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Introduction: Spinal muscular atrophy (SMA) and sporadic amyotrophic lateral sclerosis (SALS) are both motor neuron disorders. SMA results from the deletion of the survival motor neuron ( SMN ) 1 gene. High or low SMN1 copy number and the absence of SMN2 have been reported as risk factors for the development or severity of SALS., Objective: To investigate the role of SMN gene copy number in the onset and severity of SALS in Malians., Material and Methods: We determined the SMN1 and SMN2 copy number in genomic DNA samples from 391 Malian adult volunteers, 120 Yoruba from Nigeria, 120 Luyha from Kenya and 74 U.S. Caucasians using a Taqman quantitative PCR assay. We evaluated the SALS risk based on the estimated SMA protein level using the Veldink formula ( SMN1 copy number + 0.2 ∗  SMN2 copy number). We also characterized the disease natural history in 15 ALS patients at the teaching hospital of Point G, Bamako, Mali., Results: We found that 131 of 391 (33.5%) had an estimated SMN protein expression of ≤ 2.2; 60 out of 391 (15.3%) had an estimated SMN protein expression < 2 and would be at risk of ALS and the disease onset was as early as 16 years old. All 15 patients were male and some were physically handicapped within 1-2 years in the disease course., Conclusion: Because of the short survival time of our patients, family histories and sample DNA for testing were not done. However, our results show that sporadic ALS is of earlier onset and shorter survival time as compared to patients elsewhere. We plan to establish a network of neurologists and researchers for early screening of ALS.

Background: Road traffic accidents are major causes of mortality and morbidity. Therefore, we proposed to do a descriptive study of these accidents in the Diéma Referral Health Center during our study period., Material and Methods: This is a descriptive cross-sectional study, which took place in the health district of Diema (Kayes region) from February to July, 2010. It concerned patients victim of road traffic accidents and admitted to the Diema referral health center. Patient information was collected from medical records using a customized questionnaire. Data analysis was done using the SPSS 12.0 software. Quantitative variables were expressed as mean and standard deviation and categorical variables by proportions., Results: A total of 143 patients were admitted. The prevalence of accidents was 8.66%. The mean age of patients was 31.5 ± 12.2 years. The male sex was the most affected 72%. Automobiles were most involved 67.1%. The frequency of these accidents was higher in March at 30.1%. The injuries were the most common lesions with 86.1% of cases and the head was the most affected with 48.3%. Half of these accidents occurred between 8 o'clock and 12 o'clock. We observed 4.9% of deaths., Conclusion: Traffic accidents remain true public health problems today because of the serious consequences they generate. To reduce this problem, it is necessary to have well adapted roads and ensure a rigorous application of the rules of the road., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Aims: To describe the epidemiological and therapeutic aspects of rare fractures of the elbow in children and assess their prognosis., Materials and Methods: This was a retrospective study conducted from 1st January 2008 to 31st August 2009 in all children aged 0-15 years treated for rare fractures of the elbow seen before 21 days and followed in the service., Results: Rare elbow fractures represented 19.42% of total elbow fractures during the study period. Male dominance was clear: 28 boys for 6 girls with a sex ratio of 4.66:1. The average age of the children was 8.2 years with extreme of 3 and 15 years. These fractures, in most cases, were the result of a play accident in 16 cases (47.1%). The main reason for consultation was represented by a sore elbow (91.2%). Trauma was found in the right elbow 61.8% of the time and in the left elbow 38.2%. Among the most common fractures were those of the lateral epicondyle and the olecranon which accounted for 11 cases (6.28%) and 10 cases (5.71%) of all fractures of the elbow. Twenty-one children received orthopedic treatment and 13 children received surgical treatment. The average assessment of our patients follow-up was 10 months with extreme of 6 months and 16 months. The results were good in 32 children without any radiological abnormality or functional sequelae., Conclusion: The prognosis of rare fractures of the elbow is usually good if the management is efficient. Monitoring should be continued long term to watch the sequelae., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: This research aimed to analyze the epidemio- clinical characteristic and the prognosis of patients with eclampsia admitted to the intensive care unit at the University Hospital of Point G., Materials and Methods: The clinical records of all patients admitted to intensive care for eclampsia from September 2009 to February 2011 were retrospectively collected. We analyzed the following parameters: age, parity, gravidity, the admission deadline, the beginning of eclampsia compared to the term of pregnancy, the number of seizure, mode of delivery, score of Glasgow, blood pressure, proteinuria, complications and evolution., Results: Among 702 admissions, 158 patients, with a mean age of 20 ± 4 were hospitalized for eclampsia (22.5%). We recorded 106 cases of first pregnancies (67.1%) and 104 primiparous (65.8%). The admission period after the first seizure was over 6 hours for 90 patients (57%). The first seizure had occurred in ante-partum period for 69 patients, in per-partum period for 4 patients and in postpartum period for 85 patients., Ninety-three patients (59%) had consciousness disorders at admission, 12 patients received oxygen treatment .Vaginal delivery was the mode of delivery for 93 patients and cesarean section for 65 patients.Eclampsia was associated with renal failure in 25 patients, HELLP syndrome for 15 patients, the stroke for 5 patients, acute pulmonary edema for 3 patients, the coagulation disorders for one patient; and the sepsis for 6 patients. Maternal and perinatal lethality was 9.5% and 10.8% respectively., Conclusion: Eclampsia is a frequent medical and obstetric emergency in intensive care unit of the University Hospital of Point G and affects young patients during their first pregnancy and delivery. Maternal and perinatal lethality remains high, due to the delay in the cases management and the associated factors of gravity. Strong actions are needed to raise awareness for early medical visit and to prepare medical teams for better cases management., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Traumatic Brain Injury (TBI) is the second cause of admission in the emergency department at the Nianankoro Fomba hospital of Ségou. Young adults with low income are the most affected. The objective of this study is to evaluate the direct cost of the management of TBI at the emergency ward and to make a proposal for future financing of this management in Mali. We conducted a prospective study from September 2009 to December 2010 at the Nianankoro Fomba hospital of Ségou. All patients admitted in the emergency ward for TBI for more than 24 hours were included. The age range between 21-40 was the most affected. All socioprofessional categories were affected. The average cost of prescription was 55,392 CFA. Medical evacuation was necessary in 15 cases for an average fee of 60,700 CFA. Due to lack of money, 75% of deceased patients were not evacuated at the third level. The average cost of management was 99,385 CFA [range: 39,115-282,944]. The total cost of services was 7,269,320 CFA. The high cost of the management of TBI is a major determinant of morbidity and mortality of this disease., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Wireless body sensor networks (WBSNs) for healthcare and medical applications are real-time and life-critical infrastructures, which require a strict guarantee of quality of service (QoS), in terms of latency, error rate and reliability. Considering the criticality of healthcare and medical applications, WBSNs need to fulfill users/applications and the corresponding network's QoS requirements. For instance, for a real-time application to support on-time data delivery, a WBSN needs to guarantee a constrained delay at the network level. A network coding-based error recovery mechanism is an emerging mechanism that can be used in these systems to support QoS at very low energy, memory and hardware cost. However, in dynamic network environments and user requirements, the original non-adaptive version of network coding fails to support some of the network and user QoS requirements. This work explores the QoS requirements of WBSNs in both perspectives of QoS. Based on these requirements, this paper proposes an adaptive network coding-based, QoS-aware error recovery mechanism for WBSNs. It utilizes network-level and user-/application-level information to make it adaptive in both contexts. Thus, it provides improved QoS support adaptively in terms of reliability, energy efficiency and delay. Simulation results show the potential of the proposed mechanism in terms of adaptability, reliability, real-time data delivery and network lifetime compared to its counterparts.

