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Introduction Over the past two decades, the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) have dramatically declined in wealthier regions of the world as a result of preventative programmes, improved living standards and access to cardiac surgery. Nevertheless, ARF and RHD are still public health problems in less-developed regions of the world such as Oceania, south Asia and sub-Saharan Africa. Aim We report on clinical, therapeutic and prognostic aspects as well as the difficulties encountered during this first series of surgery for rheumatic valve disease in Mali. Methods This was a prospective, descriptive study conducted at the Andre Festoc Cardiac Surgery Centre from September 2018 to August 2019. Results The frequency of patients having been operated on for rheumatic valve disease was 44.73% (68 patients). The mean age of the patients was 18 ± 10 years with extremes of five and 60 years. The gender ratio was 0.7. The delay to treatment was between one and three years for 39.7% of the patients. The main diagnoses found were: mitral regurgitation in 50% of patients, mitral stenosis in 16.2% and aortic regurgitation in 10.3%. Pulmonary artery systolic pressure was 35-50 mmHg in 19.1% of patients and more than 50 mmHg in 25%. The median cardiopulmonary bypass time was 132 minutes (60-276) and median extubation time was three hours (0-96). The main complications were cardiac, renal, neurological, respiratory, gastrointestinal and infectious. In the immediate postoperative period, we recorded three deaths, which is a mortality rate of 4.4%. Conclusions Humanitarian efforts have led non-governmental organisations (NGOs) to launch surgical programmes in low-and middle-income countries in an attempt to fill the gap in these fragile healthcare systems. Cardiac surgery requires much expertise from the medical staff, as well as many material and financial resources. Empowerment of the local team is a challenge that is being realised since taking these essential steps of companionship with the NGO la Chaine de l'Espoir.

Seasonal malaria chemoprevention (SMC) was adopted in Mali in 2012 for preventing malaria in children younger than 5 years. Although this strategy has been highly effective in reducing childhood malaria, an uptick in malaria occurrence has occurred in children 5 to 15 years of age. This study aimed to investigate the feasibility of providing SMC to older children. A cohort of 350 children age 5 to 14 years were monitored during the 2019 transmission season in Dangassa, Mali. The intervention group received five monthly rounds of sulfadoxine–pyrimethamine plus amodiaquine, whereas the control group consisted of untreated children. Community acceptance for extending SMC was assessed during the final round. Logistic regression models were applied to compare the risk of Plasmodium falciparum malaria infection, anemia, and fever between the intervention and control groups. Kaplan-Meier survival analyses were used to compare the time to P. falciparum parasitemia infection between the groups. The community acceptance rate was 96.5% (139 of 144). Significant declines were observed in the prevalence of P. falciparum parasitemia (adjusted odds ratio, 0.22; 95% CI, 0.11–0.42) and anemia (adjusted odds ratio, 0.15; 95% CI, 0.07–0.28) in the intervention group compared with the control group. The cumulative incidence of P. falciparum infections was significantly greater (75.4%, 104 of 138) in the control group compared with the intervention group (40.7%, 61 of 143, P = 0.001). This study reveals that expanding SMC to older children is likely feasible, has high community acceptance, and is in reducing uncomplicated malaria and anemia in older children.

Nephroblastoma or Wilms tumor is a malignant tumor that develops at the expense of embryonic kidney tissue. It is the most common kidney tumor in children (> 90%); it represents around 5% to 14% of all childhood cancers. The aim of our work is to recall the contribution of imaging, in particular CT, in the management of this renal tumor. This is a retrospective, single-center study of 136 cases of Wilms tumors diagnosed in our clinic over a 2-year period. The mean age of the patients was 04 years with an extreme of (3 months -12 years) with a female prevalence (8 girls for 5 boys). Abdominal mass dominated in our study in clinical information. Histological confirmation was found in 12 cases, the only non-conforming case was lost to follow-up.

Summary Background Preeclampsia is one form of hypertensive disorders, responsible for severe morbidity, long-term disability and maternal and newborn mortality worldwide. Studies have assessed the role of diet on the risk of preeclampsia using various dietary patterns, however, the association between dietary pattern and the risk of preeclampsia is not entirely clear. This study aimed to determine the association between maternal dietary patterns and the risk of preeclampsia through a meta-analysis of observational studies. Methods Electronic literature was searched in 3 databases, including PubMed, Cochrane Library, and Web of Science, for articles published up to November 2020 that examined the association between dietary patterns and preeclampsia. Only studies considered observational were included. Two authors independently performed study selection and data extraction. Pooled effect sizes of eligible studies were estimated by using random-effects models for healthy diet patterns and fixed-effects models for western diet patterns. Results A total of 12 articles reporting 25 studies were selected for this study. Results from 11 articles reporting 22 studies were pooled. Healthy dietary patterns (16 studies) and western dietary pattern (6 studies) were identified. Higher adherence to a healthy dietary pattern was significantly associated with a reduced risk of preeclampsia (OR (95% CI): 0.79 (0.73–0.85), I2 = 57.2%, P = 0.009), and a significant association between higher adherence to a western dietary pattern and the increased risk of preeclampsia was found (OR (95% CI): 1.14 (1.02–1.25), I2 = 27.0%, P = 0.232). Conclusion The results suggest that adherence to dietary pattern high in vegetables, fruit, fish, whole grains and low in meat, processed food and sugar-sweetened foods has a significant potential to reduce the risk of preeclampsia in women. Furthermore, the subgroup analysis suggested that the association between healthy diet pattern and the risk of preeclampsia in the studies that assessed dietary between the first and second trimester was not significant.

Background Malaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the out of pocket costs associated with seeking treatment for malaria during pregnancy. Methods A cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). Direct costs were broken down into medical (admission fees, drug charges, and laboratory fees), and non-medical (transportation and food). Indirect costs reflected time lost due to illness. In total, 220 pregnant women in Burkina Faso and 263 in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode. Results In Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 27.1% before their IP visits. This compares to 1.3% for OP and 25.92% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$ for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 0.80US$ for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$ in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%). Conclusions High malaria treatment costs are incurred by pregnant women in Burkina Faso and The Gambia. Beyond the medical costs of fees and drugs, costs in terms of transport, food and time are significant drivers. The role of remittances, particularly their effect on accessing health care, needs further investigation.

Background: Diethylnitrosamine (DEN) is a hepatotoxin whose metabolic activation by liver cytochromes P450 is responsible for the necrosis, mutagenicity and carcinogenicity of liver cells. The purpose of this study was to evaluate the protective effects of Calotropis procera roots bark against DEN induced hepatocellular damage in rats. Material and Methods: Hepatoprotective activity of the ethanolic extract of Calotropis procera root bark were evaluated by induction of liver injury with DEN in Wistar male rats distributed in six groups of six. Serum hepatic markers, alanine amino transferase (ALAT), aspartate amino transferase (ASAT), alkaline phosphatase (ALP), total protein and albumin were evaluated and the enzymes antioxidant activities, superoxide dismutase (SOD) and catalase, as well as the level of malonedialdehyde (MDA) were determined in the liver homogenate. Histological analysis was carried out on sections of rat livers. Phytoconstituents have also been studied. Results: Pretreatment of rats with the extract showed a significant decrease in ALAT, ASAT and ALP while there was an increase in total protein and albumin compared to rats treated only with DEN. It also showed a significant increase in SOD and catalase and a decrease in MDA levels suggesting the hepatoprotective effect of the extract. Observation of liver sections confirmed the results of the biochemical parameters which would attest that the extract is hepatoprotective. Phytoconstituents such as sterols, triterpenes and phenolic compounds have been demonstrated. Conclusion: Ethanolic extract of Calotropis procera roots bark has shown hepatoprotective effects that could be due to its content in sterols and triterpenic and phenolic compounds.

