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Introduction: Neurological disorders (ND) have a high incidence in sub-Saharan Africa (SSA). In this region, systemic challenges of conventional medicine (CM) and cultural beliefs have contributed to a large utilization of traditional medicine (TM). Yet, data on TM and those who use it in the treatment of ND in SSA are scarce. Here, we systematically analyze its role as a therapy modality for ND in Mali, the socio-demographic characteristics of its users, and propose next steps to optimize the dual usages of TM and CM for patients with ND. Methods: We conducted a questionnaire study in two phases. In phase one, patients with ND answered questions on their usage of and attitudes towards TM. In phase two, the TM therapists who provided care to the patients in phase one answered questions regarding their own practices for treating ND. Patients were recruited from the country's two university neurology departments. Results: 3,534 of the 4,532 patients seen in the Departments of Neurology in 2019 met the inclusion criteria. Among these 3,534 patients, 2,430 (68.8%) had previously consulted TM for their present ND. Patients over 60 years of age most often used TM (83.1%). By education, illiterate patients utilized TM the most (85.5%) while those with more than a secondary education used TM the least (48.6%). An income greater than the minimum guaranteed salary was associated with decreased use of traditional medicine (OR 0.29, CI 0.25–0.35, p < 0.001). Among those using TM, it was overwhelmingly thought to be more effective than CM (84.6%). Linking illness to supernatural causes and believing TM therapists had a better understanding of illnesses were the most common reasons patients used traditional medicine (82.3% and 80.5%, respectively). We then interviewed 171 TM therapists who had provided care to the patients in phase one. These providers most commonly "sometimes" (62.6%) referred patients to CM and 4.1% never had. A majority of TM providers (62.6%) believed collaboration with CM could be improved by having doctor "take into account" our existence. Conclusion: Our work shows that TM plays a central role in the provision of care for patients with ND in SSA with certain cohorts using it at higher rates. Future development of treatment of ND in SSA will require optimizing TM with CM and needs buy-in from all stakeholders including conventional medicine clinicians, traditional medicine therapists, researchers, politicians, and most importantly, patients. [ABSTRACT FROM AUTHOR]

Diabetes and hypertension were the most common comorbidities among COVID-19 deaths, at 20.45% and 17.42% respectively in Mali. The aim of this study was to analyze the clinical and biological aspects of COVID-19 and diabetes in Mali from 2020 to 2023. The present study constitutes a comparative cross-sectional analytical study that included 50 patients. Data were collected at home, in the form of individual interviews with patients. Findings indicate before the pandemic, 34% of patients were obese and 54% had uncontrolled diabetes. Arterial hypertension was the only macro-angiopathic complication found in patients, with an increase in frequency during the pandemic whereas respiratory distress was observed in 25% of patients during COVID-19 infection. This means that COVID-19 is as much a risk factor associated with diabetes as diabetes is a factor affecting patients' health. [ABSTRACT FROM AUTHOR]

OBJECTIVE The aim of our study was to evaluate the frequency, type, and risk factors associated with adverse drug reactions (ADRs) in HIV-positive children with adherence to antiretroviral therapy (ART) at the Unit of Care and Accompaniment for People Living With HIV (USAC) of Bamako. METHODS A cross-sectional study was conducted at USAC of Bamako from May 1, 2014, to July 31, 2015. We included children aged 1 to 14 years with at least 6 months of ARV treatment initiated at USAC, with or without ADRs. Data collection was based on information collected from parents and clinical/biological assessments. RESULTS Median age of participants was 36 months and female sex was predominant (54.8%). Poor adherence during the study was observed in 15% of cases. Of patients in the study, 52% had a CD4 count less than 350 cells/mm³ at the time of adverse events. In bivariate analysis, we found that participants with adherence to ART tended to be younger than those with non-adherence to ART (36 vs 72 months, p = 0.093). In multivariable analysis, prophylactic treatment was the only factor marginally associated with ART adherence in HIV patients (p = 0.09). No other adverse biological effects or clinical conditions were associated with ART adherence in this study. CONCLUSIONS In this study we found that ADRs were frequent in HIV-positive patients but less frequent in ART-adherent HIV-positive children. Therefore, it is essential to regularly monitor children receiving ARVs to detect and treat the complications associated with these therapies according to ART adherence. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is a global health concern, with extended-spectrum ß-lactamases (ESBLs) and carbapenemases being major contributors. Pleural infection (PI) is a severe condition in West Africa, complicated by AMR. This study aimed to investigate the prevalence and molecular characteristics of ESBL and carbapenemase-producing enterobacteria in pleural effusions in Mali. Materials and methods: Pleural fluid samples from 526 patients with pleuritis were analyzed. Enterobacterial species were isolated and identified, and the prevalence of resistance genes (blaOXA-48, blaNDM-1, blaKPC, blaTEM, blaSHV) and virulence factors was determined. Results: Among the patients, 110 were diagnosed with enterobacterial pleuritis. Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were the main pathogens identified. Resistance to ß-lactams and cephalosporins was high, while carbapenems showed good activity. ESBL production was detected in 33.6% of isolates, with blaTEM being the most common gene. Carbapenemase gene (blaNDM-1) was found in three isolates. Conclusion: The study highlights the high prevalence of multidrug-resistant bacteria and the need for appropriate antibiotic selection based on local resistance patterns. Understanding the molecular characteristics of resistance is crucial for optimizing patient care and developing effective therapeutic strategies. Further research is needed to monitor and control AMR in PIs in Mali. [ABSTRACT FROM AUTHOR]

