Search

Summary: Introduction: Knowledge of the birth cycle is important in the organization of reproductive health services in a facility. The main objective was to study the determinants of the birth cycle at the Kalaban-Coro health center. However, it seems that there are other determinants of the birth cycle, hence the relevance of this study. Material and methods: This was a cross-sectional analytical study from October 1 to December 31, 2020. Results: The study included 977 parturients who gave birth in the department. It recorded more night deliveries (59.1%) than day deliveries (40.9%). The average age of the women was 25 years. Non-educated births were the most represented with 39% of cases. Nocturnal admissions were predominant (58.8%); 59% of parturients had a history of nocturnal delivery and 40% preferred to give birth at night, while 30% had no preference. At admission, 57.91% of parturients were in the active phase during the night, compared to 42.59% during the day; 52.6% of parturients had a nocturnal onset of labor, compared to 47.4% during the day. Conclusion: The study showed that childbirth is more frequent at night than during the day. It highlighted the admission nycthemer, the previous nycthemer of deliveries and the preference of the parturient as other determinants of the nycthemer of the delivery.

Les ingénieurs sont souvent face à un dilemme quand il s’agit de choisir un actionneur ou un mécanisme. C’est dans le but de faciliter ce choix qu’intervient cet article. Il porte sur l’analyse comparative de la puissance de sortie de trois mécanismes simples à savoir : le système bielle-manivelle, le système maneton-coulisseau et le système rotation-translation. Ces mécanismes ont la même caractéristique de la transformation d’un mouvement de rotation continu en mouvement de translation alterné. La présente étude a pour objectif de mettre la lumière sur les caractéristiques des puissances transmises aux coulisseaux des mécanismes alternatifs et mécaniques, concernés par ce travail. Pour ce faire, les puissances transmises aux coulisseaux ont été singulièrement caractérisées, suite : à leurs définitions et à l’interprétation de leurs représentations graphiques., Journal Maghrébin des Sciences Pure & Appliquée, Vol. 8, No 1 (2022): In progress

INTRODUCTION: The gynecological tumors of the patient aged over 70 constitute heterogeneous entities by their oncological and geriatric clinical presentations, which frequently expose to the proposal of “non-standard”, “adapted” or “exceptional” therapies. In Sub-Saharan Africa, cancer is a scourge whose characteristics remain to be clarified, marked by very limited means, and especially by the context of practice in rural areas. We describe in this clinical case the particularity of the management in a rural context of a case of endometrial tumor in an 83-year-old patient at stage IB. OBSERVATION: This is Mrs. M.G., aged 83 4G 4P 4 children, postmenopausal for 30 years who consults for postmenopausal metrorrhagia evolving for 3 months. A diagnostic hysteroscopy was performed showing an ulcerated mass of the uterine cavity bleeding on contact, a biopsy was performed, the result of which was a low-grade endometrial stromal sarcoma. The abdominopelvic CT scan, which demonstrates thickening of the endometrium without damage to surrounding structures, classified as stage IB endometrial tumor. The patient underwent a total hysterectomy with bilateral pelvic dissection. The postoperative course was simple. The patient was discharged on the 7th postoperative day. The result of the histological report: well-differentiated and infiltrating endometroid carcinoma invading the isthmus and the cervix. Parameters and the 4 right and left lymph nodes are unharmed. The histo-prognostic stage was pT2N0Mx. CONCLUSION: The management of endometrial cancer is possible in the rural context in elderly patients. The prognosis is good if the diagnosis is made at an early stage. Surgery could still be offered even for subjects over 80 with less comorbidity. KEYWORDS: Endometrial tumors; Elderly patient; Senegal.

Introduction : En 2018, 6605 cas de tuberculose ont été notifiés au Mali. Bamako en a notifié 32%. Malgré les efforts déployés, la tuberculose constitue un problème majeur de santé de publique. Objectif : Evaluer la prise en charge de la tuberculose pulmonaire en Commune V de Bamako de 2015 à 2018. Matériel et méthodes : Nous avons réalisé une étude transversale de septembre à octobre 2019 sur des séries de cas de tuberculose pulmonaire enregistrées au Centre de Santé de Référence (CSRéf) de la Commune V de Bamako. A l’analyse bivariée les OR ont été estimés et testées à l’aide du Khi Deux au seuil de signification de 5%. Résultats : Un total de 1221 cas a été analysé. La moyenne d’âge était de 37ans±17ans chez les hommes et 35ans±15ans chez les femmes. Les nouveaux cas étaient représentés avec 88,25%, 92,09%, 82,86% et 86,50% respectivement en 2015, 2016, 2017 et 2018. Les cas de rechute étaient de 4,88% en 2017 et 6,34% en 2015. La co-infection avec le VIH variait entre 12,38% et 15,11%. L’analyse des crachats était le plus fréquent examen réalisé avec des proportions de 76,36% à 91%. L’analyse de 5ème mois a montré une amélioration significative pour 2015 et 2016 (p