The objectives were to determine the frequency, and to describe the clinical and therapeutic aspects of amoebic liver abscess. This was a retrospective study in the general surgery department of the Gabriel Touré teaching hospital from 1 January 2004 to December 2008. Included in this study, were all patients hospitalized and treated for amoebic liver abscess. We collected 53 cases a frequency of 1.3%. This was 45 men (84.9%) and 8 women (15.1%). The sex ratio was 5.6. The average age was 39.5 years. The average consultation time was 3 weeks. The signs observed were fever 96.2% (51 cases), the hepatalgia 94.3% (50 case), hepatomegaly 90.6% (48 cases) and anorexia 88.7% (47 cases). Collections of objectified abscess in abdominal ultrasound were located in the right lobe in 79.2% (42 cases), unique in 92.5% (49 cases) and 100 mm in diameter on average. Pulmonary radiography found an elevation of the right diaphragmatic dome 66.7% (14 cases). Amoebic serology was performed in 60.4% of cases, was negative in 2 cases (6.2%). Medical treatment alone was effective in the majority of cases - 62.7% (32 cases), an ultrasound-guided paracentesis associated with medical treatment was required in 31.4% (16 cases). Surgical methods were very rarely recommended 5.9 % (3 cases). The average amount of pus was 637.6ml. Average duration of treatment was 11 days. We recorded three deaths, including one due to a sepsis on peritonitis from ruptured liver abscess and 2 cases due to HIV., Conclusion: The amoebic liver abscess is uncommon in our service. Negative serology does not exclude the diagnosis. Medical treatment is usually curative in the absence of complications., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Aims: To determine the frequency and factors of complications of intestinal stomas., Methods: This was a retrospective study over a 7 year period from January 2004 to December 2010, covering all children aged 0-15 years, who received a stoma and hospitalized in the period of study. Excluded from this study, alimentary ostomy and urological ostomy, and children whose medical records were incomplete., Results: We examined 192 cases of stoma or 27 cases/year. We noted a complication in 91 (48%) of our patients. The average age was 3.64 ± 5.03 years ranging from 6 hours and 15 years. The complicating factors were: the indication for surgery, type of stoma, the variety of stoma, surgical technique and equipment., Conclusion: The achievement of good technique and appropriate equipment would be needed to reduce some complications of the stoma., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

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.