Objective: Limited information is available regarding youth‐onset diabetes in Mali. We investigated demographic, clinical, biochemical, and genetic features in new diabetes cases in children and adolescents. Research Design and Methods: The study was conducted at Hôpital du Mali in Bamako. A total of 132 recently‐diagnosed cases <21 years were enrolled. Demographic characteristics, clinical information, biochemical parameters (blood glucose, HbA1c, C‐peptide, glutamic acid decarboxylase‐65 (GAD‐65) and islet antigen‐2 (IA2) autoantibodies) were assessed. DNA was genotyped for HLA‐DRB1 using high‐resolution genotyping technology. Results: A total of 130 cases were clinically diagnosed as type 1 diabetes (T1D), one with type 2 diabetes (T2D), and one with secondary diabetes. A total of 66 (50.8%) T1D cases were males and 64 (49.2%) females, with a mean age at diagnosis of 13.8 ± 4.4 years (range 0.8–20.7 years) peak onset of 15 years. 58 (44.6%) presented in diabetic ketoacidosis; with 28 (21.5%) IA2 positive, 76 (58.5%) GAD‐65 positive, and 15 (11.5%) positive for both autoantibodies. HLA was also genotyped in 195 controls without diabetes. HLA‐DRB1 genotyping of controls and 98 T1D cases revealed that DRB1*03:01, DRB1*04:05, and DRB1*09:01 alleles were predisposing for T1D (odds ratios [ORs]: 2.82, 14.76, and 3.48, p‐values: 9.68E‐5, 2.26E‐10, and 8.36E‐4, respectively), while DRB1*15:03 was protective (OR = 0.27; p‐value = 1.73E‐3). No significant differences were observed between T1D cases with and without GAD‐65 and IA2 autoantibodies. Interestingly, mean C‐peptide was 3.6 ± 2.7 ng/ml (1.2 ± 0.9 nmol/L) in T1D cases at diagnosis. Conclusions: C‐peptide values were higher than expected in those diagnosed as T1D and autoantibody rates lower than in European populations. It is quite possible that some cases have an atypical form of T1D, ketosis‐prone T2D, or youth‐onset T2D. This study will help guide assessment and individual management of Malian diabetes cases, potentially enabling healthier outcomes. [ABSTRACT FROM AUTHOR]

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Copyright of Revue Africaine de Chirurgie et Spécialités is the property of Faculty of Medicine & Biomedical Sciences, University of Yaounde I, Cameroon and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Objectif: L'objectif principal était d'étudier les circonstances du diagnostic et la répartition des tumeurs cérébrales chez l'enfant. Méthodologie: Il s'agissait d'une étude rétrospective descriptive réalisée chez les enfants de 0 à 15 ans hospitalisés pour tumeur cérébrale au CHU Gabriel Touré à Bamako, Mali, du 31 janvier 2007 au 3 décembre 2012. Résultats: Pendant la période d'étude, 41 enfants d'âge moyen de 5,5 ans (extrêmes : 1-12 ans) étaient admis pour une tumeur cérébrale. Le sexe masculin était prédominant (53,7 %). Le délai moyen d'admission était de 205,6 jours (extrêmes : 30-455). L'hypertension intracrânienne était le mode de révélation le plus fréquent des tumeurs primitives (26,8 %). La localisation sous-tentorielle représentait 83 % des cas. Le gliome était le diagnostic le plus souvent évoqué à la tomodensitométrie (TDM) (29,3 %). Seulement cinq malades avaient bénéficié d'une chirurgie dont deux cas d'énucléation, deux cas de dérivation et un cas de dérivation avec exérèse tumorale. Conclusion: Cette étude nous a permis de connaître la topographie des tumeurs cérébrales et la difficulté de leur diagnostic et de leur prise en charge liée au retard diagnostique. Objective: to assess epidemiologic and clinical aspects of childhood brain tumors in Mali. Methods: a retrospective, descriptive study of children aged 0-15 years with brain tumors, conducted in the pediatrics department of the Gabriel Touré University Hospital Center in Bamako, Mali, from January 31, 2007 to December 3, 2012. Results: In all, 41 cases of brain tumors were recorded during this period (mean: 5.5 years old; range: 1-12 years). Brain tumors were most frequent in the children aged 2-5 years (53.7%) and among boys (53.7%). Late stage at presentation was relatively frequent (34.1%) with a mean time to diagnosis of 10 months. Features of elevated intracranial pressure were the most frequent mode of revelation of primary tumors (26.8%). Supratentorial tumors accounted for 83% of the cases, and gliomas were most frequently (29.3%) identified on computed tomography. Only five patients underwent surgical tumor removal. Conclusion: A broader study including the other hospitals in Bamako could help to assess more accurately the epidemiology of pediatric brain tumors in Mali. [ABSTRACT FROM AUTHOR]

Aims: Determine incidence, prevalence and mortality of Type 1 diabetes (T1D) in children and youth <25 years (y) in Mali during the first 10 years of the Santé Diabète/Life for a Child program. Methods: Data were collected from the prospective program register. Diagnosis of T1D was clinical, based on presentation, clinical features, immediate requirement for insulin, and no suggestion of other diabetes types. Results: Total of 460 cases were diagnosed with T1D <25 years in 2007–2016. Male‐to‐female ratio was 1.04:1. Peak age at onset was 15–16 years (range 1.1–24 years). T1D incidence <25 years per 100,000 population/year increased from 0.12 in 2007 to 0.74 in 2016 (an 18% annualized increase, p < 0.001). Incidence peaked at 0.80 in 2014, the year after an education campaign was conducted. Incidence <15 years rose from 0.12 to 0.35 per 100,000/year in 2007 and 2016, respectively, (14% annualized increase, p < 0.001). There was a steep, consistent increase in prevalence (per 100,000) from 0.43 in 2007 to 2.90 in 2016 (p < 0.001). Prevalence <15 years was 0.34/100,000 in 2007 and 1.02/100,000 by 2016 (p < 0.001). Overall crude mortality rate was 30.0/1000 patient years, equating to a standardized mortality rate of 9.0, with vital status known for 99.8% of cases. Conclusion: Known incidence and prevalence of diabetes in Mali increased rapidly from 2007 to 2016, contemporaneous with the introduction and development of the Santé Diabète/Life for a Child program. Improved diagnosis and care resulting in lower mortality are likely contributors. True incidence may still be underestimated, with some cases still dying undiagnosed and full study ascertainment being uncertain. [ABSTRACT FROM AUTHOR]

