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Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.

In sub-Saharan Africa, Gastrointestinal parasites infections are widespread, particularly among immune deficient individuals. Prevalence of these infections varies from locality to other due to many factors. The present cross-sectional study aimed to assess the prevalence of intestinal parasites among HIV-positive children in the paediatric clinic at the University Hospital Yalgado Ouedraogo of Ouagadougou. A cross-sectional study was conducted in the University hospital of Ouagadougou from July to November 2015. Ninety-three (93) freshly issued stool samples were collected in HIV-positive children less than 15 years old. Stool samples were analysed for the presence of various intestinal parasites using direct microscopy, formol-ether concentration method, modified Ziehl Neelsen stain and Weber trichrome stain. The study included 93 HIV positive children. The prevalence of intestinal parasitic infection was 24.73% (23/93). The most detected parasites were Entamoeba coli (52.17% of total detected parasites), Trichomonas intestinalis (21.73%), Giardia intestinalis (8.65%), Entamoeba histolytica (4.34%). Patients with multi-infection (2 or 3 parasites) have been detected. The participants, 97.5% (89/93) were on cotrimoxazole prophylaxis and 81.76% (76/93) were on ARV therapy. Despite the medical care given to the HIV-infected children, the prevalence of opportunistic intestinal is high at the University hospital Yalgado Ouédraogo (CHU-YO)and deserves special attention.

Purpose The purpose of this paper is to study the factors associated with the occurrence of diseases and beriberi among prisoners incarcerated in the two largest Remand and Correctional Facilities (RCF). Design/methodology/approach This was a cross-sectional descriptive and analytical study carried out from April 20 to May 19, 2017, in the RCFs of Ouagadougou and Bobo-Dioulasso. All prisoners who consulted and those referred to the health center by the health-care team were included in the study. Complaints and diagnosed diseases information were collected using the second version of the International Classification of Primary Care (ICPC-2). The authors used a logistic regression model to perform univariate and multivariate analyses. Findings Of the 1,004 prisoners from the two RCFs included in the study (32.6%), 966 (96%) were male. The median age was 31.6 years. The distribution of diseases diagnosed using the ICPC-2 showed a predominance of gastrointestinal tract, skin and respiratory tract diseases among 206 (19.3%), 188 (17.6%) and 184 (17.2%) prisoners, respectively. A total of 302 prisoners (30.1%) had clinical beriberi, and 80 prisoners (8%) were underweight. Being incarcerated for more than nine months was independently associated with a high risk of digestive and respiratory diseases as well as beriberi. Research limitations/implications This study highlighted higher frequencies of digestive, skin and respiratory complaints and diseases in the two largest detention centers in Burkina Faso. These diseases are variously related to age, penal status and length of incarceration. In addition, underweight and thiamin vitamin deficiency responsible for beriberi are more frequent in adult prisoners, those not attending school, convicted prisoners and those with a length of stay in detention of more than nine months. These concrete results should help define a strategy and priority actions needed to reduce morbidity in prisons. Practical implications The actions should include the intervention of specialists in the field of common diseases in prisons, the improvement of individual hygiene conditions and environment, the improvement of the quality and quantity of the food ration, a strategy to reduce prison overcrowding. Other actions must be planned to allow specific groups such as women and minors to have access to health care that is adapted to them. Beyond the central concern of promoting the rights of prisoners and humanizing prisons, actions to improve the health of prisoners are part of an overall public health approach with its socio-economic and environmental implications. Social implications There is a need for a strong commitment from the State to develop a prison health policy that prioritizes the prevention of communicable and non-communicable diseases that are particularly prevalent in this context, without forgetting mental health and nutrition. This requires a collaboration of stakeholders based on better intersectorial communication, the implementation of a monitoring and evaluation system for the health of prisoners, an enhancement of the status of health-care providers working in prisons and an increase in the funding allocated to the health of prisoners with the mobilization of the necessary funds. Originality/value This study uses a primary health care classification to assess the health of inmates in a prison in Africa. It contributes to the weak evidence around prison health surveillance and health profiling of prisoners in Africa.

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

INTRODUCTION Cervical cancer screening coverage rate is

Antibiotics remains an issue in intensive care units (ICUs), because of its overuse and the emergence of bacterial resistance. The objective of the study was to evaluate the prescription of antibiotics in ICUs at university teaching and the regional hospitals in Mali. PATIENTS AND METHODS: It was a cross sectorial retrospective and multicentric study over six months. The inclusion criteria were, all the patients hospitalized in ICUs at least for 48 hours with antibiotic treatment. We also included the cost of the daily consumption of antibiotics. The Microsoft excel was used for data entry and the data analysis was done with the software Epi info version 3.5.2. RESULTS: Five hundred sixty-and-six (566) patient les responded to the inclusion criteria. The antibiotics prescription rate was 43.3%. The mean age of the patients was 36.8 ± 20.7. The women were more represented (59.7%). The monotherapy (60.6%) was the most common concept use. The third-generation cephalosporin (3GC) was used in monotherapy (27.7%). The average volume of consumption of antibiotics in monotherapy was the highest. The analysis of the data showed that the volume consumption of antibiotics was different according to grade of the prescribers which was respectively 98972.3 for anaesthesia & intensive care residents and 74990.7 for anaesthetist-intensivist. The treatment was reviewed during the rst 48 hours (99.8%) and was readapted in 106 of the patients (18.7%). We mainly increased the doses of antibiotics 77.4%. The average duration of the treatment was 5.2 ± 3.7 (days). CONCLUSION: The use of antibiotics remains high and uncontrol in intensive care units in Mali, which could be explain by the limited blood culture testing and insufcient of qualied human resource in some of the regional hospitals.

Introduction: Congenital limb gangrene is a rare pathology. In the majority of cases, no cause is identified and its treatment is not codified. Observation: 29-week premature newborn, female from poorly followed twin pregnancy. Clinical examination at admission found an unstable neonate, the presence of necrosis of the left hand and forearm well limited, with absent humeral pulse and absence of hand movement. Surgical treatment was scheduled for amputation of the limb after the agreement of the parents whose postoperative follow-ups were simple. Conclusion: Congenital gangrene remains a rare entity in neonatology.

The simultaneous double volvulus of the transverse colon and sigmoid in the same patient is a rare cause of intestinal occlusion. Two cases were observed in general surgery in Kati. Its clinical symptomatology does not differ from other occlusions as well as simple radiological images. It is an extreme surgical emergency, the diagnosis is generally intraoperative. Extensive left hemi colectomy with terminoterminal rectal anastomosis was performed. The surgical follow-up was simple.

Synchronous transverse and sigmoid colon volvulus are very rare. We report the case of a 23-year-old man who underwent emergency surgery for sigmoid colon volvulus. An intraoperative finding of transverse colon volvulus associated with sigmoid colon volvulus was made. Left and transverse colectomy was performed followed by colorectal anastomosis. The postoperative period was uneventful. Synchronous volvulus of the transverse and sigmoid colon is a surgical emergency. The clinical signs are not specific and the discovery is often intraoperative. It is necessary to know how to evoke the diagnosis in a case of sigmoid colon volvulus, to avoid inadequate management with dramatic consequences.

