Search

In Mali, malaria is a major public health problem. The region of Sikasso is classified according to the geo-climatic facies as a zone with a long seasonal transmission of malaria greater than 6 months.To describe the epidemiological, clinical and therapeutic characteristics of children aged 0- 5 years hospitalized for severe malaria in the pediatric ward of the Sikasso hospital. Variables analyzed were epidemiological, clinical, paraclinical, therapeutic and evolutionary.This is a retrospective, 12-month (January-December 2014) cross-sectional study of all 0-5-year-olds hospitalized for severe malaria at the Sikasso Regional Hospital.The hospital frequency of severe malaria was 55.82%. The age group of 12-35 months was the most concerned (45.3%). The peak frequency was in August (21.2%). Anemic, mixed (anemia and neurological) and neurological forms were the most frequent. Artemether and quinine were the antimalarials used. The use of a blood transfusion was frequent (82.8%). The lethality was 10% and the mixed form (anemia and neurology) was the most lethal ((P10Malaria remains a national concern in Mali. Improving the quality of care and prevention must be a priority to reduce the lethality that remains high.Au Mali, le paludisme constitue un problème majeur de santé publique. La région de Sikasso est classée selon le faciès géo climatique comme étant une zone à transmission saisonnière longue du paludisme supérieure à 6 mois.Décrire les caractéristiques épidémiologiques, et cliniques des enfants âgés de 0 à 5 ans hospitalisés pour paludisme grave au service de pédiatrie de l'hôpital de Sikasso.Il s'agit d'une étude transversale rétrospective sur douze mois (janvier-décembre 2014) de tous les enfants âgés de 0-5 ans hospitalisés pour paludisme grave à l'hôpital régional de Sikasso. Les variables analysées étaient épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutifs.La fréquence hospitalière du paludisme grave a été de 55,82%.La tranche d'âge de 12-35 mois a été la plus concernée (45,3%). Le pic de fréquence des cas a été atteint au mois d'aout (21,2%). Les formesanémique, mixte (anémie et neurologique) etneurologique ont été les plus fréquentes. L'artéméther et la quinine ont été les antipaludiques utilisés. Le recours à une transfusion sanguine a été fréquente (82,8%).La létalité est de10% et la forme mixte (anémie et neurologique) a été la plus létale ((P10Le paludisme reste une préoccupation nationale au Mali. L'amélioration de la qualité de la prise en charge et la prévention doivent êtreune priorité pour diminuer la létalité qui reste élevée.

Household accidental child poisonings are frequent pediatric medical emergencies in developing countries.To study the epidemiological, etiological, clinical and therapeutic aspects of acute accidental domestic poisoning in children aged 0 to 15 years admitted to the pediatric emergency department of Gabriel Toure.This was a prospective, descriptive study that ran from January 1, 2014 to December 31, 2014. All patients aged 0 to 15 years admitted to pediatric emergencies for acute intoxication were included.A hundred cases of acute accidental poisoning were collected. Children under five accounted for 94%. The majority of mothers was housewives and had custody of children (83%). Forty-nine percent of the mothers were unschooled. The place of storage of the product was indoor in 96% of cases. The product was taken by the child himself (88%). A gesture at the scene of the accident was reported in 68% of cases, the ingestion of milk (72%) and water (10%) were the first acts used. The hospital was the first resort (72%). The time between taking the product and admission to hospital was 1 to 5 hours in 58% of cases. Vomiting (37 cases), agitation (17 cases) and respiratory distress (16 cases) were the most common symptoms. Domestic products (48%) followed by drugs (33%) ranked first among the families of poisons. Caustic soda (18%) and bleach (17%) were the most commonly found intoxication products. The evolution was good with a cure without sequelae (93%).Accidental acute intoxications to household products are common in Mali. The hospital admission deadline is still long; the actions taken by patients at the accident site often aggravate their states but are largely done by the parents before the use of health care.Les intoxications accidentelles domestiques de l'enfant sont des urgences médicales pédiatriques fréquentes dans les pays en développement. Le but de notre travail était d'étudier les aspects épidémiologiques, étiologiques, cliniques et thérapeutiques des intoxications aiguës accidentelles domestiques chez les enfants âgés de 0 à 15 ans admis aux urgences pédiatriques du CHU Gabriel Touré.Il s'agissait d'une étude descriptive à collecte prospective qui s'est déroulée du 01 janvier 2014 au 31 décembre 2014. Ont été inclus tous les patients âgés de 0 à 15 ans admis aux urgences pédiatriques pour intoxications aiguës accidentelles.Cent cas d'intoxications accidentelles aiguës ont étés colligés. Les enfants âgés de moins de cinq ans représentaient 94%. La majorité des mères était des femmes au foyer et avait la garde des enfants (83%). Quarante-neuf pour cent des mères n'étaient pas scolarisées. Le lieu de stockage du produit était intradomiciliaire dans 96% des cas. Le produit était pris par l'enfant lui-même (88%). Un geste sur le lieu de l'accident était rapporté dans 68% des cas, l'ingestion de lait (72 %) et de l'eau (10%) avaient été les premiers gestes utilisés. L'hôpital était le lieu du premier recours (72%). La durée entre la prise du produit et l'admission à l'hôpital était de 1 à 5 heures dans 58% des cas. Les vomissements (37 cas), l'agitation (17 cas) et la détresse respiratoire (16 cas) étaient les symptômes les plus rencontrés. La soude caustique (18%) et l'eau de javel (17 %) étaient les produits d'intoxication les plus retrouvés. Les produits domestiques (48%) suivis des médicaments (33%) venaient en tête parmi les familles de toxiques. L'évolution était bonne avec une guérison sans séquelle (93%).Les intoxications aiguës accidentelles aux produits domestiques sont courantes au Mali. Le délai d'admission à l'hôpital reste toujours long, les gestes inappropriés apportés aux patients sur le lieu de l'accident aggravent souvent le tableau mais sont largement effectués par les parents avant le recours aux soins de santé.

