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Introduction: Impalement wounds are defined by foreign objects usually steel bars or a wooden object, piercing a body cavity in part or from one end to another and always remaining in place. Thoraco- abdominal impalements are cases of rare trauma in our exercise context. We report a case of thoraco-abdominal impalement in an 11-year-old patient as well as our therapeutic attitude in our exercise context. Observation: this is an 11-year-old student, with no medical and surgical history, received in emergency for thoraco-abdominal trauma following a play activity in the family home. Discussion: Penetrating thoraco-abdominal wounds are most often caused by gunshot wounds. Impalement is a potentially serious lesion that can be immediately life-threatening and depends on the organs affected. Our case study concerns a patient victim of a domestic accident following a playful activity within the family home. The injuring agent was a concrete rod positioned within the home without any security measures and which was used to tie up sheep intended for domestic breeding. Management of impalements must comply with rules so as not to aggravate the lesions. Conclusion: Thoracoabdominal impalement injuries are potentially serious and can be life-threatening. Its management is a challenge in countries with limited resources like ours. Good coordination of medico-surgical care allowed optimal management of the patient.

Introduction: A child is defined as “any human being under the age of 18, unless majority is reached earlier due to the legislation applicable to them. In reality, initial care is also found in multipurpose or adult emergency departments. In France (Seine-Saint-Denis), out of 390 children rescued by the Emergency Medical Assistance Service (SAMU) in 2004, 77% of child deaths were medicalized by the Regional Emergency Medical Service (SMUR). all-rounders of the department. As a result, at the hospital in Mali, many children are referred to the emergency department, while there is no pediatrician in the SAU and the technical platform is not well suited to their care,hence the objective of this work.. Methods and Materials: We conducted a prospective, longitudinal study over a period of 12 months from January 1, 2019 to December 31, 2019 at the emergency department of the hospital in Mali. The study involved patients aged zero (0) to fifteen (15) years The parameters studied were socio- demographic and clinical variables Results: During the study period, we collected 458 children aged 0 to 15 out of 6517 visits to the service, i.e. a frequency of 8.12%. The age group of 10 to 15 years was the most representative with 39% of cases. The male sex represented 58% of cases with a sex ratio of 1.36. The patients were uneducated in 10% of the cases, the workers represented 28.8% among the fathers and 54.8% of the mothers were housewives. Children belonging to families with more than three children accounted for 50.9% of cases and 39.5% of patients lived outside Bamako, the capital. Our study shows that 53.9% of patients were admitted between 8 a.m. and 4 p.m., 54.8% of patients came to the service by taxi, vehicle or motorbike and admissions by referral/evacuation represented 60.3% of case. AVP accounted for 48.7% of cases After the initial examination on admission, 36% of patients were classified as category three according to the Clinical Classification of Emergency Patients (CCMU3). Conclusion: The grounds for recourse of children from 0 to 15 years old to the general-purpose SAU of the Hospital of Mali are multiple. Accidents remain the most frequent reason for recourse in the service.

Background: Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder caused by mutation in the HTT gene and characterized by involuntary movements as well as cognitive and behavioral impairment. Since its first description 150 years ago, studies have been reported worldwide. However, genetically confirmed cases have been scarce in Africa. Objective: To describe the clinical and genetic aspects of HD in the Malian population. Methods: Patients with HD phenotype and their relatives were enrolled after obtaining consent. Symptoms were assessed using the Total Motor Scale (TMS) of the United Huntington’s Disease Rating Scale (UHDRS) and the Mini-Mental State Examination (MMSE). Brain imaging and blood tests were performed to exclude other causes. DNA was extracted for HTT sequencing. Results: Eighteen patients (13 families) with a HD phenotype were evaluated. A familial history of the disease was found in 84.6% with 55.5% of maternal transmission. The average length of the HTT CAG repeat was 43.6±11.5 (39–56) CAGs. The mean age at onset was 43.1±9.7years. Choreic movements were the predominant symptoms (100% of the cases) with an average TMS of 49.4±30.8, followed by cognitive impairment (average MMSE score: 23.0±12.0) and psychiatric symptoms with 22.2% and 44.4%, respectively. Conclusion: This is one of the largest HD cohorts reported in Africa. Increasing access to genetic testing could uncover many other HD cases and disease-modifying genetic variants. Future haplotype and psychosocial studies may inform the origin of the Malian mutation and the impact of the disease on patients and their relatives.