Malaria infections in pregnancy should be treated promptly with safe and efficacious antimalarial drugs to prevent harmful effects on the mother and fetus. To succeed, the Malian has developed NMCP guidelines for the management of malaria cases in pregnant women. The study aimed at the analysis of the prescription of antimalarial drugs based on the Mali's NMCP guidelines. We conducted a cross-sectional study during malaria transmission season from June to August 2020. The sampling concerned all prescriptions for pregnant women containing at least one antimalarial drug. The frequency of prescription of antimalarial drugs was 85%. 132 (74.16%) were preventive treatments and 46 (25.84%) curative treatments. 30 (90.91%) of pregnant women in the first trimester received one dose of Sulfadoxine-Pyrimethamine. 6 (12.5%) received three doses in the third trimester. Of the 46 antimalarial drugs prescribed for the treatment of uncomplicated malaria, 30 (65.22%) were Artemether-lumefantrine (tablet), 10 (21.74%) were Quinine (tablet). 29 (63.04%) were compliant with NMCP guidelines and 17 (36.96%) were not. The non-compliances concerned 3 prescriptions of Artemether-lumefantrine in the first trimester, 3 and 5 prescriptions of Quinine (tablet) in the second and third trimester respectively and at the end 2 and 4 non-compliances respectively for the prescription of injectable dosage forms of Quinine and Artesunate. This study showed a great noncompliance with the Mali's NMCP guidelines in the prescription of antimalarial in pregnant women. Chemoprophylaxis should be prohibited in the first trimester. Keywords: Curative and Preventive Treatment, Malaria in Pregnancy, Malaria Transmission, Mali

Several factors contribute to the development of breast cancer, including the immune system. This study is aimed to characterize the carriage of human leukocyte antigen (HLA)-DRB1*11 and 1*12 alleles in patients with breast cancer. This case-control study consisted of 96 histologically diagnosed breast cancer cases and 102 controls (cases without breast abnormalities). A multiplex polymerase chain reaction (PCR) was used to characterize the carriage of HLA-DRB1*11 and 1*12 alleles. The HLA-DRB1*11 allele was present in 26.59% of cases and 22.55% of controls. The HLA-DRB1*12 allele was present in 56.63% of cases and 55.88% of controls. This study found no direct association between the carriage of the HLA-DRB1*11 and HLA-DRB1*12 alleles and the occurrence of breast cancer. In addition, the deletion of the HLA-DRB1*11 allele is associated (beneficial effect) with obesity/overweight (OR = 0.13; 95% CI [0.01–1.14]; and p = 0.03) which is a risk for breast cancer. No direct association was found between the carriage of HLA-DRB1*11 and 1*12 alleles and breast cancer risk. However, further investigation of other HLA alleles involved in the occurrence of breast cancer may provide more information.

Mutations in the CFTR gene that lead to premature stop codons or splicing defects cause cystic fibrosis (CF) and are not amenable to treatment by small-molecule modulators. Here, we investigate the use of adenine base editor (ABE) ribonucleoproteins (RNPs) that convert A•T to G•C base pairs as a therapeutic strategy for three CF-causing mutations. Using ABE RNPs, we corrected in human airway epithelial cells premature stop codon mutations (R553X and W1282X) and a splice-site mutation (3849 + 10 kb C > T). Following ABE delivery, DNA sequencing revealed correction of these pathogenic mutations at efficiencies that reached 38–82% with minimal bystander edits or indels. This range of editing was sufficient to attain functional correction of CFTR-dependent anion channel activity in primary epithelial cells from CF patients and in a CF patient-derived cell line. These results demonstrate the utility of base editor RNPs to repair CFTR mutations that are not currently treatable with approved therapeutics.

Background and Purpose The indication and benefit of plasma level of antiepileptic (AEDs) has been debating in the monitoring of people living with epilepsy and the epilepsy treatment gap has largely been documented in developed countries. This study was aimed to highlight the epilepsy treatment gap between rural and urban Mali. Methods We conducted a pilot study on AEDs treatment from September 2016 to May 2019. For 6 months, 120 children and young adults living with epilepsy (rural site, 90; urban site, 30) received phenobarbital, valproic acid and/or carbamazepine. At our rural study site, we determined the AED plasma levels, monitored the frequency, severity and the duration of seizure, and administered monthly the McGill quality of life questionnaire. At our urban study site, each patient underwent an electroencephalogram and brain computed tomography scan without close monitoring. Results At the rural study site, patients were mostly on monotherapy; AED levels at 1 month (M1) (n=90) and at 3 months (M3) (n=27) after inclusion were normal in 50% at M1 versus 55.6% at M3, low in 42.2% at M1 versus 33.3% at M3 and high in 7.8% at M1 versus 11.1% at M3. AED levels at M1 and at M3 were significantly different p

Background: The diagnosis of tuberculosis (TB) has mostly been relied on a long-used method called sputum smear microscopy. In 2010, Xpert MTB/RIF assay was approved by the World Health Organization for simultaneous TB diagnosis and detection of resistance. Our current study was undertaken to compare the diagnostic performance of Xpert MTB/RIF assay to auramine staining-based light-emitting diode-Fluorescence Microscopy (LED-FM) considering culture as the gold standard method for pulmonary and extrapulmonary TB. Method: Pulmonary and extrapulmonary specimens of suspected TB patients were examined in this study. From January 2016 to June 2019, sputum, urine, superficial swabs, gastric aspirates, and pleural infusion specimens were collected from new and previously treated TB individuals. Specimens were examined using Xpert MTB/RIF, LED-FM, and Mycobacterium culture techniques to evaluate their performance. Results: A total of 697 suspected TB samples were included in this analysis, and of these, 469 (67.29%) were positive for all three used methods. The overall sensitivities, specificities, and positive and negative predictive values were 99.6%, 62.0%, 88.4%, and 98.2% for Xpert MTB/RIF and 88.0%, 95.6%, 99.0%, and 60.7% for LED-FM, respectively, compared to culture method. Conclusion: The sensitivity of Xpert MTB/RIF assay was observed to be higher than the LED-FM method, thus suggesting this molecular technique as a promising tool for the diagnosis of pulmonary and extrapulmonary TB, which will help in the management of TB infections in developing countries such as Mali.

Slow spinal compressions are due to the development of an expansive process in the spinal canal. It is a very common pathology, the diagnosis of which is mainly clinical. However, magnetic resonance imaging occupies an essential place in the site diagnosis and etiological research in the management. Non-traumatic spinal cord compression is a diagnostic and therapeutic emergency, requiring early and appropriate management. MRI is the benchmark imaging examination for this pathology. No similar previous MRI study in Mali. We undertook this work with the aim to determine the place of MRI in the diagnosis of spinal cord compressions in Mali hospital. Method and Patients: This was a descriptive retrospective study, carried out at the hospital’s medical imaging department from January 1, 2017 to December 31, 2018 (02 years). It involved all patients, regardless of sex and age, sent for an MRI examination of the spine, and in whom spinal cord compression was diagnosed. We used a 0.35T low-field MRI machine with solid-state antennas. Results: We collected 179 cases of spinal cord compression MRI out of 585 spinal MRI performed, (frequency of 30.59%). The average age was 53.5 years with a male predominance (sex ratio 3.7). Motor disorders were the most common reason for examination (41%). We used the T1 T2 sagittal and T2 axial sequences. IV injection of gadolinium was performed in 48% of patients. The topographic lesions were: cervical (54.7%), thoracic (31.3%) and several segments (9.5%). The lesions concerned the compartments: extradural (79.3%), intradural (4.5%), and intramedullary (16.2%). The processes were degenerative (57.5%). tumorous (29.6%), infectious (12.3%) and vascular (0.6%). Conclusion: MRI is the benchmark imaging test for the management of non-traumatic spinal cord injury. Myelo-CT can be an alternative in the absence or in case of MRI contraindication.