Background: Drug resistant tuberculosis presents a major public health challenge. Case presentation: We present here the first two patients diagnosed with extensively drug resistant tuberculosis in Bamako, Mali. Genotypic findings suggest possible nosocomial transmission from the first patient to the second one, resulting in superinfection of the second patient. After being diagnosed with extensively drug resistant tuberculosis in August 2016, the patients only started receiving appropriate treatment 10 months later. Conclusion: The identification of these patients highlights the need for improved diagnostic and treatment algorithms for better surveillance and management of drug resistance in Mali. In the interest of these as well as future patients suffering from resistant tuberculosis, all steps recommended for programmatic management of drug resistant tuberculosis must be urgently prioritized in order to strengthen the multidrug resistant tuberculosis program. [ABSTRACT FROM AUTHOR]

Aware of the rapid spread of Ebola virus (EBOV) during the current West African epidemic, Mali took several proactive steps to rapidly identify cases within its borders. Under the Mali International Center for Excellence in Research program, a collaboration between the National Institute of Allergy and Infectious Diseases and the Malian Ministry of Higher Education and Scientific Research established a national EBOV diagnostic site at the University of Sciences, Techniques and Technologies of Bamako in the SEREFO Laboratory. Two separate introductions of EBOV occurred in Mali from neighboring Guinea, but both chains of transmission were quickly halted, and Mali was declared "Ebola free" on 18 January 2015 and has remained so since. The SEREFO Laboratory was instrumental in the success of Mali's Ebola response by providing timely and accurate diagnostics. As of today, the SEREFO Laboratory has tested 103 samples from 88 suspected cases, 10 of which were EBOV positive, since the Ebola diagnostics unit started in April 2014. The establishment of Ebola diagnostics in the SEREFO Laboratory, safety precautions, and diagnostics are described. [ABSTRACT FROM AUTHOR]

Summary: Aims: Determine the frequency of hospital born infection, identify the risk factors and determine the most responsible germs and their sensibility. Methods: The authors conducted a prospective study from January 1st to December 31st, 2007 with all children hospitalized in the service of paediatric surgery during at least 48h. Children hospitalized least than 48h or those who disappeared were not included. Hospital-born infection was identified according to criteria of Center for Disease Control (CDC) of Atlanta. Results: The frequency was 7.4%. The mean age of patients was 8.7 years. The sex-ratio was 1.66 for men. The recruitment mode, the score of National nosocomial infection surveillance system (NNISS), the Altemeier classification, the mode of surgery and the time of hospitalization were the determining factors of hospital born infection with P <0.05. The following germs were found to the culture: Escherichia coli (15 cases), Staphylococcus aureus (5 cases), Pseudomonas aeruginosa (4 cases), Klebsiella pneumoniae (1 case), Escherichia cloacae (1 case) and Escherichia agglomerans (1 case). All of these germs were resistant to amoxicillin. [Copyright &y& Elsevier]

In Mali, a country in West Africa, cumulative confirmed COVID-19 cases and deaths among healthcare workers (HCWs) remain enigmatically low, despite a series of waves, circulation of SARS-CoV-2 variants, the country's weak healthcare system, and a general lack of adherence to public health mitigation measures. The goal of the study was to determine whether exposure is important by assessing the seroprevalence of anti-SARS-CoV-2 IgG antibodies in HCWs. The study was conducted between November 2020 and June 2021. HCWs in the major hospitals where COVID-19 cases were being cared for in the capital city, Bamako, Mali, were recruited. During the study period, vaccinations were not yet available. The ELISA of the IgG against the spike protein was optimized and quantitatively measured. A total of 240 HCWs were enrolled in the study, of which seropositivity was observed in 147 cases (61.8%). A continuous increase in the seropositivity was observed, over time, during the study period, from 50% at the beginning to 70% at the end of the study. HCWs who provided direct care to COVID-19 patients and were potentially highly exposed did not have the highest seropositivity rate. Vulnerable HCWs with comorbidities such as obesity, diabetes, and asthma had even higher seropositivity rates at 77.8%, 75.0%, and 66.7%, respectively. Overall, HCWs had high SARS-CoV-2 seroprevalence, likely reflecting a "herd" immunity level, which could be protective at some degrees. These data suggest that the low number of cases and deaths among HCWs in Mali is not due to a lack of occupational exposure to the virus but rather related to other factors that need to be investigated. [ABSTRACT FROM AUTHOR]

Introduction Retinoblastoma is one of the most common malignant tumours among children in Africa. However, very few studies on this disease have been published, especially studies from French-speaking countries in Africa. Patients and methods Prospective study over a period of 30 months from 1 January 2005 to 30 June 2007 on all cases of retinoblastoma diagnosed and treated in the Paediatric Oncology Unit of the Gabriel Touré Hospital in Bamako, Mali. Treatment was two courses of preoperative chemotherapy (cyclophosphamide, adriamycine and vincristine), enucleation for many patients, and then two courses of adjuvant chemotherapy with the same drugs. Results During the study period, 55 cases of retinoblastoma were treated, which represents 33.1% of all the solid tumours, coming second in frequency after lymphomas (39.7%). The mean age of the patients was 4.2 years. Boys were the most affected, with a sex ratio of 2:1. Forty-nine mothers (89.1%) and 46 fathers (83.6%) had no formal education. Thirty-seven children (67.3%) were from rural areas. Unilateral cases were predominant (49 cases (89.1%)). Ten cases (10.9%) were bilateral. Exophthalmos was the leading symptom (30 cases (54.5%)). The survival rate at 30 months was 56% with 18% lost at follow-up. Conclusion Mortality as a result of retinoblastoma remains high in our region because diagnosis is always late and it is difficult to follow-up the patients. Education of healthcare workers and raising awareness in the general population would improve the survival rate of retinoblastoma patients in Africa. [ABSTRACT FROM AUTHOR]

Four strains isolated by microbial culturomics from breast milk of healthy mothers from Mali were not identified and characterized by taxono-genomics. This led us to propose the new genera and species Lactimicrobium massiliense , Anaerolactibacter massiliensis and Galactobacillus timonensis containing type strain Marseille-P4301T (CSUR P4301T), Marseille-P4302T (CSUR P4302T) and Marseille-P4641T (CSUR P4641T), respectively. The strain Marseille-P4482 represents a novel species, Acidipropionibacterium timonense, in a previously known genus with type strain being Marseille-P4482T (CSUR P4482T). [ABSTRACT FROM AUTHOR]