Our objectives were to determine the frequency, clinical, and therapeutic aspects and to evaluate the cost of care., Patients and Method: This was a retrospective, analytical study, , carried out in the general surgery department of the teaching hospital Gabriel Touré from 1 January 2000 to December 2008. Were included in this study all patients operated for necrotic ulcer in the service., Results: Seventy -nine (79) patients were identified which represents 0.6 % of our admissions. There were 48 men (60.8%) and 31 women (39.2%) . The sex ratio was 1.5 . The average age was 33.6 years, with extremes ranging from 31-81 years and the standard deviation = 19.7. The diagnosis was based on clinical and paraclinical investigations in all patients (100 %). The average period of consultation was 1.2 months, with extremes ranging from 1 - 24 months and the standard deviation = 0.8. Traditional medications were given to 38 patients (48.1%). The ulcer was multiple in 20 patients (25.3%). In 57 cases (72.2%) it sat in the lower limb and in 22 cases (27.8 %) in the upper limb. The average diameter was 24.3 cm and the standard deviation = 15.1. Trauma and infection were, respectively, the main causes in 63 patients (79.7 %) and 10 patients (12.6%). The most frequent germs found were the Staphylococcus aureus in 40 patients (50.6%) and Proteus mirabilis in 10 patients (12.7%). The thin skin autograft was performed in 66 patients (83.5 %). Healing was complete in 52 patients (78.8%), with a morbidity of 21.2 % (14 cases) . Infection was observed on graft and edema, 5 cases each (7.6%), graft rejection 4 cases (6.1%). The average hospital stay was 2.3 months. The average cost was 237,450 with a range of 75,000 to 500,000 FCFA., Conclusions: Necrotic ulcer is an uncommon pathology in our department. The lack of consultation and the use of traditional medication are the main factors of seriousness., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Goal: The aim of this study was to take stock of the practice of the loco-regional anesthesia (LRA) at the University Hospital Center of Point G from January 2004 to December 2008., Materials and Method: This is a retrospective study, assessing the practice of LRA. The demographic data, the surgery, the technical characteristics of the procedure made, the type of local anesthetic used, adverse events were evaluated., Results: The LRA involved 1261 patients - 8.30% of the total number of surgical procedures occurring during the studied period. The American Society of Anesthesiology (ASA) classification was used for the evaluation of patients in scheduled surgery. The patients belonged to class 1 (50.40%) and Class 2 (49.60%). The main surgical procedures were: 26.20% surgical prostatic adenomectomy, 23.80% of caesarean section, and the fistulogram test for 19.04%. The LRA techniques performed were: spinal anesthesia, 87.60%, epidural anesthesia, 12%. Three hundred and three adverse events (24%) have been reported, three (1%) of them have resulted in the death of the patient. The incidence of arterial hypotension was 94.40%, and 4.6% for bradycardia. The three heart attacks were fatal (0.024 ‰). Patients operated under spinal anesthesia and patients aged 60 years and older had more adverse events with 20% and 10.38% for p <0.05 respectively. Sixty eight failures (5.4%) were observed., Conclusion: The practice of LRA at the University Hospital of Point G is characterized by adverse events and a low number of deaths. Patients operated under spinal anesthesia and patients aged 60 years and older are at greatest risk of adverse events., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Introduction: Providing care for penetrating abdominal wounds is a controversial subject. The aim of this project was to describe their epidemiological, clinical and therapeutic aspects., Materials and Methods: This retrospective study conducted over 4 years, from January 2006 to January 2010 concerned 70 cases of penetrating abdominal injury in the general surgery department of the Gabriel TOURE teaching hospital. Non-piercing and animal horn related abdominal injuries were not included., Results: We collated 70 cases of penetrating abdominal wounds; representing 1.2% of hospitalisations during the studied time frame. The patients were 12 to 59 years old with a mean age of 27.7 years and a sex-ratio of 9 to 1 for men. 27 patients (38.36%) came from districts I and II of Bamako. Criminal injuries was the main cause of injury encountered representing 70% cases. 3 of the patients had psychiatric antecedents and 45.7% of patients regularly consumed drugs. The epiploon and small intestine were the main eviscerated organs (51.4% cases). 