for girls. The causal agent was more frequently thermal (85%) by hot liquid. Burn was caused by domestic accident in 95%. 14 of our patients were seen by a doctor after 24 months of burn and another 14 were after 36 months. A functional deficit was noted to the physical examination in all our patients. The treatment was surgical in 26 patients. Results were judged well in 16 cases, little good in 8 and bad 2 case. A good initial treatment done in a fear condition permit to reduce the number of sequel of the hand and to stay less severe.

Describe the severity of bone lesion and evaluate the results of the treatment of osteomyelitis in patients with sickle cell disease.It was about a prospective study done from December 2005 to November 2006 in patients with confirmed sickle cell admitted for osteomyelitis.We gather together 62 cases of osteomyelitis in sickle cell disease among 120 cases, which was about 51.7%. The mean age has been 17 years. The diagnosis was made on biology and x rays. 46.78% of our patients were sickle cell homozygote. Bone pain was the 1st reason of consultation with 53.2% of cases. Staphylococcus aureus and salmonella were the most frequent germs, with 43.55% each. Complications were noted in 32.26% because of diagnosis delay (P 0.05). Delay in the management or incorrect treatment can result in a severe and definitive sequel for the functional future of those patients.

Were to determine the frequency, to describe the clinical and therapeutic aspects digestive stoma.It was about six months an exploratory study from January 1st to June 30th, 2008 in the department of surgery general of the CHU Gabriel Touré. Were included in this study all the patients carrying a enter stoma or a colostomy, old of more than 15 ans. The digestive dents, the other types of stoma and the patients old of less than 15 years, were excluded. The results were analyzed by the software Epi information version 6.4 Fr, the tests of Khi 2 and Student with a threshold of significance for P0.05.We college 32 patients are 7.4% of all digestive surgical operations, 13.3% of the abdominal urgencies; composed of 26 men (81.25%) and 6 women (18.75%). The sex ratio at summer of 4.3. The average age was 44, 8 years with a standard deviation 8, 13 and the extremes varying between 16-80 years. Twenty and one (65.6%) sick were operated in urgency. We carried out 29 cases (90.6%) of final stoma, 3 cas (9.4%) side, 21 cas (65.6%) of colostomy, 9 cas (28.1%) of ileostomies. They were temporary in 25 cas (78.1%) and final 7 cas (21.9%). The volvulus of the sigmoid colonist with necroses 10 cas (31.3%), the peritonitis by typhus perforation ilea 9 cas (28.1%), occlusions on tumor of the left colonist 8 cas (25%), the traumatic perforations ileales 2 cas (6.3%), the digestive dents post appendicectomies 2 cas (6.3%) and the congenital megacolon 1 cas (3%) was the indications of the stoma. the operational continuations were simple in 21 cas (65.6%). The principal found complications were: coetaneous irritation 7 cas (21.8%), the prolapsed stomiale 4 cas (12.5%), the suppuration peristomial 3 cas (9.4%), the releasing of Stoma 3 cas (9.4%), the retraction of the stoma 3 cas (9.4%),the psychological disorders 3 cases (9.4%), the hemorrhage 2 cas (6.3), necroses peristomial 2 cas (3.1%), septic shock 2 cas (6.3%), and 1 cas (3.1%) of evisceration, obstruction of the bowels, shock hypovolemic. The intermediate duration of hospitalization was of 37,5 jours with a standard deviation = 13.58 and extremes varying between 02-73 days. Death rate was of 9.4%.The assumption of responsibility of the stomies is difficult in the absence of stomatherapeutes, and of the high cost of the parenteral nutrition in our context .

the omphalocèle is an evolution of the extra embryonic coulombs between the 32th and the 72th days of the pregnancy. The treatment depends on his volume. In Mali; few works were published on the omphalocèle and its treatment.we brought together 111 cases of omphalocèles during 8 years of study with the aim of determining the epidemiological factors and describing the clinical and therapeutic aspects.49 patients on 111 were of the male and aged between 4,2 days with weight between 2500 - 3500 g. The diameter of the r snare was superior to 8 cms in 29(26,13%) cases and has benefited a conservative treatment according to Grobb. 13 patients had a rupture of the membrane. The liver has been found in 29 time (26,13%) in the sac and 35 case and associated malformation. 20 cases of death have been observed. Antenatal ultrasound found exomphalos in 9 cases. Any mother had a story of teratogenic medications and 67 mothers were multipared.Omphaloceles are multidiscipli-nary surgical emergencies. Antenatal echogra-phy is useful for the antenatal diagnosis.