In this study, we aimed to determine the major causes of limb amputations to improve its treatment.We conducted a-18 month prospective study from March 2015 to September 2016 at the Hospital of Sikasso, a hospital of second reference in Mali.We carried out 50 major limb amputations including 25 men and 25 women aged 38.9 years old on average with extremes of 3 and 80 years old. The amputed limb was the upperlimb in 38 cases (76%) and the lowerlimb in 12 cases (24%). Housewives were the most represented with 18 cases (36%), followed by farmers with 15 cases (30%). The amputation was done immediately or in delayed emergency in 32 cases (54%). Trauma was the most frequent etiology with 13 cases (26%). The post-operative complications have been met in 47 cases. They have been dominated by stump pain and delayed healing in 23 cases (49%) each, suppuration in 10 cases (21%) and the stump necrosis in 3 cases (7%). The mortality rate was 8% (4 cases). We have made prosthetic apparatus for18 patients (36%).The limb amputation is frequent and youths were the most involved. Due the lack of financial support, 64% of our patients could not afford prosthesis.Le but de ce travail était de déterminer les causes des amputations majeures des membres afin d'améliorer leur prise en charge.il s'agissait d'une étude prospective de 18 mois. Elle s'est déroulée de Mars 2015 à Septembre 2016à l'hôpital de Sikasso,un hôpital de deuxième référence du Mali. Elle a porté sur 50 patients (25 hommes et 25 femmes).Nous avons réalisé 50 amputations majeures des membres chez 25 hommes et 25 femmes avec un âge moyen de 38,9 ans et des extrêmes de 3 ans et 80 ans. Dans 38 cas (76%) l'amputation avait concerné le membre inférieur et dans 12 cas (24%) le membre supérieur. Les ménagères étaient les plus représentées soit 18 cas (36%) suivies des agriculteurs dans15 cas (30%). L'amputation était réalisée en urgence ou urgence différée dans 32 cas (54%). L'étiologie traumatique était la plus fréquente soit13 cas (26%).Les complications post-opératoires ont été rencontrées dans 47 cas. Elles ont été dominées par la douleur du moignon dans 23 cas (49%), la suppuration dans 10 cas (21%), le retard de cicatrisation 11 cas (23%) et la nécrose du moignon dans 3 cas (7%). Le taux de mortalité était de 8% (4 cas). Nous avons confectionné des appareils prothétiques pour 18 patients soit 36%.L'amputation de membre a été fréquenteet a concerné le sujet jeune. Par manque de moyens financiers 64% de nos patients ne sont pas appareillés.

The authors are reporting here a documented case of hyperparathyroidism leading to hypercalcemia diagnosed spontaneously. A 75-year old female patient with has been treated since 3-4 years with metformin and ramipiril fortype 2 diabetes and high blood pressure, respectively. She was seen in our endocrinology outpatient visit for tingling in the arms associated with cervical pain with increasing intensity over the last six months. The patient's mother was diabetic and her father had high blood pressure. The diagnostic of primary hyperparathyroidism, resulting from a diffuse hyperplasia of the parathyroid gland, was retained after medical, biological, chirurgical and anatomo-pathological investigations. The blood level of PTH1-84 was 916.60pg/ml Normal value=15-68.3pg/ml.Diffuse poly-arthralgia in the neck and the lower limbs may not always be due to arthrosis in elderlies. Further investigation such as the dosage of blood level of calcium and PTH are required.Les auteurs rapportent un premier cas d'hyperparathyroïdie primaire de découverte fortuite documentée au Mali et responsable d'hypercalcémie. Il s'agissait d'une patiente âgée de 75 ans, diabétique de type 2 depuis trois ans traitée par metformine et hypertendue depuis 4ans traitée par ramipril ; venue en consultation externe en endocrinologie pour fourmillement brachial et douleur cervicale diffuse augmentant progressivement d'intensité depuis 6 mois. Aux antécédents familiaux de diabète chez la mère et hypertension artérielle chez le père. Apres les investigations médicaux, biologiques, chirurgicaux anatomopathologiques le diagnostic retenu fut une hyperparathyroïdie primaire (PTH1-84= 916,60pg/ml (N=15-68, 3pg/ml) causée par hyperplasie diffuse de la glande parathyroïde.La présence de poly arthralgie diffuse cervicale et des membres inférieurs peut ne pas être seulement due à une arthrose chez le sujet âgé. Cela mérite une investigation plus approfondie telle que le dosage de la calcémie et de la PTH.

Metastatsic tumoral ascites are characterised by the presence of cancerous cells in peritoneal fluid. They are frequent at an advanced stage of cancer. The goal of our work was to study cytology's contribution in the diagnosis of metastatic ascites at the teaching hospital of Point G.It was a 3 years retrospective and prospective study, from January 2013 to December 2015. The study included every ascitic samples containing malignant cells at the teaching hospital of Point G. We looked for clinical informations in the patient's fold to find the primary cancer site, the histological diagnosis and the folllowup.We collected data from 213 patients with ascite. Among them, 61 where malignant (28.6 %). Sixty-six percent (66%) of our patients were women. The most represented range age was from 46 to 60 years with a mean of 57.7 years. Housewives were the most frequent among our patients with a rate of 50.8%. Ovarian cancer was the first site with metastatic ascite (26%). It was followed by liver and stomach with respectively 20% and 18%. Ascite was the first clinical manifestation in 36% patients with cancer. It was isolated in 78%. After 6 months, the mortality rate was 76.6%.The cytology of ascite liquid is an imortant test for the diagnostic of metastatic ascites.Les ascites métastatiques cancéreuses sont caractérisées par la présence de cellules cancéreuses métastatiques dans le liquide péritonéal. Elles sont fréquentes à un stade avancé des cancers. Il s'agissait de déterminer la contribution de la cytologie au diagnostic et à l'évaluation du pronostic des ascites métastatiques dans le service d'Anatomie et Cytologie Pathologiques du CHU du Point G.Notre étude s'est étendue de Janvier 2013 à Décembre 2015; soit une période de 3 ans. Elle était rétrospective et prospective incluant tous les patients dont l'étude cytologique des liquides d'ascitea mis en évidence des cellules malignes. Le dossier médical des patients a été exploité pour la recherche du site primitif et du diagnostic histologique éventuel et le suivi.Sur 213 examens cytologiques de liquide d'ascite; 61 étaient malins, soit un taux de 28,64%. La tranche d'âge la plus répresentée était de 46 à 60 ans avec un âge moyen de 53,7 ± 14,7 ans. Le sexe féminin était dominant avec un taux de 66%. La profession la plus fréquente était les ménagères soit un taux de 50,82%. Le siège primitif le plus fréquent était l'ovaire (26%). Il était suivi par le foie et l'estomac avec respectivement 20% et 18%. L'ascite a été le signe révélateur du cancer dans 36% des cas. Elle était isolée dans 78%. Après 6 mois de suivi, le taux de mortalité était 75,6%.L'examen cytologique constitue un examen paraclinique dans le diagnoticdes ascites metastatiques cancéreuses.