17/53 patients received non-surgical treatment. The rate of laparotomia was of 30.2% and postoperative morbidity 15.1%., Conclusion: Treating penetrating abdominal injury remains difficult. A good selection of patients allow the service to lower the rate of laparotomia., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Acute intestinal invagination is a rare pathology in adults; even more so on specific fields as in pregnant women. Therapeutic indications depend on the duration of the invagination. We noted a cases of acute intestinal invagination after 72 hours of evolution in a multiparous 35 year old woman, 27 weeks pregnant, successfully treated by surgery and tocolysis., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Aims: To determine related factors of complications typhoid perforations in the small intestine in children., Material and Method: A retrospective study was conducted between June 1 st , 2005 to June 30 th , 2010 in all children aged 0 to 14 years treated for peritonitis by ileal perforations in the service of paediatric surgery at the Gabriel Touré teaching hospital. Traumatic perforations and patients with incomplete files were not included in this study., Results: In 5 years time we gathered 105 cases of ileal typhoid perforation. After surgical treatment early outcomes were simple in 70 patients (66.6%), a parietal suppuration had been noted in 15 patients (14.3%) and fistula in 4 (3.9%). Sixteen patients (15.2%) died. Complications were related to patient's age, ASA Score, time frame of care, quantity of peritoneal fluid, number and site of perforation, surgical techniques and the duration of surgery P(<0.05). Sex, anaemia, surgeon, and perforation diameter did not significantly influence the rate of complications., Conclusion: Reduction of morbi-mortality happens through prevention, earlier diagnosis and appropriate management of typhoid fever., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Aims: The aim of this study was to describe the clinical and therapeutic aspects of peritonitis by typhoid ileal perforation in a tropical typhoid fever endemic area., Patients and Methods: A descriptive retrospective study over an 8 year period (January 2000 to December 2007) was undertaken in a visceral service of the Point G teaching hospital in Bamako, Mali. Only patients diagnosed and operated for peritonitis presenting lesions or perforations of the final ileum were included in the study., Results: The data from 120 patients meeting the inclusion criteria was collected. The average age was 22.7 years old. Triad abdominal pains (120 cases; 100%), vomiting (41; 62.3%), lack of matter and gas (22; 32.3%) constituted the main part of the functional signs. The physical examination showed a localised abdominal defence (7 cases, 10.3%), generalized defence (98 cases; 81.6%), and 2 unspecified cases (2.9%). A "wood belly" abdomen was palpated among 105 patients (87.5%), as well as umbilical hernias (106 cases; 88.3%). The Felix and Widal agglutination test was positive for 75 patients (62.5%) and negative for 27 patients (22.5%). During the operation, the quantity of aspirated pus was higher than 1500 ml in 2 cases and lower or equal to 500 ml in 57.4% of cases. The site of the perforation was ante mesenteric in 64 cases (53.3%). Excision-suture and abdominal cleansing were the most common surgical procedures (68 cases; 57%). Postoperatively 19 patients (15.83%) died of septic shock. The average duration of hospitalization was 20.6 days., Conclusion: The peritonitis by typhoid ileum perforation is still the cause of a high mortality rate in our country. The prevention by the vaccination in young populations could decrease the incidence of pathology and the serious complications which result from this., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: Describe the therapeutic and diagnostic aspects of gastric cancer perforations at the general surgery department of the Gabriel Touré teaching hospital., Patients and Method: A retrospective survey was conducted over 11 years (January 1999 to December 2010). It included all patients having had surgery for peritonitis by gastric cancer perforation at the service during that time frame., Results: We found 14 cases of peritonitis due to gastric perforation, of which 9 were male and 5 female. The main clinical symptoms were abdominal pain (100%), weight loss (100%) and abdominal contraction (98.8%). Endoscopy allowed to note a pyloric antrum budding tumor in 4 patients before perforation. Radiography of the abdomen without preparation showed pneumoperitoneum in 8 cases. In all cases, the histological type recorded was adenocarcinoma. The antral seat was the most common (64.3%). Palliative surgery was immediately performed in all cases. We recorded two cases of fistula tract and 3 cases of infection of the lining, as well as 2 cases of postoperative mortality., Conclusion: Gastric cancer perforation is rare and of bad prognosis as it survives on advanced cancer., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: To evaluate the management of postoperative pain in the Point G teaching hospital., Patients and Methods: We carried out a prospective study, in 2008. Inclusion criteria for the personnel: be a staff member from the department of surgery or anaesthesia reanimation; willing to fill out the questionnaire. Inclusion criteria for patients: to be operated and hospitalized in one of the departments of surgery and anaesthesia reanimation., Results: We collated the responses of 600 patients and 113 personnel. 92% of the patients underwent post-operative analgesia. The delay between the request and treatment of the patient was extensive in 92% of cases. The medical personnel and nursing staff had not received specific training on treating the pain in respectively 55% and 70% of cases. We noted an absence of informational support and of pre-established consensual protocols, written and validated on the management of postoperative pains., Conclusion: The treatment of the postoperative pains shows important shortcomings within the Point G teaching hospital and these insufficiencies are found across levels., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