The occurrence of an event planned or unplanned during anesthesia is a concern for staff. This event may jeopardize the success of surgery gesture. Pediatric Surgery therefore has its own specific complications that it requires anesthesia.To evaluate the incidence of adverse events during anesthesia in pediatric surgery scheduled.Descriptive non-randomized study.Descriptive non-randomized study on adverse events related to anesthesia in children over a period of seven months. It took place in the anesthesia and intensive care unit and the pediatric surgery unit of Gabriel Toure hospital in Bamako. It focused on patients aged 0 to 12 years scheduled for surgery under general anesthesia during the study period.Sixty six percent of patients selected was male gender with a sex ratio of 3 in favor of males. The average age was 2 years with extremes of 16 days and 12 years and a standard deviation of 2.93. The old history of premature was found in 36% of patients and 2% of asthmatic. The number of patients experiencing an adverse event is 42 on a total of 107 patients collected either 39.25%. When the children were younger than one year adverse events occurred with 30, 76%. The occurrence of adverse events was more frequent when the child was not intubated with P0.05. All adverse events have received support except tachycardia, late revival but all developed positively.This study estimates the incidence of adverse events in anesthesia during pediatric surgery. The overall rate of patients experiencing an adverse event is relatively high. Children age less than or equal to one year are most vulnerable.

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).

This prospective descriptive study was carried out from August 2007 to January 2008 in the emergency surgery department of Gabriel Touré Hospital in Bamako, Mali. A series of 184 patients treated for head and neck injuries was compiled. Patients presenting strictly neurosurgical lesions were excluded. Most of the patients included in this series were young single city-dwelling males (mean, age, 27 years; M/F sex ratio, 4.3. Most injuries were sustained in road traffic accidents (93%). The most common injuries were epistaxis and multiple fractures of facial bones, cervical spine and petrosal bone. These injuries ere often associated with avulsive wounds involving the external ear and nose. The main complication risks fell into four categories, i.e., circulatory loss, upper airway obstruction, functional and/or morphological impairment, and coma-related death (Glasgow score8). Shortage of medication and/or disposable treatment kits was a major handicap for optimal management of head and neck injuries.

This work presents the results of the behavioural and serologic survey on HIV/AIDS conducted from December 2007 to December 2008 among the group of STD (sexually transmitted disease) patients, supposed to be at HIV infection risk. In Mauritania, the last survey of HIV seroprevalence among the STD patients goes up to the year 1995 (the prevalence was estimated then to be 0.9%). The goal was to determine the seroprevalence of HIV and syphilis and to gather information on the knowledge, the sexual behaviours on a risk concerning the HIV/AIDS, and the sexually transmitted disease among these patients. The census has been made on over 224 STD patients during the period of the study, without predominance of sex and with a majority of young adults. The prevalence for HIV is 9% and for the syphilis it is 10%. Actually, the condom is widely underused by this group, even in occasional intercourse. The STD patients are a group of risk towards HIV, because of their risk behaviours and low level of knowledge.

This work reports the results of one year (November 2004-October 2005) descriptive study of tumours located in the head and neck areas in the ENT department of the University-Hospital of Gabriel Toure in Bamako. Were included in the study patients whose files showed epidemiology data: age, sex, profession, residence and period of the medical checking, and exposition factors: anatomic location, results of histology and image data of the tumours. Where excluded from the study the patients whose file were not completed and those that have had eye and brain tumours From the data base of the department, a total of 60 cases of tumours were monitored and 25 others cases were excluded according to the criteria. Among the 60 cases, 24 tumours (40%) were malign and 36 were benign. Goiter was the most found benign tumor according to the results of the hystology analysis. In most cases (15 out of 36, 41.67%) the histology analysis showed an colloid adenoma Other rare tumors like rhinoscleroma (5 cases out of 36, 13.89%), nose invertus papilloma (2 cases out of 36, 5.55%) where found. These were easily diagnosed and treated. In the group of malign tumors, the pharyngolaryngeal cancer was the most found (11 cases out of 24) and the most predominant histology of these cancers was the epidermoid carcinoma. Two of these cancers were found in patients below fifteen years of age, but no other risk factors like expositions was noted in the files of these two patients. Other malign tumors have been found: nose and sinusal cancers and thyroid carcinoma. In most cases these tumors were diagnosed at an advanced stage.