Objective: The aim was to take stock of the screening and treatment of precancerous and cancerous lesions of the cervix in the health district of commune V of Bamako, the “G” point and the Gabriel Toure University Hospital in Bamako, Mali. Patients and Methods: This was a descriptive, cross-sectional, analytical study with retrospective and prospective data collection over an 8-year period from January 1, 2010 to December 31, 2017. This was a multi-center study. Results: From January 1, 2010 to December 31, 2017, 42,492 women were screened, representing a frequency of 24.30%. The median age of the women screened was 32 years; 25% were under the age of 25. Three-fourth of the women screened was in the 20 - 49 age group. Of the 22,842 women screened, 90.1% of them had a normal col to IVA/IVL. However, 4.1% of cervical positivity had with acetic acid and 5.1% of positivity to Lugol. 0.7% of the women screened clinically had cancerous lesions. Histologically, 96.5% of the women screened had a normal cervix with benign lesions. For pathological histological findings, we noted 2.6% of precancerous lesions and 0.8% of squamous cell carcinomas and 0.1% of adenocarcinoma. Conclusion: Improved screening indicators with IVA/IV reduce the rate of morbidity and mortality from cervical cancer.

Teenage pregnancy is common in Mali due to the high rate of unwanted pregnancies and early marriages. The general objective of this study was to study emergency cesarean delivery in adolescent girls at the referral health center (RHC) in commune I of the district of Bamako. It was a descriptive study with prospective data collection from January 1 to December 31, 2018. Any adolescent girls in whom an emergency caesarean section was performed were included. The data were entered and analyzed on SPSS 20.3. Results: we have collected 616 adolescent parturients, 202 caesareans were performed in emergency, with a frequency of 32.8%. The average age was 17 with the extremes of 13 and 19. Early marriage was found out in 95.5% of our patients, 40 adolescent girls were primiparous (20%), 4 of whom had an inter-reproductive interval of less than a year. The main indications for cesarean section were fetal distress in 71 cases (35%), fetal-pelvic disproportion, scar uterus in the border pelvis (11% each), breech presentation in 15 cases (7%). Anemia (10.4%) was the main complication, followed by vascular pedicle attack (5.94%), infection of the operating site (1.5%) and a bladder wound (0.99%). Fetal mortality was 1.4% and neonatal 3.8%. Conclusion: the association between adolescence and caesarean section in emergency constitutes risk factors which increase maternal and neonatal morbidity and mortality. Fighting these factors improves the survival of the mother and the newborn.

Background Malaria and malnutrition represent major public health concerns worldwide especially in Sub-Sahara Africa. Despite implementation of seasonal malaria chemoprophylaxis (SMC), an intervention aimed at reducing malaria incidence among children aged 3–59 months, the burden of malaria and associated mortality among children below age 5 years remains high in Burkina Faso. Malnutrition, in particular micronutrient deficiency, appears to be one of the potential factors that can negatively affect the effectiveness of SMC. Treating micronutrient deficiencies is known to reduce the incidence of malaria in highly prevalent malaria zone such as rural settings. Therefore, we hypothesized that a combined strategy of SMC together with a daily oral nutrients supplement will enhance the immune response and decrease the incidence of malaria and malnutrition among children under SMC coverage. Methods Children (6–59 months) under SMC coverage receiving vitamin A supplementation will be randomly assigned to one of the three study arms (a) SMC + vitamin A alone, (b) SMC + vitamin A + zinc, or (c) SMC + vitamin A + Plumpy’Doz™ using 1:1:1 allocation ratio. After each SMC monthly distribution, children will be visited at home to confirm drug administration and followed-up for 1 year. Anthropometric indicators will be recorded at each visit and blood samples will be collected for microscopy slides, haemoglobin measurement, and spotted onto filter paper for further PCR analyses. The primary outcome measure is the incidence of malaria in each arm. Secondary outcome measures will include mid-upper arm circumference and weight gain from baseline measurements, coverage and compliance to SMC, occurrence of adverse events (AEs), and prevalence of molecular markers of antimalarial resistance comprising Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps. Discussion This study will demonstrate an integrated strategy of malaria and malnutrition programmes in order to mutualize resources for best impact. By relying on existing strategies, the policy implementation of this joint intervention will be scalable at country and regional levels. Trial registration ClinicalTrials.gov NCT04238845. Registered on 23 January 2020 https://clinicaltrials.gov/ct2/show/NCT04238845

Background: One of the four key strategies of the Global Polio Eradication Initiative (GPEI) is high immunization coverage, with oral polio vaccine as part of routine immunization schedules. However, given the weak routine immunization structures in the African Region, coverage is enhanced with supplemental immunization activities (SIAs), and mop-up immunizations. Unfortunately, anecdotal information show that vaccination teams sometimes omit some catchments areas without immunization. This paper thus describes the use of “Call Centers” in detecting missed populations and taking prompt corrective action. Method: The study was based on review of call records during polio supplemental immunization campaigns in Bol Districts in Chad from February to May 2018. The immunization coverage resulting from these campaigns was compared with that of February 2018. A compilation of data – details on communities, community leaders, and their phone numbers was performed. On the eve of the campaign, community leaders were alerted on the vaccinators’ visitThe community leaders were called on the eve of the campaign to alert them on the visit of the vaccinators. At the end of each day, activities (visits as well) were reviewed at the coordination centres Vaccinators were asked to return to any community where community leaders did not confirm visits). Result: Telephone calls allowed the verification and confirmation of the vaccinators visits in 92% of cases. Villages where vaccination was planned but which were not reached were revisited. More than 1,011 children were caught up through this approach in 10 villages in the Bol district. Conclusion: In conclusion, call centers played significantly higher role in generating covering more children with immunization during immunization campaign.

Introduction: Chad is a country within the Lake Chad sub region, currently at risk for poliovirus infection. The Lake Chad Task Team on polio eradication in this sub region made significant efforts to reduce the risk of polio transmission in Chad by tacking immunization teams in the Island Settlement using a Geographic Information System (GIS) technology. This article demonstrates the application of GIS technology to track vaccination teams to monitor immunization coverage in the Island settlements, reduce the number of missed settlements, to provide evidence for vaccination implementation and accountability and improve team performance. Methods: In each district where tracking was conducted, global positioning system–enabled Android phones were given to each team on a daily basis and were used to record team tracks. These tracks were uploaded to a dashboard to show the level of coverage and identify areas missed by the teams. Results: In 2018, tracking covered 30 immunization days, in six rounds. Approximately average of 1173 Island settlements were tracked and covered in each of the six rounds. A total of 806,999 persons aged 0-10 years were immunized, out of which 4273 were zero dose cases at the point of their immunization. Tracking activities were conducted. There was an improvement in the geographic coverage of settlements and an overall reduction in the number of missed settlements. Conclusions: The tracking of vaccination teams and Island settlements ensured useful information for planning and implementation of polio campaigns and enabled supervisors to evaluate performance of vaccination teams

Background In malaria-endemic areas, pregnant women and especially first-time mothers are more susceptible to Plasmodium falciparum. Malaria diagnosis is often missed during pregnancy, because many women with placental malaria remain asymptomatic or have submicroscopic parasitemia, masking the association between malaria and pregnancy outcomes. Severe maternal anemia and low birthweight deliveries are well-established sequelae, but few studies have confirmed the relationship between malaria infection and severe outcomes like perinatal mortality in high transmission zones. Methods Pregnant women of any gestational age enrolled at antenatal clinic into a longitudinal cohort study in Ouelessebougou, Mali, an area of high seasonal malaria transmission. Follow-up visits included scheduled and unscheduled visits throughout pregnancy. Blood smear microscopy and polymerase chain reaction (PCR) analysis were employed to detect both microscopic and submicroscopic infections, respectively. Intermittent preventative treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) was documented and prompt treatment regardless of symptoms given upon malaria diagnosis. Results Of the 1850 women followed through delivery, 72.6% of women received 2 or more IPTp-SP doses, 67.2% of women experienced at least 1 infection between enrollment up to and including delivery. Malaria infection increased the risks of stillbirth (adjusted hazard ratio [aHR] 3.87, 95% confidence interval [CI]: 1.18–12.71) and preterm delivery (aHR 2.41, 95% CI: 1.35–4.29) in primigravidae, and early neonatal death (death within 7 days) in secundigravidae and multigravidae (aHR 6.30, 95% CI: 1.41–28.15). Conclusions Malaria treatment after diagnosis, alongside IPTp-SP, is insufficient to prevent malaria-related stillbirth, early neonatal death and preterm delivery (PTD). Although IPTp-SP was beneficial in Mali during the study period, new tools are needed to improve pregnancy outcomes. Clinical Trials Registration NCT01168271.