Oxidative stress represents an imbalance between the endogenous antioxidant defenses and the production of pro-oxidant molecules. The present study describes oxidative stress markers (oxidant and antioxidant) metabolic disturbances in diabetic and non-diabetic patients at the Internal Medicine and Endocrinology ward of hospital of Mali.We conducted a descriptive case / control study involving 30 diabetic and 30 non-diabetic patients. Studied markers were Glutathione erythrocyte peroxidase (GPX), intra erythrocyte Superoxide dismutase (SOD), plasmatic uric acid, direct and total bilirubins, albumin and markers for diagnosis and monitoring of diabetes.Non-diabetic patients (9%) had higher glutathione peroxidase levels compared diabetics (3%) (p = 0.005). An increase in superoxide dismutase was observed in 73.3% of diabetics versus 40% of nondiabetics (p = 0). The albumin, uric acid and bilirubin levels were identical in both populations. Glycated hemoglobin was significantly correlated with microangiopathies (p = 0.0058) and macro angiopathies( p=0,0007) in diabetics.The study showed an increase in antioxidant defenses in diabetics by the elevation of superoxide dismutase and a relative normalization of glutathione peroxidase.Le stress oxydant est un déséquilibre entre les défenses antioxydantes endogènes et la production de molécules pro-oxydantes. L'objectif principal était d'étudier les différents marqueurs du stress oxydatif (oxydant et antioxydant) chez les sujets diabétiques et non diabétiques au niveau du service de médecine interne et d'endocrinologie de l'hôpital du Mali à Bamako.l'étude était transversale avec comparaison entre 30 sujets diabétiques et 30 sujets non diabétiques. Les marqueurs étudiés : Glutathion peroxydase érythrocytaire (GPX), la Superoxyde dismutase (SOD) intra érythrocytaire, l'acide urique plasmatique, Les bilirubines directes et totales, l'albumine ainsi que quelque marqueur de diagnostic et de suivi du diabète.Trois pour cent de nos diabétiques avaient un taux de glutathion peroxydase élevé contre 9% des non diabétiques (p =0,005) ; augmentation de la Superoxyde dismutase des diabétiques 73,3% contre 40% des non diabétiques (p =0). Taux d'albumine, acide urique et la bilirubine identiques dans les deux populations ; hémoglobine glyquée était corrélée significativement aux complications dégénératives micro angiopathies (p=0,0058) et macro angiopathies (p=0,00017) chez les diabétiques.l'étude a montré une augmentation des défenses antioxydantes chez les trente diabétiques par l'élévation de la Superoxyde dismutase et normalisation relative du glutathion peroxydase.

To study the cases of pelvic ureteral stones in our daily practice and to discuss the epidemiological, clinical and therapeutic aspects.We performed a descriptive retrospective study of 37 cases of patients with pelvic ureteriasis. These files were collected in the Urology Department of Gabriel Touré Hospital in Mali from 30/01/2014 to 31st December 2017. For each patient we studied: age, sex, clinical, para-clinical and therapeutic aspects.We had 37 cases. The average age of patients was 41.86 ± 12.58 years with extremes of 22 and 72 years. The average consultation time was 2 years +/- 1year1 / 2 with extremes ranging from 4 days to 9 years. Urinary schistosomiasis was the most common medical history (6 cases). The clinical symptomatology was dominated by nephric colic. The ASP / Ultrasound pair allowed diagnosis in the majority of cases. The treatment was surgical in all cases.Extracorporeal lithotripsy and ureteroscopy are currently the gold standard in the treatment of these lithiases. Open surgery remains relevant in our epidemiological and socioeconomic context. Although it is the most traumatic surgical technique, it has the advantage of being able to extract the lithiasis in one single step and correct any associated urological abnormalities.évaluer la prise en charge des cas de lithiase de l'uretère pelvien dans notre pratique quotidienne et discuter les aspects épidémiologiques, cliniques et thérapeutiques.Nous avions réalisé une étude rétrospective descriptive portant sur 37 dossiers de patients porteurs de lithiase de l'uretère pelvien. Ces dossiers ont été colligés dans le Service d'urologie de l'hôpital Gabriel Touré au Mali du 30 /01/2014 au 3l décembre 2017. Pour chaque patient nous avons étudié l'âge, le sexe les aspects cliniques, paracliniques et thérapeutiques.Nous avions recensé 37 patients porteurs de lithiase de l'uretère pelvien. L'âge moyen des patients était de 41,86±12,58 ans avec des extrêmes de 22 ans et 72 ans. Le délai moyen de consultation était de 2ans avec des extrêmes allant de 4 jours à 9 ans. La bilharziose urinaire était l'antécédent médical le plus fréquent (6 cas). La symptomatologie clinique était dominée par la colique nephretique. Le couple ASP/ Echographie permettait le diagnostic dans la majorité des cas. Le traitement a été chirurgical dans tous les cas.La lithotripsie extracorporelle, l'urétéroscopie sont actuellement le gold standard du traitement de ces lithiases. La chirurgie ouverte reste d'actualité dans notre contexte épidémiologique et socio-économique c'est la technique opératoire la plus traumatisante, elle présente l'avantage de pouvoir en un seul temps extraire la lithiase et corriger d'éventuelles anomalies urologiques associées.