Establish the frequency of osteoarthritis in our service an establish an adequate therapeutic protocol.It is about a retro and prospective study realised from January 2001 till January 2004 on all the 0 to 15 years old children treated and followed in the service for osteoarthritis. Ten patients having no complete file or having disappeared during the study were excluded.41 cases of osteoarthritis brought together in 26 boys and 15 girls. It occupied 0.8% of the hospitalization and 1.14% of the surgical activities. The average age of our patients was of 4.58 years+/-4.41 with extremes going from 0 to 15 years old. The noted facilitating factor was sickle cell disease (70.7%). The hip was the most affected articulation (48.8%). The staphylococcus was the most met germ (48.8%).A meticulous examination of a child presenting an articular pain and its management within a better time are necessary to avoid the frequent invalidating sequel in our country.

Evaluate the efficiency of the treatment of pain by analgesic according to World Health Organization (WHO).We made a descriptive and analytic study in majors sickellers in pain crisis admitted in the service of paediatric of the hospital Gabriel Touré Bamako from January 2005 to January 2006. The efficiency of the treatment by painkiller was evaluated at second hour and at the 24 hour.Our study concerned 70 children with major of sickle cell of both sexes and aged from 6 to 15 years in pain crisis. In 87.1% pain disappeared with painkillers palier I (paracetamol) and 12.9% had necessitated to pass to palier II (buprenorphine) an 64.3% our patients the pain disappeared in a period less than 12 hours with an average of 3 hours against only 35.7% soothed in a period more than 12 hours with average of 64 hours 3 minutes. Pain from the head and limbal region were the most sensible to the treatment.The treatment of pain by palier according to who is efficient in children sickeller.

Evaluate the epidemio-clinical and therapeutic aspects of the femur's fracture of the child.It was about a prospective study done from October 1st, 2005 to September 30, 2006 on all children of 0 to 15 years old admitted for femur fracture, treated and followed in the trauma center of hôpital Gabriel Touré. Disappeared patients have not been included.We brought together during a period of 12 months 47 cases of fracture in 45 children representing 26 % of the activities of trauma unit of hôpital Gabriel Touré. Among our patients 25 were boys and 20 girls. The average age was 7.5 yeras +/-4. The public highway accident was the first cause (68.8%) followed by domestic accident (22.2%), sportive (6.6%), obstetrical (2.2%). The treatment was orthopaedic in 52.17% and surgical in 47.83%. Complications were the following: residual pain in 6.6%, length disparity of the limbs in 4.4%, secondary slipping in 2.2% and hypertrophic callus in 2.2%. P0.05. The results were good in 71.7 % of the cases, passable in 24 % and bad in 4.3% of the cases.Femur fracture is a frequent affection by which the first cause remains the public highway accident.

Burkitt's lymphoma was first described in Africa where it remains one of the most common malignant tumors in children. To our knowledge there have been no large series describing Burkitt's lymphoma involving the maxillofacial area or any other location in Malian children. The purpose of this retrospective single-center study was to describe clinical, laboratory, and therapeutic findings in children treated for maxillofacial Burkitt's lymphoma in the Oncology Unit of the Gabriel Touré Pediatric Hospital in Bamako, Mali from January to December 2006. A total of 38 cases of Burkitt's lymphoma were diagnosed during the study period. This series includes 24 children (63.2%) under the age of 15 years in whom diagnosis of previously untreated maxillofacial Burkitt's lymphoma was confirmed by cytology. All patients were treated using the GFA 2005 protocol for Burkitt's lymphoma. There were 17 boys and 7 girls (sex ratio of 2.4). In all cases the disease was advanced, i.e. stage III in 87.5% and stage IV in 12.5%. Following three cycles of Endoxan in association with 3 injections of metothrexate and hydrocortisone, complete remission was observed in 37.5% and 16.6% were lost from follow-up. Treatment complications after 6 cycles included hematologic toxicity in 71.5% and alopecia in 100%. Most patients (70.8%.) presented no infectious episode. Follow-up examination at one year showed that 29.2% of patients remained in complete remission. Despite limited resources for treatment and surveillance, the survival rate in our series of patients treated for advanced stage Burkitt's lymphoma was about 30%. It is likely that a strategy based on an information campaign to enhance the awareness and knowledge of parents, training of medical and paramedical staff, and improvement of management facilities could further reduce mortality due to Burkitt's lymphoma in Malian children.