Malnutrition is a major public health problem in Mali, along with the country’s political and security instability. We initiated this work with the objective of determining the frequency as well as the risk factors favoring the occurrence of malnutrition in children aged 6 - 59 months hospitalized in the pediatrics department of the Gabriel Toure University Hospital in Bamako, country reference service to identify potential interventions to plan. A cross-sectional study was carried out over a period of 4 months. A bivariate logistic regression analysis allowed us to identify risk factors with degree of significance if p 0.05. During the study period, 2888 children were hospitalized, including 348 aged 6 to 59 months, or a frequency of 12.04%. One in two children was malnourished, i.e. a frequency of 50%. It more frequently affected infants aged between 6 and 23 months with a frequency of 33.7%, with a hospital frequency of growth retardation which was 23% including 14.7% of severe form. The emaciation was 27% of which 18.7% were severe form. The underweight was 42.2% with 31% in severe form. We found the diet inequality in all malnourished and non-malnourished children. A bivariate analysis showed that children with an out-of-school mother have a 2.4-fold risk of being malnourished (OR = 2.425; CI = 1.9 - 4.2; p 0.03). Also children from households with no stable income (non-salaried father) have twice the risk of children from a household with stable income (OR = 2.120; IC = 1.1 - 4.1; p 0.002). Finally, inappropriate nutrients (early introduction of food and early weaning) have been strongly associated with the occurrence of malnutrition. The prevalence of malnutrition reflects the way children eat. Emphasis should be placed on nutritional education and financial stability in households.

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

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

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

Introduction: Health care-associated infection is an infection acquired during the care delivered in the hospital or in any other care establishment which was neither present, nor in incubation at the admission of the patient or at the time of delivering the care or which does not manifest itself only after the patient has been discharged or an infection contracted by the professional in the course of his duties. Objectives: To identify mean causative germs and to determine their sensitivity to antibiotics and to identify the risk factors of health care-associated infection. Material and methods: It was about a prospective longitudinal study conducted from November 1, 2017 to April 1, 2018 (6 months) in all children admitted to the pediatric surgery service. Non-consenting parents and outpatient necrosectomy case have not been included in this study. Results: This study included 200 patients, of whom 30 experienced the hospital acquired infections with an infection rate of 15%. The surgical site infection was the most common type, with 16 cases (53.3%), followed by burns in 13 cases (43.3%) and urinary tract infection in 1 case (3.3%). The average age of patients with infection was 56.33 ± 48.66 months with extremes of 1 and 180 months. The sex ratio was 1.30 for infected patients and was 1.83 for uninfected patients. The main bacteria responsible for surgical site infection were: Escherichia coli (4 cases), Acinetobacter baumanii (3 cases), Klebsiella pneumoniae (2 cases), Staphylococcus aureus (2 cases), Enterobacter cloacae (1 case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis (1 case). Among burn patients, the most frequent germs were: Acinetobacter baumanii (7 cases), Klebsiella pneumoniae (6 cases), Staphylococcus aureus (6 cases), Escherichia coli (4 cases), Pseudomonas aeruginosa (2 cases) and Enterobacter faecalis (2 cases). Escherichia coli was noted only in the case of urinary tract infection. Antibiotics tested were: amoxicillin, amoxicillin associated with clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin. Germs were resistant to amoxicillin in 88.9% of cases, sensitive to the amoxicillin-clavulanic acid combination in 85% of cases, sensitive to tobramycin and gentamicin. Recruitment methods and length of hospitalization were the risk factors noted. Conclusion: Massive awareness among all healthcare providers should be conducted on the adoption of standard precautions for the prevention of health care-associated infections and on the rules of antibiotics prescription to reduce the incidence of health care-associated infection and slow the resistance of germs to antibiotics.