Objective: In light of numerous obstetric evacuations to the Point G University Hospital and taking into account the practice of cesarean section for many years in the service, it seemed necessary to us to make our contribution to the study of cesarean section by putting emphasis on maternal and perinatal prognosis in the Obstetric Gynecology Department of the Point G university hospital. Method and materials: We conducted a retrospective cross-sectional study in the Gynecology and Obstetrics Department of the Point G University Hospital, from January 01, 2018 to December 31, 2018. The Point G University Hospital is a 3rd level center of reference in the field of obstetrics in Mali. There is no neonatal ward. The study included all women who gave birth in the gynecology and obstetrics department during the study period. All prophylactic and emergency Caesarean section records during the period in which management took place in the ward were included. The records of patients who had a prophylactic or emergency cesarean section in other health facilities and non-usable records were not included. Data were collected using a pre-established survey form. The variables analyzed were socio-epidemiological, clinical and prognostic. Data were analyzed using IBM SPSS software version 16.00. The Chi2 test and Fischer’s exact test were used to highlight risk factors. The significance level retained was p 0.05. Operational definition: Nulliparous: A woman who has never given birth; Primipara: A woman who gave birth once; Pauciparous: A woman who has a number of deliveries between two and three; Multiparous: A woman who has a delivery count of between four and six pregnancies; Large multipara: A woman who has given birth more than six times. Results: We recorded 608 deliveries by cesarean section out of a total of 1573 deliveries, i.e. a rate of 38.6%. The majority of caesarized patients were between 20 and 29 years old or 41.94%, the average age was 26 years old. Out-of-school patients were the most represented, or 44.41%. They were pauciparous in 34.4% of cases. The pregnant majority had performed at least 04 antenatal consultations, or 68.91%. In 74, 51% of the cases the patients carried a pregnancy estimated to term. Cesarean section was performed urgently in 85.36% of cases and eclampsia crisis was the most common maternal indication, or 27.97% among the 379 cases. We recorded 10 maternal deaths or 1.64%. The bleeding disorder was responsible for half of our deaths, or 50%, from retro-placental hematoma. The fetal prognosis was dominated by neonatal distress with 19.08% of cases. We recorded 101 cases of stillbirths, or 16.61%, and 23 cases of early neonatal death, or 3.78%. Our study found a statistically significant relationship between the type of cesarean section and neonatal death with Fisher’s exact test = 27.772, P 0.0001.

Introduction: Bart’s syndrome is a rare neonatal pathology combining congenital skin aplasia affecting the extremities and congenital epidermolysis bullosa, exceptionally described on black skin. Observation: A 2-day-old male newborn was referred for multiple ulcerations of the limbs observed at birth. The clinical examination found an absence of bilateral and symmetrical skin occupying almost all of the two lower limbs with some flaccid bubbles. The vascular network was clearly visible. The rest of the skin coating was normal. The diagnosis of Bart syndrome in connection with epidermolysis bullosa was evoked clinically and despite pediatric and dermatological management, the evolution was rapidly fatal by severe sepsis. Discussion: Bart syndrome corresponds to a clinical picture of congenital skin aplasia associated with congenital epidermolysis bullosa suspected by areas of fragility and sometimes bubbles. All types of congenital epidermolysis bullosa may be associated with this syndrome. The clinical diagnosis is generally easy but the therapeutic management is difficult and the prognosis reserved. Conclusion: Bart syndrome is a curious congenital association of well-defined skin symptoms, the etiopathogeny of which still remains poorly elucidated, hence the difficulty of establishing an antenatal diagnostic strategy or giving appropriate genetic advice.

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.

Through its impact on morbidity and mortality and the cost of medical care, Venous Thromboembolism (VTE) has a significant influence on the quality of care in a surgical environment. The objectives were to determine the risk of postoperative venous thromboembolism and to assess its prophylactic management in the general surgery department of Gabriel Toure University Hospital. This was a prospective observational study from May 01, 2018 to December 31, 2018. It included all patients of 18 years old and over, operated in regulated surgery, under general anesthesia in the department. For all of these patients, Caprini score was used to assess the risk of VTE. The ninth American College of Chest Physicians’ Consensus was used as guidelines to assess Thromboprophylaxis practices in the ward. The Caprini score was evaluated in 80 patients for 8 months. The average age was 50.2 years. The sex ratio was 0.48. The risk level of VTE was low in three patients (3.8%), moderate in 13 patients (16.3%), high in 34 patients (42.5%) and highest in 30 patients (37.5%). The main risk factors found were major surgery (87.5%), age > 40 years (72.5%), cancer (33.8%), bed rest (31.2%), obesity (27.5%) and minor surgery (12.5%). Early mobilization was performed in all patients. Pharmacologic prophylaxis was required in 80% of our patients but only 38.8% had received low molecular weight heparin. VTE complicated 5 procedures, including 3 cases of deep vein thrombosis of the limbs and 2 cases of pulmonary embolism who died. Venous thromboembolism is serious and common in surgical settings. Its prevention remains insufficient in our context.

Neonatal mortality remains a public health problem in Mali. The neonatal referral is a systemic factor determining the neonatal prognosis. This work was initiated to determine the frequency of neonatal referrals and to determine their prognosis. Patients and Methods: A cross-sectional study was carried out from November 1, 2019 to January 31, 2020 in the neonatology service of the pediatrics department of the Gabriel Toure University Hospital in Bamako. All newborns referred by another health structure in the country were included in this stud. All newborns referred by another health structure in the country were included in this study. To determine the risk factors related to the neonatal referral, we performed univariate and multivariate analyzes to determine the odds ratios and fitted with a significant p probability if p 0.05 and the 95% confidence interval. Results: The frequency of referrals was 54.3%. Newborns came from basic structures in 19.3% of cases, from tertiary structures in 6.7%. The main reason for transfer was prematurity (40.2%) followed by perinatal anoxia (15.3%), malformations (15.3%), respiratory distress (15.2%) and infection neonatal (9.1%). The ambulance was the primary means of transfer in 71.3%. In 80% of cases the transfer had been made within the first 24 hours of life. On admission, a third of the newborns (31.1%) were less than 1500 g, hypothermic in 43.8% and febrile in 15.1%. The evolution was marked by 40.2% of deaths. The analysis of prognostic factors, allowed us to observe that the more the newborn is premature or of low weight the more risk of death was very high with respectively 18.5 times in the less than 28 weeks of amenorrhea (WA) (ORa = 18.5; CI = 1.9 - 180; p = 0.012) and 6.6 times in those less than 1000g (ORa = 6.6; CI = 1.4 - 29.7; p = 0.015). Likewise, any change in body temperature increased risk of death by 1.9 times compared to normothermia. Conclusion: The establishment of a neonatal referral system is necessary to reduce neonatal mortality in our context.