The accidental intoxications constitute more and more a serious problem among young children in the developing countries because of their frequency and difficulties for taking care of those victims. The objective of our work was to study acute intoxications among children in order to determine the frequency, to identify the products in question and to determine the impact of those accidents in the future life of the victims. The study was carried out in the Paediatric Service of the CHU Gabriel Touré from January 2001 to June 2002. We enrolled 89 children from 0 to 15 years of age. Information on our patients was recorded on investigational questionnaire and completed with data from their entry and hospitalization records. Among 8237 children hospitalized during the study period, 89 of them had acute intoxication i.e. 1.08%. Children less than five years of age were more frequent with 85.4% with a male prevalence of 61.8%. Antimalarial drugs and petroleum were the most accused products. Administration of milk and provoked vomiting were the attitudes and practices of the entourage of the victims when intoxication occurs. The evolution was favourable in 67.2% of the cases with a hospital lethality of 13.7%.

DRANK: The goal of this work is to determine the factors of surgical mortality in period neonatal and to emphasize the difficulties of the assumption of responsibility.Retrospective study of 222 cases over 10 years from January 1992 to December 00 realized in the service of Paediatric surgery of the National Hospital Donka. We studied the age of the patients to the first consultation according to whether it is received before or after the 6th day of birth, the socio-economic level was appreciated according to the mode of dwelling, accessibility with drinking water and electricity, the diet, associated malformations, the postoperative results.In 10 years (January 1992 at December 2001), we recorded 222 surgical cases of newborn emergency interesting the digestive tract (27.48%), the abdominal wall (37.39%), the parts urogenital (2.25%) and neurological (32.88%). We noted a male prevalence of 64.41% and surgical newborn mortality was 29.28%. The delay with the consultation, poverty on the one hand and the lack of the means of reanimation, the insufficiency of qualified personnel, were the principal factors of risk in our series.The surgical newborn urgencies gather affections which require an immediate and adequate assumption of responsibility. The early diagnosis is a requirement; it must be done in the room of childbirth. The childbirth in residence, the ignorance of these affections by much of experts involves the delay with the consultation. The insufficiency of personnel qualified in paediatric surgery and infantile anaesthesia-reanimation, the poverty of the parents who must deal with the medical expenses of the new-born babies are as many factors which delay the time of intervention. The training of the specialists in paediatric anaesthesia-reanimation, the formation continues agents of health on all the levels on the tracking of the newborn urgencies, the creation of the centers of reanimation, the motivation of the personnel looking after in these structures and the intervention of the medical O.N.G. will be major assets to improve the assumption of responsibility and to decrease the death rate.

Most newborn deaths are associated with birth asphyxia (40%), low birth weigt and prematurity (25%) and infections (20%). In Mali, in the Community Health Centers (CSCOM) exercises a staff composed of the nurse chief of health centers (ICPM) assuring the supervision of the matrons that is charged in pregnancy and the newborn. An investigation KAP (Knowledge, Attitudes and Practises) initiated in order to assess the knowledge and the practices of the community health centers agents on birth asphyxia. The survey was cross-sectional and that took place in September 2004. Have been included in the study the matrons, the nurse chief available at the time of the survey. The multiplicity of the names mentioned among which Ninakili dégou (27,3%) and Niominè (15,2%) are the most frequent and show the necessity of a qualitative investigation to find a name. Prolonged labor more than 12 hours (73,3%) and the stained amniotic liquid (63,3%) are the most recognized signs during labor making fear the birth asphyxia. In our survey the prolonged labor (63,7%), the infection/malaria of mother (60,7%) and the Dystocic delivery (45,5%) were the mostly reported causes of birth asphyxia. The pale or bluish coloration (69,7%), the irregular or lack of breath (69,7%), the lack of cry (63,6%) were known as the main signs of birth asphyxia. We noted some good practices as aspirating with a bulb (69,7%) and clearing upper ways with a finger covered with gauze (30,3% ); doing the mouth to mouth (51,5%); stimulating the newborn (66,7%). The improvement of the neontatal mortality requires the training of the staff and the equipment of the centers in small simple materials of resuscitation.

Laparoscopic surgery is now a widely accepted modality for gastrointestinal surgery. In this report the authors evaluate their four-year experience with laparoscopic surgery in a total of 494 patients in Abidjan, Ivory Coast. Cholecystectomy and appendectomy were the main indications in this series. However laparoscopic surgery has a wide range of applications in Black Africa not only for elective indications such as evaluation of chronic abdominal pain and digestive cancer but also emergency indications such as peritonitis and abdominal trauma.