Introduction: La frequence du diabete de l’enfant et de l’adolescent est fonction dans nos pays de la facilite d’acces aux centres de soins, sa mortalite est encore forte a cause du defaut d’education et de pris en charge adequate. Patients et méthodes: Étude retrospective descriptive sur 10 ans (de Janvier 1999 a Decembre 2008) concernant les enfants de moins de 20 ans hospitalises ou vus en consultation externe. Des variables cliniques et paracliniques d’evaluation du diabete ont ete analysees. Résultats: La fréquence hospitalière a été de 1,92% (n = 32/1823). l’échantillon était composée de 18 garçons : 51,4% et 17 filles : 48,6%, avec un sexe ratio de 1,05. la moyenne d’âge des patients était 13 ans avec des extrêmes a 5 ans et 19 ans. Le pic d’incidence était 14-19 ans. Le mode de découverte du diabète a été la cetoacidose : 51,5% (n = 18/35) avec coma dans 44% (n = 8/15). Aucun antecedant familial n’a été retrouve dans 68,6% (n = 24/35). Le diabète était de type 1 : 94,3% et de type 2 : 5,7%. L’évolution a été emaillee de complications métaboliques aigues a type de coma acido cetosique : 40% (n = 14/35) et de coma hypoglycémique : 31,4% (n = 11/31). Des complications dégénératives sont apparues plutôt que classiquement admis ; une rétinopathie est découverte avant 5 ans d’évolution dans 5,7% et une néphropathie avant 7 ans d’évolution dans 2,86%. Plus de la moitié des enfants : 54,3% ont été irrégulier dans leur suivi ou perdu de vue. Le traitement aussi était fait de manière irrégulière dans 54,3%. Conclusion: le diabète chez l’enfant est une réalité médicale dans nos hôpitaux. Des actions de prévention pour certains et d’éducation thérapeutique pour tous permettront un meilleur control de la maladie dans les pays a ressource limitée. [Copyright &y& Elsevier]

Objectif: disposant grâce au GFAOP de drogues anticancéreuses depuis 2005 pour traiter nos enfants atteints de cancer, nous avons initié ce travail afin d’évaluer essentiellement les caractéristiques épidémiologiques de nos patients et les résultats de la prise en charge. Patients et Méthodes: Tout enfant de 0 à 15 ans atteint de cancer documenté et traité a été inclus dans cette étude rétrospective allant du 1er janvier 2005 au 31 décembre 2007. Résultats: Durant la période d’étude 217 cas de cancer ont été traités sur 18659 hospitalisations soit 1,2 %. Le rétinoblastome occupait la première place (32,3 %), puis le lymphome de Burkitt (22,1 %), le néphroblastome (16,6 %). Le sex-ratio était de 1,6 en faveur des garçons. La tranche d’âge la plus atteinte était 5-9 ans. 38 % de nos malades venaient de la capitale. Le nombre de malades a été croissant : 32 en 2005, 85 en 2006 et 100 en 2007. Le délai de diagnostic était supérieur à trois mois dans 40 % des cas. 60 % de nos patients étaient à des stades tardifs. Nous avions enregistré 33,2 % de rémission complète, 25,8% de perdus de vue, 25,8% de décès par tumeur, 2,8 % de rechute. Conclusion: L’incidence du cancer pédiatrique augmente dans nos pays alors que sa prise en charge souffre de nombreux problèmes. [ABSTRACT FROM AUTHOR]

Introduction: Très peu de séries africaines sur la maladie de Hodgkin pédiatrique sont rapportées. Objectif: décrire dans tous les aspects les différents cas de lymphome de Hodgkin traités dans notre unité d’oncologie pédiatrique. Patients et Méthodes: Tout patient atteint de maladie de Hodgkin a été inclus dans cette étude rétrospective s’étendant du 1er janvier 2005 au 31 décembre 2007. Les patients avaient été traités par COPP/ABV. Résultats: Durant la période d’étude au total 217 cas de cancers de l’enfant ont été diagnostiqués et traités. Parmi ces cas de cancers, 7 étaient des lymphomes de Hodgkin (0,04 %). Le sex-ratio était de 6 en faveur des garçons : 86 % contre 14 %. L’âge moyen était de 11,71 ans avec des extrêmes de 6 et 15 ans. Dans 71,4 % des cas le délai de diagnostic était compris entre 4 et 12 mois. 71,4 % des cas étaient des stades II de la classification d’Ann Arbor et 28,6 % des stades III. Histologiquement on notait : 42,8 % de formes scléronodulaires, 28,6 % de formes à prédominance lymphocytaire, 14,3 % de cellularité mixte, 14,3 % de formes à déplétion lymphocytaire. En Mars 2009, 71,4 % des malades étaient en rémission complète, 28,6 % étaient décédés. Conclusion: Avec une chimiothérapie bien conduite, le pronostic de la maladie de Hodgkin reste bon. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) remains an important global health issue worldwide. Despite this scourge threatening many human lives, especially in developing countries, thus far, no advanced molecular epidemiology study using recent and more accurate tools has been conducted in Mali. Therefore, this study aimed to use variable-number tandem repeats of mycobacterial interspersed repetitive units (MIRU-VNTR) technology coupled with the spoligotyping method to accurately determine the hot spots and establish the epidemiological transmission links of TB in Bamako, Mali. In a cross-sectional study, 245 isolates of Mycobacterium tuberculosis complex (MTBC) were characterized using spoligotyping and MIRU-VNTR, and an epidemiological investigation was conducted. Of the 245 isolates, 184 (75.1%) were formally identified. The most widespread strain was the Cameroon strain (83; 45.1%). Eight major clusters were identified: Ghana (27; 14.7%), West African 2 (22; 12%), Haarlem (13; 7.1%), H37Rv (t) (8; 4.3%), Latin American Mediterranean (8; 4.3%), and Uganda I and II (6; 3.3%). Statistical analysis showed a significant difference between lineages from the respective referral health centers of Bamako, Mali (P = 0.01). This study establishes, for the first time, an accurate spatial distribution of circulating MTB strains in Bamako, Mali. The data was used to identify strains and "hot spots" causing TB infection and can also be used for more targeted public health responses, particularly for hot spots of drug-resistant strains. [ABSTRACT FROM AUTHOR]