Cryptogenic stroke is an old definition that designates an ischemic stroke with no identifiable cause. The term of the embolic stroke of undetermined source was then introduced to identify non-lacunar strokes in whom thromboembolism was the likely mechanism. This subgroup of cryptogenic strokes remains heterogeneous with many potential and possibly associated embolic causes. Covert atrial fibrillation is probably less often involved than initially expected, in contrast to intracranial and extracranial atherosclerosis. The cardiologist should be involved in the search of underlying causes of ischemic stroke by helping the neurologist to identify the most likely diagnosis. Further research is necessary to select populations that may benefit from more effective and individualized treatment.

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.

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.

Resume Introduction Les ataxies spinocerebelleuses dominantes ou SCA sont des maladies neurologiques causees par des mutations dans plusieurs genes. En fonction des contextes socioculturels, surtout dans des populations a faible niveau educatif, de telles pathologies sont susceptible d’engendrer d’autres types de souffrances en dehors de celles dues a l’atteinte physique et au handicap. Le present travail a pour objectif de determiner l’impact du vecu de cette maladie chez les patients ainsi que chez leurs parents. Methodes Il s’est agi d’une approche qualitative realisee a travers des entretiens cliniques semi-directifs, des observations neuropsychiatriques et l’administration de l’echelle de depression d’Hamilton. Resultats L’etude a concerne une famille polygame dans laquelle les meres avaient eu 10 et 12 maternites. Les manifestations neurologiques ont concerne quatre enfants d’une meme fratrie uterine et, de facon fruste, le pere. La mere de ces enfants etait designee comme responsable de la transmission de la maladie et avait presente une depression reactionnelle. Des reactions d’irritabilite, d’anxiete et de depression ont ete observees chez deux patients et un frere non atteint. L’apparition de la maladie etait associee a l’eclosion d’un conflit familial latent lie au statut du pere qui n’a ete etabli que quatre annees plus tard. Conclusion Dans un contexte socioculturel de polygamie, le declenchement d’une ataxie dominante avec notion d’anticipation est susceptible de raviver des conflits intrafamiliaux latents et de se repercuter sur la sphere psychologique et sociale des personnes affectees et de leur entourage.

Cryptogenic stroke is an old definition that designates an ischemic stroke with no identifiable cause. The term of the embolic stroke of undetermined source was then introduced to identify non-lacunar strokes in whom thromboembolism was the likely mechanism. This subgroup of cryptogenic strokes remains heterogeneous with many potential and possibly associated embolic causes. Covert atrial fibrillation is probably less often involved than initially expected, in contrast to intracranial and extracranial atherosclerosis. The cardiologist should be involved in the search of underlying causes of ischemic stroke by helping the neurologist to identify the most likely diagnosis. Further research is necessary to select populations that may benefit from more effective and individualized treatment.

Background Schizophrenia is a relatively common disease worldwide with a point prevalence of around 5/1000 in the population. The aim of this present work was to assess the demographic, clinical, familial, and environmental factors associated with schizophrenia in Mali. Methods This was a prospective descriptive study on a series of 164 patients aged at least 12 years who came for a follow-up consultation at the psychiatry department of the University Hospital Center (CHU) Point G in Mali between February 2019 and January 2020 for schizophrenia spectrum disorder as defined by DSM-5 diagnostic criteria. Results Our results revealed that the male sex was predominant (80.5%). The 25–34 age group was more represented with 44.5%. The place of birth for the majority of our patients was the urban area (52.4%), which also represented the place of the first year of life for the majority of our patients (56.1%). We noted that the unemployed and single people accounted for 56.1 and 61% respectively. More than half of our patients 58.5% reported having reached secondary school level. With the exception of education level, there was a statistically significant difference in the distribution of demographic parameters. Familial schizophrenia cases accounted for 51.7% versus 49.3% for non-familial cases. The different clinical forms were represented by the paranoid form, followed by the undifferentiated form, and the hebephrenic form with respectively 34, 28 and 17.1%. We noted that almost half (48.8%) of patients were born during the cold season. Cannabis use history was not observed in 68.7% of the patients. The proportions of patients with an out-of-school father or an out-of-school mother were 51.2 and 64.2%, respectively. Conclusion The onset of schizophrenia in the Malian population has been associated with socio-demographic, clinical, genetic and environmental characteristics.