Xeroderma pigmentosum is related to a defect of the enzymes involved in repairing the oncogenic effects of ultraviolet exposure. The condition is found all over the world, in all ethnicities and races. This rare genodermatosis is often unknown in countries lacking specialist in dermatology. This scarcity and insufficiency of qualified personnel give rise to difficulties in diagnosing this pathology, especially in West Africa where XP is wrongly diagnosed for other pathologies. Objective: To share with colleagues the problem of diagnosis of Xeroderma pigmentosum in countries with insufficient number of dermatologist and poor technical platform. Observation: 21-year-old man, with no pathological history of dermatosis was seeking for medical consultation because of cutaneous dryness and photophobia. Previous visits at several health centers failed to diagnose the condition and no noticeable improvement was seen from given treatment. Verbal questioning found the notion of consanguinity (his father and his mother are cousins, and belong to the same Dogon group). Cutaneous pigmentary disorders were absent at birth but appeared at the age of 12 years. Physical examination highlighted photophobia in addition to specific clinical and paraclinical signs allowed to diagnose Xeroderma pigmentosum varying type. Conclusion: in West Africa, the challenge of diagnosis of Xeroderma pigmentosum is undoubtedly related to a lack of qualified personnel and technical means of diagnosis, which makes its frequency underestimated.Le Xéroderma pigmentosum (XP) est lié à un défaut des enzymes impliquées dans la réparation des effets oncogènes de l'exposition aux ultraviolets. L'affection se rencontre dans le monde entier, dans toutes les ethnies et races. Cette génodermatose rare est souvent méconnue dans les pays en manque de spécialiste en dermatologie. Cette rareté de Xeroderma pigmentosum et l'insuffisance de personnel qualifié engendrent des difficultés diagnostiques de cette pathologie surtout en Afrique Occidentale où le XP est diagnostiqué à tort pour d'autres pathologies.Partager avec les confrères la problématique de diagnostic de Xéroderma pigmentosum dans les pays en insuffisance de dermatologues et de plateau technique.il s'agissait d'un patient de 21 ans, sexe masculin, sans antécédents pathologique de dermatoses, issu d'un mariage consanguin qui a consulté pour sècheresse cutanée et photophobie après un long parcours dans beaucoup des centres de santé de la place sans diagnostic et sans amélioration notable, chez qui l'interrogatoire a retrouvé la notion de consanguinité (son père et sa mère sont des cousins, et provenaient du même clan Dogon),l'absence de troubles pigmentaires cutanées à la naissance et l'apparition des troubles pigmentaires cutanées à l'âge de 16ans. L'examen physique a objectivé la photophobie en plus des signes cliniques et paracliniques specifiques ce qui a permis de retenir le diagnostic de Xéroderma pigmentosum, forme variante.en Afrique Occidentale, la difficulté diagnostique de Xéroderma pigmentosum est sans doute en rapport avec un manque de personnel qualifié et des moyens techniques de diagnostic, ce qui rend sa fréquence sous-estimée.

The diabetic foot wound is a real public health problem, 10% of the reasons for hospitalization. The risk of amputation is 10 to 30 times higher in diabetics than the general population.To study the problem of amputations of the diabetic foot.This was a descriptive and cross-sectional study that took place in the Department of Medicine and Endocrinology of the Mali Hospital from July 1st, 2016 to June 30th, 2017.Twenty-five (25) diabetic patients were enrolled in our study. The sex ratio was 0.66. At admission, 100% of our patients had arterial disease, 96% neuropathy, and mixed foot in 80%. Poor glycemic control in 64% of patients; osteitis in 52% of cases; 92% of the patients had a 100% amputation risk according to the University of Texas classification. Nearly half or 46% of patients had amputations in the leg. We recorded 1 death case that is 4%.The problem of amputation of diabetic feet is a function of the poor equilibrium and progressive neurological and vascular complications of diabetes.La plaie du pied diabétique constitue un réel problème de santé publique, 10% des motifs d'hospitalisation. Le risque d'amputation est de 10 à 30 fois plus élevé chez les diabétiques que la population générale.Etudier la problématique des amputations du pied diabétique.II s'agissait d'une étude descriptive et transversale qui s'est déroulée dans le service de médecine et d'endocrinologie de l'hôpital du Mali du 1er Juillet 2016 au 30 Juin 2017.Vingt-cinq (25) patients diabétiques ont été recrutés dans notre étude. Le sex ratio était de 0,66. A l'admission, 100% de nos patients avaient une artériopathie, 96% une neuropathie, et un pied mixte dans 80%. Un mauvais équilibre glycémique chez 64% des patients ; l'ostéite dans 52% des cas; 92% des patients avaient un risque d'amputation à 100% selon la classification de l'université du Texas. Près de la moitié soit 46% des patients ont été amputé au niveau de la jambe. Nous avons enregistré 1 cas de décès soit 4%.La problématique de l'amputation des pieds diabétiques est fonction du mauvais équilibre et des complications évolutives neurologiques et vasculaires du diabète.