Introduction: Panorama studies of autoimmune and auto-inflammatory diseases are still very little carried out in Africa and particularly in Mali. The objective of this descriptive study with retrospective collection was to describe the epidemiological and clinical profile of all autoimmune and auto-inflammatory diseases in the department of internal medicine at the University Hospital Center of the Point G. Methods: This was a descriptive study with a retrospective survey of the records of patients hospitalized for autoimmune and auto-inflammatory diseases in the department of internal medicine at the CHU of Point G for a study period of 15 years from January 1, 2005 to December 31, 2019. We included in the study all patients hospitalized for autoimmune and auto-inflammatory diseases. Results: During the study period (January 31, 2005 to December 31, 2019), 6383 patients were hospitalized in internal medicine at the University Hospital Center of the Point G, of which 317 patients presented with autoimmune and/or auto-inflammatory disease with an average annual hospital recruitment rate of 21 ± 7.87 cases per year. The female sex accounted for 64.98% with a sex ratio of 0.54. The mean age of patients was 35.27 ± 16.27 years and the extreme ages were 07 and 79 years. Out of the 317 medical records included according to our inclusion criteria, there were 07 cases of association between autoimmune disease and autoinflammatory disease, i.e. 14 cases of autoimmune and autoinflammatory diseases. A total of 331 autoimmune diseases and/or auto-inflammatory diseases were collected, i.e. a frequency of 5.19%, including 291 cases of autoimmune diseases (221 cases of organ-specific autoimmune diseases and 70 cases of systemic autoimmune diseases) and 40 cases of autoinflammatory diseases (no case of monogenic forms, 08 cases of “systemic” polygenic forms and 32 cases of “organ-specific” polygenic forms). Organ-specific autoimmune diseases were dominated by type 1 diabetes (141 cases), Graves’ disease (48 cases) and systemic autoimmune diseases by systemic lupus erythematosus (43 cases), rheumatoid arthritis (16 cases). Among the auto-inflammatory diseases, the “systemic” polygenic forms were dominated by Horton’s disease (02 cases) and the “organ-specific” polygenic forms by gout (16 cases), ulcerative colitis (08 cases). Conclusion: It appears from our study that autoimmune and autoinflammatory diseases are characterized in internal medicine by their frequent occurrence in women and preferably between 25 and 44 years of age with very disparate distribution. We also observed a predominance of organ-specific autoimmune diseases over systemic ones, and “organ-specific” polygenic autoinflammatory diseases over “systemic” ones.

Ileal perforation of typhus origin is a common and serious complication of typhoid fever in tropical environments. It is one of the main causes of morbidity in surgery in Mali. However, it would be preventable if salmonellosis were properly managed upstream, and if our living environments were cleaned up. The purpose of this study is to report on the experience of the Kati UHC General Surgery Department in the management of peritonitis by typhic perforation and to assess its prognosis. Patients and Method: This is a retrospective descriptive study that took place from January 2007 to December 2020 in the General Surgery department of the Hospitalo-University BSS Center of Kati (Mali). We have included patients who have undergone peritonitis with confirmed typhic ileal perforation with laparotomy. The other etiologies of peritonitis by ileal perforation were not retained. Results: In 14 years, we collected 89 cases of peritonitis by typhic ileal perforation. It accounted for 3.14% (89/2829) of surgical procedures, 37.5% (89/1181) of visceral surgical emergencies and 27.6% (89/322) of all acute peritonitis causes combined. There were 70 men against 29 women; the sex ratio was 2.4 with an average age of 25.8 years (extremes 8 years to 65 years). Anastomosis resetions (ileo ileal and ileocolic) predominated in 71.8% of patients. However, the ileo stoma was performed in 5.6%. A significant relationship (p 0.05) was observed between high mortality and MPI score > 26. Morbidity was 39.4% with mortality of 15.7%. The average length of stay in hospital was 12.2 days. Conclusion: Typhoid ileal perforation is common in young male adolescents in visceral surgery. This pathology generates significant morbidity. However with the extension of hand washing after Ebola disease its frequency has dropped.

Introduction: Penile skin flap urethroplasty is a technique for replacing or enlarging an obstructed urethra. We aim to report our experience in the practice of this surgical technique. Patients and method: This was a prospective and descriptive study of penile skin flap urethroplasty indicated for urethral stenosis between January 2014 and December 2019. Results: A total of 21 penile skin flap urethroplasties for urethral stenosis were performed. The average age was 38.6 years old. The stenosis was of sclero-inflammatory origin in 15 cases (71.43%). It was of bulbo-perineal, penile, and penile-bulbar topography in about a third each. A history of urethral surgery was reported in 80.95% of the cases. The average length of the stenosis was 6.8 cm. Mundy circular skin flap urethroplasty about 15 cases (71.43%), and Quartey rectangular skin penile flap urethroplasty about 6 cases (28.57%) were the surgical techniques performed. The postoperative follow-up was favorable in 19 cases (90.48%). Two cases of urethral fistula (9.52%) underwent the 2nd urethroplasty. Urination at 1 year was satisfactory. No relapse has been reported to date. However, 4 patients (19.04%) reported asthenic ejaculation, and 1 patient (4.76%) a marked decrease in sexual pleasure. Conclusion: This surgical technique is effective in terms of voiding when the surgical indications are well chosen. The sexual aspect must be taken into account and the intervention only offered to those who really need it.

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.

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. We report an observational study which aims to describe the epidemiological, clinical and therapeutic aspects of small bowel obstruction. This study was carried out in the General Surgery Department of Hopital Somine DOLO de Mopti from October 1, 2016 to October 1, 2018. A total of 114 patients were recorded for whom the diagnosis was related to an occlusion. The median age was 37 years with extremes ranging from 6 months to 90 years. Male sex was predominant with a sex-ratio of 1.8. The frequency of small bowel occlusions over all occlusions was 74.03%. The most encountered clinical signs were as followed: abdominal pain (100%), vomiting (88.6%), cessation of materials and gas (79.9%) and meteorism (62.3%). All patients underwent medical imaging, the most common of which was an abdomen without preparation X-ray (AWP). On the etiological level, the main causes found postoperatively were: flanges and adhesion (55.2%), strangulated hernias (28.0%), acute intussusception (6.1%), small bowel volvulus (3.5%) and small bowel tumor (1.6%). Releasing the bridles was the most common surgery process (28.0%). The morbidity of the immediate follow-up was (13.1%) and the mortality was (7.0%). This high mortality is due to ignorance of the signs of seriousness and the socio-cultural barrier (decision of the patriarch to agree to a surgical intervention), the late use of hospital facility and the limited financial capability of the patients.

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.

Introduction: convulsion is a frequent cause of neurological and cognitive sequelae and then of epilepsy. The objective of this work was to describe the socio-demographic, clinical, therapeutic, and evolutionary aspects. Methodology: This was a descriptive retrospective study carried out in the general pediatrics department of CHU-Gabriel Toure. It took place over a period of 02 years from January 2017 to December 2018. We included all children aged 1 to 59 months hospitalized in the ward for convulsion. Results: During the study period, 2653 children aged 2 months to 59 months were hospitalized in the general pediatric ward. We included 288 medical records of children who presented with a seizure on admission. Convulsions represented 11% of pediatric hospitalizations from 1 month to 59 months. The average age was 29 months. Fever was present in 86% of patients. The cerebrospinal fluid (CSF) test was positive in 38 patients. Hypoglycemia was present in 14 patients. Serum calcium was low in 3 patients. The most implicated etiologies were malaria 70%, meningitis 20%, and dehydration 13%. Management consisted of airway clearance, oxygen therapy as needed, and administration of diazepam (54%). Antibiotics were prescribed in 77% of cases and antimalarials in 70%. The average length of hospital stay was 8 days with extremes of 1 and 30 days. The outcome was favorable in 95% of cases. Sequelae were observed in 5% of cases and one case of death was observed. Conclusion: Acute convulsions are one of the most common causes of hospitalization in children under 5 years old. The causes were dominated by infectious diseases (malaria, meningitis). The appropriate course of action was the administration of diazepam rectally.