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

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

Aim: To compare paracetamol saving followed by the association of ketamine chlorhydrate - magnesium sulfate to ketamine chlorhydrate and analyze cost after the 2 protocols administration., Material and Methods: We conducted this comparative study from June 2005 to January 2006 in the services of anesthesiology and resuscitation and visceral surgery of the teaching hospital Gabriel Touré, Bamako. 80 patients were split into 2 groups - group A receiving: 0,25mg/kg of ketamine chlorhydrate plus 50mg /kg of magnesium sulfate, group B receiving: 0,25mg/kg of ketamine chlorhydrate., Results: The 2 groups were compared by anthropometrical and clinical data (age, sex, weight) and ASA. The reduction of paracetamol dosage was 57, 50 % of the 4 g actually used per day in A group against 48, 50% in B group., Conclusion: Ketamin chlorhydrate associated to magnesium sulfate insure a post-operative analgesic saving in visceral surgery. Cost of analgesia actually used is reduced., (Le comitée de rédaction se réserve le droit de revoyer 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 sonserver un examplaire du manuscrit, des figures et des tableaux.)

Objective: To evaluate the short term outcome of patients who underwent pleuro-pulmonary decortication., Method: This is a retrospective study of 174 patients treated for thoracic empyema in Point G Hospital, Bamako/Mali, between 2004 and 2007. Perioperative data of 51 patients who underwent pleuro-pulmonary decortication had been recorded., Results: Of the 174 patients treated, 51 (29.3%) underwent pleuro-pulmonary decortication. 84.5% were male and 70.6% were less than 45 years old. A recent history of tuberculosis was found in 59%. Among the four patients selected for a thoracoscopic procedure, only two were treated successfully. A conventional postero-lateral thoracotomy was used in the remaining 49 patients. The lung expansion, estimated intraoperatively, was complete in 43 cases and incomplete in eight cases. Among these eight patients with incomplete lung expansion, four developed a secondary empyema and required a thoracoplasty. The postoperative mortality was 6% (three patients)., Conclusion: In our hospital, one third of patients with thoracic empyema required a pleuro-pulmonary decortication. Incomplete lung expansion is a potential risk factor of postoperative infection necessitating re-operation or more extensive surgical procedures., (Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

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.)

A 27-year-old woman, gravida 1, was seen at our surgical emergency department with abdominal pain at 25 weeks' gestation. She had pain, nausea and vomiting, a temperature of 37°C and a blood pressure of 100/70 mmHg. The cervix was closed, and an ultrasound scan showed a normal single fetus. A plain abdominal radiograph showed distension of the colon and a sigmoid volvulus. At emergency laparotomy, non-gangrenous sigmoid colon was resected with primary anastomosis. There were no complications, and 4 months later the patient delivered a healthy infant. Early diagnosis of sigmoid volvulus in pregnancy and prompt intervention minimise maternal and fetal morbidity and mortality.

Objective: To study the etiologies, therapeutic and prognosis factors of coma in the elderly in the Department of Anesthesia and Intensive Care of Gabriel TOURE Teaching Hospital, Mali., Materials and Methods: This was a prospective descriptive study of all cases of coma in the elderly, registered from February 1, 2008 to January 31, 2009 at the Department of Anesthesiology CHU Gabriel Touré, Bamako., Results: During the study period, 564 patients were admitted to the intensive care unit (ICU) in which 174 (30.85%) were older people. We collected 100 subjects with impaired consciousness, the object of our study, which represented 17.73% of all admissions in the Department of Anesthesiology during the study period and 57.47% of all admissions of older people; 66% of our subjects were male. Hypertensive patients accounted for 60% of cases. In 46% of cases, it was a coma from cardiovascular causes and in 28% of cases; it was a coma of metabolic origin. The diagnoses made in the wake of the care of the elderly in ICU were predominantly stroke (46%) and electrolyte disturbances (13%). The coma was sudden onset in 58% of cases, including 28 cases of stroke whether 48.27%. The prognosis was marked by a fatality with 51% of deaths in our sample., Conclusion: The prognosis improvement of the elderly in coma through to the introduction of proxy measures.

Goals: In the frame of the project "Bringing the healthcare near to the people of Municipality of Zegoua" one goal was the strengthening of SLIS and its adaptation to the context of decentralization., Methodology: The research included the decentralized collection and analysis of health data (modern and traditional) and the presentation of key indicators in graphical form to local authorities, to support decision making., Results: The analysis of data from 2006-2008 found: the increase in Curative Consultation from 0.24 to 0.40; achieving universal coverage in Pre-Natal Consultations and Assisted Deliveries, 86.12% coverage in Post-Natal Consultations. For 2008, the evolution of key indicators for month was presented to local authorities and the data were also disaggregated by village. The analysis of financial data allowed to draw up the balance of the Zégoua Polycentric CHCs, and to monitor the capital of essential drugs. About Traditional Medicine, it was identified one traditional healer for 236 inhabitants. The average was 277 patients per month. The first cause of consultation was malaria. The availability of essential information presented in an understandable form has enabled local authorities to identify and locate health problems, and to take timely targeted decisions., Conclusion: These results demonstrate the importance of strengthening the SLIS and of its adaptation to the context of decentralization, as part of the consolidation of local health systems.