Objectives: This study in female sex workers (FSWs) aimed to: (1) estimate type-specific incidence and persistence of human papillomavirus (HPV) infection in Cotonou (Benin) and Bamako (Mali); and (2) identify the factors associated with type-specific incidence and persistence of high-risk HPV (HR-HPV) infection. Methods: A 1-year prospective cohort study on cervical cancer screening, and HPV and human immunodeficiency virus (HIV) infections was conducted among FSWs in Cotonou and Bamako from 2017 to 2019. Poisson regression models assessed factors associated with the incidence of HR-HPV infection, while log-binomial regression was performed to identify factors associated with the persistence of HR-HPV infection. Adjusted relative risks (ARR) and 95% confidence intervals (95% CI) were estimated. Results: The incidence of HR-HPV infection was 46.98 per 1000 women-months (predominant types HPV16, HPV35 and HPV59). Factors associated with the incidence of HR-HPV infection were age

INTRODUCTION Cervical cancer screening coverage rate is

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

Background: Noncommunicable diseases are the leading cause of death in the world and low and middle-income countries suffer from preventable premature death. The aim of this study was to assess the risk factors for non- communicable disease (NCDs) in general and particular cardiovascular diseases (CVDs) among the outpatients of our department of medicine. Methods: We performed a cross-sectional study from April to December 2017 by the consecutive enrollment of outpatients who attended in our department of medicine of Hopital Somine DOLO de Mopti, Mali. Clinical and laboratory data were measured for cardiovascular risk assessment. Framingham Risk Score (FRS) and Systemic Coronary Risk Estimation (SCORES) were computed by using Framingham and SCORE equations. Metabolic syndrome was defined using the harmonized criteria from the International Diabetes Federation (IDF) and the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). Data were captured in excel and analyzed with R version 4.0.3. The statistical significance was set at p = 0.05. Results: A total of 292 patients were enrolled in this study. The prevalence of traditional cardiovascular risk factors was 36.64%, 21.57%, 14.04%, and 13.01% for high blood pressure, hyperglycemia, smoking, and alcohol consumption, respectively. The metabolic syndrome accounted for 23.63%. The mean body mass index was 26.10 ± 7 kg/m2. The overall 10-year risk for cardiovascular events or death was 26.3% and 8.6% according to the FRS and SCORE equation, respectively. The 10-year risk of cardiovascular events according to the FRS was significantly higher in subjects aged 50 and above compared to subjects aged under 50 years, 34.46% vs 13.16%, p < 0.001. Likewise, the 10-year risk for cardiovascular death according to SCORE equation was also significantly higher in subjects aged 50 and above compared to subjects under 50 years, 9.43% vs 2.09%, p = 0.02. Regarding gender, the FRS was significantly higher in men compared to women 49.50% vs 7.84%, p < 0.001. This same trend was observed with the SCORE, 14.67% vs 4.13%, p = 0.03. Conclusion: Our data corroborate the increasing prevalence of cardiovascular risk factors in SSA. A comprehensive cardiovascular risk factors assessment should be implemented in all stages of health facilities and a longitudinal follow-up could help shed a light on the epidemiology of NCDs in general and particularly CVDs and thereby improve their control policies in SSA.

AIM: To determine the frequency and describe the anatomoclinical features of urologic cancers attending at the surgical oncology unit of Donka National Hospital. MATERIALS AND METHODS: This study was retrospective and descriptive concerning the patients followed and treated for urological cancers at the Donka oncological surgery unit from 2007 to 2017. Age, sex, primary sites and histological types were studied. RESULTS: We recorded 40 cases of urological cancers, 31 (77.5%) of which were male. Their age ranged from two to 81, with an average of 44.0 years. Primary sites were kidney (14 cases), prostate (12 cases), bladder (eight cases), testis (four cases), penis (one case) and urethra (one case). Kidney cancer were nephroblastoma (seven cases) and clear cell carcinoma (seven cases). All prostate cancers were adenocarcinomas. Bladder cancer included urothelial carcinoma (three cases), squamous cell carcinoma (two cases), lieberkhunien adenocarcinoma (one case), rhabdoid sarcoma (one case) and carcinoma poorly differentiated (one case). Testicular cancers were embryonic carcinomas (two cases) and seminomas (two cases). Penile and urethra cancers were respectively squamous cell carcinoma and urothelial carcinoma. CONCLUSION: Urologic cancers were relatively common in our unit. The most common were kidney, prostate and bladder cancers.

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

Introduction: Complete cervico-urethral transection is a vesicovaginal fistula characterized by total disinsertion of the urethra from the bladder. It is a fistula of the cervico-urethral intersection threatening the mechanism of continence. The aim of this study was to describe the epidemiological and therapeutic aspects of this type of fistula. Patients and Methods: This was a descriptive retrospective study on patients who have had surgery for cervico-urethral transection from June 01, 2012 to June 01, 2015. Results: Cervico-urethral transections (n = 76) accounted for 33.77% of all urogenital fistulas admitted to our department of surgery during the study period. The average age was 25.02 ± 8, 6 years. Married patients accounted for 85.58%, 72.36% had not received any classical education. Fistulas less than one year old made up 56.58% of cases, associated lesions were perineal tears 25.0%, vaginal sclerosis, 21.05%, vaginal straps, 13.15%, rectovaginal fistula, 2.63% and the shortness of the urethra less than 2.5 cm in 42.10% of cases. All surgeries were performed vaginally with a 98.68% fistula closure rate and an average of 1.68 surgeries per patient. After closure of the fistula, 10.67% of patients presented a residual urinary incontinence. Conclusion: Complete cervico-urethral transection is a frequent vesicovaginal fistula. She sometimes exposes to urinary incontinence after closing the fistula. The results of his surgery are often good at the cost of multiple intervention.