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.

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

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.

Introduction: In Mali, Intensive nutritional recovery and education units have been established throughout the country and the pediatric unit of Gabriel Toure Teaching Hospital started in May 2010. The objective was to analyze the factors influencing the performance indicators at the Intensive nutritional recovery unit in the Pediatric of Gabriel Toure Teaching Hospital. Material and Methods: Cross-sectional, descriptive and analytical study, it took place over a period of 6 months (June 1 to November 30, 2016). All severe malnourished children under 5 years of age were included. The parents or caregivers of these children as well as the staff of the Intensive nutritional recovery unit were asked about their opinions. Result: During the study period, 4724 children were hospitalized in the service. There were 259 cases of severe acute malnutrition with a frequency of 5.5%. The 12-23 month age group was the most represented with 44.79%. Sex ratio of 0.90. Patients were exclusively breastfed (76.06%) before 6 months of age and 36.68% had not benefited from supplement foods after 6 months. The most common reason for consultation was anorexia with 66.79% of cases. Muscle wasting was the most found sign on physical examination (66.79%). Marasmus was the most represented form of malnutrition (87.65%). The failure of the appetite test was the main complication of management with 42.86% of cases. The combination of milk F75 + F100 + PPN was used for management in 87.26% of cases. Treated successfully are 54.83%. We recorded 18.53% dropout. There was a statistically significant association between the treaties successfully and the father's occupation (OR = 2.7, p = 0.028). The association between death and complications was statistically significant (OR = 21.345, p = 0.001). There was a statistically significant association between treatment discontinuation and financial problems (OR = 3.037, p = 0.005). The death rate was 23.55%. Conclusion: The financial problems of the parents and the association of the complications (serious pathologies) constitute factors which influence considerably on the indicators of performance.

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.

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.

Objective: To evaluate the knowledge, attitudes, and practices on oral hygiene (OH) of students of three Quranic schools of Koutiala, Mali. Material and Methods: It was carried out a descriptive prospective study with 300 students in three Quranic schools in the city of Koutiala, Mali. The data analyzed with the Epi Info 3.5.4 software. Results: The male sex was the most represented with 57.7% and the sex ratio = 0.73. The most represented age group was 8-12 with 52% with an average age of 17 years and minimum and maximum age of was 8 and 26 years. It was observed that 98.3% of students had a notion of knowledge about oral hygiene and this information was given by parents / elders in 60% of cases. They claimed that people who do not brush their teeth properly are the most likely to get tooth decay in 93.3% of cases. Regarding dental caries, 61.3% of students said that caries is transmitted by lack of oral hygiene; 33.3% of students said that using toothbrushes and having good oral hygiene are ways to avoid oral diseases. It was thought in 93.3% of cases that a good oral hygiene prevents oral diseases. The students brushed their teeth every day (98%) and they had a consultation with the dental surgeon in 8.7% of the cases. Conclusion: This study shows that students had knowledge of oral hygiene and preventive measures. Efforts should be made to promote, prevent, screen and manage oral diseases in Quranic schools while involving parents in the processes.