Background Cervical cancer (CC) is the most common female cancer in many countries of sub‐Saharan Africa (SSA). We assessed treatment guideline adherence and its association with overall survival (OS). Methods Our observational study covered nine population‐based cancer registries in eight countries: Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. Random samples of 44–125 patients diagnosed from 2010 to 2016 were selected in each. Cancer‐directed therapy (CDT) was evaluated for degree of adherence to National Comprehensive Cancer Network (U.S.) Guidelines. Results Of 632 patients, 15.8% received CDT with curative potential: 5.2% guideline‐adherent, 2.4% with minor deviations, and 8.2% with major deviations. CDT was not documented or was without curative potential in 22%; 15.7% were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease. Adherence was not assessed in 46.9% (no stage or follow‐up documented, 11.9%, or records not traced, 35.1%). The largest share of guideline‐adherent CDT was observed in Nairobi (49%) and the smallest in Maputo (4%). In patients with FIGO stage I–III disease (n = 190), minor and major guideline deviations were associated with impaired OS (hazard rate ratio [HRR], 1.73; 95% confidence interval [CI], 0.36–8.37; HRR, 1.97; CI, 0.59–6.56, respectively). CDT without curative potential (HRR, 3.88; CI, 1.19–12.71) and no CDT (HRR, 9.43; CI, 3.03–29.33) showed substantially worse survival. Conclusion We found that only one in six patients with cervical cancer in SSA received CDT with curative potential. At least one‐fifth and possibly up to two‐thirds of women never accessed CDT, despite curable disease, resulting in impaired OS. Investments into more radiotherapy, chemotherapy, and surgical training could change the fatal outcomes of many patients. Implications for Practice Despite evidence‐based interventions including guideline‐adherent treatment for cervical cancer (CC), there is huge disparity in survival across the globe. This comprehensive multinational population‐based registry study aimed to assess the status quo of presentation, treatment guideline adherence, and survival in eight countries. Patients across sub‐Saharan Africa present in late stages, and treatment guideline adherence is remarkably low. Both factors were associated with unfavorable survival. This report warns about the inability of most women with cervical cancer in sub‐Saharan Africa to access timely and high‐quality diagnostic and treatment services, serving as guidance to institutions and policy makers. With regard to clinical practice, there might be cancer‐directed treatment options that, although not fully guideline adherent, have relevant survival benefit. Others should perhaps not be chosen even under resource‐constrained circumstances., With a multinational collection of registry data and multimodal evaluation of degree of therapy guideline adherence, this study adds population‐based evidence on the status of cervical cancer care and outcomes in the setting of sub‐Saharan Africa.

Many African countries have reported declines in malaria incidence, attributed to the implementation of control strategies. In Mali, artemisinin-based combination therapy (ACT) was introduced in 2004, and long-lasting insecticide-treated nets (LLINs) have been partially distributed free of charge since 2007. In the Malian town of Bandiagara, a study conducted from 2009 to 2013 showed a stable incidence of malaria compared with 1999, despite the implementation of ACTs and LLINs. Since 2016, seasonal malaria chemoprevention has been scaled up across the country. In addition to these strategies, the population of Bandiagara benefited from indoor residual spray implementation in 2017 and 2018 and continued universal bed net coverage. This study aimed to measure the incidence of malaria in Bandiagara, given this recent scaling up of control strategies. A cohort of 300 children aged 6 months to 15 years was followed up from October 2017 to December 2018. We performed monthly cross-sectional surveys to measure anemia and the prevalence of malaria infection by microscopy. The overall incidence of symptomatic malaria was 0.5 episodes/person-year. Malaria incidence in children up to 5 years old significantly declined since 2012 and since 1999 (incidence rate ratio estimates: 6.7 [95% CI: 4.2–11.4] and 13.5 [95% CI: 8.4–22.7]), respectively. The average prevalence of malaria parasitemia was 6.7%. Malaria incidence was higher in children older than 5 years than in those younger than 5 years, highlighting the need to extend malaria control efforts to these older children.

Introduction: Intracranial suppurations are neoformed purulent collections including, in decreasing order, cerebral abscesses, subdural empyemas and extradural empyemas. Otorhinolaryngologic infections are one of the main causes, especially in older children and adolescents. We report 3 clinical cases of endocranial suppurations treated at the Mali Hospital. Clinical Cases: 1) Observation 1. IK was a 14-year-old boy, who was hospitalized in our department for fever, headache and left hemiplegia. The emergency brain scan showed a right frontal and interhemispheric subdural empyema associated with multifocal sinusitis. Surgical drainage associated with ceftriaxone: 100 mg/Kg/d in direct intravenous (DI), metronidazole: 10 mg/Kgs/12hours in slow intravenous (SI) for 15 days, gentamycin: 3 mg/Kgs/d in SI for 3 days, paracetamol 15 mg/Kgs/6hours in SI, 10% glucose serum: 100 ml/Kg/d were given. The bacteriological analysis of the pus came back sterile. The postoperative period was calm. 2) Observation 2. This was a 14-year-old boy with a history of headaches who was admitted to our department for left hemiplegia. An emergency brain scan showed a right pre-suppurative encephalitis associated with a right fronto-ethmoidal and maxillary sinusitis. He was put on ceftriaxone 100 mg/kg/d in DI for 21 days, gentamycin: 3 mg/Kg/d in SI for 3 days; metronidazole: 10 mg/kg/12hours in SI for 21 days, paracetamol: 15 mg/kg/6hours in SI. After 3 weeks of medical treatment, a follow-up brain scan revealed an interhemispheric and right subdural empyema. Surgical drainage was associated with the triple antibiotic therapy initially instituted. The bacteriological analysis of the pus was sterile. The postoperative course was calm. 3) Observation 3. N.M was an 11-year-old boy, who was admitted with fever and left hemiplegia. An emergency brain scan revealed a right hemispheric subdural empyema associated with an intracerebral abscess and pansinusitis. Surgical drainage associated with ceftriaxone 100 mg/kg/d in DI for 15 days, gentamycin; 3 mg/kg/d in SI for 3 days, metronidazole: 10 mg/kg/12hours in SI for 15 days and paracetamol: 15 mg/kg/6hours in SI were instituted. Staphylococcus aureus was isolated in the pus of the abscess. The postoperative course was calm. Conclusion: Endocranial suppurations of sinus origin are serious and frequent infections in children in developing countries. Its diagnosis must be evoked in front of any hemiplegia associated with a fever or headache and confirmed by a cerebral scanner.

Purpose: The purpose of this study was to determine HIV prevalence among participants admitted to the delivery room and recent birth attendants. Materials and Methods: This was a descriptive, cross-sectional, analytical study, with a prospective collection from February 1, 2018 to January 31, 2019 at fousseyni Daou Hospital in Kayes, Mali. Results: During our study period, we recorded 4269 deliveries. HIV-positive patients known before labour accounted for 0.21%. Four hundred and six participants received counselling/testing in the delivery room; of which 36 refused the test: 8.87% and 370 accepted or 91.13%. Thirteen patients tested positive or 3.51%. The 20 - 35 age group was the most represented at 76.92%. Positive patients tested received ARV treatment in the delivery room in 92.31% of cases; and 1 patient or 7.69% did not receive treatment for refusal. Vaginal delivery was the most common at 77%, with caesarean section 23%. Newborns had a good prognosis in their first weeks of life in 85%; fetal lethality was observed in 15% of newborns including 1 case of fresh stillbirth and 1 case of pediatric deaths for neonatal suffering. Conclusion: Counselling and voluntary HIV/AIDS testing during labour and immediate postpartum can detect many pregnant women who escape screening during antenatal consultations.