The Pica syndrome is an eating disorder characterized by an excessive or abnormal desire to consume a non-nourishing substance which can be relatively harmless, or potentially harmful for the health. It is a rare affection secondary to the accumulation of diverse nature foreign bodies inside the digestive tract and more especially at the stomach level. Gastro-intestinal localization is the most frequent, and can remain long time asymptomatic. Treatment is surgical. We report 3 cases of digestive complication of Pica syndrome. The first one was operated for gastric perforation due to nail (53 nails, a pin and bands of tape recorder cassette ingested), the second one for trichobezoar and the last had a subocclusion by pieces of granite.

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

The nephroblastoma is the third pediatric cancer in Mali, this study aimed to describe the prevalence and prognosis of nephroblastoma relapses. Methods: It was a descriptive retrospective study over a 10-year period from January 2005 to March 2015. We collected children aged 0 to 15 years followed for relapse of nephroblastoma in the pediatric oncology unit of university hospital center (UHC) Gabriel Toure. Results: The frequency of relapse of nephroblastoma was 7.4% (19 cases) whose mean age was 42 months with a sex ratio of 1.3. The relapse occurred before the end of the postoperative course in 16% of cases (3 patients). It was local recurrence in 52% of cases (10 patients), pulmonary 16% (3 patients), and hepatic 11% (2 patients). According to the SIOP classification, 47% of patients were diagnosed in stage III (9 patients) and 21% (4 patients) in stage IV. The tumor was high risk in 37%. Palliative chemotherapy was performed in 63% of the patients (12 patients) and the remaining seven were put on a high risk diet. The overall survival at 5 years was 21% or 4 patients. Conclusion: Our results showed all the difficulties in the management of nephroblastoma relapses in our context.

The objective of our study was to evaluate hepatitis B virus (HBV) infection in an urban population. This longitudinal study was conducted in Bamako District and Kati Commune. After a preparatory phase, the persons who accepted the protocol were assessed for HBsAg. HBsAg carriers had blood collection for HBeAg assay, viral load assessment, genotyping, DNA mutation testing, and severity of hepatic fibrosis and necrosis. At the end of this study, 1475 persons were included, of which 195 had HBsAg positive confirmed, that is to say 13.97%. The mean age of HBsAg positive patients was 35.11 ± 11.12 years with a sex ratio of 2.68. HBeAg was found in 8.9% of the patients tested for this antigen. The viral load was undetectable in 10.52% of patients and greater than 2000 IU/mL in 32.24% of cases. Fibrosis ≥ F2 and necrosis ≥ A2 were found in respectively 19.72% and 6.80% of cases. Genotype E was found in 91.6 patients and an R249S mutation observed in 39.04% of cases. Conclusion: HBV infection has a serious impact on socio-economic development in Mali because it affects mainly the young male population, hence the need to organize preventive measures effectively.

Background :Non-Hodgkin lymphomas are the first childhood cancer in sub-Saharan Africa. Objective: The purpose of this study was to assess non-Hodgkin lymphomas cases in our setting. Methodology: A retrospective and descriptive study carried out in the pediatric oncology unit of the Gabriel Toure Teaching Hospital Bamako over 10 years from 1st January 2005 to 31th December 2015. Results: We exploited 274 (21.6%) cases of Non-Hodgkin Lymphoma out of 1295 cancer cases registered, the age group 6 - 10 years was the most represented (46.4%); the male sex was predominant with a sex-ratio of 1.8; digestive signs were the most common signs of discovery (44.2%) followed by maxillary swelling (42.7%); the majority of patients (52.9%) consulted between 1 and 3 months after the onset of signs; the malnutrition rate was 39.8%, of which 24.1% were severe cases and 15.7% were moderate rate. Abdominal localization was the most common (43.1%) followed by maxillofacial localization (33.9%). Almost all were Burkitt type cytology (92.7%), the majority (73.4%) were in Murphy stage III. Almost all (96%) had received chemotherapy and the modified LMB 01 protocol was widely used (62.4%). The majority of patients (85%) were chemosensitive at day 7 or after the third cyclophosphamide injection but at the end of induction only 31% were in complete remission. Gastrointestinal toxicity was the most common (37.13%) followed by hematologic toxicity 35.09 %; 9.12 % of patients were lost of follow-up and 22.26% died. Tumor progression was the most common cause of death (60.66%) followed by infection (21.31%). Conclusion: In light of these findings, the late diagnosis and the poor management of NHL, as well as the limited ability to primarily treat metabolic complications, explain the high case-fatality rate, hence the important role of early diagnosis and treatment multidisciplinary.