Summary: Background: Neonatal malaria is classicaly known to be rare in malaria endemic countries. However, reports increasingly suggest an underestimation of its true frequency. The aim of this study was to determine the prevalence of congenital and neonatal malaria in infants admitted in tertiary reference hospital in Mali using three complementary diagnostic methods. Methods: The study was conducted in neonatalogy unit of the pediatric ward of the teaching hospital Gabriel Toure in Bamako, Mali from October 1st 2006 to March 17th 2008. In-patient infants aged between 0 and 28days and their mothers were included. Malaria was diagnosed on infants and mothers venous blood using a rapid diagnostic test (RDT, OptiMAL IT®), light microscopy of thick smear and polymerase chain reaction (PCR). Results: Overall 267 infants and 146 mothers were included. The mean age and weight of the infants were 2.7days and 2862.4g respectively. Light microscopy of thick smears and PCR amplification of parasite DNA were both negative in the infant population. Mothers had a mean age of 25years. Microscopy of thick smears was negative in all samples collected from these mothers while the RDT detected one case of Plasmodium falciparum and PCR detected seven cases of P. falciparum and two cases of P. ovale. Conclusion: Congenital and neonatal malaria remain of a rare occurrence in in-patients infants admitted in a tertiary reference hospital in Mali. [Copyright &y& Elsevier]

• MDR-TB was associated with younger age in Mali. • HIV was not a risk factor for MDR-TB. • MDR-TB did alter the patient's physical condition compared to susceptible TB. • Tobacco consumption did not increase the risk of developing MDR-TB. MDR-TB is a major threat to global TB control. In 2015, 580,000 were treated for MDR-TB worldwide. The worldwide roll-out of GeneXpert MTB/RIF® has improved diagnosis of MDR-TB; however, in many countries laboratories are unable to assess drug resistance and clinical predictors of MDR-TB could help target suspected patients. In this study, we aimed to determine the clinical factors associated with MDR-TB in Bamako, Mali. We performed a cross-sectional study of 214 patients with presumed MDR-TB admitted to University of Bamako Teaching Hospital, Point-G between 2007 and 2016. We calculated crude and adjusted odds ratios for MDR-TB disease diagnosis using SPSS. We found that age ≤40 years (OR = 2.56. 95% CI: 1.44–4.55), two courses of prior TB treatment (OR = 3.25, 95% CI: 1.44–7.30), TB treatment failure (OR = 3.82, 95% CI 1.82–7.79), sputum microscopy with 3+ bacilli load (OR = 1.98, 95% CI: 1.13–3.48) and a history of contact with a TB patient (OR = 2.48, 95% CI: 1.11–5.50) were significantly associated with confirmation of MDR-TB disease. HIV was not a risk factor for MDR-TB (aOR = 0.88, 95% CI: 0.34–1.94). We identified several risk factors that could be used to identify MDR-TB suspects and prioritize them for laboratory confirmation. Prospective studies are needed to understand factors associated with TB incidence and clinical outcomes of TB treatment and disease. [ABSTRACT FROM AUTHOR]

A moderately halophilic and strictly aerobic bacterium was isolated from a human stool as part of a study on the diagnosis of childhood malnutrition in Mali. Strain Marseille-Q1616T is a Gram-stain-positive, rod-shaped, catalase-positive and oxidase-negative bacterium. It has a genome size of 3.91 Mbp with 39.79% G+C content, which contains 3954 protein-coding genes including genes encoding phosphomycin resistance and Listeria monocytogenes , 16 rRNA genes and 64 tRNA genes. Strain Marseille-Q1616T exhibited a 96.3% 16S rRNA gene sequence similarity and shared an OrthoANI value of 70.64% (the highest observed) with Virgibacillus kekensis , the phylogenetically closest validly published species. Based on phenotypic and phylogenetic evidence and genomic average nucleotide identity values, we suggest the creation of a new species within the Virgibacillus genus, named Virgibacillus doumboii sp. nov., type strain Marseille-Q1616T (= CSURQ1616). [ABSTRACT FROM AUTHOR]

La mortalité néonatale en général et celle des prématurés en particulier reste préoccupante dans notre contexte. But: Notre travail avait pour objectif d’étudier les facteurs associés à la mortalité des prématurés dans notre contexte. Matériel et Méthodes: Il s’agit d’une étude transversale, descriptive qui s’est déroulée du 15 octobre 2006 au 15 janvier 2007 dans l’unité de néonatologie du CHU Gabriel Touré. Ont été inclus tous les nouveau-nés référés prématurés hospitalisés. Résultats: Nous avons inclus 327 prématurés. Les naissances out born ont représentées 85,9 %. Le transfert a été fait par taxi dans 50,2 % des cas. Une hypothermie a été retrouvée chez 60,5 % à l’admission. Le taux de mortalité a été de 33,3 %. Les facteurs associés à la mortalité ont été le poids de naissance < 1000g (p < 0,0001), l’âge gestationnel < 28SA (p < 0,0001), l’hypothermie (p < 0,0001), la détresse respiratoire (p = 0,002), le transport à pied (p = 0,004). Conclusion: La réduction de la mortalité des prématurés passe par une amélioration du système de transfert et des conditions de prise en charge dans notre contexte. [ABSTRACT FROM AUTHOR]

Les femmes enceintes constituent l’un des groupes vulnérables de la population. Objectif: Notre travail avait pour but d’évaluer les connaissances générales sur le VIH/SIDA et la transmission verticale des gestantes. Matériel et Méthodes: Notre étude qui s’est déroulée dans le Centre de Référence de la Commune IV a porté sur 322 femmes enceintes reçues en consultation prénatale recensées durant 3 mois du 1er juin au 31 août 2007. Résultats: Très peu des gestantes interrogées avaient fait la démarche de dépistage du VIH (24 %), généralement au cours de CPN (15,21 %). Une faible proportion (14,3 %) des sujets de notre étude connaissait la sérologie du père. La majorité des femmes (93 %) était informées de la possibilité de la transmission mère enfant du VIH. La transmission pendant la grossesse est la période la plus citée (83,85 %) puis l’allaitement maternel (12,42 %) ; l’accouchement n’a jamais été évoqué comme période de TME. Les moyens évoqués pour réduire la TME du VIH ont été la prise de médicaments pendant la grossesse (20,8 %) ou l’accouchement (1,5 %), le dépistage précoce (12,42 %) et l’allaitement artificiel (6,21 %). Conclusion: Les connaissances des gestantes sur le VIH et la transmission verticale du VIH sont satisfaisantes. [ABSTRACT FROM AUTHOR]