Aim: To evaluate the effect of lidocaîne use by IV during endotracheal intubation., Patients and Method: Our study was simple insu randomized prospective and comparative. It was done at the teaching hospital Gabriel Touré of Bamako from march to September 2005. Patients were distributed in 3 groups. The first group I: got fentanyl 2 nmg /kg+penthotal 5mg/kg+vecuronium 0.1mg/kg and intubation 3 mn later. The group II: lodocaîne 1,5mg +fentanyl 2nmg/kg+penthotal 5mg /kg + vecuronium 0.1mg/kg and intubation 3mn later. The group III: lodocaïne 1.5 mg/kg+pentothal 5mg/kg+vecuronium 0.1mg/kg and intubation 3 mn later., Results: The mean arterial pression to intubation has been 105.88±13.82 mmhg in the groupI, 96.60±15.01mmhg in the group II and 96.44±12.09mmhg in the group III with P = 0.008. To incision it has been 99.12±11.82 in the group I, 94.90 ±6.67 mmhg in the group II and 92.26±8.81 mmhg in the groupIII with P = 0.017., Conclusion: Lidocaïne, used alone in Iv or associated to fentanyl 3 mn before intubation prevents hypertension related to intubation and incision.

Introduction: Myocardial infarction is a major emergency involving life-threatening in the absence of appropriate treatment. The aim of this study was to analyze the problem of management of myocardial infarction in a second reference hospital in Mali., Patients and Methods: This was a prospective descriptive study over a period of six months from January to June 2010. It concerned all patients admitted for myocardial infarction in intensive care.The diagnosis was suspected in chest pain or the occurrence of complications (PAO, cardiogenic shock) and electrocardiogram signs on at least two precordial leads. The parameters studied were: age,reason for admission, risk factors, hemodynamic parameters, the deadline for completion of the ECG, the topography of lesions and electrical changes within 15 days., Results: A male was found with a mean age of 54.62 years. Chest pain was the main reason for admission (6 cases) followed by cardiogenic shock (1 case) and acute pulmonary edema (1 case). The electrocardiogram was performed in 7 patients more than 24 hours after admission. The anterior territory was the most affected. On admission three patients had a systolic pressure below 90 mmHg.The evolution was marked by occurred heart failure (3 cases) and death (2 cases)., Conclusion: The lack of diagnostic and therapeutic method in our heath facility helps to increase morbidity and mortality associated with myocardial infarction.

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: Myocardial infarction is a major emergency involving life-threatening in the absence of appropriate treatment. The aim of this study was to analyze the problem of management of myocardial infarction in a second reference hospital in Mali. PATIENTS AND METHODS : This was a prospective descriptive study over a period of six months from January to June 2010. It concerned all patients admitted for myocardial infarction in intensive care.The diagnosis was suspected in chest pain or the occurrence of complications (PAO, cardiogenic shock) and electrocardiogram signs on at least two precordial leads. The parameters studied were: age,reason for admission, risk factors, hemodynamic parameters, the deadline for completion of the ECG, the topography of lesions and electrical changes within 15 days., Results: A male was found with a mean age of 54.62 years. Chest pain was the main reason for admission (6 cases) followed by cardiogenic shock (1 case) and acute pulmonary edema (1 case). The electrocardiogram was performed in 7 patients more than 24 hours after admission. The anterior territory was the most affected. On admission three patients had a systolic pressure below 90 mmHg.The evolution was marked by occurred heart failure (3 cases) and death (2 cases)., Conclusion: The lack of diagnostic and therapeutic method in our heath facility helps to increase morbidity and mortality associated with myocardial infarction.

Object: Studying the Epidemiological and clinical profile of accidents on public ways at the welcome service of emergencies, CHU Gabriel Touré within the scope of accident reduction on public ways and an improvement of their taking in charge., Methodology: Retro prospective study over a three-year- period including all the files of any patient emitted for accident happening on public ways without regard to race and sex., Result: Over a three-year-period (from January 2007 to December 2009). Our team has analized 2450 hospitalization files with a follow-up going from 0 to 45 days. The most concerned ages range from 15 to 29 years (43 per cent) with a male predominance (81 per cent). The mechanism motorcycles-pedestrians (30.9 per cent) was the most represented. The mains lesions observed were cranial traumatisms (58.9 per cent), followed with fractures of limbs (13.5 per cent). Death-rate has been risen at the level of young men above all (from 15 to 29 years) and it was mainly due to cranial traumatisms., Conclusion: Accidents on public ways represent a keen problem in matter of public health. The taking in charge of the curse should be very urgent. Information, communication and education of all the professional and social stratums seem necessary.