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

We undertook a prospective and descriptive observational study on abdominal trauma from February 1, 2016 to August 31, 2017. The aim of this work was to identify the typology and management of abdominal trauma cases in our surgery department. Overall, abdominal trauma represented 3.54% (62/1751) of all surgeries during the study period. Among the 62 cases, men accounted for 59 and women for 3. The sex ratio was 19.67. The mean age was 24 ± 15 years. Road accidents were the most represented with 43.5% of cases. The couple of signs, hypovolemic shock and abdominal pain and decrease on blood pressure were the prominent clinical symptoms with 100.0%, and 50.0% of cases, respectively. Abdominal ultrasound and abdominal x-ray without contrast were performed in 67.0% and 18.0% of cases, respectively. Abdominal trauma was divided into two entities: contusion 68% and wounds 32%. Medical treatment was sufficient in 23.00% of cases. Laparotomy as a surgical approach was performed in 77.0% of cases. Local hemostasis plus drainage (27.08%), splenectomy (25.00%), suture (14.58%), hemostasis by tamponade (8.33%) and colostomy (2.08%) were undertaken as surgical procedures when it came to deal with contusions. Debridement of wounds plus suture and hemostasis by tamponade was performed in 18.73% and 4.16 cases, respectively. The most observed lesions were those of the spleen with 27.42% and those of the small bowel with 24.19%. The postoperative follow-up was straightforward in 83.33% of cases. The overall mortality was 4.17%.

Introduction: Small bowel obstruction (SBO) is defined as a complete and persistent cessation of the transit of materials and gases. It occurs in a segment of the digestive tract located between the pylorus and the colorectal junction. Herein, we report a case of small bowel obstruction (SBO) following excessive consumption of wild grapes with no previous abdomen medical or surgical history. Presentation of case: A 65-year-old male farmer presented with cessation of materials and gas associated with vomiting of food and then bilious. The abdomen was bloated and painful on palpation with a moving, painful mass in the left iliac fossa. The hypothesis of acute occlusion of the colon was retained and confirmed on the X-Ray which showed a dilation of small bowel with air-fluid levels. The diagnostic of acute SBO was retained. We performed urgently a median laparotomy. We found the dilation of the loops from the jejunum to the sigmoid colon with a compact mass at the sigmoid colon of 15 cm in length and 6 cm in diameter. We proceeded to crush the mass that was made up with wild grape seed fecal, and push it back to the rectum. The phytobezoar made up with wild grape seeds was extracted through the anus with the fingers after anal dilation. After extraction of the bezoar, the patient’s complaints completely subsided. Discussion: SBO is a frequent emergency surgical pathology. SBO induced by phytobezoar often occurs in patients with abdomen surgery history. However, it is particularly rare in virgin abdomen. Conclusion: This case report aims to raise awareness of phytobezoar as a cause of SBO in elderly even though without abdomen surgery history.

- Label: BACKGROUND NlmCategory: BACKGROUND content: "Sub-Saharan Africa and south Asia contributed 81% of 5\xC2\xB79 million under-5 deaths and 77% of 2\xC2\xB76 million stillbirths worldwide in 2015. Vital registration and verbal autopsy data are mainstays for the estimation of leading causes of death, but both are non-specific and focus on a single underlying cause. We aimed to provide granular data on the contributory causes of death in stillborn fetuses and in deceased neonates and children younger than 5 years, to inform child mortality prevention efforts." - Label: METHODS NlmCategory: METHODS content: "The Child Health and Mortality Prevention Surveillance (CHAMPS) Network was established at sites in seven countries (Baliakandi, Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya; Bamako, Mali; Manhi\xC3\xA7a, Mozambique; Bombali, Sierra Leone; and Soweto, South Africa) to collect standardised, population-based, longitudinal data on under-5 mortality and stillbirths in sub-Saharan Africa and south Asia, to improve the accuracy of determining causes of death. Here, we analysed data obtained in the first 2 years after the implementation of CHAMPS at the first five operational sites, during which surveillance and post-mortem diagnostics, including minimally invasive tissue sampling (MITS), were used. Data were abstracted from all available clinical records of deceased children, and relevant maternal health records were also extracted for stillbirths and neonatal deaths, to incorporate reported pregnancy or delivery complications. Expert panels followed standardised procedures to characterise causal chains leading to death, including underlying, intermediate (comorbid or antecedent causes), and immediate causes of death for stillbirths, neonatal deaths, and child (age 1-59 months) deaths." - Label: FINDINGS NlmCategory: RESULTS content: Between Dec 10, 2016, and Dec 31, 2018, MITS procedures were implemented at five sites in Mozambique, South Africa, Kenya, Mali, and Bangladesh. We screened 2385 death notifications for inclusion eligibility, following which 1295 families were approached for consent; consent was provided for MITS by 963 (74%) of 1295 eligible cases approached. At least one cause of death was identified in 912 (98%) of 933 cases (180 stillbirths, 449 neonatal deaths, and 304 child deaths); two or more conditions were identified in the causal chain for 585 (63%) of 933 cases. The most common underlying causes of stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180 stillbirths) and congenital infection or sepsis (27 [15%]). The most common underlying causes of neonatal death were preterm birth complications (187 [42%] of 449 neonatal deaths), perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis (50 [11%]). The most common underlying causes of child deaths were congenital birth defects (39 [13%] of 304 deaths), lower respiratory infection (37 [12%]), and HIV (35 [12%]). In 503 (54%) of 933 cases, at least one contributory pathogen was identified. Cytomegalovirus, Escherichia coli, group B Streptococcus, and other infections contributed to 30 (17%) of 180 stillbirths. Among neonatal deaths with underlying prematurity, 60% were precipitated by other infectious causes. Of the 275 child deaths with infectious causes, the most common contributory pathogens were Klebsiella pneumoniae (86 [31%]), Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and cytomegalovirus (34 [12%]), and multiple infections were common. Lower respiratory tract infection contributed to 174 (57%) of 304 child deaths. - Label: INTERPRETATION NlmCategory: CONCLUSIONS content: Cause of death determination using MITS enabled detailed characterisation of contributing conditions. Global estimates of child mortality aetiologies, which are currently based on a single syndromic cause for each death, will be strengthened by findings from CHAMPS. This approach adds specificity and provides a more complete overview of the chain of events leading to death, highlighting multiple potential interventions to prevent under-5 mortality and stillbirths. - Label: FUNDING NlmCategory: BACKGROUND content: Bill & Melinda Gates Foundation.