Background: Pulmonary embolism (PE) is a severe form of venous thromboembolic disease. In Africa, prevalence of PE in hospitalized medical patients varies among studies. Objective: Aim of this work was to study the epidemiological, clinical, therapeutic and evolution aspects of PE in the medicine department of Mali’s Hospital Bamako-Mali. Methodology: This was a retrospective cross-sectional study carried out from January 01, 2017 to December 31, 2020 in the medicine department of Mali’s hospital Bamako, including all inpatients admitted for PE during the study period. Results: Of 1814 hospitalized patients, 54 patients had pulmonary embolism. Hospital frequency of pulmonary embolism was 2.97%. Predominance was female and sex-ratio M/F was 0.38. Mean age in our series was 54.24 ±1.19 years. Predisposing factors to pulmonary embolism were dominated by obesity 37%, high blood pressure 35.2% and history of cardiovascular disease 20.4%. Dominant signs were dyspnoea and chest pain in 83.3% and 70.4% of cases respectively. Probability of pulmonary embolism was high in 40.7% according to Wells score. Patients with right heart failure were 22.2%. EKG showed sinus tachycardia70.4% and S1Q3 aspect 7.4%. Heart right chambers were dilated at transthoracic echography 42.6%. Obstruction was bilateral at chest angio CT for 51.9% and proximal for 42.6%. Deep venous thrombosis was associated at EP in 16.6%. Treatment was low weight molecular heparin followed by vitamin K antagonist or direct oral anticoagulant. One patient was successfully treated by thrombolysis. Hospital mortality was 16.7%. Conclusion: PE is a serious disease probably underdiagnosed. It is responsible of important mortality.

Background: The rapid diagnostic tests play a pivotal role in the screening of viral markers in blood qualification for transfusion in limited resource setting. Therefore, it is important to assess their analytical performances to ensure their proper functioning. Material and Methods: We performed a cross- sectional study by successive recruitment to assess the diagnostic value of rapid diagnostic tests algorithms using ELISA as a reference test. A total of 661 blood from donors were enrolled for this study. Rapid Diagnostic Tests (RDTs) and ELISA tests were performed for each sample by a couple of double-blinded biotechnologists. Data were collected on case report form and captured in Microsoft Excel then the file was imported and analyzed using R software version 4.0.3. Results: The diagnostic accuracy for the algorithms are summarized in Table 1. For HIV-algorithm, the internal validity parameters were as follow: sensitivity (sens) 99.0% (95% CI = 97.8, 99.5); specificity (spec) 98.3% (95% CI = 90.9, 99.7); positive likelihood ratio (PLR) 57.4 (95% CI = 8.2, 401.0); negative likelihood ratio (NLR) 0.01 (95% CI = 0.0005, 0.02); diagnostic odd ratio (DOR) 4710. HBV-Ag/Ab RDTs achieve the following diagnostic accuracy: sens 99.7% (95% CI = 98.3, 99.9); spec 98.8% (95% CI = 96.9, 95.5); PLR 81.8 (95% CI = 30.9, 217.0); NLR 0.003 (95% CI = 0.0004, 0.02); DOR 14,110. The analytical performances of HCV-Ab RDTs were as follow: sens 98.7% (95% CI = 97.5, 99.4); spec 93.1% (95% CI = 78.0, 98.1); PLR 14.3 (95% CI = 3.8, 54.5); NLR 1.5 (95% CI = 0.8, 2.8); DOR 962.6. The parameters evaluating the external validity of RDTs screening for the three viral markers when the theorical prevalence was 5% are summarized in Figure 3. At the prevalence , 99.99% and 99.94%. At the same prevalence, we found the following Positive Predictive Values (PPV) 70.82%, 77.59% and 37.35% for HIV-Ag/Ab RDTs, HBV-Ag RDTs and HCV-Ab RDTs algorithms, respectively. The overall areas under the received operating characteristic (ROC) curves were 98.6%, 99.2% and 99.2%; 95.9% for HIV-Ag/Ab RDTs, HBV-Ag RDTs and HCV-Ab RDTs algorithms, respectively. Conclusion: RDTs algorithms can play a pivotal role in the screening of HIV-Ab/Ag, HBs-Ag in the setting of resources limited-countries where financial and technical expertise shortages are a standard fare. However, their use for diagnostic purposes must be done with great caution and the result must necessarily be confirmed with an ELISA or molecular technique particularly for HCV-RDTs algorithm which achieved an NLR value > 0.1.

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%.

Sacrospinous fixation (SSF) or Richter’s intervention (RI) aims to treat genital prolapse by securing the posterior vaginal wall to the small sacrospinous ligament. It is performed by low approach and includes a dissection of the pararectal space, visual exposure of the sacrospinous ligament and a needle with strait needle holder with nonabsorbable threads. It is often associated with a more complex corrective procedure, including cystocele cure, vaginal hysterectomy and posterior myorrhaphy. The objective of this study is to report the results of SSF in the gynecology department of Hopital du Mali. A descriptive study was conducted from September 2014 to September 2015 concerning 37 patients operated on for uterine prolapse (UP). All patients with grade III UP were included in our study in whom a unilateral hysterectomy (UH) and sacrospinous fixation (SSF) were performed. All the patients were scheduled. Preoperatively they had benefited from an assessment and a pre-anesthetic consultation. Hospitalization of at least 24 hours prior to the operation was required. Postoperative follow-up was two years with a physical examination at 3 months, 9 months and 15 months, and phone calls between physical consultations. During the study period, we performed 37 RIs. The mean age of the patients was 48 years with extremes of 41 to 73 years. The large multiparity was found out in 35 cases (94.59%), the pauciparous were two with 3 deliveries for each. Long labor of more than 18 hours was found out in 9 patients (24.32%) and home delivery in 13 cases (35.13%). The duration of the occurrence of prolapse was at least two years and 35 patients were going through menopause. The type of anesthesia used for the surgery was spinal anesthesia for all patients. The average duration of the operation was 90 minutes. Complications occurred in three patients or 8.10% of cases, two cases of acute urine retention and one case of hematoma of the para-rectal space. The medium time of hospital stay was 5 days. The anatomical result was satisfactory in all patients. However, two patients presented with grade II rectocele one year after the operation. Sacrospinous fixation is a technique suitable for our patients who present with genital prolapse with extreme laxity of the suspension ligaments. Well done, it brings anatomical satisfaction and its complications are rare and slight.

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.