Purpose: Determine the epidemiology of intoxications in the emergency service medico-surgical., Materials and Methods: The stady was retrospective and transversal from January 2002 to December 2006 in the service of medical surgical emergencies of the teaching hospital Gabriel Touré. Where included all patients admitted and presenting with acute poisoning. Chi2 test was used to compare our results and the level of significance set at p <0.05., Results: Over 5 years, 365 cases of intoxication were collected on a total of 10997 admission with a prevalence of 3.32 %. Patients aged of 0-20 years accounted for 46.58% of cases. The female patients were predominant with 62.47 % of cases. Pupils and students predominated with 31.51 %. Antimalarials were found primarily at the base of poisoning with 32.33 % of cases of drug poisoning. The digestive tract was predominant with 97.81%., Conclusion: The typical profile of acute poisoning is a young female pupil or student who took a voluntary drug substance.

Background: Recently, a number of Global Health Initiatives (GHI) have been created to address single disease issues in low-income countries, such as poliomyelitis, trachoma, neonatal tetanus, etc.. Empirical evidence on the effects of such GHIs on local health systems remains scarce. This paper explores positive and negative effects of the Integrated Neglected Tropical Disease (NTD) Control Initiative, consisting in mass preventive chemotherapy for five targeted NTDs, on Mali's health system where it was first implemented in 2007., Methods and Findings: Campaign processes and interactions with the health system were assessed through participant observation in two rural districts (8 health centres each). Information was complemented by interviews with key informants, website search and literature review. Preliminary results were validated during feedback sessions with Malian authorities from national, regional and district levels. We present positive and negative effects of the NTD campaign on the health system using the WHO framework of analysis based on six interrelated elements: health service delivery, health workforce, health information system, drug procurement system, financing and governance. At point of delivery, campaign-related workload severely interfered with routine care delivery which was cut down or totally interrupted during the campaign, as nurses were absent from their health centre for campaign-related activities. Only 2 of the 16 health centres, characterized by a qualified, stable and motivated workforce, were able to keep routine services running and to use the campaign as an opportunity for quality improvement. Increased workload was compensated by allowances, which significantly improved staff income, but also contributed to divert attention away from core routine activities. While the campaign increased the availability of NTD drugs at country level, parallel systems for drug supply and evaluation requested extra efforts burdening local health systems. The campaign budget barely financed institutional strengthening. Finally, though the initiative rested at least partially on national structures, pressures to absorb donated drugs and reach short-term coverage results contributed to distract energies away from other priorities, including overall health systems strengthening., Conclusions: Our study indicates that positive synergies between disease specific interventions and nontargeted health services are more likely to occur in robust health services and systems. Disease-specific interventions implemented as parallel activities in fragile health services may further weaken their responsiveness to community needs, especially when several GHIs operate simultaneously. Health system strengthening will not result from the sum of selective global interventions but requires a comprehensive approach.

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

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 .

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

Aims: To evaluate mortality and morbidity related to brain trauma., Patients and Methods: It was about a descriptive study done on brain trauma patients admitted to the emergency of the teaching hospital Gabriel Touré from January to august 2004. Every patient admitted for brain trauma with ornote associated lesions was included. A p < 0.05 was considered significant. RESULTS During 8 months time 324 patients have been admitted for brain trauma. The male to female ratio was 3.1. School age and academic populations have represented 79 patients (24.4%). Brain trauma has happened in 268 cases (82.8%) in a context of public way accident. These accidents have concerned pedestrian in 42% of cases (auto-pedestrian or motorcycle-pedestrian). The morbidity rate was 11 %. Conclusion Intracerebral lesion are mostly seen in brain trauma. Being a pedestrian in an accident context may expose to brain trauma.

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

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.

Aims: Determine the aetiologic factors and evaluate the result of our chirurgical treatment., Patients and Methods: It was about a prospective study done from October 1st 2005 to March 31,2007 on all women seen for urinary discomfort in whom cystocele have been found., Results: The hospital frequency of cystocele has been 3.54%. The mean age of our patients has been 48 years. In the patient history dystocic delivery have been found in 7 cases (43.75%), foetal macrosomia in 7 cases, chronic constipation in 1 case (6.25%) and 4 patients were menopausal. For the parity 10 patients were big multi pares, 3 were multi pares (18.75%), 2 were pauci pares (12.5%) and 1 were nullius pare. Cystocele were classed 1st degree in 3 patients, 2nd degree in 9 patients (56.25%) and 3rd degree in 4 others (25%). Anterior plasty of the vaginal wall was done in 11 patients (68.75%) and anterior and posterior plasty of the vaginal wall in 5 patients (31.25%). After 6 months, 62.5% of patients have a good anatomic result and 68.75% a good functional result. Anatomic results were bad in 6.25%. Cystocele is frequent in young women in Mali. It is often related to obstetrical trauma. A rapid diagnosis and care will improve the prognosis.