International audience; BACKGROUND:The population exposed to malaria within African cities has steadily increased. However, comprehensive data on life-threatening malaria features and risk factors in children from urban areas with seasonal malaria transmission, such as in Bamako (Mali), are lacking.METHODS:Children admitted to the Gabriel Touré Hospital in Bamako with severe malarial anemia (SMA) and/or cerebral malaria (CM) were prospectively included in the study. Indicators of either SMA or CM were analyzed using logistic regression; and death hazard ratios (HRs) were estimated through survival analysis.RESULTS:The study included 455 children: 66% presented with CM, 34% with SMA, 3% with hypoglycemia (HG); 5% with dehydration; 17% with respiratory distress (RD); 25% with splenomegaly; and 92% with hepatomegaly. The children with CM were older than those with SMA. CM was more often associated with dehydration, HG, and RD, whereas SMA was more often associated with splenomegaly. The overall case fatality rate was 16%, and 94% of the children who died had CM. HG [HR: 2.37; 95% confidence interval (CI): 1.04-5.39; P = 0.040], RD (HR: 4.23; 95% CI: 2.46-7.30; P < 10(-6)) and a deep coma with a Blantyre score of less than 3 (HR: 6.78, 95% CI: 2.43-18.91; P < 10(-3)), were all independent predictors of death.CONCLUSIONS:These findings delineate the patterns of severe malaria in children in a West African mesoendemic urban setting. They validate practicable prognostic indicators of life-threatening malaria for use in the limited facilities available in African health centers and provide a frame of reference for further research addressing life-threatening malaria in this setting.

The hypothesis that tumor necrosis factor (TNF) aggravates malaria in children is supported by observations that TNF polymorphisms and high TNF levels have been associated with cerebral malaria. Nevertheless, severe malaria was not associated with polymorphisms located at positions −308A and −238A in the TNF alpha gene promoter or with a high TNF level in plasma in children from Bamako, Mali.

The paper presents the results of a study of immunological parameters in the indigenous adult population of an endemic area of Guinea in tropical malaria of varying severity and the time course of changes in these parameters in different phases of the disease during delagil treatment. Examination of 101 patients has established that tropical malaria in re-infected patients is not accompanied by severe immunosuppression though there is a clear tendency towards lymphocytic immunodeficiency in patients with higher parasitemia and a severe course of the disease. The greatest manifestations of immunosuppression coincide with the high oxygen metabolism of phagocytes, which confirms their important role in the pathogenesis of immune disorders and common syndrome in malaria.

Background The pathogenic mechanisms of cerebral malaria (CM) are unclear but are thought to involve cytokine-mediated inflammation enhanced by parasite sequestration in the brain microcirculation. The role that interferon (IFN)-gamma could play that would enhance inflammation but also reduce parasitemia is unclear. Methods Plasma IFN-gamma concentrations were measured by enzyme-linked immunosorbent assay in 96 children with CM and 40 children with uncomplicated malaria (UM) who had been recruited from Gabriel Toure Hospital (Bamako, Mali). We investigated the relationship between IFN- gamma concentrations and disease by nonparametric analysis. Polymorphisms in IFNG were characterized by restriction enzyme analysis or size-determination electrophoresis. Associations between polymorphisms and CM were evaluated by the family-based association test on 240 families. Results During episodes of malaria, IFN-gamma concentrations were lower in children with CM than in children with UM (P = .007). IFNG-183T (P = .009) and IFNG-183G/T (P = .013) were found to be less frequent than expected in children with CM. A trend toward association was also observed between IFNG(CA)14/(CA)14 (P = .073) and CM. The IFNG-183G/T and IFNG(CA)14/(CA)14 genotypes were more frequent in children with UM than in children with CM (odds ratio, 0.30 and 0.34, respectively). Conclusions The low plasma IFN- gamma concentrations in children with CM and the associations between a reduced risk of CM and (1) the IFNG-183T allele (which increases gene transcription) and (2) the IFNG-183G/T genotype are consistent with the concept that IFN-gamma protects against CM.

This work is the result of a retrospective study carried out over three months, from February to April 2002 in the ENT service of Gabriel Touré hospital of Bamako (Mali). The purpose of the study was to find out the prevalence of HIV/aids among ENT patients over the study period. Out of 691 patients, there were 19 cases of seropositivity (2.7%). These seropositive patients were quite often young women, over half of them urban (16/19), jobless and unpaid. The oro-pharyngo-laryngology symptoms though not often obvious in the HIV/AIDS manifestations deserve to be studied more as they can point out possible screening.