Bowel transit disturbances favored by pregnancy and injuries during childbirth would be triggering or aggravating factors for anal pathologies. The objective of this work was to study the epidemiology, diagnosis, and treatment of anal pathologies during pregnancy and 6 weeks after delivery. We carried out a prospective, multi-centric, and analytical study in 10 obstetric units in Bamako from June 1 st , 2019, to May 31 st , 2020. After informed consent, we enrolled all first-trimester pregnant women admitted to the hospitals and who were followed up through the postpartum. We conducted a rectal examination in each participant and an anoscope in those with an anal symptom. Hemorrhoidal diseases were diagnosed in the case of external hemorrhoids (thrombosis or prolapse) or internal hemorrhoids. During the study period, we followed up 1,422 pregnant women and we found 38.4% (546) with anal pathologies (hemorrhoidal diseases in 13% (192), anal fissure in 10.5% (150) and anal incontinence in 8.6% (123). Risk factors for the hemorrhoidal disease were age of patient ≥30 years old aRR=5.77, 95% CI 4.57-7.34; p=0.000; a existence of chronic constipation aRR=2.61, 95% CI 1.98-3.44; p=0.000; newborn weight >3500 g aRR= 1.61, 95% CI 1.25-2.07; p=0.000 and fetal expulsion time >20 minutes aRR= 6.04, 95% CI 5.07-7.27; p=0.000. The clinical signs observed were constipation, anal pain, bleeding, and pruritus. The treatment was based on counseling on hygiene and diet, the use of laxatives, local topicals, and analgesics along perineal rehabilitation. Anal pathologies were common during pregnancy and 6 weeks after delivery. Pregnant women must be screened systematically for such pathologies. Early diagnostic and appropriate treatment would reduce serious complications., Competing Interests: The authors declare no competing interests., (Copyright: Adégné Togo et al.)

Breast cancer is the leading cancer in women worldwide. A better understanding of this pathology by women can contribute to significantly reducing its morbidity and mortality., Aim: It was to evaluate women's knowledge about breast cancer in the obstetrics and gynecology department of the district hospital of commune II of Bamako., Patients and Methods: We carried out a descriptive and analytical cross-sectional study with prospective collection of data from July 1 to August 31, 2021. It concerned women admitted to gynecological consultation without notion of emergency, who agreed to participate in this study., Results: In 2 months, 390 women agreed to participate in this study, of which almost half of the women (45.1%) had no knowledge of the risk factors, clinical signs and means of screening for breast cancer. breast. Women's knowledge of breast cancer was influenced by age, education level, profession, religion and marital status (p<0.001)., Conclusion: Breast cancer remains poorly understood by women. Intensifying awareness campaigns can help increase women's understanding of this scourge., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Fibroadenomas are the most common benign breast disorders. The aim of this study was to identify the clinical and therapeutic aspects of fibroadenoma in the obstetric gynecology department and General Surgery of Teaching hospital Gabriel TOURE in Bamako Mali., Patients and Methods: The study was descriptive with retrospective data collection from July 1, 2018 to July 31, 2021. The records of patients treated for fibroadenoma were included in accordance with ethical principles guaranteeing anonymity and confidentiality of data., Results: A total of 112 patients were selected for the study period, representing 15. 9% of all breast pathologies. We recorded 642 cases of breast mass, with fibroadenoma accounting for 16.72% of these breast tumors. Among all 154 benign breast tumors, fibroadenoma accounted for 72%. The mean age was 27 years, with a standard deviation of 14.8 years (13 years and 62 years). The 20-35 age group was the most represented, at 44%. The frequency of fibroadenoma decreased with increasing gestational age and parity. Over 60% of patients were overweight. The main reason for consultation was the presence of breast swelling. Unilateral left breast swelling was predominant in 46% of cases, and location in the upper-outer quadrant accounted for 50%. Surgical excision was the most frequent management modality, accounting for 56,2% of cases., Conclusion: fibroadenoma of the breast are a fairly common benign condition. Diagnosis requires surveillance. Surgical treatment should be discussed according to age, size and the presence of risk factors for malignancy., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Objectives: The aim of this work was to study the prognostic factors of breast cancer and their correlation with survival in women in the General Surgery Department of the Gabriel Touré CHU in Bamako., Materials and Methods: This was a cohort study from January 2020 to December 2022, a period of 36 months., Results: A total of 67 patients were registered. The mean age was 47.6 ±13.3 years; the mean time to consultation was 12.7 ±11.6 months. A breast mass was palpable in 82% of cases; its mean size was 7.18 cm±3,97. It was a non-specific infiltrating ductal carcinoma in 95.52% of cases. SBR grade 3 was found in 32.84%. Advanced stages (III and IV) accounted for 77.61% of cancers. The majority of cancers (50.74%) were triple-negative subtypes. Mastectomy with axillary dissection was performed in 95.52% of patients, with significant lymph node involvement in 35.82% of cases. Targeted therapy was performed in 7.46% of cases. Post-operative follow-up was straightforward in 89.09% of cases. Overall survival was 26.30 months with a median survival of 23.86 months. SBR3 grade and triple-negative subtype were the prognostic factors that significantly influenced survival., Conclusion: Efficient management of breast cancer requires proper assessment of prognostic factors. Biomolecular factors SBR-EE and triple-negative had a strong correlation with survival., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Breast cancer is the leading cancer in Mali. The objective of this study was to evaluate the risk factors of breast cancer associated with reproduction., Patients and Methods: We conducted a case-control study (January 2017 - September 2021) at the Gabriel Touré Teaching Hospital. The sample consisted of 200 cases and 400 controls. A multivariable logistic regression model was used to identify reproductive factors associated with breast cancer. Adjusted odds ratios (AOR) were produced with their 95% confidence intervals., Results: The mean age of cases was 46.1 years ± 14.6 vs 33.1 years ± 12.1 for controls. Menopausal women constituted 37.5 % of cases vs only 4% in the controls group. Nulliparity and breastfeeding were negatively associated with breast cancer (p <0,001) while postmenopausal women had a8.09-fold increase in the risk of breast cancer., Conclusion: Nulliparity, breastfeeding and menopause were the reproductive factors associated with breast cancer in Mali., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Oncology therapies have repercussions on the quality of life of patients. This quality of life is a cardinal element in the care pathway of patients. We initiated this work to assess the quality of life after mastectomy., Material and Method: We carried out a descriptive cross-sectional study over a period of 5 years from January 2016 to December 2020 in the General Surgery Department of the Gabriel Touré University Hospital. We included all patients who had undergone surgery for breast cancer with histological evidence and who had undergone a mastectomy and agreed to answer the questionnaire., Results: The QLQC3O questionnaire is a cancer-specific scale used to establish the quality of life score like many others, but with the difference that it is simpler, easier to use and more widely used. We have recorded 79 cases of mastectomy for breast cancer. The prevalence of mastectomy was 5.8%. The median age was 58 years. Patients had at least one child 92.38%. Non-specific ductal carcinoma was the most common histological type with 87.33%. The side effects of mastectomy affect the area of symptoms were the most difficult stage to bear with p value not significant. These situations have seriously affected self-esteem. Among the side effects affecting quality of life (52 cases), digestive disorders (22 cases) were in the first place, followed by dyspnea (7 cases) and financial difficulties (8 cases) which resulted in the sale of goods., Conclusion: The place of quality of life remains undeniable in the therapeutic strategy and its evaluation improves the therapeutic choice., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