Toussaint Rouamba,1,* Houreratou Barry,2,* Esperance Ouédraogo,1 Marc Christian Tahita,1 Nobila Valentin Yaméogo,3 Armel Poda,4 Arnaud Eric Diendéré,5 Abdoul-Salam Ouedraogo,4 Innocent Valea,1 Amariane M Koné,2 Cherileila Thiombiano,2 Isidore Traoré,2 Zekiba Tarnagda,1 Serge A Sawadogo,6 Zakaria Gansané,7 Yibar Kambiré,8 Idrissa Sanou,8 Fatou Barro-Traoré,8 Maxime K Drabo,1 Halidou Tinto1 On behalf of the CHLORAZ Study Group1Institut de Recherche en Sciences de la Santé (CNRST-IRSS), Nanoro, Burkina Faso; 2Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso; 3Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso; 4Centre Hospitalier Universitaire Sourou Sanon, Bobo-Dioulasso, Burkina Faso; 5Centre Hospitalier Universitaire de Bogodogo, Ouagadougou, Burkina Faso; 6Centre PrïmO Nelson Mandela (Promotion de la Recherche et de l’Innovation en Immunologie Médicale de Ouagadougou), Ouagadougou, Burkina Faso; 7Clinical Monitoring in Africa-Clinical Research Organization, Ouagadougou, Burkina Faso; 8Centre Hospitalier Universitaire de Tengandogo, Ouagadougou, Burkina Faso*These authors contributed equally to this workCorrespondence: Toussaint RouambaInstitut de Recherche en Sciences de la Santé (CNRST-IRSS), 528, Avenue Kumda-Yoore, BP 218 Ouagadougou CMS 11, Ouagadougou, Nanoro, Burkina FasoTel +226 666 532 04Email rouambatoussaint@gmail.comIntroduction: Though chloroquine derivatives are used in the treatment of coronavirus disease 2019 (COVID-19) in many countries worldwide, doubts remain about the safety and efficacy of these drugs, especially in African communities where published data are scarce.Methods: We conducted an observational prospective cohort study from April 24 to September 03, 2020, in Burkina Faso to assess (as primary outcome) the clinical, biological, and cardiac (electrocardiographic) safety of chloroquine or hydroxychloroquine plus azithromycin administered to COVID-19 patients. The main secondary outcomes were all-cause mortality and median time of viral clearance.Results: A total of 153 patients were enrolled and followed for 21 days. Among patients who took at least one dose of chloroquine or hydroxychloroquine (90.1% [138/153]), few clinical adverse events were reported and were mainly rash/pruritus, diarrhea, chest pain, and palpitations. No statistically significant increase in hepatic, renal, and hematological parameters or electrolyte disorders were reported. However, there was a significant increase in the QTc value without exceeding 500ms, especially in those who received chloroquine phosphate. Three adverse events of special interest classified as serious (known from chloroquine derivatives) were recorded namely pruritus, paresthesia, and drowsiness. One case of death occurred. The average onset of SARS-CoV-2 PCR negativity was estimated at 7.0 (95% CI: 5.0– 10.0) days.Conclusion: Hydroxychloroquine appeared to be well tolerated in treated COVID-19 patients in Burkina Faso. In the absence of a robust methodological approach that could generate a high level of scientific evidence, our results could at least contribute to guide health decisions that should be made based on different sources of scientific evidence including those from our study.Keywords: SARS-CoV-2, chloroquine, hydroxychloroquine, azithromycin, safety, virus shedding

Surveys were conducted in 2016 and 2017 across the main cassava-growing regions of Burkina Faso to assess the status of cassava mosaic disease (CMD) and to determine the virus strains causing the disease, using field observation and phylogenetic analysis. CMD incidence varied between regions and across years but was lowest in Hauts-Bassins (6.0%, 2016 and 5.4%, 2017) and highest in Centre-Sud (18.5%, 2016) and in Boucle du Mouhoun (51.7%, 2017). The lowest CMD severity was found in Est region (2.0) for both years and the highest in Sud-Ouest region (3.3, 2016) and Centre-Sud region (2.8, 2017). The CMD infection was primarily associated with contaminated cuttings in all regions except in Hauts-Bassins, where whitefly-borne infection was higher than cuttings-borne infection in 2016. PCR screening of 687 samples coupled with sequence analysis revealed the presence of African cassava mosaic-like (ACMV-like) viruses and East African cassava mosaic-like (EACMV-like) viruses as single infections at 79.5% and 1.1%, respectively. Co-infections of ACMV-like and EACMV-like viruses were detected in 19.4% of the tested samples. In addition, 86.7% of the samples positive for EACMV-like virus were found to be positive for East African cassava mosaic Cameroon virus (EACMCMV). Phylogenetic analysis revealed the segregation of cassava mosaic geminiviruses (CMGs) from Burkina Faso into three clades specific to ACMV, African cassava mosaic Burkina Faso virus (ACMBFV), and EACMCMV, confirming the presence of these viruses. The results of this study show that EACMCMV occurrence may be more prevalent in Burkina Faso than previously thought.

Objective The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. Patients and methods We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (± 5 years) and sex. We analyzed local and general factors. Results During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5 ± 15.8 years for cases and 46.5 ± 16.2 years for controls (P = 0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR] = 2.10; 95% confidence interval [CI]: 1.21–3.42), diabetes (OR = 3.97; 95% CI: 1.95–6.13), nicotine addiction (OR = 5.07; 95% CI: 2.20–11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR = 7.85; 95% CI 4.60–14.21) and voluntary cosmetic depigmentation (OR = 2.29; 95% CI: 1.19–3.73). Conclusion Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

The number of HIV-infected patients in the world is estimated at 34 million, including 30.1 million adults with 2.7 million new infections and 1.8 million deaths from HIV according to the 2011 UN AIDS report [1]. The prevalence of HIV infection in the general population of Mali is estimated at 1.1% according to DHSM-V [2]. Cardiovascular manifestations are increasingly encountered during our consultations with patients living with HIV. Thus we initiated this work with the aim of studying the cardiovascular lesions during the HIV-AIDS in the department of internal medicine of the point G. Methods: This retrospective descriptive study was conducted in the Internal Medicine department of the University Hospital Center (CHU) of the Point G from January 2008 to December 2012. Having included all HIV + patients hospitalized in the service with cardiovascular manifestations and who had performed a chest X-ray, cardiac and vascular ultrasound, electrocardiogram and/or cerebral computed tomography. Results: At the end of this work, 20 patients with cardiovascular lesions were identified in 273 hospitalized patients during the study period, i.e. a frequency of 7.3%. The 40 to 50 age group accounted for 45.0% with an average age of 42.4 ± 8.73 years. The most common cardiovascular risk factors were hypertension and active smoking with 31.58% each. Pericarditis accounted for 32% of cases, followed by cardiomyopathies with 23%. Conclusion: In our study, cardiovascular lesions are common in PHAs and etiologies are dominated by pericarditis.

Aim: To describe the epidemiological, therapeutic and prognostic aspects of eclampsia at the second reference hospital in the urban commune of Segou in Mali. Patient and Methods: This was a descriptive, cross-sectional, analytical, retrospective and prospective study based on a comprehensive de-engineering. It covered a 3-year period from January 1, 2010 to December 31, 2012 and involved 176 cases. Results: The incidence of eclampsia during the study period was 2.9%. Classically, it occurred in 74.4% in young primigeste, in 73.9% in the 3rd trimester of pregnancy and 26.1% of cases during postpartum. We recorded maternal complications such as retro-placental hematoma, acute kidney failure and delivery hemorrhage. The case fatality rate was 2.3% or 4 cases of maternal death. At the fetal level, there was 29.5% prematurity, 31.8% neonatal suffering, 11.4% hypotrophy, 11.9% in utero fetal death and 7.4% early neonatal death. Conclusion: The maternal-fetal prognosis remains reserved despite the progress made in the management of eclampsia in our services.