The closure anomalies of the peritoneal-vaginal canal include several clinical entities, which are at the origin of various symptomatology.To study the anatomo-clinical and therapeutic aspects of pathologies of the peritoneal-vaginal canal.This was a prospective study from January 1During the study period, 2,699 children were treated in pediatric surgery, of which 150 cases of pathology of the peritoneal-vaginal canal had a hospital frequency of 5.5%. The average age was 3.25 ± 9.63 years. The sex ratio was 14. The reason for consultation was intermittent or permanent inguinal or inguino-scrotal swelling in all children. The pathology was discovered by the parents during the pushing efforts in 46.7%. Inguino-scrotal swelling was found on physical examination in 40% of cases. The right side was reached in 60% of the cases. Hernia accounted for 80.6% of these pathologies. We recorded 31 cases of strangulation and 11 cases of craze. Immediate operative follow-up was simple in 92% of patients. This rate was 96% after 6 months.Pathologies of the peritoneal-vaginal canal are very common in pediatric surgical practice. The first place of these pathologies is occupied by hernia. They preferentially affect male infants.Les anomalies de fermeture du canal péritonéo-vaginal (CPV) regroupent plusieurs entités cliniques qui sont à l'origine d'une symptomatologie variée.étudier les aspects anatomo-cliniques et thérapeutiques des pathologies du canal péritonéo-vaginal.il s'agissait d'une étude prospective du 1er Janvier au 31 Décembre 2015 réalisée dans le service de chirurgie pédiatrique du CHU Gabriel Touré. Elle a porté sur tous les enfants de 0-15 ans présentant une pathologie du canal péritonéo-vaginal opérés dans le service pendant la période d'étude. N'ont pas fait partie de cette étude, les cas non opérés et ou non vus pendant la période d'études.Durant la période d'étude 2699 enfants ont été pris en charge en chirurgie pédiatrique dont 150 cas de pathologies du canal péritonéo-vaginal soit une fréquence hospitalière de 5,5%. L'âge moyen était de 3,25± 9,63 ans. Le sexe ratio était de 14. Le motif de consultation était la tuméfaction inguinale ou inguino-scrotale intermittente ou permanente chez tous les enfants. La pathologie a été découverte par les parents lors des efforts de poussées dans 46,7%. La tuméfaction inguino-scrotale a été retrouvée à l'examen physique dans 40% des cas. Le côté droit était atteint dans 60% des cas. La hernie a représenté 80,6% de ces pathologies. Nous avons enregistré 31 cas d'étranglement et 11 cas d'engouement. Les suites opératoires immédiates ont été simples chez 92% des patients. Ce taux était de 96% après 6 mois.Les pathologies du CPV sont très fréquentes dans la pratique chirurgicale pédiatrique. La première place de ces pathologies est occupée par la hernie. Elles touchent préférentiellement les nourrissons de sexe masculin.

Cerebral miliary tuberculosis is a rare and serious disease due to the hematogenic spread of bacillus tuberculous. It occurs more often in a debility context. Stereotaxic biopsy allows to establish the final diagnosis. But, in most of the cases it is presumptive based on clinical and biological features, and the regression of symptoms under anti tuberculosis treatment, of which depends the vital prognosis. We report the case of an immunocompetent patient, smoker who presented with cerebral military.La miliaire tuberculeuse cérébrale est une affection rare et grave due à la dissémination hématogène des bacilles tuberculeux. Elle survient le plus souvent sur un terrain de débilité. La biopsie stéréotaxique permet d'établir le diagnostic définitif. Mais dans la plus part des cas il est présomptif basé sur d'éléments d'orientation clinique et biologique et la régression des signes sous traitement anti tuberculeux, dont dépend le pronostic vital. Nous rapportons le cas d'un patient immunocompétent, tabagique ayant présenté une miliaire cérébrale.

To assess knowledge and practices on iron prescription in the pediatric ward of the Gabriel Touré university hospital of Bamako, Mali.A cross-sectional study was carried out from the 1st to 31st July 2012 in the service. We presented the participants with a questionnaire and analyzed the medical files of children aged 1-60 months old who received an iron prescription. Each prescriber's consent was solicited and obtained prior to the study.Fifty prescribers were interviewed, among them 10 pediatricians (20%), 31 pediatrics' residents (62%), 2 generalist physicians (4%), 7 medical student (14%); and 100 medical records were analyzed. More than half of the prescribers were aware of the need of iron in children, with 42% knowing about iron reserves. 8% of prescribers knew that iron absorbed through food was heme iron or non-heme iron. Thirty percent of patients received iron at a dose of 8 to 10mg/kg. Length of treatment was not indicated in 92% of patients.In our context, sufficient theoretical knowledge and of children's iron need did not exclude bad prescription practices. Future studies should analyze the reasons of behind this discrepancy.Evaluer les connaissances et les pratiques relatives à la prescription du fer dans le service de pédiatrie du Centre Hospitalier Universitaire Gabriel Touré (CHU-GT) de Bamako, Mali.Il s'agissait d'une étude transversale réalisée du 1nous avons enquêté cinquante prestataires dont 10 pédiatres (20%), 31 médecins CES de pédiatrie (62 %), 2 médecins généralistes (4%), 7 étudiants en fin de cycle médical (14%) et analysé 100 dossiers. Trente pour cent des prestataires ont correctement défini le fer. Plus de la moitié des prestataires connaissaient les besoins en fer chez l'enfant. Les réserves en fer étaient connues de 42% des prestataires. Huit pour cent des prestataires savaient que les fers apportés par l'alimentation étaient le fer héminique ou le fer non héminique. Trente pourcent des malades ont reçu le fer à la dose de 8 à 10mg/kg. La durée du traitement n'a pas été précisée chez 92% des malades.Dans notre contexte la bonne connaissance théorique des indications et des règles de prescription du fer chez l'enfant n'excluait pas les mauvaises pratiques de sa prescription. D'autres travaux devraient analyser les raisons de cette discordance.