Artificial induction of labor (AIL) is the set of techniques intended to induce childbirth in order to reduce maternal-fetal mortality. The aim of this paper was to study the maternal and fetal prognosis after the artificial induction of labor with misoprostol. It was a descriptive prospective study conducted from September 1, 2018 to February 28, 2019 at the maternity unit of the Referral Health Center (RHC) in commune I of Bamako. It was about any pregnant woman at term who had received misoprostol as part of the artificial induction of labor. 102 cases of artificial induction with misoprostol 200 μg were collected out of 3641 deliveries, or a frequency of 2.8%. The age group 28 - 32 years accounted for 56.86% with an average age of 28.8 years. Multiparous represented 54.90% of the number. The history of diabetes and hypertension involved 37.25% of the pregnant women. The main indication was premature rupture of membranes (PRM) (40.2%). Induction was performed between the 37th and 41st week of amenorrhea (69.6%). The trigger index according to BISHOP was greater than 7 (50.98%). Induction was done only with 3/4 of misoprostol tablet 200 μg (43.14%). The average labor time was 7 hours (89.22%). The vaginal birth concerned 92.16% of pregnant women. An APGAR10 was noted in 97.85% of newborns after 05 minutes. AIL with misoprostol was practiced at the Center. The main indication was the premature rupture of the membranes. It improves the maternal and fetal prognosis.

Introduction: Diabetes is a heterogeneous group of metabolic diseases characterized by chronic hyperglycemia resulting from a defect in the secretion and/or action of insulin, diagnosed by the observation of high levels of glucose in the blood, responsible in the long term for vascular and nervous complications. The diabetic foot is the set of pathological manifestations affecting the foot in relation to the diabetic disease. Approximately 5% of diabetics present a chronic lesion of the foot. Objective: To describe the epidemiological and clinical aspects of the diabetic foot in the medicine/endocrinology department of the Mali hospital. Methodology: This was a retrospective descriptive study from November 2011 to December 2015. It focused on diabetic patients hospitalized in the department with a foot wound and aged 14 years and over. Results: The study involved 94 patients out of 828 hospitalized, a prevalence of 11.35%. Our series included 36 (38.3%) men and 58 (61.7%) women, i.e. a sex ratio of 0.61%. The mean age was 42.66 years with extremes of 14 and 81 years. Type 2 diabetes was present in 95% of the patients with a duration of evolution of more than 5 years in 60.6% of the cases. The mechanism of occurrence of the wounds was minor trauma in 54 cases (57.4%). Self-medication was the primary treatment in 70 patients (74.5%). More than 50% of the patients wore unsuitable footwear. Clinical and para-clinical examinations revealed isolated neuropathy in 37 cases (39.4%), necrotic wound in 37 cases (39.19%), poor glycemic control: HbA1c > 7% (98.9%), absence of osteitis (57.4%), normal Doppler ultrasound 45 cases (45.7%), stenosing arteriopathy 11 cases (22.3%), non-stenosing 3 cases (20.2%), germs present 56 cases (59.6%) including 21 cases (22.4%) of Staphylococcus aureus. Conclusion: Diabetes and diabetic foot constitute a real public health problem. They are responsible for dreadful and sometimes disabling complications. Its management is multidisciplinary and requires significant financial resources.

Summary: A malignant tumour that develops from the bronchial epithelium and then invades the lungs. It ranks third after colorectal and breast cancer. In Mali, computed tomography (CT) is the main imaging tool used at all stages of treatment. We had initiated this study with the objective of specifying the place of CT in the diagnosis of primary bronchopulmonary cancer at the hospital of Mali. Method: This is a prospective and descriptive study conducted by the Medical Imaging and Thoracic Surgery departments at Mali Hospital from March 2014 to February 2015. All the patients who have benefited from a CT scan and presenting at least one histologically confirmed bronchopulmonary tumor were included. Results: We were recruiting 60 patients with bronchopulmonary cancers out of 500 referred for a thoracic CT scan performed, a frequency of 12%. There was one male patient with a sex ratio of 4H/1F. The average age was 60 years. The history of smoking was 85%. The symptoms were dominated by general condition (63.33%), cough (25%) and haemoptysis (58.33%). CT scans were performed in all patients. The lesions were located more in the lower lobes (71%). The tumours were: heterogeneous tissue density (70%), spiculated contours (80%), and the histology was more non-small cell carcinoma. Conclusion: The incidence of bronchopulmonary cancer is very high and its prognosis is poor at an advanced stage. The evaluative role of CT and biopsy guidance has given it a place of choice in its management. The diagnosis of certainty remains histology.

Introduction: Complete cervico-urethral transection is a vesicovaginal fistula characterized by total disinsertion of the urethra from the bladder. It is a fistula of the cervico-urethral intersection threatening the mechanism of continence. The aim of this study was to describe the epidemiological and therapeutic aspects of this type of fistula. Patients and Methods: This was a descriptive retrospective study on patients who have had surgery for cervico-urethral transection from June 01, 2012 to June 01, 2015. Results: Cervico-urethral transections (n = 76) accounted for 33.77% of all urogenital fistulas admitted to our department of surgery during the study period. The average age was 25.02 ± 8, 6 years. Married patients accounted for 85.58%, 72.36% had not received any classical education. Fistulas less than one year old made up 56.58% of cases, associated lesions were perineal tears 25.0%, vaginal sclerosis, 21.05%, vaginal straps, 13.15%, rectovaginal fistula, 2.63% and the shortness of the urethra less than 2.5 cm in 42.10% of cases. All surgeries were performed vaginally with a 98.68% fistula closure rate and an average of 1.68 surgeries per patient. After closure of the fistula, 10.67% of patients presented a residual urinary incontinence. Conclusion: Complete cervico-urethral transection is a frequent vesicovaginal fistula. She sometimes exposes to urinary incontinence after closing the fistula. The results of his surgery are often good at the cost of multiple intervention.

Introduction: According to Mali’s National Immunization Center, the Haemophilus influenzae b (Hib) vaccine coverage rate was 90% in 2015. Our work aimed to study invasive bacterial infections due to Haemophilus influenzae type b in children aged 0 - 15 years hospitalized in the pediatrics department of the UH-GT. Method: We carried out a retrospective descriptive study from January 2017 to December 2018 (i.e. 2 years) among children aged 0 - 15 years and hospitalized for Haemophilus influenzae type b infection confirmed by culture (blood culture, Cerebro-spinal Fluid, and pleural and skin fluid). Results: Thirty-three cases of Hib infections were collected giving a frequency of 0.2% and the age group 3 months to 3 years was the most affected (72.73%). Children who received no vaccine accounted for 21.21%. The Cerebro-spinal Fluid culture and other samples (pleural and skin) identified the bacterium in 100% of cases, against 72.72% in the blood culture Meningitis was the most frequent pathology (78.79%) and the lethality was high (21.21%). Conclusion: Despite the introduction of the Hib vaccine in the routine immunization program in Mali, Hib infections remain with a high lethality linked to meningitis.

Introduction: the objective was to describe the epidemiological and histological aspects of malignant abdominal tumors in children. Methodology: This was a descriptive, cross-sectional study conducted from January 1, 2017 to December 31, 2018. We included all patients aged 0 to 15 years with histologically confirmed abdominal malignancies. Results: We collected 46 files of malignant tumors of the abdomen (35% of pediatric cancers). The majority of patients were under 5 years old (65%). The sex ratio was 1.7. They were generally from disadvantaged socio-economic backgrounds (67%). The average consultation time was 50 days. The main reasons for consultation were abdominal mass (48%), pain (17%) or distension (9%). The mass was large, hard (89%), immobile (71%) and painful (46%). Malnutrition was found in 80% of patients. The mass was retro-peritoneal in 63% of cases and renal in 54%. It was solid in 94% of cases and heterogeneous in 76% of cases. The assay for tumor markers was not performed. Anemia was present in all patients. Fine needle aspiration was performed in 43%, biopsy in 37% and myelogram in 15% of cases. spinal cord involvement was observed in 28% of Burkitt’s cases. The main cancers diagnosed were nephroblastoma (52%), Burkitt’s lymphoma (26%) and neuroblastoma (13%). Stage 1 and stage 2 were frequent in 20% and 22% of cases, respectively; 36% of cases were not staged. The average duration of chemotherapy was 11 weeks. Total resection was performed in 30% of cases. The outcome of the patients was marked by total remission in 65%. Conclusion: Abdominal malignancies are very common in children. The diagnosis of certainty is late in our context.