Objective: To describe the epidemiological aspects, clinical characteristics, aspects of childbirth and to determine the maternal and perinatal prognosis during the delivery of adolescent girls at the reference health centre of commune VI of the district of Bamako in Mali. Materials and Methods: This was a descriptive, cross-sectional, analytical case-control study from January 1 to December 31, 2018, or 12 months with prospective data collection. Results: During the study period from January 01 to December 31, 2018, we recorded 1768 teenage deliveries out of a total of 9012 deliveries, a frequency of 19.61%. The average age of the cases was 17.4 ± 1 years. Single adolescent girls accounted for 14.67% (OR = 3.05, P = 0.001) unintended pregnancies (11.67% vs. 2.3%; P = 0.000007; OR = 5.52), the non-completion of the antenatal consultation (14.67% vs. 5.33%; P = 0.0001; preterm births (14.33% vs. 7.67%); P = 0.01; OR = 2.5), anaemia (7.33% vs. 3%; P = 0.009; OR = 2.01), instrumental extractions (P = 0.00008, OR = 2.87), perineal tears (P = 0.0016; OR = 3.05), mechanical dystocies (P = 0.0039); low birth weights (P = 0.039; OR = 2.2) were found to be significantly higher in adolescent girls than adults. Conclusion: Teenage versus adult births are associated with many more maternal-fetal complications.

Objective: Analyze the maternal mortality in the two departments of CHU Point “G” in Bamako, because of high maternal mortality rate in our country. Material and Methods: This was an analytical cross-sectional study on maternal deaths from February 19, 2005 to November 19, 2019 for patients admitted in both departments and who died during the pregnancy-puerperal period at CHU Point “G”. All the patients who died outside this pregnancy-puerperal period were not retained. The data were entered and analyzed using SPSS 12.0 software. The statistical test used was that of Chi2, the statistical significance threshold was fixed at 5%. Results: During our study, we recorded 389 maternal deaths out of 16,033 admissions in 15 years and 18,060 live births during the same period making a maternal mortality ratio of 2153.931 and a frequency of 2.426. At the end of our study, we noted that the frequency of maternal deaths was higher in 2014: 12.9% (50/389). The maternal death predominantly affected women aged of 20 - 24 with a frequency of 22.4% (87/389). The multiparity (166/389 making 42.7%), illiteracy (341/389 making 87.7%), the poor evacuation conditions (non-medicalized transport): 263/389 making 67.6%; the evacuation without any evacuation sheet: 259/389 making 66.6%), poor CPN (Prenatal consultation) quality (undone CPN: 191/389 making 49.1%) and the poor monitoring of delivery works (no use of partograph in 343/389 making 88.2%) were the factors favoring maternal deaths. The main causes of maternal deaths were direct in 231/389 making 59.4% with hemorrhage in first line: 21.1% (82/389), infection (61/389 cases making 15.68%), dystocia: 50 cases making 12.85% and high blood pressure and complications (38/389 making 9.76%); indirect in 158/389 cases making 40.6% (Figures 1-3). The majority of women 65.8% (256/389) of our patients died in the gynecology and obstetrics department; in the Resuscitation department 73/389 making 18.8%; in the operating room 43/389 making 11.1% and the deaths that were observed on arrivals represented 17/389 making 4.4%. In our study, 10.3% (40/389) of our patients died in the antepartum, 57.1% (222/389) in perpartum, and 32.6% (127/389) in the postpartum (Figure 4). The need not covered in blood transfusion represented 91.5% the cases either 356/389. Conclusion: The frequency of maternal deaths is very high in our country. Reducing the rate of maternal deaths requires improving the SONU (cares obstetrical and neonatal emergency).

Perforation of a pseudo appendicular tumor of bilharzial origin (bilharzia) is a rare etiology of acute peritonitis. His diagnosis is histopathological. The existence of comorbid malaria and surgical pathology is frequent in having a positive thick drop with Schistosoma mansoni eggs in his stool. After 3 months, the patient is doing well. In conclusion, we recommend the histopathological analysis of the surgical specimen after appendectomy and the detection of haematozoa for malaria in any case of fever in a surgical environment.

Highlights • We report the very first case Management of gastric perforation in situs inversus totalis in a 45-year-old adult. • The symptoms of acute peritoneal syndrome have evolved about 48 h. • The thoraco-abdomino-pelvic scan confirmed the diagnosis of gastric perforation and situs inversus totalis. • The patient underwent laparotomy (suture of gasturic perforation, appendicectomy) with uneventful postoperative course., Introduction Situs inversus is a rare congenital malformation often discovered during childhood. It can cause diagnosis errors in adulthood. Its association with gastric perforation is an extremely rare event in the literature. Its diagnosis is made by an adequate morphological assessment. Presentation of case A 45-years-old man, was admitted to the surgical emergency department for generalized acute abdominal pain initially sitting in the right hypochondrium, accompanied by bilious vomiting and a stop in intestinal transit, progressing for 48 h. He had no known surgical history. The clinical examination noted an altered general state (WHO III) and a peritoneal syndrome. A diagnosis of generalized acute peritonitis has been made. An x-ray of the abdomen without preparation revealed a bilateral pneumoperitoneum with a cardiac point on the right. The thoraco-abdomino-pelvic CT scan confirmed the diagnosis. After resuscitation, the patient underwent a laparotomy with gastroraphy and appendectomy. The postoperative follow-ups were without an uneventful, over a 15-month follow-up. Discussion Situs inversus totalis is an uncomon event. Its exact etiology is still unknown. Some authors incriminate an autosomal recessive gene. In our context, its diagnosis is a surprise. Its revelation by gastric perforation is an extremely rare event. Surgical treatment must be performed early. Prognosis is generally better. Conclusion In developing countries the diagnosis of situs inversus is a surprise during a pathology which led the patient to a medical consultation. CT-scan is one of the key paraclinic exams for its diagnosis.

Objectives: The goal was to assess the risk factors for emergency cesarean section versus prophylactic caesarean section. Materials and Methods: This was a descriptive analytical cross-sectional study of the Type Cas/Witnesses at the Reference Health Centre of Commune V of the District of Bamako in Mali. The sample consisted of 100 cases for 200 controls (1 case for 2 controls) with retrospective collection of data for the period from January 1 to July 11, 2011 (6 months and 11 days). Results: During the study period, out of a total of 3559 deliveries, we recorded 2,794 vaginal deliveries, 78.50% and 765 caesarean sections or 21.50%. Of the 765ceras, we performed 353 emergency caesarean sections or 46.15% and 412 prophylactic caesarean sections 53.85%. We have selected 100 prophylactic caesarean section files and 200 emergency caesarean section files. The average age of the patients was 27.41 years-5.84 with extreme ages of 14 to 40 years. 100% of our patients (Cas) had performed at least one antenatal consultation compared to 83.5% of the parturients evacuated (Witnesses). The most frequently cited reasons for evacuation were: acute fetal suffering, non-cephalic presentation and excessive uterine height with 30%, 17.5% and 12% respectively. The bulk of the caesarean section indications were dominated by dystocies with 90% in cases compared to 65% in Witnesses, followed by acute fetal suffering with 30% in Witnesses. We recorded 30% perinatal deaths among Witnesses compared to 1% in Cases. We recorded 16 uterine ruptures in the Witnesses among which 2 hysterectomies and 14 hystererraphia. Conclusion: Prophylactic caesarean section improves maternal and perinatal prognosis more than emergency caesarean section.