Malaria is one of the rare public health plagues which has been prevailing over centuries. It is severe around the world poverty line and remains the most widely spread disease in intertropical zones. The Afro-tropical region, which accounts for 8% of the world population, bears the heaviest malaria burden, with 80% to 90% of cases (200 to 280 millions) among which, 90% are due to P. falciparum.To study neuromalarian lesions in 0-15 year old children in the Pediatric Unit at Gabriel Touré, University Hospital.From February 2009 to January 2010 the study covered 92 children, aged 0-15 years old, with neuromalarian lesions hospitalized at the Pediatric unit of the Gabriel Toure University Hospital.2230 patients were received suffering from malaria, among whom 1320 hospitalized for neuromalarian. 92 cases (6.97%) of neuromalarian lesion were identified. There were 57 boys and 35 girls, with 1.63 sex ratio. 0 to 5 years old age group was the most significant, accounting for 67.39% of subjects. Axial hypotony was the most frequent lesion encountered (65.22%). Temporary blindness was reported in six patients (6.52%). Behavior disorders were reported in seven patients (7.61%). Five patients (5.43%) were victim of hemiplegia. Axial hypotonicity was associated with aphasia in thirty-seven patients (40.22%) and peripheral hypertonia in eighteen patients (19.57%). Seven patients (7.61%) became epileptic and six (6.52%) were suffering from dystonia. Recovery effects were 50% in the short term and 73.9% in the medium term.Despite progress made in terms of diagnosis and care, malaria still remain a fearsome pathology and source of neuromalarian lesions among which some lead to permanent disability. Early intervention and proper treatment could reduce the incidence of neuromalarian lesions.le paludisme est l'un des rares fléaux de santé publique qui ait traversé les siècles sans perdre de son activité. Il sévit dans la ceinture de pauvreté du monde et représente la maladie parasitaire la plus répandue dans le monde intertropical. La région afro-tropicale, qui ne compte que 8% de la population supporte le plus lourd fardeau du paludisme avec 80–90% des cas (200 à 280 millions) dont 90% dus à plasmodium falciparum.L'objectif de cette étude était d'étudier les séquelles du neuropaludisme dans le service de pédiatrie.De Février 2009 à Janvier 2010, nous avons réalisé une étude portant sur les séquelles du neuropaludisme dans le service de pédiatrie du CHU Gabriel Touré. L'étude concernait les enfants de 0–15 ans, hospitalisés et ayant gardés des séquelles neurologiques après un neuropaludisme.2230 patients ont été admis pour paludisme dont 1320 hospitalisés pour neuropaludisme. Nous avons recensé 92 cas (6,97%) de séquelles neurologiques .Il y avait 57 garçon contre 35 filles soit un sexe ratio de 1,63. La tranche d'âge de 0 à 5 ans était la plus représentée, soit 67,39%.L'hypotonie axiale était la séquelle la plus fréquemment rencontrée (65,22%).Elle était associée à l'aphasie chez trente sept patients (40,22%) et à l'hypertonie périphérique chez dix huit patients (19,57%). Sept patients (7,61%) sont devenus épileptiques et six (6,52%) ont présenté une dystonie. La récupération des séquelles a été de 50% à court terme et de 73,9% à moyen terme.le paludisme, malgré les progrès réalisés dans sont diagnostic et sa prise en charge demeure toujours une affection redoutable et pourvoyeuse de séquelles neurologiques dont certaines sont responsables de handicap permanent.