The practice of excision in girls poses a significant risk to their health. The objective of this study was to determine the immediate acute complications associated with this practice.This was a retrospective descriptive study over a period of 15 months including all girls aged 0-15 years hospitalized for acute complications related to excision within 7 days of the practice in the pediatric department of the University Hospital Gabriel Toure.We collected 17 patient files. The median consultation time was 43 h. The main reason for consultation was post-excision bleeding in 76.4% of the cases. Pallor associated with respiratory distress was found in almost all cases. On admission, four girls (23.5%) were comatose and five girls (29.4%) showed signs of shock. The reasons for hospitalization were hemorrhage associated with post-excisional sepsis (52.9%), complicated shock anemia (23.5%), and severe post-excision anemia (23.5%). The average hemoglobin level was 5.5 g/dL; there was severe anemia in 94.1% of the girls (Hb7g/dl). All the girls received blood transfusions with red blood cell concentrate. The other treatments received were local care (100%), administration of analgesics (100%), antibiotic therapy (82.4%), and oxygen therapy (41.2%). The outcome was unfavorable in two patients (11.8% deaths).This study shows the seriousness of the immediate complications associated with the practice of excision.

to assess epidemiologic and clinical aspects of childhood brain tumors in Mali. 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. 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. A broader study including the other hospitals in Bamako could help to assess more accurately the epidemiology of pediatric brain tumors in Mali.

Objective: This study aims to analyze clinical, paraclinical and therapeutic aspects of sinusitis complications in the Otorhinolaryngology department at the teaching hospital of Gabriel Toure in Bamako. Materials and methods: This descriptive and longitudinal study was conducted on 12 months from March 2012 to February 2013 in 9 cases of sinusitis complications in the department of Otorhinolaryngology at the University Hospital Gabriel Toure in Bamako. Results: The average age of patients was 22.7 years; a median of 19 years within 6 men and 3 women with almost 12.9 days of care seeking duration. The factors of risky were the use of nonsteroid anti-inflammatory drugs NSAID (4 cases), maxillofacial trauma (1 case) and HIV (1 case). Facial pain was the major symptom, such as frontal oedema, rhinorrhea with pus shedding and nasal obstruction. Computer tomography was used for complications specification. Frontal sinusitis was the most encountered with subperiosteal abscess (44.4%). Streptococcus pneumoniae was identified in 3 cases. Medical treatment associated to surgery was conducted on 7 patients. Two cases of death have been registered. Conclusion: The complicated sinusitis is an emergency and dangerous disease requiring specific care by a multidisciplinary staff. Much of complications are commonly encountered despite the antibiotic era.

Le but principal de ce travail etait d’etudier l’encephalopathie hepatique sur cirrhose dans le service d’hepatogastroenterologie du CHU Gabriel-Toure, Bamako, Mali. Il s’agissait d’une etude longitudinale, prospective qui s’est deroulee sur une periode de 14 mois allant de janvier 2013 a fevrier 2014. Pendant cette periode, une frequence hospitaliere de 6,5 % de l’encephalopathie hepatique a ete observee. La moyenne d’âge etait de 46,4 ± 15 ans (extremes: 13 et 84). Le sex-ratio etait de 1,42. Un antecedent d’ictere, d’hemorragie digestive et d’encephalopathie hepatique etaient observes respectivement chez 23, 13 et 6 patients. A l’admission, 74,6 % des malades etaient en encephalopathie. L’encephalopathie hepatique etait au stade II dans 65,1 % des cas et a son premier episode dans 65,1 % des cas. La mortalite immediate a ete de 66,7 %. L’encephalopathie hepatique est une complication redoutable des hepatopathies chroniques. Sa prise en charge reste complexe dans notre contexte.