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.

Introduction: Uterine rupture is a complete or incomplete non-surgical continuity solution of the wall of the gravid uterus. Indeed, it is a Affection obstetrical condition whose maternal-fetal prognosis is poor in terms of morbidity and mortality. Objectives: To assess the risk factors for uterine rupture in the Koutiala Health District. Methods: This was a descriptive and analytical cross-sectional prospective collection study from January 1, 2019 to December 31, 2019, a 12-month period. In our study, all patients admitted to the maternity ward were included during the study period for which the diagnosis of uterine rupture was made. Results: Out of a total of deliveries, we recorded 27 cases of uterine rupture, a frequency of 1.04%. The average age of our patients was 32 years with extremes of 19 and 45 years. We notice 92.6% of uterine ruptures during the transfer. Almost 3/4 of our parturients were out of school 70.4% versus 11.1% in primary school and 18.5% in secondary school. The majority of patients affected by uterine rupture came from rural areas 85.2%. Only 14.8% were from Koutiala city. The admission time to the Koutiala Reference Health Centre was 2 hours 30 minutes in 50.85% of our patients with extremes of 15 minutes and 4 hours 30 min. The average parity was 6.30 - 3036; large multiparous accounted for 63% in our sample followed by multiparous 18.5%. As for pregnancy follow-up, 100% of the patients had not performed any prenatal consultations. In 85.2% hysterrhaphy was performed intervention and hysterectomy in 14.8%. Maternal prognosis was satisfactory in 96.30% of cases. From the point of view of morbidity: 1 case of bladder-vaginal fistula was recorded and corrected by the bladder survey at home for 15 days. Late complications were the occurrence of anemia in 16 patients who were transfused and 1 case of phlebitis. We recorded 1 maternal death and 25 stillbirths. Conclusion: Uterine rupture is one of the leading causes of maternal and fetal mortality in Mali.

We report a case of torsion of an ovarian tumor in a 68-year-old woman with no medical and surgical history. The diagnosis was made in front of an intermittently painful pelvic mass. The treatment consisted of a left annexectomy; the anatomopathological examination revealed a fibro-inflammatory and hemorrhagic cyst. Postoperative results were simple with a 12-month follow-up.

Background: Very common symptom in children, fever, perhaps a warning sign of more or less severe pathology, rapidly progressive, including an invasive bacterial infection such as acute pyelonephritis (APN). The aim of this work was to study the bacteriological profile and antibiotic sensitivity of APN in children. Methods: A prospective study involving any infant or child aged 3 months to 15 years with an acute fever (≥38°C) in which a urine test strip was performed in the pediatric department of the teaching hospital Gabriel Toure between April 1st and May 15th, 2019 (45 days). Results: 124 children were included out of 244 febrile patients. Infants (3 - 23 months) predominated (52.8%) with a sex ratio of 2. Seventy-five percent of children came directly from home and 30.6% were on antibiotic prior to admission. The urine bag sample was taken in 55.6% and the urine was macroscopically cloudy in 32.3%. Stigmas of urinary tract infection at the urinary strip were present in 56.5%. Confirmation of acute pyelonephritis (APN) by CytoBacteriological Urine Examination (CBUE) was 29% with Escherichia coli (63.9%) or Enterococcus faecalis (30.5%). Sensitivity was excellent for ciprofloxacin and imipenem (100%). The overall resistance was greater for gentamicin, cotrimoxazole, ceftriaxone, cefotaxime and amoxicillin-clavulanic acid (Threshold: 17.9% - 95.6%). APN was associated with bacteremia in 2.8% with hospitalization for 45.2% and mortality of 11.1% (due to severe acute malnutrition, severe dehydration and multifocal infection). Conclusion: The APN, daily activity of pediatrician in Bamako, is observed in one third of febrile children associated with a major life-threatening condition of risk factors, then the likely antibiotherapy could be amikacin in our context.

Introduction: The factors of nephroblastomas’ relapse are a set of elements playing a role in the reappearance of cancer cells in the same place of the kidney or in other regions of the body after a 5-year remission. Objectives: To determine the frequency and the factors of nephroblastomas’ relapse in the pediatric oncology unit and pediatric surgery of the academic hospital Gabriel Toure. Materials and methods: This was a retrospective study carried out from January 1, 2005 to December 31, 2019 in all children treated for nephroblastoma relapses in the pediatric oncology unit and in the pediatric surgery service. Results: In 15 years, we have managed 182 cases of nephroblastoma, of which 128 cases were declared in complete remission after 5 years and 12 cases presented a recurrence. The relapses factors were: capsular break, intraoperative tumor rupture, presence of an associated malformation, surgery without neoadjuvant chemotherapy and tumor surgical stage (p 0.05). Patients’ age at diagnosis, sex, number of neoadjuvant and adjuvant chemotherapy sessions and histological type were not decisive (p > 0.05). Conclusion: Relapses are more and more frequent in cases of nephroblastoma. The correct use of the protocol would avoid these recurrences.

Cesarean operation permits to save the mother and fetus. However, in developing countries as ours, complications related to this cesarean are not to be neglected. It constitutes an important cause of maternal and fetal morbidity and mortality. Here we rapport the experience of our structure about the complications of cesarean. Objectives: The objectives of this study were to study the complications the complications of cesarean section at teaching hospital Gabriel TOURE, Bamako Mali. Materials and methods: We have carried out a cross sectional analytic study from January 1st 2003 to December 31st 2013. All the patients who gave birth by cesarean operation in gynecology-obstetric service of teaching hospital Gabriel TOURE were included during this period of study. Descriptive statistics were used, Chi-square test Pearson, and Cochran Armitage test have been used to calculate the P-value of trend. We performed multivariate analyses with a high alpha threshold of 10%, and then logistic regression multivariate. Results: We have registered 28,376 deliveries with 9509 cases of cesarean (33.5%) and a complication cesarean rate of 32% (3049/9509). The main risk factors for cesarean operation completions were adolescence primiparity, obesity, the non-realization of antenatal care, evacuations and co-morbidities. Intraoperative complications were dominated by hemorrhage 8.3% and bladder lesion 1.1%, whereas anemia (58.8%) and parietal infection (21.1%) dominated the postoperative complications table. The evacuation (Odds Ratio adjusted (ORa) = 1.96) as well pre-eclampsia/eclampsia (ORa = 2.34) and the sicle cell disease (ORa = 9.99) were the main influencing factors of material death. Praevia placenta (ORa = 1.75) abruption placenta (ORa = 11.08) and fetal malformation (ORa = 2.21) dominated the influencing factors of perinatal death. Conclusion: The cesarean complications rates were high in our improvement of the quality of antenatal care. The reorganization and revitalization of the reference and against reference system will permit to program some cesarean operation to reduce the morbidity related to caesarean.