Introduction : Les infections respiratoires aiguës (IRA) constituent l'une des principales causes de morbidité et de mortalité infantile au Mali. L'objectif de ce travail était de décrire les aspects épidémiologiques, cliniques et thérapeutiques de la bronchiolite aiguë du nourrisson au service de pédiatrie du CHU Gabriel Touré. Méthodologie: Il s'agit d'une étude rétrospective portant sur 112 nourrissons âgés de 1 à 24 mois hospitalisés dans le service de pédiatrie générale pour bronchiolite aiguë. L'étude s'étalait sur une période d'un an (du 1er janvier au 31 décembre 2012). Résultats: Les nourrissons âgés de 1 à 6 mois étaient majoritaires (69%). L'âge moyen des patients était de 6 mois avec des extrêmes de 1 et 24 mois. Le sexe masculin était prédominant (63%) avec un sex-ratio de 1,73. Le principal motif de consultation était la difficulté respiratoire (87%). Le pic d'hospitalisation était au mois de novembre (33%). Les principaux signes cliniques en plus des sibilants étaient la toux, la rhinorrhée et la détresse respiratoire (97%). La fièvre était présente dans 38% des cas et la cyanose chez 4% des patients. La saturation en oxygène était inférieure à 94% chez 50% des patients. La kinésithérapie respiratoire a été faite chez un tiers des malades. Tous les malades avaient reçu une corticothérapie et une nébulisation avec du salbutamol et sérum physiologique. Une antibiothérapie a été faite chez 85% des patients. La durée moyenne d'hospitalisation était de 6 jours avec des extrêmes de 1 et 30 jours. Le taux de guérison était de 98 %. Conclusion : La bronchiolite est une pathologie bénigne et fréquente chez le nourrisson de 1 à 6 mois qui évolue favorablement dans la majorité des cas.

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

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 44 - N° 3 - p. 276-279

Soil surface crusting influences water infiltration and runoff but its impact on soil organic carbon (SOC) losses by sheet erosion is largely unknown. Because there are different mechanisms of sheet erosion, from raindrop detachment and transport by raindrops interacting with flow (RIFT), to detachment and transport by flow, that require a certain slope length to be operative, this study examined the impact of slope length on SOC and nutrient losses. Field experiments were conducted on crusted soils in the Sahel region of Africa. Three replicates of micro-plots (1 m x 1 m), plots (10 m long x 5 m width) and long plots (25 m x 6 m) were installed for each crust type in the area (structural, STRU; desiccation, DES; gravel, GRAV; and erosion, ERO) and followed for each rainfall event in the 2012 rainy season. Sediment, SOC content in sediments and selected nutrients (NO3-; PO43-) in the runoff were analyzed to evaluate the annual losses by sheet erosion. SOC losses decreased significantly with increasing slope length from 0.24 g C m(-1) on micro-plots to 0.04 g C m(-1) on plots and to 0.01 g C m(-1) on long plots and similar trends were observed for NO3- and PO43- losses. This suggested a strong scale dependency of sheet erosion with the efficiency of transport by saltation and rolling by RIFT decreasing significantly with increasing slope length, by 6 folds in average between 1 and 10 m, with values between 1.8 on DES crusts and 19 on STRU crusts. These results on the relationship between soil crusting and sheet erosion should be further used to mitigate against the loss of SOC through the implementation of improved soil conservation techniques, as well as to improve soil erosion and/or SOC models.

Introduction: Childhood acute lymphoblastic Leukemias (ALL) is relatively rare in sub-Saharan Africa but probably underdiagnosed. The aim of this work was to describe the epidemiological, clinical, and therapeutic aspects of ALL in the pediatric oncology unit of Bamako. Patients and Methods: It was a retrospective, descriptive study on 33 children with ALL, treated at the pediatric oncology unit of Bamako according to a protocol developped by the French African Pediatric Oncology Group (FAPOG). Results: The mean age of patients was 10 years with extremes of 2 and 15 years and a sex ratio (M/F) of 3.7. The majority of patients were over 5 years of age (79%). Clinically, pallor was noted in 72% of cases, fever in 79% and 24% had a hemorrhagic syndrome. Biologically, the tumor lysis was present in all patients, all patients hemoglobin level less than 10 g/dl, 91% had thrombocytopenia and 51% had leukocytosis (>50 Giga/l). Complete remission at the end of induction was 64%, with 27% of early deaths. After a mean follow-up time of two years, we recorded 12% of loss of follow-up and 82% of deaths. The global survival was 6%. Conclusion: Childhood ALL have a very poor prognosis in Mali. Early diagnosis and adapted protocols to high risk patients will help reduce early deaths and improve the survival of patients in remission.