Despite the efforts made to fight the tuberculosis, Mycobacterium tuberculosis still remains a public health problem, particularly for low-income countries. According to the World Health Organization data, our country, Mali has detected only half of the 10,385 cases of tuberculosis expected for 2014 for a population of 17,309,000 inhabitants. The objective of this present work was to describe the different clinical aspects and the epidemiology of tuberculosis at Hospital Somin&eacute Dolo in Mopti. We performed a retro-prospective and descriptive of tuberculosis cases diagnosed in our department of medicine between May 2016 and August 2018. A total of 96 tuberculosis cases were recorded, i.e. 4.6% and 1.0% for hospitalizations and consultations patterns, respectively. The median of age was 41 with extremes from 5 to 80 years. The age group [31 - 40 years] was the most affected with 20.8%. Men and women were affected in identical proportions, i.e. 50%. Pulmonary locations were the most frequent with 55.2%. Pleural tuberculosis was far the most frequent of the extra-pulmonary forms with 24.0% followed by the peritoneal and bone localization with 6.3% each. The majority of patients were followed on an outpatient basis, i.e. 90.6%. The disease lethality was 7.3%. Our data show that the cases of extra-pulmonary tuberculosis are in an increasing proportion and their diagnosis confirmation remains difficult in our context.

Introduction: Cardiovascular diseases constitute the deadliest pathology in the world with 31% of global mortality in 2018. This is how we felt it necessary to conduct a study on cardiovascular diseases in emergency units of Senegal, more precisely in Dakar, in order to know epidemiological profile of these patients. Methods: The study setting was the reception and emergency units of the Hopital de Pikine and Hopital Principal de Dakar. This was an observational, descriptive cross-sectional study with an analytical aim to search for factors associated with the occurrence of cardiovascular disease. The study ran from January 25th to February 5th, 2018 at the Hopital de Pikine and from February 25th to March 5th, 2018 at Hopital Principal de Dakar. The source population consisted of patients over 18 years of age and not in a state of pregnancy, who were been received there and had given their free and informed consent to participate in the survey. A representative sample had drawn and a consecutive recruitment of eligible patients were been carried out. The data collection tools were been based on the WHO STEPwise survey questionnaire. Data collection was been carried out in accordance with ethical rules. Results: The study involved 615 patients. The proportions of sedentary lifestyle, low daily consumption of fruits/vegetables, overweight and obesity were 72.4%, 96.4%, 22.7% and 17.3% respectively. This was 55.5% of women who had a waist circumference that corresponded to a high risk of a cardiovascular event and 10.2% for men. 38.9% of patients had blood pressure above 140/90mmhg and 32.2% said they had never controlled their blood pressure in their life. The use of a consultation in a health structure to control his blood pressure was by far the most frequent modality with 61.4%. The proportion of people with cardiovascular disease was 50.1%. Hypertensive flare-ups/hypertensive emergencies were the leading complications diagnosed with 33.33%. Factors associated with the occurrence of cardiovascular disease were sex, age, professional status and body mass index. Discussion & Conclusion: The risk factors for cardiovascular disease are highly represented in our emergency units. In addition to the available care offer, the identification of factors associated with the occurrence of cardiovascular diseases in patients who are been seen there will allow targeted preventive actions within this fragile and vulnerable population. All this to help achieve target 3.4 of the Sustainable Development Goals (SDGs) by 2030. Furthermore, according to the associated factors identified, it appears that achieving SDG 8 will greatly contribute to the prevention of cardiovascular disease. This proves the urgency and interest of an integrated multi-ministerial vision in our strategic plans for the prevention against major non-communicable diseases and cardiovascular diseases in particular.

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

Obesity and excess weight are on the rise in developing countries, which is a source of legitimate concern on the part of the institutions responsible for the health of populations. Overweight and obesity are the fifth most common risk factor for death worldwide, killing at least 2.8 million people each year. In view of the importance of the subject and the lack of sufficient data in our context, it seemed appropriate to us to carry out this preliminary work in Burkina Faso on a population of subjects followed in consultation with Nutrition and Dietetics. The general objective of our work, of a descriptive cross-sectional type, was to describe the epidemiological, clinical, biological and therapeutic aspects of obesity in a population of consultants, black Africans over a period of one year. The study concerned three (03) private care establishments (clinics) in the city of Ouagadougou in which a Nutrition and Dietetics consultation was available. This was a descriptive cross-sectional study which concerned 64 patients followed in nutrition and dietetics consultations from January 2 to December 31, 2012. The material of the study is represented by the analysis of the files of 64 patients followed in consultation of Nutrition and Dietetics in three (03) medical clinics. The most affected age groups were 30 to 40 years (19 cases) and 40 to 50 years (18 cases); 53 women (82.8%) and 11 men (17.2%), i.e. a sex ratio of 4.82. Among our patients, 12 people were overweight (18.75%), 23 had moderate type I obesity (35.94%), 15 severe type III (23.44%) and 14 had type III obesity massive (21.87%). Android-like obesity was predominant in 53 people (82.81%). Among our patients 16 (25%) presented with dyslipidemia, 49 (76.56%) had eating disorders. The most common cloudy snacking was observed in 33 people (67.35%). In terms of evolution and therapy, 31 people (48.44%) followed the diet at term; the others had either abandoned or discontinued treatment, namely therapeutic changes in lifestyles. A total of 51.56% were lost to follow-up. The mean duration of follow-up was 2.7 months. In sum, obesity mostly affects young adults (30 to 40 years old) and females, with a predominance of type I obesity (moderate). Android-type obesity was predominant in both sexes. Preventive actions are needed for citizens of Ouagadougou.

We report a case of a unilateral conjunctival neoformation in a 44-year-old female melanoderma subject. It was a conjunctival squamous cell carcinoma (CSC). The risk factor was exposure to sunlight and dust. No HIV or HPV infection was found. The treatment consisted of simple removal of the tumour with a healthy margin of 3 to 4 mm. After a postoperative follow-up of 18 months, there was no recurrence. As CSC is the most common conjunctival malignancy and given the rate of recurrence with the possibility of associated local invasion, early diagnosis with long-term follow-up is necessary.

Uterine leiomyomas (myomas) are the most common benign tumors of the female genital tract. They affect 20% to 25% of women of childbearing age and are 3 to 9 times more common in black women. We initiated this study in order to report the socio-demographic aspects and the indications for leiomyomas surgery at Hopital du Mali. This was a retro-prospective descriptive study, conducted in the gynecology department of Hopital du Mali from January 1, 2015 to December 31, 2019. Any patients, regardless of their age, in whom a leiomyomas had been detected and surgically treated were included. We had collected 180 cases of surgery for leiomyomas out of 950 surgical procedures, with a frequency of 18.94%. The 36 - 45 age group represented 45% of our patients with an average age of 35 years. Nulligravida accounted for 48.9% and nulliparous (60%). The main reason for consultation was the desire to become pregnant (53.33%). A history of myomectomy was found out in 15.55% of patients. Pelvic ultrasound figured out 64.44% interstitial myomas. Myomectomy was performed in 88.88% of cases and hysterectomy in 11.12% of cases. Among our patients 39.37% had become pregnant. Operative complications were dominated by anemia 14.44%. Leiomyoma was the histological tissue found in all cases of myomectomy. The average duration of hospitalization was 3 days. Conclusion: Leiomyomas surgery is the first scheduled gynecological surgical activity. Laparotomy remains the primary route of entry. The indications are dominated by the desire for pregnancy.