Introduction: acute pharyngitis is found in children as well as in adults. The peak incidence is between 5 and 15 years. The responsible germs are of viral or bacterial origin; the group A hemolytic beta streptococcus haunts this condition. Objective: Study the factors associated with acute pharyngitis in the ENT department of the CHU Gabriel TOURE in Bamako. Methods: A descriptive and analytical prospective study was conducted from August 30, 2015 to August 30, 2016. The study population consisted of patients admitted to the ENT department of the CHU Gabriel Toure in Bamako for acute pharyngitis. Data was collected using a questionnaire during the interview and physical examination. They were entered using Epi Data software version 3.01 and analyzed using R 3.1.2 software. Results: We collected 234 cases of pharyngitis between August 30, 2015 and August 30, 2016. The sex ratio (F / M) was 1.32. The mean age was 28.21 ± 14.20 years. The majority of patients presented with erythematous angina (81%). The group A hemolytic beta streptococcus was the predominant germ (58%). The active antibiotics on the germ were penicillin, amoxicillin, and cephalosporin. This germ was associated with erythematous angina and the risk was 3.99, CI (1.88-8.45). Complications were noted in 7 patients (3%) upon admission, including 1 case of cervical cellulitis and 6 cases of palatine tonsil phlegmon. No deaths have been recorded. Conclusion: The aspect of the palatine tonsil does not allow to evoke a viral or bacterial etiology from where the interest to carry out a bacteriological examination in particular the culture which could orient a bacterial etiology and help the practitioner to rationalize the indication of antibiotic therapy.

The maxillary mucocele sinus are rare and may extend outside the sinus and cause a facial deformity and orbital manifestations.We report a case of giant mucocele of the right maxillary sinus from a 48 year old man. The history of disease has found a right cheek tumefaction. hypoesthesia of the right hemifacial, nasal obstruction lasting for 2 years. CT scan of the facial confirmed diagnosis by showing a cystic mass of the right maxillairy sinus bulging into the right nasal cavity with bone thinning without bone lysis. The treatement is removal of the mucocelique pochet by Caldwell-Luc under general anesthesia and allowed disparition of symptoms.Africa the Caldwell-Luc seems to us preferable because of diagnosis tardif the origin of the importance of the expansion.Les mucocèles du sinus maxillaire sont rares et peuvent s'étendre en dehors du sinus et entrainer une déformation faciale et des manifestations orbitaires.Nous rapportons un cas de mucocèle géante du sinus maxillaire droit chez un homme de 48 ans. L'histoire de la maladie a retrouvé une tuméfaction jugale droite, une hypoesthésie de l'hémiface droite, une obstruction nasale évoluant depuis 2 ans. Le scanner du massif facial a confirmé le diagnostic en montrant une masse kystique du sinus maxillaire droit bombant dans la fosse nasale, avec amincissement des parois osseuses, sans lyse osseuse. Le traitement, a consisté à l'exérèse de la poche mucocélique par voie de Caldwell-Luc sous anesthésie générale, et a permis la disparition de la symptomatologie.En Afrique le Caldwell-Luc nous semble préférable du fait du diagnostic tardif à l'origine de l'importance de l'expansion.

The objective of this work was to analyze the diagnostic circumstances and the therapeutic management of mediastinal disease of a cervical origin.We conducted a longitudinal prospective and retrospective descriptive study in the ENT department of the Gabriel Touré Hospital in Bamako, involving the records of patients treated for mediastinitis complicating cervical cellulite from January 2011 to April 2014.Eight patients met our inclusion criteria. The median age was 29 years, the standard deviation was 10.23 years with extremes of 25 and 57 years. All were initially admitted for dental reasons. The median time to consultation was 13 days with extremes of 10 days and 1 month. Six patients had non-steroidal anti-inflammatory drugs before entry into the service. Cervical and thoracic CT scan was used to guide diagnosis in all cases. Seven patients underwent mediastinal drainage through cervicotomy, 3 patients underwent percutaneous pleural drainage under ultrasound guidance. We had two deaths.Mediastinitis in cervical cellulitis is a serious infectious disease where the mortality rate remains high. Mediastinal drainage was performed by cervical route. Prevention is based on the awareness and the importance of dental hygiene and getting proper and early treatment for dental cavities.L'objectif de ce travail était d'analyser les circonstances de diagnostic et la prise en charge thérapeutique des affections médiastinales à point de départ cervical.Nous avons mené une étude descriptive longitudinale pro et rétrospective dans le service d'ORL du CHU Gabriel Touré de Bamako et qui a concerné les dossiers des patients traités pour médiastinite compliquant une cellulite cervico-faciale de janvier 2011 à Avril 2014.Huit patients ont répondu à nos critères d'inclusion. L'âge médian était de 29 ans, l'écart type était de 10,23 ans avec des extrêmes de 25 et 57 ans. La porte d'entrée a été dentaire dans tous les cas. Le délai médian de consultation était de 13 jours avec des extrêmes de 10 et 1 mois. Six patients avaient eu des antiinflammatoires non stéroïdiens avant leur admission dans le service. Le scanner a permis d'orienter diagnostic, en montrant des signes en faveur de médiastinite, dans tous les cas. Sept patients ont bénéficié d'un drainage du médiastin par voie de cervicotomie, 3 patients ont bénéficié d'un drainage pleural percutané sous guidage échographique. Nous avons eu deux décès.La médiastinite au cours de la cellulite cervicale représente une pathologie infectieuse grave avec une mortalité qui reste élevée. Le drainage médiastinal a été effectué par voie cervicale. La prévention repose sur la sensibilisation de la population et sur l'importance de l'hygiène dentaire et la prise en charge correcte et précoce des caries dentaires.

