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Adnexal torsion is a spontaneous rotation of the ovary and sometimes the fallopian tube around its axis which can interfere with arterial supply and lead to ischemia It is a rare complication of an ovarian cyst, which can occur at any age, from the fetal period to adulthood. The mature cystic teratoma accounts for 20% of all ovarian tumors and is seen especially in young girls and therefore is most often benign. It's a surgical emergency. We report here two cases of adnexal torsion operated at the level of the pediatric surgery unit of the Hospital of Mali The two girls are 14 and 13 years old, nulligest and normoregulated with recurrent abdominal pain admitted for acute pelvic pain. On palpation, an abdomino-pelvic mass of a firm and painful consistency is noted. An abdominopelvic ultrasound was performed in both cases and revealed torsion of the left adnexa on the left ovarian cyst in the first and on the right in the second. The surgical procedure performed was manual detorsion and cystectomy in both cases. The anatomopathological examination concluded with a dermoid cyst In the two girls and their postoperative course was simple.

To study the epidemiological-clinical profile of sickle cell patients in the health district of Bla. Method: This was a prospective and descriptive study over 1 year, from February 2021 to January 2022; relating to all patients who were screened with the TDR_Sikle Scan and/or followed up during the study period. Results: We performed the TDR in 982 patients from all the consultations (N= 2976). The mean age was 29.6 ± 3.8 years. SS and SC sickle cell disease represent 8.04% (79 cases). Children 23.52% (28 patients) and women 64.35% (51 patients). SS married couples represented (13.92%). Anemia was the most common reason for consultation (47%), followed by bone and joint pain (29%). 33% of the patients (26 cases) had a complication, of which 15 patients had had a CVO and 6 patients (23%) a worsening of the anemia. We have recorded 1 death. Conclusion: regular medical follow-up of sickle cell patients considerably improves the vital prognosis. The frequency of sickle cell traits remains high including SS and SC forms.

Blunt abdominal trauma being one of the most common abdominal emergencies; they explain the patient's indication of armed expectation in the absence of any notion of hemodynamic instability. The objectives were to determine the hospital frequency, to identify the etiologies and to analyze the therapeutic modalities. The study was retrospective and prospective from January 1, 2010 to December 31, 2018 involving 45 patients treated for hemoperitoneum in the general surgery department of Sikasso hospital. All patients admitted to the department for blunt abdominal trauma with hemoperitoneum were included. We collected 45 patients whose mean age was 18.7 years (extreme 3 - 55 years). The sex ratio was 4.6 in favor of men (37 M, 8 F). We found 23 (51.12%) cases of AVP, 13 (28.89%) cases of falls from a height, 11 (7.7%) cases of aggression, hoof kick 1 (2.22%). 19 (42.22%) patients had low haemoperitoneum, 16 (35.56%) medium abundance, 10 (22.22%) high abundance. 32 (71.11%) provided non-operative treatment with a mean hospital stay of 13.7 days (range 5 to 20). 1 patient was unstable, it was activated 24 hours later. We immediately had 12 patients (26.67%) with an average hospital stay of 16.5 days (extreme 10 -24) and the postoperative course was simple in 66.67% (8 cases). We recorded 1 death (2.22%).

In our surgical practice we have experienced abdominal trauma by stretcher. The case we are reporting to you was a 65-year-old subject who was the victim of a motor-cart type traffic accident with piercing of the abdomen. by stretcher and taken to Sikasso hospital. A laparotomy made it possible to discover mesenteric contusions, hemoperitoneum without visceral lesion. We aspirated 200ml of hemoperitoneum after extraction of the stretcher, closure of the abdominal wall. We propose to review the literature in order to discuss the therapeutic modalities.

Cross-reinal ectopia implies that one of the two kidneys seats on the contralateral side, it is a congenital anomaly very rare. The two (2) Kidneys can be merged or not giving the superimposed kidney appearance. This anomaly is most often asymptomatic and fortuitous discovery (by imaging or reverse of an autopsy). We report observation of a 22-year-old patient carry of crossed renal ectopia with fusion discovery following of pelvian pain intermittent low intensity calmed down by paracetamol. The aim of this work was to bring the place of imaging in the therapeutic management of ectopic kidneys with review of the literature.