In March 2021, in the framework of a partnership between the Geneva University Hospitals (HUG), the Santé Diabète Organization and the Ministry of Health of Mali, a 4-day workshop training course was organized with the objective of strengthening the skills of caregivers in Therapeutic Patient Education (TPE) for children and young people with type 1 diabetes. To ensure interprofessionalism, physician-nurse pairs already working together in health structures in 7 regions of Mali participated in the training. Beyond complementarity between health professionals, the aim was to cope with the realities of the Malian health system. All activities were co-chaired by physician-nurse pairs, specialized in diabetes and in TPE. A total of 30 professionals took part in the training, which consisted of 2 days of classroom training and 2 days of hands-on training with type 1 diabetic children and their families. To build the caregivers capacity in TPE, we chose innovative approaches with activities allowing the immediate application of skills learned with various pedagogical tools. The beneficiaries are not only the professionals, but also the children, teenagers and their families, including the trainers., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêt., (Copyright © 2021 SFMTSI.)

BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB. METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpo B sequencing to identify initial RR-TB. RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpo B sequencing results. Twenty-six (2.6%, 95%CI: 1.7-3.7) had mutations conferring rifampicin resistance. Most frequent rpo B mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M ( P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%. CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.

Background: The external quality assessment (EQA) or external quality control is an evaluation conducted by a certified external organization to inquire about the quality of the results provided by a laboratory. The primary role of EQA is to verify the accuracy of laboratory results. This is essential in research because research data should be published in international peer-reviewed journals, and laboratory results must be repeatable. In 2007, the University Clinical Research Center (UCRC's) biosafety level 3 (BSL-3) laboratory joined the EQA program with the College of American Pathologists in acid-fast staining and culture and identification of mycobacteria as per laboratory accreditation preparedness. Thus, after 11 years of participation, the goal of our study was to evaluate the performance of our laboratory during the different interlaboratory surveys., Methods: We conducted a descriptive retrospective study to evaluate the results of UCRC mycobacteriology laboratory from surveys conducted during 2007 and 2017., Results: Of the 22 evaluations, the laboratory had satisfactory (100% of concordance results) in 18 (81.8%) and good (80% of concordance results) in 4 (18.2%). Overall, the laboratory was above the commended/accepted limits of 75%., Conclusion: So far, UCRC's BSL-3 performed well during the first 11 years of survey participation, and efforts should be deployed to maintain this high quality in the preparedness for laboratory accreditation and support to clinical trials., Competing Interests: None

The occurrence of Ebola virus (EBOV) in West Africa during 2013-2015 is unprecedented. Early reports suggested that in this outbreak EBOV is mutating twice as fast as previously observed, which indicates the potential for changes in transmissibility and virulence and could render current molecular diagnostics and countermeasures ineffective. We have determined additional full-length sequences from two clusters of imported EBOV infections into Mali, and we show that the nucleotide substitution rate (9.6 × 10(-4) substitutions per site per year) is consistent with rates observed in Central African outbreaks. In addition, overall variation among all genotypes observed remains low. Thus, our data indicate that EBOV is not undergoing rapid evolution in humans during the current outbreak. This finding has important implications for outbreak response and public health decisions and should alleviate several previously raised concerns., (Copyright © 2015, American Association for the Advancement of Science.)

Objective: The aim was to evaluate the results of surgical treatment of occlusion of the sigmoid colon due to volvulus., Patients and Methods: This was a retrospective study from 1996 to 2010 of all patients undergoing surgery for sigmoid volvulus in surgical wards of the University Hospital of Bamako., Results: A total of 417 patients were identified including 379 men and 38 women. The mean patient age was 45.7 ± 18.3 years. The general condition of the patients was good in 70.5% and altered in 29.5% of cases. Colonic necrosis was present in 80 patients (19.2%). Single-stage resection with immediate anastomosis was performed in 149 patients (35.73%). Two-stage surgery was performed in 268 cases (64.27%). The initial stage of the two-stage procedure was colostomy in 167 cases and simple detorsion in 101 cases. The surgical approach had an impact on mortality in patients who were in poor general condition. Single-stage surgery resulted in higher mortality (12/149; 8.05%) than two-stage surgery (5/268; 1.87%), and the difference was statistically significant (P=0.0005)., Conclusion: Single-stage surgery for sigmoid volvulus carries a high risk of death when it is performed in patients with poor general condition. Indications for surgery must take into account the patient's general condition and the viability of the torsed sigmoid colon., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Unlabelled: Cancer today is being treated as a public health problem in Africa, as in developed countries., Objective: The aim of this retrospective study was to evaluate the epidemiology and outcome of children treated in the Pediatric Oncology Unit of Gabriel Touré Teaching Hospital in Bamako (Mali), six years after it opened., Methods: Retrospective study of the files of all children aged 15 and younger diagnosed with cancer and treated by chemotherapy between January 1, 2005, and December 31, 2010., Results: The study included 690 children. Their mean age was 24 months. The time from observation of first symptoms to consultation was less than 3 months in 200 cases (29%), from 3 to 10 months in 256 (37.1%), and more than 10 months in 234 (33.9%). The five most common childhood cancers were malignant non-Hodgkin's lymphoma (NHL) (n=231, 33.5%), retinoblastoma (n=170, 24.6%), nephroblastoma (n=102, 14.8%), acute lymphoblastic leukemia (n=54, 7%), and Hodgkin's disease (n=34, 4%). Six years after the unit opened and after a mean follow-up of 3 years, we recorded 272 deaths (39.4%); at least 238 children are still alive (34.5%), with 180 cases (26.1%) lost to follow-up., Conclusion: Childhood cancer survival is still low in Mali, and the rate of loss to follow-up quite high.