Les hemorragies digestives par rupture des varices œsophagiennes et/ou gastriques, sont de constatations frequentes dans nos contrees. D’importants progres ont ete faits dans leur prise en charge par les traitements endoscopiques. Le but principal de notre etude etait de rapporter notre experience et de faire etat de la morbidite liee a la ligature des varices œsophagiennes (LVO) dans notre contexte. Il s’agissait d’une etude longitudinale prospective et descriptive qui a porte sur les patients admis au centre d’endoscopie digestive pour hemorragie digestive haute et s’est deroulee de mai 2012 a juin 2014 dans le service de medecine du CHU Gabriel Toure. Quarante patients admis pour hemorragie digestive par rupture des varices œsophagiennes ont ete inclus. L’âge moyen de nos patients etait de 40,8 ±10,9 ans avec des extremes de 7 et 53 ans. Le sex-ratio (H/F) etait de 1,85. 30% de nos patients avaient des VO grade II et 70% des VO grade III. Les etiologies etaient dominees par la cirrhose post virale B (92,5%), la cirrhose post-virale C (5%) et dans 2,5% des cas on ne retrouvait pas d’etiologie. Trois seances de ligatures ont pu etre effectuees chez 22 patients soit 55%. L’intervalle moyen entre les seances de ligatures etait de quatre semaines. Une patiente est decedee par suite de recidive hemorragique apres une seule seance de ligature non imputable a la technique. L’eradication des VO etait obtenue dans 62,5%.

L’objectif de ce travail etait d’analyser les facteurs favorisants, les aspects diagnostiques et therapeutiques des cellulites cervico-faciales au cours des grossesses et de determiner le pronostic materno-foetal. Nous avons realise une etude descriptive observationnelle longitudinale au cours de la periode de janvier 2011 a mars 2013 et incluant des dossiers de patientes atteintes de cellulite cervico-faciale lors des grossesses prises en charge par le service d’ORL et de chirurgie cervico-faciale de l’Hopital Gabriel Toure de Bamako. Dix patientes repondaient a nos criteres d’inclusion. L’âge median etait de 23 ans. La porte d’entree a ete dentaire dans tous les cas. Trois patientes avaient recu une antibiotherapie et 3 autres une antibiotherapie associee a des anti-inflammatoires non steroidiens. Le traitement medicochirurgical avait permis la guerison dans 8 cas. Deux deces ont ete enregistres et 4 mort-nes. La cellulite cervico-faciale au cours de la grossesse est une pathologie grave dans le contexte ouest-africain, pouvant engager le pronostic vital de la mere et ou de l’enfant. La prevention repose sur le controle de l’etat dentaire et l’information des patientes sur l’importance de l’hygiene dentaire.

Le diabete et l’infection par le VHC constituent de veritables problemes de sante publique mondiaux. Le but principal de notre etude etait d’etudier la prevalence du VHC dans la population diabetique. Il s’agissait d’une etude observationnelle prospective qui s’est deroulee de juin 2009 a mai 2010 au CHU Gabriel Toure et au Centre de lutte contre le diabete de Bamako. Le dosage des transaminases et la recherche de l’Ac anti VHC ont ete effectues chez tous les malades. La recherche des signes d’hypertension portale par l’endoscopie digestive haute, l’echographie abdominale, la PCR quantitative et les autres bilans biologiques de l’hepatite C ont ete systematiquement proposes aux patients porteurs des Ac anti VHC. 25 patients diabetiques sur 250 (10%) ont ete retrouves porteurs du virus HCV. L’âge moyen des patients etait de 49,5 ± 17, 6 ans avec un sex-ratio de 0,38. L’infection par le VHC n’etait pas significativement associee au type de diabete (p = 0,54). La majorite des patients avaient un diabete de type 2 mal equilibre, et le genotype 2 etait le plus frequent. Une correlation positive est observee entre la prevalence du diabete sucre et l’infection par le VHC dans notre region. Cette elevation de prevalence est une donnee importante, permettant un meilleur depistage et une meilleure prise en charge de ces deux maladies.