Introduction: Road traffic accidents (RTAs) are nowadays a real worldwide scourge because of the high number of victims. In Mali, we have little data related to the characteristics of deaths related to MVAs, hence the interest of this study which aimed to determine the sociodemographic, clinical and paraclinical characteristics of deaths involving a motorcycle received in our forensic medicine unit. Materials and method: This was a prospective, monocentric, cross-sectional study conducted from January 1, 2016 to December 31, 2016 in the forensic medicine unit of the CHU GT. Were included, all deaths involving a motorcycle received in our unit and accompanied by a requisition. Results: Of 458 MVA deaths, we identified 147 motorcycle deaths, a prevalence of 32.1%. The mean age was 36.5 years with extremes of 1 to 72 years and a sex ratio of 7.65. Students were the most represented, 90 cases (25.18%). The motorcycle mechanism was more frequent 90 cases (61.9%). The month of May and the hours from 19:00 to 05:00 were the most frequent times of occurrence of accidents respectively 37 cases (25.2%) and 76 cases (51.7%). Polytraumatic lesions were found on 83 bodies, i.e. 56.46%. Death was noted on arrival in 80% of cases and none of our bodies had undergone autopsy. Conclusion: Motorcycle accidents on public roads remain a major public health problem in our country.

Plummer Vinson syndrome is a rare condition characterized by cervical dysphagia associated with iron deficiency anemia and a ring on the upper esophagus. Sometimes its unusual presentation can lead to misdiagnosis. We report the observation of a patient with Plummer-Vinson syndrome, revealed by upper dysphagia.

Introduction: In the recent past, it was not possible to treat coronary disease in Mali due to a lack of technical facilities. All our coronary patients were evacuated to the Maghreb, France or the sub-region to receive adequate care. In 2019, the opening of an interventional cardiology room at the University Hospital "Luxembourg" and the training of a team has allowed the local management of a good number of Malians and foreigners suffering from coronary pathology. We report here the results of 30 months of activities. Methodology: We performed a perspective analysis of coronary angiograms and angioplasties performed in our center from September 2019 to February 2022. Clinical, paraclinical including angiographic data were collected and analyzed. Results: Between September 2019 and February 2022, 670 patients underwent coronary angiography, 262 of whom were followed by angioplasty. Male gender was predominant (72.6%), a sex ratio of 2.62. The mean age was 59 years and the 46-65 age group was the most dominant (50.24%). High blood pressure was the main cardiovascular risk factor (33.8%). Chronic coronary syndrome was the most frequent indication (59.8%) followed by coronary syndromes (38.3%). The radial route was used in 98%. Coronary angiography was pathological in 69%. Multitruncular lesions were predominant (35.5%) followed by monotruncular (32.8%). 39.10% of our patients underwent angioplasty. Complications were minimal (3%) and mortality was 2.03%. Conclusion: In our developing countries, we are witnessing an epidemiological transition with the decrease in infectious diseases and the emergence of non-communicable diseases, particularly coronary diseases. Their management requires an adequate technical platform, qualified human resources, and multidisciplinary collaboratio

Introduction: The aim of this study was to analyze the epidemioclinical aspects of iatrogenic urological lesions, to describe the anatomical lesions and to establish a link between surgery and these lesions. Materials and methods: Descriptive and retrospective study carried out in the urology department of Sikasso hospital from January 2016 to December 2018. Results: In total, 26 patients suffering from iatrogenic urological lesions secondary to gyneco-obstetric surgery were recruited, ie 2.86% of our activities and 17.74% of female urogenital lesions. Average age: 31, 88 ± 11, 54 years old; Average age at 1st marriage: 15.00 ± 1.87 (12 - 20). Almost all of our patient was out of school, homemaker, in unpaid jobs and 83.33% from rural Sikasso. Seventeen patients (65, 38%) were 1.55 m shorter and of these 25% had not received antennal care. Labor stagnation (mean duration: 47, 22 ± 20, 48 hours) was the main indication with 90.47% of stillbirths. The main complaint (92, 30%) of our patients was leakage of urine, followed by abdominal-lumbar pain and abdominal distension associated with anuria. Urogenital fistulas (91.66%); urinary tract infection (20.83%) and acute renal failure 11.53% were common complications. The most common causal operation (76.91%) was cesarean section, often performed by general practitioners. The bladder was more frequently (65, 40%) affected by these injuries than the ureter (34, 60%). Regarding the surgical approach, an open transvesical fistulorrhaphy in two planes or a vesicoureteric reimplantation was performed. The result was excellent in 88, 46% of cases and bad in 11 and 53%. Conclusions: Iatrogenic urologic complications of gyneco-obstetric surgery were not uncommon. Early diagnosis and appropriate management could improve its prognosis. The preventive measures are based on the promotion of girls' education and socio-economic life, good antennal care and the continuing training of health care providers in charge of managing obstetric