We carried out a retrospective and descriptive study in the Medicine and Endocrinology service of the Mali Hospital from January 2015 to December 2018. Nine cases of anomalies in sexual differentiation were referred for pubertal delay, growth retardation, gynecomastia, micropenis or infertility. Outcomes: The average age was 14 years; 5 patients were declared female at birth; 2 were married without children; 7 patients came from the region of Kayes; 8 patients consulted for pubertal delay; 1 patient presented with association of a blind vagina and 2 bilateral inguinal gonads. 3 of 4 patients declared male at birth had a micropenis; 2 patients had gynecomastia with a history of hypospadias. Ultrasound and biological data showed a clinical-hormonal picture of hypergonadotropic hypogonadism in 6 patients, 1 case of hypogonadotropic hypogonadism with hypercorticism and 2 cases with normal gonadotropic axis; two cases of azoospermia. Karyotypic analysis showed: 3 cases of SK, 2 cases of Klinefelter Syndrome, 2 cases of Androgen Insensitivity Syndrome and 2 cases of male 46 XX syndrome including one with sry negative. Conclusion: The precise diagnosis of anomalies in sexual differentiation remains complicated in Mali, due to the inadequacy of the technical platform. Diagnosis must be made at an early stage to allow normal growth, puberty and satisfactory fertility. Taking charge of the medical treatment possibly associated with plastic surgery could give good results.

Objective: To describe the epidemiological aspects, to determine the reasons leading women to give birth outside of health facilities and to determine the maternal prognosis. Patients and Methods: This was a cross-sectional, analytical, quantitative and qualitative descriptive study over a period from 1 June to 31 December 2016 (7 months) on unassisted childbirth in the health district of commune V of Bamako. Results: We recorded 70 unsured deliveries, a frequency of 1.04% out of a total of 6719 deliveries. The extreme ages were 15 years and 41 years with an average age of 28 years. 90% of the birth attendants were married and 10% were single. The women's profession: 48% were housewives, 11% saleswomen, 13% hairdressers, 4% female teachers. Education level: 71% were uneducated and 29% educated. Among those who are educated, their level was primary in 50%, secondary in 32% and higher in 18%. 42% had done antenatal consultation. The main reasons: ignorance of work 44.3%; religious beliefs and societal burdens 10.0%; fear of caesarean section 4.3%; late-night birth labour 5.7%; lack of financial and/or transport means 17.1%; distance from the locality 2.9%; insecurity 2.9%. Maternal and perinatal prognosis: complications were mostly hemorrhagic and concerned 27 (39%) patients. These included uterine atony (13 cases), placental retention (8 cases), soft part lesions (6 cases). We have not recorded any maternal deaths. For the condition of newborns at the time of admission: 88% of newborns were alive, 11% were stillborn fresh and 1% stillborn macerated. Conclusion: The reasons are multifactorial and seem to be a reflection of our society.

The sigmoid volvulus is an acute strangulation of the colon by the twisting of the sigmoid loop around its mesenteric axis resulting in partial or complete obstruction of the colonic lumen. It is the most common intestinal volvulus and is an absolute medical and surgical emergency. Objectives: Determine the frequency of sigmoid colon volvulus, describe clinical and para-clinical signs, describe treatment, and determine morbidity and mortality. Methodology: This was a retrospective and prospective study performed in the General Surgery Department of Sikasso. This study concerned patients admitted and operated for sigmoid volvulus from January 1, 2014 to December 31, 2017. Retrospective Phase: We have created survey cards to study the following parameters: 1) The age and the sex; 2) The clinical signs and associated defects; 3) The radiological examinations, endoscopic; 4) The established treatment whether medical, or surgical; 5) The evolution and the postoperative consequences; 6) The admission period. Prospective Phase: At the admission each patient to benefit: a complete interrogation, a complete physical examination, additional examinations including radio of the abdomen without preparation, the rate of hemoglobin and hematocrit, grouping/rhesus. Support: Our data were collected from medical records and operating records of patients in the department. Results: We collected 54 cases of sigmoid volvulus (the annual frequency was 13.5 cases for year), which accounted for 58.1% of colonic occlusions 19.6% of intestinal occlusions and 5.9% of operative operations in emergency. The average age was 47.13 with extremes of 18 and 102 years, The sex ratio is 4.40% in favor of men. Abdominal pain, vomiting, stopping of materials and gases were present in 32 (59.3%) patients. Von Wahl’s triad was present in 36 patients (66.7%), the rectal ampoule empty in 92.6%. On the X-ray of the abdomen without preparation, 70.37% of the image was recorded as a double leg. The sigmoid was necrotic in 37% of cases, and a sigmoid volvulus and necrotic hail in 7.4% of cases. We found a simple sigmoid volvulus in 61% of cases. We performed an immediate anastomosis resection in 63%, a Hartmann resection in 29.6%, an immediate anastomosis resection plus an ileostomy in 7.4%. Operative follow-up was simple in 85.2%, with a morbidity of 11.1%, and a mortality of 14.8%. Conclusion: Sigmoid volvulus is a serious surgical emergency requiring early diagnosis and management to improve prognosis. Pre-, postoperative and postoperative resuscitation associated with immediate anastomosis resection, or resection plus Hartmann, would reduce morbidity and mortality.

Objective: Pediatric jaundice is caused by various conditions. Although some data is available on this issue, data from Mali is insufficient. The present retrospective observational study was an attempt to determine the etiology of pediatric jaundice in the pediatric department of Gabriel Toure teaching hospital in Bamako, Mali. Methods: We reviewed all pediatric patients with jaundice who were hospitalized and treated in this department during January 1 to December 31, 2016 (n = 168). Result: Pediatric jaundice patients accounted for 1.88% of the hospitalized patients, with median age of 6 years and male/female ratio being 1.6. Infectious, cholestatic, and hemolytic jaundice accounted for 75%, 11% and 10%, respectively. Malaria and sickle cell disease accounted for 67% and 9%, respectively. Hepatomegaly and splenomegaly were observed in 49 (29%) and 23 (13.7%) patients, respectively. Of 168, 9 patients died. Conclusion: Infectious jaundice, especially jaundice due to malaria, was the most frequent. However, variety of etiologies was observed, of which the practitioners should be aware. The observation presented here may become fundamental data in health-policy making in this area.

Summary: We attempted to determine the obstetric prognosis of women without antenatal care in the Health District of Commune V of Bamako, Mali. Materials and Methods: We undertook this retrospective case-control study from January 1 to March 31, 2017. Of all women having given birth to during this period in this district, we compared characteristics and obstetric outcomes between women without antenatal care (study group) vs. those with antenatal care (age/parity matched control). Results: 13.8% of women were without antenatal care (23.45 ± 9.56 years of age: 13 - 42). Study group (without antenatal care), compared with control, was significantly more likely to be household helpers (OR = 2.5 [2.0 - 3.4]) and single (OR = 2.3 [1.8 - 2.8]). Study group women were more significantly likely to have the following poor obstetric outcomes: premature rupture of the membranes, post-maturity, low birth weight, hypertensive disorders of pregnancy, uterine rupture, fetal death, anemia, fetal malposition, cesarean section, postpartum hemorrhage, puerperal infection and maternal death. Study group showed a higher risk of early neonatal death, low Apgar score, and transfer to Neonatology institute. Conclusion: In accordance with the previous reports in any other countries, no prenatal checkup causes higher poor outcome of both mothers and infants/neonates also in this area.

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.