Introduction : Notre objectif était d'évaluer le statut nutritionnel et certaines attitudes relatives à l'hygiène dans la commune de Bamba. Matériel et méthodes : Notre étude s'est déroulée du 15 février au 5 mars 2008 au niveau la commune de Bamba dans le cercle de Bourem, région de Gao. Il s'agissait d'une étude transversale descriptive par sondage en grappes à deux degrés. L'étude a porté sur 604 enfants de 6-59 mois et 376 mères. La balance électronique a été utilisée pour mesurer le poids et la toise de Shorr pour la taille. Les données ont été collectées à l'aide de questionnaires avant d'être saisies et analysées sur logiciel EPI-INFO 6.04, ENA et SPSS 13.0. Résultats : Nous avons observé que le nombre garçons étaient légèrement inférieurs aux filles avec un ratio de 0,8. Le fleuve constituait la principale source d'approvisionnement en eau des ménages aussi bien en saison sèche (53,9 %) qu'en saison pluvieuse (55 %). La plupart des enfants (71,2 %) se lavaient les mains avant de manger même s'ils le faisaient dans un seul récipient. Nous avons observé des carences nutritionnelles notamment l'émaciation avec 14,2% [IC à 95 % (±0,89)], le retard de croissance 32,5% [IC à 95 % (±1,03)] et l'insuffisance pondérale 37,6% [IC à 95 % (±1,13)]. Conclusion et recommandation : Le niveau d'hygiène et les carences nutritionnelles se sont avérés très préoccupants selon les résultats que nous avons observés. Des enquêtes ultérieures seront nécessaires en vue de mieux comprendre les connaissances attitudes et pratiques des populations au niveau de la commune.

Introduction : Les detresses respiratoires sont une cause majeure de morbidite et de mortalite en pediatrie ; l’objectif de notre etude etait d’etudier les aspects epidemiocliniques des detresses respiratoires chez les enfants âges de 1 a 59 mois dans le service de pediatrie de CHU. Gabriel Toure. Methodologie : Il s’agit d’une etude transversale descriptive sur douze mois du 1 er au 31 decembre 2012 au service de pediatrie du CHU Gabriel Toure Bamako Mali. Tous les enfants de 1 a 59 mois presentant une detresse respiratoire ont ete inclus. Resultats : Ainsi 678 dossiers d’enfants en detresse respiratoire sur un total de 2241 hospitalises en pediatrie ont ete analyses soit un taux d’admission de 30,25%. 64,75% des enfants avaient un âge compris entre 1 et 11 mois. Le sex-ratio etait de 1,38 en faveur des garcons; les signes de lutte respiratoire (battement des ailes du nez, tirage intercostal et le geignement) etaient presents dans 96,22%. La pathologie pulmonaire la plus frequente etait la pneumonie (68,36%) celle extra-pulmonaire etait le paludisme grave (11,80%). Le taux de mortalite etait de 20,65%. Conclusion : les detresses respiratoires restent une importante cause de mortalite du nourrisson dans notre contexte avec des problemes majeurs de prise en charge Mots cles : Detresse respiratoire, Sante publique, Pediatrie

Le but de notre etude etait d’inventorier les atteintes hepatiques medicamenteuses dans les services d’hepatogastroenterologie du CHU Gabriel-Toure et de medecine interne du CHU du Point « G ». Notre etude a ete longitudinale et prospective de janvier a decembre 2006. Elle a porte sur des patients ayant presente une hepatite apres une prise medicamenteuse en l’absence de toute autre cause d’hepatopathie. Les patients ont ete examines et ont beneficie d’examens paracliniques pour confirmer l’atteinte hepatique et eliminer une cause autre que medicamenteuse. Au terme de cette etude, 27 patients ont repondu a nos criteres d’inclusion, dont 9 hommes et 18 femmes d’âge moyen de 36,7 ± 11,9 ans (extremes: 16–75 ans). Une notion de prise reguliere de medicament a ete retrouvee chez 81,5 % des patients. Les signes cliniques etaient domines par la fievre (70,4 %) et les arthralgies (62,9 %). L’ictere etait constate chez 77,8 % des patients. L’association lamivudine, stavudine et nevirapine (Triomune®) a ete la plus incriminee (48,1 %). La mortalite a ete de 25,9 %. Les atteintes hepatiques medicamenteuses ne sont pas exceptionnelles au Mali. Elles doivent etre recherchees a cause de leur potentiel evolutif vers une insuffisance hepatocellulaire.