Introduction: Uterine rupture is one of the main causes of maternal and fetal mortality in Mali. Method: This was a descriptive cross-sectional prospective study in the Gynecology - Obstetrics department of the Sikasso hospital from January 01, 2018 to June 30, 2019, i.e. eighteen months. The study covered all cases of childbirth recorded in the Gynecology - Obstetrics Department of Sikasso Hospital during the study period. Results: During these 18 months of study, we recorded 68 cases of uterine rupture out of a total of 4,815 deliveries, ie a frequency of 1.41%. Regarding the mode of admission, 93% were evacuated against 7% who came on their own. For the evacuated patients, 82.4% arrived by ambulance against 13.2% by personal car and 4.4% by public transport. The duration of labor was ≥ 12 hours in 22.1% of cases. Lesions were associated with rupture in 19.1% of cases. The use of uterotonics was responsible for uterine rupture in 54.4% of cases and 7.4% of patients had a generally narrowed pelvis. Simple hysterorrhaphy was performed in 30%, hysterorrhaphy associated with tubal ligation resection in 50% and subtotal hysterectomy in 20% of cases. Lack of schooling, the lack and poor quality of prenatal care have been factors that increase maternal and perinatal morbidity and mortality. The maternal-fetal prognosis was poor with 11.7% maternal deaths and 86.8% perinatal deaths. Conclusion: Better screening of populations at risk, quality ANC, early diagnosis and rapid and adequate management will improve the maternal-fetal prognosis.

Goiter is the most common endocrine pathology in the world [2]. Its medical treatment is based on hormone therapy, iodotherapy and its surgical treatment is based on thyroidectomy. Familial goiter appeared to be more common in the gotrigenic regions of Europe, rarer in North America. In Africa, particularly in Mali, there have been few studies on familial goiter. The purpose of this study was to report 4 cases of goiter in the same siblings with a history of goiter in the mother and paternal grandmother to review the literature.

Pedicle torsion is the most common complication of ectopic spleen. The observation we bring was the case of a 20 year old lady admitted to the emergency room with an acute surgical abdomen picture evolving for about two years. Clinical examination revealed generalized abdominal pain and a mass in the right iliac fossa. The torsion of the spleen was suspected by the clinic, the abdomino-pelvic ultrasound and confirmed during an exploratory laparotomy. Intraoperatively the spleen was necrotic on a long twisted pedicle indicating a splenectomy.

Antibiotics remains an issue in intensive care units (ICUs), because of its overuse and the emergence of bacterial resistance. The objective of the study was to evaluate the prescription of antibiotics in ICUs at university teaching and the regional hospitals in Mali. PATIENTS AND METHODS: It was a cross sectorial retrospective and multicentric study over six months. The inclusion criteria were, all the patients hospitalized in ICUs at least for 48 hours with antibiotic treatment. We also included the cost of the daily consumption of antibiotics. The Microsoft excel was used for data entry and the data analysis was done with the software Epi info version 3.5.2. RESULTS: Five hundred sixty-and-six (566) patient les responded to the inclusion criteria. The antibiotics prescription rate was 43.3%. The mean age of the patients was 36.8 ± 20.7. The women were more represented (59.7%). The monotherapy (60.6%) was the most common concept use. The third-generation cephalosporin (3GC) was used in monotherapy (27.7%). The average volume of consumption of antibiotics in monotherapy was the highest. The analysis of the data showed that the volume consumption of antibiotics was different according to grade of the prescribers which was respectively 98972.3 for anaesthesia & intensive care residents and 74990.7 for anaesthetist-intensivist. The treatment was reviewed during the rst 48 hours (99.8%) and was readapted in 106 of the patients (18.7%). We mainly increased the doses of antibiotics 77.4%. The average duration of the treatment was 5.2 ± 3.7 (days). CONCLUSION: The use of antibiotics remains high and uncontrol in intensive care units in Mali, which could be explain by the limited blood culture testing and insufcient of qualied human resource in some of the regional hospitals.