Colonic intussusception on carcinoma is rare. We report the case of an ileo-coeco-colic invagination on carcinoma of the right colon that occurred in a 40-year-old patient. The clinical symptomatology had a tendency to tumoral pathology of the colon. The ultrasound performed revealed acute intussusception. During the operation, we found an ileoceco-colic intussusception. A right hemicolectomy was performed. Anatomopathological examination of the operative specimen confirmed the diagnosis of adenocarcinoma. Conclusion: Intussusception is uncommon in adults, and is often indicative of an organic barrier to colon. His symptomatology is not very specific. Ultrasound and abdominal computed tomography help in the diagnosis. Surgical excision followed by anatomopathological examination of the operative specimen allows the diagnosis to be made histologically.

La méningite est une inflammation des méninges : les enveloppes de la moelle épinière et du cerveau dans lesquelles circule le liquide céphalorachidien. Bien que les épidémies dans la ceinture méningitique soient dues à Neisseria meningitidis du sérogroupe A, la survenue en 2000 d'une épidémie au niveau mondial a permis de mettre en cause la responsabilité de N. meningitidis du sérogroupe W135, et en 2016 la survenue d'une épidémie de méningite causée par N. meningitidis du sérogroupe C au Mali. Un cas de méningite W135/y a été détecté par le service d'infectiologie du CHU Point G le 18 Juin 2019. Par la suite nous avons investiguer le cas de méningite W135/Y dans l'aire de santé de Yirimadio en commune VI dans le District de Bamako en Juin 2019. Notre objectif était décrire le cas, déterminer le potentiel de diffusion de la maladie, proposer des mesures de contrôle. Il s'agissait d'un patient de 42 ans avec méningite W135 et Y ayant bénéficié d'une meilleure prise en charge au CHU contrairement au cabinet privé. La guérison a intervenu sans séquelles. Nous avons effectué un briefing du personnel du cabinet par rapport à son implication dans la surveillance épidémiologique.

Introduction : Au plan mondial, le nombre de cas de rougeole a augmenté de 300% lors des trois premiers mois de 2019 comparativement à la même période pour 2018. Les faibles couvertures vaccinales de l'aire de santé de Tominian Central, la notification de cas suspects par le district en 2018 et les récentes épidémies de rougeole survenue dans la région constituent une préoccupation sanitaire locale. Cette étude a pour but d'évaluer le système de surveillance de la rougeole de l'aire de santé de Tominian Central. Méthodes : Nous avons conduit une étude transversale utilisant les données de surveillance de la rougeole de 2009 à 2018 de l'aire de santé de Tominian Central. Nous avons appréciés les attributs d'organisation et de fonctionnement, utilité, sensibilité, réactivité, simplicité, sensibilité, représentativité et la qualité des données. Les agents chargés de la surveillance de la rougeole ont été interviewés. Résultats : À l'exception du cabinet médical, il existait un système de rapportage des données de la surveillance de la rougeole et la preuve de leurs transmissions au niveau supérieur est vérifiable. Le personnel du CSCom et du cabinet médical chargé de la notification n'ont réalisée aucune action de santé publique dans la surveillance de la rougeole. Un seul cas suspect de rougeole a été notifié par le Centre de santé de référence. Conclusion : Le système de surveillance de la rougeole de Tominian Central apparaît comme étant fonctionnel, moins utile, moins sensible, moins représentatif, moins réactif. Des efforts supplémentaires sont nécessaires pour le dynamiser.

En 2018, le Mali a notifié 1485 cas de rougeole dont 4 décès chez les enfants de moins de 5 ans. Depuis 1998 les données de surveillance épidémiologique de la rougeole n'ont pas été analysées, d'où l'objectif de cette étude est d'analyser les données de la rougeole de 2009 à 2018 du district sanitaire de Tominian. Méthodes : Une étude transversale rétrospective a été menée sur les données de la rougeole de 2009 à 2018 à Tominian. Elles ont été analysées en temps, lieu et personnes. Les résultats ont été exprimés en fréquences et proportions. Résultats : Au total 96 cas de rougeole ont été enregistrés avec zéro décès. Il y avait 24 cas confirmés biologiquement et 17 par lien épidémiologique. Les moins de cinq ans étaient les plus représentés avec 42,71% avec une prédominance du sexe masculin (55 cas). 2013 a été l'année avec le nombre plus élevé (31 cas) et aucun cas n'a été notifié en 2011 et 2014. La plupart des cas sont apparus entre Mars et Avril. L'aire de santé de Ouan a notifié le plus de cas avec 32 (33%) tandis que 9 aires n'ont notifié aucun cas pendant 10 ans. Les couvertures vaccinales du district sont restées en dessous de 95%. Conclusion : La rougeole évolue de façon cyclique à Tominian avec une couverture vaccinale inférieure à 95%. La majorité des cas étaient des enfants de sexe masculin non vaccinés. Neuf aires de santé n'ont réalisé aucune notification.