Le but principal de cette etude etait d’evaluer les aspects epidemiologiques et semiologiques des troubles fonctionnels intestinaux (TFI) dans les centres de sante de reference de Bamako. Il s’agissait d’une etude transversale menee de juin 2006 a novembre 2006. Pendant la periode d’etude, 104 patients ont repondu aux criteres d’inclusion sur 487 patients, soit une frequence de 21,35 % de la population examinee. L’âge moyen etait de 30,5 ± 11,5 ans, la tranche d’âge de 16–26 ans predominait avec 45,2 %. Le sex-ratio etait de 0,5 en faveur des femmes. Les signes fonctionnels les plus frequemment retrouves ont ete la douleur abdominale (97,1 %), le meteorisme/ballonnement abdominal (51,9 %) et la constipation (45,2 %). Un absenteisme frequent etait rapporte par 65,8 % des patients. Les TFI peuvent etre consideres comme un probleme de sante publique. Les couts du traitement et des explorations et les absences frequentes au travail constituent les veritables problemes socio-economiques.

Evaluate the risk brought by the traditional practice in the evolution of the foreign bodies of the aesophagus.30 years old male with migration from the oesophagus of a fish bone in soft tissue of the neck, which could have been favored by the traditional practice. The diagnosis of migration was suspected when a laterocervical mass appeared after a traditional processing. The rigid aesophagoscopy was negative and the scanner allowed to identify the foreign body in an extraluminal location. It was removed by cervicotomy. Postoperative was uneventful.

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

The multiple variant of aero-digestive foreign bodies' pathology determine many complex aspects with regard to their physiopathology, nature, and their location. The presence of a medical handicap or any particular condition could increase morbidity and expose to major risks. We are reporting here about 4 cases including an esophagus foreign body in a leprosies patient, an esophago-gastric case in a mental disorder patient, and two laryngeal-tracheal-bronchial cases during epileptic episodes. From the rarity of such accidents in an adult to their happening during a loss of consciousness or a delirious state, the clinical history is always missing. The symptoms are atypical and may misguide. The classical penetration syndrome cannot be reported. Only a clinical examination carefully conducted and completed with targeted para clinical examinations can help make early diagnosis. Endoscopy of the Esophagus on one hand, and endoscopy of the trachea and lungs on the other hand were used to extract these foreign bodies.

The main goal of our study was to evaluate cirrhosis course on one year. The study was prospective and longitudinal from January 2005 to December 2006 in the center of hepatology and gastro-enterology of CHU Gabriel Touré. The patients had one year follow up and examinated every three months. In this study 57 patients were included. Mean age was 41,5 + 15,3 years. Ascite and jaundice were the main clinical signs respectively 70.2% and 54.4%. Ascite or its increase was the most complication in 67.5% of cases (p = 0.002). The global mortality was 82.5% and it was high in the three first months, caused by hepatocellular carcinoma, digestive bleeding and hepatic encephalopathy respectively 33.3%, 27.3% and 15.2%. Abdomen pain, ascite and jaundice have an predictive value for high mortality (p between 3.10-3 et 10-7). Early examination, therapeutic observance and good management of cirrhosis complications could reduce the mortality.

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

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

Diagnosis and therapeutic of foreign bodies of the oropharynx are not difficult in general. The diagnosis is usually obvious for the adult. We report a case of foreign body of the oropharynx observed in a patient, psychologically stable, which occurred two months after a traumatism. The patient was not aware of the existence of the foreign body. It was extracted two months after the accident by endo-oral track under general anaesthesia. The nature of the foreign body, the fortuity of its discovery and its presence for a long time reported here are of interest.

Les cancers digestifs sont de plus en plus constates dans nos regions, probablement du fait de la disponibilite plus importante des moyens diagnostiques. Le but principal de notre travail etait d’etudier l’epidemiologie de ces affections dans les services d’hepato-gastro-enterologie et de chirurgie generale du CHU Gabriel Toure. Il s’agissait d’une etude transversale portant sur les patients hospitalises de fevrier a juin 2007 puis de fevrier a juin 2008. Nous avons retrouve 115 cancers digestifs sur 1 547 patients hospitalises, soit une frequence de 7,4 %. Le sex ratio etait de 1,5 en faveur des hommes et l’âge moyen des patients etait de 56,6 ± 2,4 ans. Les cancers de l’estomac et le CHC etaient plus frequents avec respectivement : 59,1 % et 19,1 % des cas. Les femmes au foyer et les cultivateurs (couches socio-economiques defavorisees) etaient plus frequemment atteints, avec respectivement 34,8 % et 33 % des cas. La salaison, la fumaison, la consommation de tabac, de to (pâte cuite de cereale) avec potasse ont ete les facteurs de risque les plus retrouves dans respectivement 74,8 %, 80,9 %, 33,9 % et 99,1 % des cas. Les cancers digestifs constituent un veritable probleme de sante publique.