Erythrocyte G6PD deficiency is the most common worldwide enzymopathy. The aim of this study was to determine erythrocyte G6PD deficiency in 3 ethnic groups of Mali and to investigate whether erythrocyte G6PD deficiency was associated to the observed protection against malaria seen in Fulani ethnic group. The study was conducted in two different areas of Mali: in the Sahel region of Mopti where Fulani and Dogon live as sympatric ethnic groups and in the Sudanese savannah area where lives mostly the Malinke ethnic group. The study was conducted in 2007 in Koro and in 2008 in Naguilabougou. It included a total 90 Dogon, 42 Fulani and 80 Malinke ethnic groups. Malaria was diagnosed using microscopic examination after Giemsa-staining of thick and thin blood smear. G6PD deficiency (A-(376/202)) samples were identified using RFLP (Restriction Fragment Length Polymorphism) assay and analysis of PCR-amplified DNA amplicon. G6PD deficiency (A-(376/202)) rate was 11.1%, 2.4%, and 13.3% in Dogon, Fulani, and Malinke ethnic group respectively. Heterozygous state for G6PD (A-(376/202)) was found in 7.8% in Dogon; 2.4% in Fulani and 9.3% in Malinke ethnic groups while hemizygous state was found at the frequency of 2.2% in Dogon and 4% in Malinke. No homozygous state was found in our study population.We conclude that G6PD deficiency is not differing significantly between the three ethnic groups, Fulani, Dogon and Malinke.

The Sahelian region, characterized by erratic, heavy rainfalls and low soil organic carbon (SOC) stocks, is highly vulnerable to land degradation. While water erosion is recognized as being a main mechanism of SOC losses, little research has yet been done to investigate the role which soil surface crusting might have on SOC losses. The main objective of this study was to evaluate the impact of soil surface crusting on SOC losses. This study was conducted in Tougou Catchment (37 km 2 ), northwest of Burkina Faso, which receives a cumulative mean annual rainfall of 500 mm y − 1 . The area is characterized by sandy soils with varying types of surface crusts. The four different crust types studied were: structural crusts (STRU), which were found under cultivated soils, which were plowed annually; perennial desiccation crusts (DES), gravel (GRAV) and erosion (ERO) crusts, generally found in the degraded semi-arid savannas. Three micro-scale runoff plot (1 × 1 m 2 ) replicates were installed on each of the different types of surface crusts observed in the catchment. Water and sediment samples were collected from the runoff plots after every rainfall event (n = 10) of the 2011 rainy season. The sediment samples were analyzed for organic carbon (OCsed), while the water samples were examined for dissolved organic carbon (DOC). The average of organic carbon losses with sediment (OC L sed), was 0.37 g C m − 2 y − 1 for ERO, 0.36 g C m − 2 y − 1 for DES, 0.24 g C m − 2 y − 1 for STRU and 0.15 g C m − 2 y − 1 for GRAV. DOC accounted for a minute contribution to SOC losses i.e. less than 0.05%. STRU with 10.42 mg C l − 1 showed the highest DOC content, followed by GRAV (6.13 mg C l − 1 ), DES (5.06 mg C l − 1 ) and ERO (4.92 mg C l − 1 ). The OC enrichment ratio (ER) of sediments to that of the 0–0.1 m bulk soil was less than one for DES, GRAV and ERO (0.39, 0.69 and 0.75, respectively) and reached 1.14 for STRU. This pointed to a greater SOC protection from erosion by the perennial crusts of the degraded savannas (DES, GRAV and ERO), as compared to crusts of cultivated fields. Thick, sand-enriched crusts, DES and GRAV, seemed to provide the greatest OC protection. This study pointed out a significant relationship between soils crusting on SOC erosion. It showed that the formation of loose and sandy crusts provides greater SOC protection from water erosion, which in turn may improve SOC stabilization and associated soil functions, such as soil fertility, water-holding capacity and sequestration of atmospheric carbon.