Lumbosciatica is a frequent reason for consultation in general medicine and emergency medicine with an estimated incidence between 2% and 14%. There are several therapeutic modalities, including infiltrations, which are very controversial. Based on this observation, we conducted a prospective study in which 19 patients had undergone epidural and peri-radicular infiltration; the epidural was the most represented infiltration in 68.4% of the patients, the peri-radicular was in 21.1% of them and the combination of both was in 10.5% of the cases, with only 30.6% of the infiltrations carried out under radioscopy. The molecules used were Triamcinolone Acetonide-based Kenacort and Methylprednisolone Acetate-based Depo-Medrol. The evolution of post-infiltration pain decreased significantly in 94.7% of cases, with a statistically significant difference (p = 0.04). No complications were observed in our patients and none of them had resorted to surgery during the follow-up period except for a single case of recurrence of pain relieved by periodic spaced infiltrations. Despite the small size of our sample, we can conclude that infiltration techniques still have a place in the management of Lumbosciatica alongside the surgery.

We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic shock and abdominal pain and decrease on blood pressure were the prominent clinical symptoms with 100.0%, and 50.0% of cases, respectively. Abdominal ultrasound and abdominal x-ray without contrast were performed in 67.0% and 18.0% of cases, respectively. Abdominal trauma was divided into two entities: contusion 68% and wounds 32%. Medical treatment was sufficient in 23.00% of cases. Laparotomy as a surgical approach was performed in 77.0% of cases. Local hemostasis plus drainage (27.08%), splenectomy (25.00%), suture (14.58%), hemostasis by tamponade (8.33%) and colostomy (2.08%) were undertaken as surgical procedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative follow-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.

Introduction: Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. Herein, we report a case of small bowel obstruction (SBO) following excessive consumption of wild grapes with no previous abdomen medical or surgical history. Presentation of case: A 65-year-old male farmer presented with cessation of materials and gas associated with vomiting of food and then bilious. The abdomen was bloated and painful on palpation with a moving, painful mass in the left iliac fossa. The hypothesis of acute occlusion of the colon was retained and confirmed on the X-Ray which showed a dilation of small bowel with air-fluid levels. The diagnostic of acute SBO was retained. We performed urgently a median laparotomy. We found the dilation of the loops from the jejunum to the sigmoid colon with a compact mass at the sigmoid colon of 15 cm in length and 6 cm in diameter. We proceeded to crush the mass that was made up with wild grape seed fecal, and push it back to the rectum. The phytobezoar made up with wild grape seeds was extracted through the anus with the fingers after anal dilation. After extraction of the bezoar, the patient’s complaints completely subsided. Discussion: SBO is a frequent emergency surgical pathology. SBO induced by phytobezoar often occurs in patients with abdomen surgery history. However, it is particularly rare in virgin abdomen. Conclusion: This case report aims to raise awareness of phytobezoar as a cause of SBO in elderly even though without abdomen surgery history.

Background Seasonal malaria chemoprevention (SMC) involves administering antimalarial drugs at monthly intervals during the high malaria transmission period to children aged 3 to 59 months as recommended by the World Health Organization. Typically, a full SMC course is administered over four monthly cycles from July to October, coinciding with the rainy season. However, an analysis of rainfall patterns suggest that the malaria transmission season is longer and starting as early as June in the south of Burkina Faso, leading to a rise in cases prior to the first cycle. This study assessed the acceptability and feasibility of extending SMC from four to five cycles to coincide with the earlier rainy season in Mangodara health district. Methods The mixed-methods study was conducted between July and November 2019. Quantitative data were collected through end-of-cycle and end-of-round household surveys to determine the effect of the additional cycle on the coverage of SMC in Mangodara. The data were then compared with 22 other districts where SMC was implemented by Malaria Consortium. Eight focus group discussions were conducted with caregivers and community distributors and 11 key informant interviews with community, programme and national-level stakeholders. These aimed to determine perceptions of the acceptability and feasibility of extending SMC to five cycles. Results The extension was perceived as acceptable by caregivers, community distributors and stakeholders due to the positive impact on the health of children under five. However, many community distributors expressed concern over the feasibility, mainly due to the clash with farming activities in June. Stakeholders highlighted the need for more evidence on the impact of the additional cycle on parasite resistance prior to scale-up. End-of-cycle survey data showed no difference in coverage between five SMC cycles in Mangodara and four cycles in the 22 comparison districts. Conclusions The additional cycle should begin early in the day in order to not coincide with the agricultural activities of community distributors. Continuous sensitisation at community level is critical for the sustainability of SMC and acceptance of an additional cycle, which should actively engage male caregivers. Providing additional support in proportion to the increased workload from a fifth cycle, including timely remuneration, is critical to avoid the demotivation of community distributors. Further studies are required to understand the effectiveness, including cost-effectiveness, of tailoring SMC according to the rainy season. Understanding the impact of an additional cycle on parasite resistance to SPAQ is critical to address key informants’ concerns around the deviation from the current four-cycle policy recommendation.

A recent randomized controlled trial, the WANECAM (West African Network for Clinical Trials of Antimalarial Drugs) trial, conducted at seven centers in West Africa, found that artemether-lumefantrine, artesunate-amodiaquine, pyronaridine-artesunate, and dihydroartemisinin-piperaquine all displayed good efficacy. However, artemether-lumefantrine was associated with a shorter interval between clinical episodes than the other regimens. In a further comparison of these therapies, we identified cases of persisting submicroscopic parasitemia by quantitative PCR (qPCR) at 72 h posttreatment among WANECAM participants from 5 sites in Mali and Burkina Faso, and we compared treatment outcomes for this group to those with complete parasite clearance by 72 h. Among 552 evaluable patients, 17.7% had qPCR-detectable parasitemia at 72 h during their first treatment episode. This proportion varied among sites, reflecting differences in malaria transmission intensity, but did not differ among pooled drug treatment groups. However, patients who received artemether-lumefantrine and were qPCR positive at 72 h were significantly more likely to have microscopically detectable recurrent Plasmodium falciparum parasitemia by day 42 than those receiving other regimens and experienced, on average, a shorter interval before the next clinical episode. Haplotypes of pfcrt and pfmdr1 were also evaluated in persisting parasites. These data identify a possible threat to the parasitological efficacy of artemether-lumefantrine in West Africa, over a decade since it was first introduced on a large scale.

Following Plasmodium falciparum infection, individuals can remain asymptomatic, present with mild fever in uncomplicated malaria cases, or show one or more severe malaria symptoms. Several studies have investigated associations between parasite transcription and clinical severity, but no broad conclusions have yet been drawn. Here, we apply a series of bioinformatic approaches based on P. falciparum’s tightly regulated transcriptional pattern during its ~48-hour intraerythrocytic developmental cycle (IDC) to publicly available transcriptomes of parasites obtained from malaria cases of differing clinical severity across multiple studies. Our analysis shows that within each IDC, the circulation time of infected erythrocytes without sequestering to endothelial cells decreases with increasing parasitaemia or disease severity. Accordingly, we find that the size of circulating infected erythrocytes is inversely related to parasite density and disease severity. We propose that enhanced adhesiveness of infected erythrocytes leads to a rapid increase in parasite burden, promoting higher parasitaemia and increased disease severity., To understand malaria symptoms, several studies investigate association between parasite’s transcriptome and disease severity. Here, Thomson-Luque et al. reanalyze available transcriptomic data of P. falciparum and find that longer circulation of infected erythrocytes without sequestering to endothelial cells associates with decreasing parasitaemia and less severe disease.