Twenty-four percent of the Gabonese population has sickle cell trait, and 1-3% has sickle cell disease. Patients' management must follow well-defined protocols that take into account the debilitating effect of severe pain episodes.To evaluate the three-step analgesic ladder for control of pain for sickle cell disease pain crises.This is a prospective and descriptive study based on surveys filled between February 2000 and March 2001. Surveys were restricted to sickle cell disease patients having developed pain crises before and during their stay at the hospital. The assessment of the pain was based on the DEGR and EVA scales. The treatment followed the World Health Organisation's analgesic ladder. The criteria used for estimate pain severity and sedation duration were measured before, 2 and 24 h after treatment administration began (H0, H2 and H24) to evaluate its effectiveness.Sixty children were included. All the social layers of the population were represented. The school level was variable. Fifty-six percent of the patients suffered their first pain crisis before they were 1 year old. Thirty-one percent had annual crises and 20% monthly crises. Pain was located in joints in 35% of the cases, and in joints and bones in 15% of the cases. Eighty-one percent of the pain crises were successfully treated in stage I. The passage to stage II occurred in the remaining cases (18.3% of the cases).The WHO's three-step analgesic ladder for control of pain is effective for the sickle cell disease pain episodes. Stage I drugs relieved the pain for 81.6% of the patients in a relatively short time (2-16 h). It was not possible to go to stage III.

Noma is a necrotic stomatitis, frequent in undernourished children in tropical countries. Its occurrence in adults is extremely rare and has recently been described during AIDS. We report two new cases.The first patient, a 37 year-old farmer, consulted for a mutilating ulcer of the commissure of the right lip. The second patient, a 25 year-old woman, consulted for an ulcerating and necrotic tumefaction of the left cheek. Anamnesis reconstructed the chronology of the lesions and a cutaneous biopsy revealed non-specific ulcers. The status of health of both patients was poor and they both exhibited positive HIV serology.The diagnosis of noma is easy and based on clinical manifestations. The characteristic aspect is that of a mutilating ulcer of the face with conventional progression: tumefaction, followed by ulceration and finally elimination necrosis. This disease predominates in children. Its discovery in adults is a sign of poor prognosis because it may reveal an HIV infection at the AIDS stage.It is important to draw the attention of practitioners on the interest of performing HIV serology when confronted with an adult exhibiting a noma, and to evoke a noma when confronted with a tumefaction of the face rapidly progressing towards necrosis.

This study is about bacteriological aspects of purulent meningitis in Bamako area upon 1,541 strains collected from 1979 to 1991. It showed that N. meningitidis, S. pneumoniae and H. influenzae b are responsible. In general, N. meningitidis is the most frequent, but this depends on years and months. Since 1988, N. meningitidis serogroup C has supplanted serogroup A. N. meningitidis is predominant between 7 to 30 years. S. pneumoniae between 1-28 days and 31 to 68 years, H. influenzae between 1 month to 6 years. The frequency of these species is the same in male and female. The 3 species are quite sensitive to antibiotics tested except sulphonamides and cotrimoxazole. Meanwhile, the appearance of strains of S. pneumoniae to penicillin and H. influenzae to ampicillin must be followed with interest to check any time the importance of the phenomenon.

A community trial of the microfilaricide ivermectin undertaken in an hyperendemic focus of blinding onchocerciasis in Ghana. One objective was to investigate the safety of this new drug when used in mass treatments. 14,911 persons (61.5% of the census population) were treated with ivermectin. Of these, 15% reported with adverse reactions which were generally similar to those reported in the clinical trials. However, cutaneous reactions were relatively less frequent while brawny oedema of the limbs and inguinal gland pain were important. The severe reactions consisted of 37 cases of Severe Symptomatic Postural Hypotension (SSPH), 13 cases of severe fever and two cases of severe dyspnoea. The latter two cases represented life threatening situations, but there was no evidence that they were complications of ivermectin treatment. Only four of the SSPH cases required treatment. All severe adverse reactions were managed successfully and recovered within one day, usually within a few hours. The incidence of adverse reactions was highest the first day after treatment. Thirteen cases of delayed reactions were reported during a four-week follow-up. There was a highly significant relationship between incidence of adverse reactions and intensity of infection but no relation with ivermectin dosage within the range of 130-200 mcg/kg. The results suggest that ivermectin is sufficiently safe to be used in mass treatments. However, mass distribution of this drug should not be undertaken without adequate monitoring.