INTRODUCTION : Le mélanome sous-unguéal est un sous-type distinct de mélanome malin cutané provenant de structure à l’intérieur de l’appareil unguéal. Son taux d'apparition est faible, représentant 0,7 à 3,5% du total des tumeurs malignes. Nous rapportons un cas de mélanome sous-unguéal de l’index gauche métastatique découvert devant une adénopathie axillaire homolatérale illustrant ainsi l’agressivité de cette tumeur et son mauvais pronostique lorsque son diagnostic est tardif. OBSERVATION : Patiente de 59 ans, admise en consultation pour une masse axillaire droite ulcéro-nécrotique évoluant depuis six mois. A l’examen, on notait une altération de l’état générale, téguments et conjonctives pâles avec des œdèmes des membres inférieurs, mous, indolores et gardant le godet. Localement, on notait une plaque d’aspect noirâtre de l’index gauche, asymétrique, à bordure irrégulière atteignant les 2ème et 3ème phalanges avec destruction unguéal, prenant les parties molles associé à une adénopathie homolatérale ulcéro-nécrotique avec des métastases cutanées en transit multiples de mélanome de l’avant-bras droit, la biopsie de l’adénopathie axillaire avait un aspect histologique en faveur d’un mélanome. CONCLUSION : Notre cas clinique rapporte le pronostic sombre de mélanome malin ainsi que son fort pouvoir métastatique, la rareté des localisations sous-unguéal et sa méconnaissance dans la population générale font qu’il peut être découvert tardivement d’où la nécessité d’un examen minutieux pour ne pas passer à côté d’un mélanome.

INTRODUCTION : De nombreux facteurs pronostiques ont été décrit pour les cancers de l’œsophage avec des stades différents, en particuliers ceux présentant des métastases ganglionnaires. Notre objectif était d’étudié l'impact des facteurs locaux liés à la tumeur sur le pronostic des patients atteints de carcinomes épidermoïdes de l'œsophage non métastatiques. MATERIELS ET METHODES : Nous avons revu rétrospectivement les données de 278 patients consécutifs atteints de carcinomes épidermoïdes de l'œsophage entre Janvier 2009 et Décembre 2016. Les facteurs pronostiques tels que le volume du GTV, le diamètre maximal du GTV et la longueur du GTV ont été analysés. RESULTATS : Les résultats de l'analyse de la courbe ROC ont montré que la valeur critique pronostique du volume du GTV, du diamètre maximal du GTV, de la longueur du GTV et de la longueur du transit baryté étaient respectivement de 27,98 cm3, 1,80 cm et 5,85 cm et 4,25 cm. L'analyse univariée a montré que le volume du GTV (p=0,0184), le diamètre maximal du GTV (p=0,0246), la longueur du GTV (p=0,0035) et la longueur du transit baryté (p=0,0004) étaient les facteurs pronostiques de survie. La longueur du transit baryté (p=0,0149) était le seul facteur pronostique du contrôle local. L'analyse multivariée a montré que la longueur du transit baryté (p=0,0013), le diamètre maximal du GTV (p=0,0047) et la longueur du GTV (p=0,0032) étaient les facteurs pronostiques indépendants associés à la survie. La longueur du transit baryté (p=0,0037) était le facteur pronostique indépendant pour le contrôle local. CONCLUSION : La longueur de la lésion œsophagienne était le principal facteur pronostique lié aux patients atteints de carcinomes épidermoïdes de l'œsophage non métastatiques, par conséquent, nous suggérons que les médecins accordent suffisamment d'attention et un traitement actif aux patients avec un long transit baryté.

Introduction: Leishmaniasis transmitted by sandflies is an important vector-borne disease. In Chad, information on sandflies is outdated, and so this study was designed to update the sandfly fauna. Methods: Sandflies were collected in five health districts representing two geoclimatic zones using sticky traps and pyrethrum sprays in indoor and peridomestic habitats between September 2019 and December 2020. All collected sandfly specimens were identified based on species-level morphological characters. Results: A total of 2,015 specimens belonging to 13 species of sandflies (one Phlebotomus and twelve Sergentomyia) were collected and identified. The vector of human cutaneous leishmaniasis, Phlebotomus duboscqi, represents 0.65% of all collected sandflies and is the only representative of the Phlebotomus genus to be collected predominantly inside human dwellings. Phlebotomus orientalis, the vector of visceral leishmaniasis previously collected in Chad in 1976 was not found in this study. Sergentomyia clydei, Sergentomyia schwetzi, Sergentomyia antennata and Sergentomyia africana were the most abundant species collected with 44.71%; 22.73%; 16.03% and 11.17%, respectively. Sergentomyia schwetzi and Sergentomyia dubia, the two species involved in the transmission of canine leishmaniasis, were found in five and four study sites respectively. Conclusion: According to our results, the sandfly fauna of the two geoclimatic zones of Chad is comprised of 13 species. Our data showed that, unlike P. orientalis which was not found, P. duboscqi is present in four of the five sites surveyed. Therefore, these areas are at risk and remain potential foci of cutaneous leishmaniasis. However, the need for further studies such as vector species detection, their seasonal fluctuations and their vector competence.