Background: Artemether-lumefantrine is a highly effective artemisinin-based combination therapy that was adopted in Mali as first-line treatment for uncomplicated Plasmodium falciparum malaria. This study was designed to measure the efficacy of artemether-lumefantrine and to assess the selection of the P. falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multi-drug resistance 1 (pfmdr1) genotypes that have been associated with drug resistance. Methods: A 28-day follow-up efficacy trial of artemether-lumefantrine was conducted in patients aged 6 months and older suffering from uncomplicated falciparum malaria in four different Malian areas during the 2009 malaria transmission season. The polymorphic genetic markers MSP2, MSP1, and Ca1 were used to distinguish between recrudescence and reinfection. Reinfection and recrudescence were then grouped as recurrent infections and analyzed together by PCR-restriction fragment length polymorphism (RFLP) to identify candidate markers for artemether-lumefantrine tolerance in the P. falciparum chloroquine resistance transporter (pfcrt) gene and the P. falciparum multi-drug resistance 1 (pfmdr1) gene. Results: Clinical outcomes in 326 patients (96.7%) were analyzed and the 28-day uncorrected adequate clinical and parasitological response (ACPR) rate was 73.9%. The total PCR-corrected 28-day ACPR was 97.2%. The pfcrt 76T and pfmdr1 86Y population prevalence decreased from 49.3% and 11.0% at baseline (n = 337) to 38.8% and 0% in patients with recurrent infection (n = 85), p = 0.001), respectively. Conclusion: Parasite populations exposed to artemether-lumefantrine in this study were selected toward chloroquine-sensitivity and showed a promising trend that may warrant future targeted reintroduction of chloroquine or/and amodiaquine.

Human immunodeficiency virus (HIV) case-based surveillance (CBS) systematically and continuously collects available demographic and health event data (sentinel events*) about persons with HIV infection from diagnosis and, if available, throughout routine clinical care until death, to characterize HIV epidemics and guide program improvement (1,2). Surveillance signals such as high viral load, mortality, or recent HIV infection can be used for rapid public health action. To date, few standardized assessments have been conducted to describe HIV CBS systems globally (3,4). For this assessment, a survey was disseminated during May-July 2019 to all U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries with CDC presence† (46) to describe CBS implementation and identify facilitators and barriers. Among the 39 (85%) countries that responded,§ 20 (51%) have implemented CBS, 15 (38%) were planning implementation, and four (10%)¶ had no plans for implementation. All countries with CBS reported capturing information at the point of diagnosis, and 85% captured sentinel event data. The most common characteristic (75% of implementation countries) that facilitated implementation was using a health information system for CBS. Barriers to CBS implementation included lack of country policies/guidance on mandated reporting of HIV and on CBS, lack of unique identifiers to match and deduplicate patient-level data, and lack of data security standards. Although most surveyed countries reported implementing or planning for implementation of CBS, these barriers need to be addressed to implement effective HIV CBS that can inform the national response to the HIV epidemic.

Avian hepatitis E virus (aHEV), clinically important in poultry industry, can cause death and reduce egg production of chickens, resulting in significant economic losses in the poultry industry. However, little is known about this aHEV infection in Burkina Faso. This study presents the results of distribution and characterization of aHEV in domestic and wild birds without clinical disease. In total 173 birds liver samples were collected from four Burkina Faso provinces, between February 2015 and June 2016. Reverse transcription polymerase chain reaction (RT-PCR) with aHEV specific degenerate primers was used to screen the presence of aHEV. RNA of aHEV was detected in 29 (16.8%) liver samples. Of these, the prevalence was diverse in different species of birds; the most frequent level was 35.3% in Numida meleagris, respectively followed by 23.5% in Gallus gallus domesticus, 13.3% in Streptopelia turtur, 13.3% in Columba livia, 6.7% in Anas platyrhynchos and 3.3% in Pternistis natalensis. The present study firstly revealed the prevalence of HEV infection in six species of birds in Burkina. It is therefore important to conduct further research on the impact on poultry mortality and egg production in our country. Key words: Avian hepatitis E virus, zoonosis, birds, prevalence, Burkina Faso.

The uterus bicorne is a uterine malformation whose pathophysiology is known but the etiology remains obscure. Few studies have been interested in this subject. This is the clinical observation of Mrs. X 26-year-old housewife nulliparous who consulted for repeated late spontaneous abortions. The clinical examination was normal. The ultrasound revealed a double uterine cavity in Y, in favor of a unicervical bicorne uterus. At hysterosalpingography, the tubes were permeable and the uterus doubled with a single cervix. The treatment consisted of a uterine plasty. The postoperative course was simple. The patient gave birth to a newborn male 20 months after surgery.

West Africa is one of the regions in Africa with the highest levels of malaria transmission a descriptive study was carried out to inventorise the medicinal plants traditionally used against malaria by traditional therapists in five malaria endemic areas of the Segou region, in Mali. Sixty-five traditional therapists were randomly selected to be part of the study. Questions were posed using semi-structured interviews, which solicited information on species used, plant organs used, as well as methods of preparation and routes of administration of decoctions. Results indicate that 69 species distributed over 27 families are used to treat malaria. The most represented families are Fabaceae (24.63%), Combretaceae (13.04%), Rubiaceae (7.24%) and Meliaceae (5.79%). The most cited species are Argemone mexicana (CF=0.78), Combretum micranthum (CF=0.84), Conocarpus biocarpa (CF=0.70), Gardenia sokotensis (CF=0.75) and Mitragyna inermis (CF=0.81). The recipe mostly involves leaves (82.43%), with the decoctions mainly taken orally. Key words: Antimalarial plants, ethnobotanical survey, Segou, Mali.

OBJECTIVE To evaluate utilization of third-line overactive bladder (OAB) treatments including percutaneous tibial nerve stimulation (PTNS), sacral nerve stimulation (SNS), and intradetrusor botulinum toxin A (BTX) among privately insured patients and examine factors associated with their use. MATERIALS AND METHODS Using MarketScan claims (2015-2017), we identified patients who underwent third-line OAB treatments based on procedure codes. Factors of interest included location, age, health plan, among others. We fit multivariable logistic regression models to estimate associations between pertinent factors with receipt of PTNS and SNS relative to BTX and associations between provider type and practice location with each treatment modality. RESULTS We identified 7383 patients (mean age 50.9) in our cohort. SNS was used most frequently (n = 3602, 48.8%), while PTNS was used least frequently (n = 955, 12.9%). PTNS patients were more likely to reside in metropolitan areas (vs BTX: OR 1.6, 95%CI 1.3-2.1; vs SNS: OR 2.2, 95%CI 1.7-2.8), be aged 55 years or older (vs BTX: 54% vs 47%, OR 1.6, 95%CI 1.2-2.1; vs SNS: 54% vs 45%, OR 1.6, 95%CI 1.2-2.0), and be covered under a health maintenance organization (vs BTX: 17% vs 10%; vs SNS: 17% vs 10%, P

Background Most of our knowledge of the biological basis of major depressive disorder (MDD) is derived from studies of chronic stress models in rodents. While these models capture certain aspects of the behavioral and neuroendocrine features of MDD, the extent to which they reproduce the molecular pathology of the human syndrome remains unknown. Methods We systematically compared transcriptional signatures in two brain regions implicated in depression—medial prefrontal cortex and nucleus accumbens—of humans with MDD and of 3 chronic stress models in mice: chronic variable stress, adult social isolation, and chronic social defeat stress. We used differential expression analysis combined with weighted gene coexpression network analysis to create interspecies gene networks and assess the capacity of each stress paradigm to recapitulate the transcriptional organization of gene networks in human MDD. Results Our results show significant overlap between transcriptional alterations in medial prefrontal cortex and nucleus accumbens in human MDD and the 3 mouse chronic stress models, with each of the chronic stress paradigms capturing distinct aspects of MDD abnormalities. Chronic variable stress and adult social isolation better reproduce differentially expressed genes, while chronic social defeat stress and adult social isolation better reproduce gene networks characteristic of human MDD. We also identified several gene networks and their constituent genes that are most significantly associated with human MDD and mouse stress models. Conclusions This study demonstrates the ability of 3 chronic stress models in mice to recapitulate distinct aspects of the broad molecular pathology of human MDD, with no one mouse model apparently better than another.