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

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

Objectives: Evaluate the epidemio-clinical and therapeutic aspects of the femur's fracture of the child., Materiel and Methods: It was about a prospective study done from October 1st, 2005 to September 30, 2006 on all children of 0 to 15 years old admitted for femur fracture, treated and followed in the trauma center of hôpital Gabriel Touré. Disappeared patients have not been included., Results: We brought together during a period of 12 months 47 cases of fracture in 45 children representing 26 % of the activities of trauma unit of hôpital Gabriel Touré. Among our patients 25 were boys and 20 girls. The average age was 7.5 yeras +/-4. The public highway accident was the first cause (68.8%) followed by domestic accident (22.2%), sportive (6.6%), obstetrical (2.2%). The treatment was orthopaedic in 52.17% and surgical in 47.83%. Complications were the following: residual pain in 6.6%, length disparity of the limbs in 4.4%, secondary slipping in 2.2% and hypertrophic callus in 2.2%. P>0.05. The results were good in 71.7 % of the cases, passable in 24 % and bad in 4.3% of the cases., Conclusion: Femur fracture is a frequent affection by which the first cause remains the public highway accident.

Unlabelled: The gains of the struggle against the pain of the child are still fragile and poorly insured despite advances in both information and evaluate the degree of pain in the range of means at our disposal. The absence of systematic management of pain especially post-operative pain in pediatric surgery and the difficulty of obtaining a vein justify this study., Purpose: The purpose was to compare analgesic effect of three protocols., Type of Study: prospective and comparative study., Material and Method: Our study was prospective and comparative. It took place in the services of anesthesia and intensive care and pediatric surgery of Gabriel Toure Hospital in Bamako during October 2003 to July 2004.Patients were randomized to three protocols: protocol A patients who received paracetamol suppository at a dose of 15 mg/kg,protocol B patients who received niflumique acid suppository at a dose of 13 mg/kg and protocol C patients who receiving combination paracetamol at a dose of 15 mg/kg with acid niflumique at a dose of 13 mg/kg per rectally. The first dose for each protocol was administered after anesthetic induction. In Protocol C paracetamol was administered immediately after induction and niflumique acid on awakening., Results: During the period, 202 patients were randomized to three protocols: protocol A (n = 65), protocol B (n = 69),protocol C (n = 68). Poignant pain has been observed with EVS ladder against none with the grid OPS.Patients of protocol C surgery for hernia had moderate pain with 4.40% of cases against 9.60% of patients in the protocol B with P = 0.0024 and 12% of patients in Protocol A, with P = 0.0018 in OPS. Patient's protocol C surgery for hernia showed no intensive pain against 14.20% of the patients in protocol B and 11.4% of patients in group A with EVS scale. No side effects related molecules have been observed in the three protocols., Conclusion: Association of paracetamol and niflumique acid provides a quality analgesia by postoperative rectally in pediatric surgery.

Wolbachiae are bacterial endosymbionts of insects and many filarial nematodes whose products trigger inflammation in filarial infections. The dependence of the parasites on their endosymbionts has also led to the use of antibiotics directed against the Wolbachiae, therapy that has been demonstrated to have a profound salutary effect on filarial infections. The identification of Wolbachiae in Mansonella species has been conclusively shown for Mansonella ozzardi (Mo), but not for Mansonella perstans (Mp). Using primers known to amplify the 16S ribosomal DNA of other filarial Wolbachiae, an identical 1393bp band was found in all samples tested. Sequence analysis of these samples demonstrated a single consensus sequence for Mp Wolbachia 16S rDNA that was most similar to Wolbachia sequences from other filarial nematodes. When aligned with the only other Mansonella Wolbachia sequence (Mo) there were only 8 nucleotide differences in the 1369bp overlapping sequence. Phylogenetic dendrograms, examining the relationship of the Mp Wolbachia to other Wolbachia 16S rDNA, showed that the Wolbachia tracked almost identically to the 5S rRNA of their parasite host. Wolbachia surface protein (WSP) was also demonstrated in protein extracted from Mp-containing whole blood. In advance of a treatment trial of Mp, a method for the quantitation of Mp Wolbachia was developed and used to demonstrate not only a relationship between microfilarial numbers and Wolbachia copy numbers, but also to demonstrate the effect of antibiotic on ridding Mp of Wolbachia.

Aim: To determine the hospital frequency, identify the risks factors and evaluate the mortality of the early postoperative complication., Patients and Methods: It was about a prospective study done from January first to May 31st 2006. All children from 0 to 15 years old operated in settled or urgent surgery and follow in the service were concerned of this study., Result: We brought together 47 cases of complication in 40 patients on a total of 631 children operated in five months. The average age of our patients was of 51.9 months +/- 47.4. The average period of hospital stay was of 4.3 days +/-3.12. A germ was found in the pus in 13 patients. A lung opaqueness was found in three patient's and a germ was present in the urine in 3 also. The average period of appearance of complications was of 7.7 days +/-1.3. The infection of the operating site occupied 2.5%, evisceration 1.1%, haematoma 0.9%, digestive fistula 0.3% and postoperative occlusion 0.15%. The death rate was 1.9%., Conclusion: The type of surgery, the mode of recruitment, the duration and conditions of the hospital stay were the factors of the postoperative complications.