Objectif : Ce travail visait a etudier la morbidite et la mortalite chez les enfants âges de 01 a 59 mois hospitalises dans le service de pediatrie generale du CHU Gabriel Toure. Materiels et Methodes : Il s’agissait d’une etude retrospective, descriptive, sur une periode de 12 mois allant du 1 er janvier au 31 decembre 2013. Resultats : Nous avons inclus 1625 enfants âges de 01 a 59 mois soit 58% des patients hospitalises. Le tiers des patients avait moins d’un an. Les garcons representaient 57 % de notre echantillon avec un sex ratio de 1,33. La majorite des patients (83%) etait issu de milieu social defavorise. Les principaux diagnostics retrouves etaient le paludisme (45%), les infections respiratoires aigues (20,30%), et la malnutrition aigue severe (20,06%). Les patients gueris representaient 82,3% et le taux de mortalite etait estime a 3,3%. La majorite des patients decedes etait des filles (51%). Les deces etaient plus frequents en juillet et aout. Les trois principales causes de deces etaient la malnutrition (47%), le paludisme (32%) et les infections respiratoires aigues (19%). Nous avons enregistre 48 sorties contre avis medical (3%) et 81 cas d’evasion (5%). Conclusion : La morbidite et la mortalite en pediatrie restent preoccupantes dans notre pratique. Elles sont liees a des affections pour la plupart evitables par l’information, l’education et la communication. Mots cles : morbidite, mortalite, enfants, pediatrie, Bamako.

Des etudes effectuees au Burkina Faso et au Mali ont montre une difference de susceptibilite au paludisme entre les Peulhs et les autres groupes ethniques sympatriques, Dogons et Mossis. Nous avons mene une etude longitudinale avec des passages transversaux de 2003 a 2005, visant a evaluer la relation entre anemie et paludisme dans la susceptibilite entre Dogons et Peulhs, deux groupes ethniques sympatriques dans le Sahel malien. La repartition par sexe etait comparable dans les deux groupes ethniques (p = ns). Les Peulhs sont en majorite eleveurs et les Dogons cultivateurs. Ils etaient exposes au meme taux d’inoculation entomologique et vivent dans des conditions socio-economiques similaires. Les passages transversaux ont ete effectues durant la saison de transmission (septembre 2003 et 2005) et la saison seche (mars 2004). Pour le suivi de cohorte, effectue d’aout a decembre 2005, nous avons utilise le protocole de suivi clinique de l’OMS de 28 jours, apres une dose curative d’antipaludiques chez les enfants souffrant de paludisme maladie. Au cours des passages transversaux, les Peulhs presentaient un taux d’hemoglobine significativement plus bas que les Dogons : en 2005 le taux d’hemoglobine moyen etait de 9,4 g/dl chez les femmes peulhs contre 10,7 g/dl chez les femmes dogons (p = 0,0002). Les donnees de l’etude longitudinale ont montre que les enfants de 0–14 ans peulhs avaient des taux d’hemoglobine moyens significativement plus bas que les enfants dogons. A j0, le taux moyen d’hemoglobine etait de 9,6 g/dl chez les Dogons contre 8,7 g/dl chez les Peulhs (p = 0,01). Cette difference etait statistiquement significative a j28 apres le traitement antipaludique avec un taux d’hemoglobine de 10,6 g/dl chez les Dogons vs 9,3 g/dl chez les Peulhs (p < 0,001). Nous avons trouve que l’anemie etait significativement associee a la splenomegalie chez les Peulhs (53,2 % d’anemie vs 10,2 % d’indice splenique) [p = 0,004], et les Dogons (32,9 % d’anemie vs 1,1 % d’indice splenique) [p = 0,005]. Cette difference entre Dogons et Peulhs, quant a la frequence de l’anemie, merite une etude des facteurs determinants dans ces ethnies sympatriques. Les Peulhs dans cette region du Mali souffrent plus d’anemie que les Dogons, malgre leur moindre susceptibilite au paludisme.