A six-month prospective surveillance study of postoperative surgical site infections (SSIs) was undertaken between January and June 2010 in paediatric patients aged <15 years, in the University Hospital Gabriel Touré, Mali. SSI was documented in 43 out of 352 children (12.2%). SSIs were significantly more common after emergency operations, in patients with a National Nosocomial Infection Surveillance System (NNISS) score of 2 or 3, and in patients operated on by trainee rather than by experienced surgeons. Children with anaemia or malnutrition were significantly more likely to develop infection postoperatively. Patients' sex, duration of preoperative stay and the number of patients in the hospital room were not considered as risk factors for infection (P>0.05)., (Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Unlabelled: The objectives were to determine the frequency, to describe the clinical, therapeutic aspects and to evaluate the cost of the assumption of responsibility of occlusions by supports and or adherences. It was about a retrospective study carried out in the department of surgery general of the CHU Hôpital Gabriel TOURE from January 1st, 2002 to December 2008. Were included in this study all the patients operated for occlusion of hail on Brides and Adherence confirmed in per operational. We colligé 659 acute obstructions of the bowels whose 100 occlusions of hail on supports and adherences is a frequency of 17,8%. They were 55 men (55%) and 45 women (45%). The sex-ratio was of 1,2. The average age was 39,7 years with the extremes varying between 15ans and 80 years. Eighty eight of our patients had surgical antecedents including 14 (16%) of surgery known méso colic and 74 (84%) of surgery under méso colic. Twelve patients had antecedents of contusion and untreated abdominal infections. Among the signs of the occlusive syndrome, the abdominal pain was found at all the malades100 (100%), the vomiting (98), the stop of the matters (88) and the gases (80). The ASP was carried out at 98 of our patients and 74 (75,5%) presented radiological images in favor of the occlusion of hail. The leading cause of occlusion was the supports (67), the supports and adherences (18) and adherences (15). The small intestine was hyperhémié chez14 patient, was necrosed among 16 patients and normal in the 70 cases. The surgical treatment consisted with a section of the support among 60 patients Adhésiolyse among 15 patients, a Adhésiolyse section among 10 patients, a résection Iléostomie among 10 patients and a résection - immediate anastomosis among 5 patients. The rate of morbidity was of 28%, it related to the infection of the operational site 18cas, the digestive dent 6cas and the eventration 4cas. Mortality was of 8%. Intermediate duration of hospitalization 14,8 days. The average costs of the assumption of responsibility were of 156.900 francs CFA., Conclusion: Mortality and postoperative morbidity are not negligible. Gravity of this pathology underlines the interest of it's fast assumption.

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

Objectives: Were to determine the frequency, to describe the clinical and therapeutic aspects digestive stoma., Material and Methods: It was about six months an exploratory study from January 1st to June 30th, 2008 in the department of surgery general of the CHU Gabriel Touré. Were included in this study all the patients carrying a enter stoma or a colostomy, old of more than 15 ans. The digestive dents, the other types of stoma and the patients old of less than 15 years, were excluded. The results were analyzed by the software Epi information version 6.4 Fr, the tests of Khi 2 and Student with a threshold of significance for P < 0.05., Results: We college 32 patients are 7.4% of all digestive surgical operations, 13.3% of the abdominal urgencies; composed of 26 men (81.25%) and 6 women (18.75%). The sex ratio at summer of 4.3. The average age was 44, 8 years with a standard deviation 8, 13 and the extremes varying between 16-80 years. Twenty and one (65.6%) sick were operated in urgency. We carried out 29 cases (90.6%) of final stoma, 3 cas (9.4%) side, 21 cas (65.6%) of colostomy, 9 cas (28.1%) of ileostomies. They were temporary in 25 cas (78.1%) and final 7 cas (21.9%). The volvulus of the sigmoid colonist with necroses 10 cas (31.3%), the peritonitis by typhus perforation ilea 9 cas (28.1%), occlusions on tumor of the left colonist 8 cas (25%), the traumatic perforations ileales 2 cas (6.3%), the digestive dents post appendicectomies 2 cas (6.3%) and the congenital megacolon 1 cas (3%) was the indications of the stoma. the operational continuations were simple in 21 cas (65.6%). The principal found complications were: coetaneous irritation 7 cas (21.8%), the prolapsed stomiale 4 cas (12.5%), the suppuration peristomial 3 cas (9.4%), the releasing of Stoma 3 cas (9.4%), the retraction of the stoma 3 cas (9.4%),the psychological disorders 3 cases (9.4%), the hemorrhage 2 cas (6.3), necroses peristomial 2 cas (3.1%), septic shock 2 cas (6.3%), and 1 cas (3.1%) of evisceration, obstruction of the bowels, shock hypovolemic. The intermediate duration of hospitalization was of 37,5 jours with a standard deviation = 13.58 and extremes varying between 02-73 days. Death rate was of 9.4%., Conclusion: The assumption of responsibility of the stomies is difficult in the absence of stomatherapeutes, and of the high cost of the parenteral nutrition in our context .

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