Appendicular mucocele is a rare appendicular tumor characterized by dilation of the appendicular lumen with linear changes in the mucosa and hypersecretion of mucus. We report a case of appendicular mucocele in a 73-year-old patient. Clinically, there was pain in the right iliac fossa, nausea, sometimes vomiting, and a poorly defined mass palpated in the right iliac fossa. The abdominal ultrasound found an appendicular plastron and the complete blood count showed leukocytosis. The patient underwent an appendectomy and the operative consequences were simple, the pathological examination of the operative specimen concluded that there was a mucinous cystadenoma of the appendix.

Clitoral cyst remains a common pathology in our regions given the persistence of traditional female genital mutilation practices. Cyst forms in the bed of clitoris carried entirely by excision. In our case the consultation was motivated by the size of the cyst, psychological trauma, discomfort and gravity caused by the tumor. Our gesture consisted of surgical exeresis with attempt to restore little lips. The operating procedures were simple and the result was satisfactory. Through this case we want to highlight the complications of excision and the treatment of clitoral scar cyst.

BACKGROUND AND AIMS La drépanocytose est une maladie potentiellement mortelle dans les populations africaines, en particulier chez les enfants de moins de 5 ans. Dans des contextes à ressources limitées, l'amélioration de leur prise en charge passe par un diagnostic précoce et fiable. Nous avons évalué l'acceptabilité maternelle et des professionnels de santé et les performances diagnostiques de deux tests de diagnostic rapide (TDR) pour le dépistage systématique de la drépanocytose chez le nouveau-né au Mali. METHODS Un dépistage systématique des Syndromes Drépanocytaires Majeurs (SDM) (HbSS, HbSC ou HbS/B-thalassémie) a été implémenté à l'accouchement chez les nouveau-nés dans trois maternités à Bamako et Kayes. Les deux TDR (SickleScan® et HemotypeSC®) ont été réalisés à partir de sang de cordon et comparés à la technique de référence, la chromatographie liquide à haute performance (CLHP). Les nouveau-nés diagnostiqués SDM sont pris en charge. RESULTS Parmi les 4333 femmes ayant accouché entre avril et août 2021, 84,6% ont donné leur accord pour le dépistage néonatal. Au total, 3 648 nouveau-nés ont été diagnostiqués par HPLC dont 1,64% présentaient un SDM (0,63% HbSS, 0,85% HbSC et 0,16% HbSB+thalassémie), 78,21% une hémoglobine normale (HbAA), 19,84% étaient porteurs d'hémoglobine S, 0,22% étaient homozygotes pour l'HbC et 0,08% avaient une HbC/B+thalassémie. Comparé à l'HPLC, le SickleScan et l’HemotypeSC avaient respectivement une sensibilité de 81,67% et 78,33%, une spécificité de 99,75% et 99,67%, une valeur prédictive négative de 99,69% et 99,64% et une valeur prédictive positive de 84,48% et 79,66%. CONCLUSIONS Cette étude montre que le dépistage systématique des SDM à la naissance est bien accepté par les familles et professionnels de santé. Les deux TDR ont eu des performances de diagnostic remarquables par rapport à l'HPLC pour identifier les SDM, faisant de ces TDR un outil de choix pour un dépistage néonatal abordable, rapide et facile à utiliser.

Toussaint Rouamba,1,2 Paul Sondo,2 Isidore W Yerbanga,2 Adelaide Compaore,2 Maminata Traore-Coulibaly,2 Franck S Hien,2 Nassirou A Diande,2 Daniel Valia,2 Innocent Valea,2 Patricia Akweongo,3 Rita Baiden,4 Fred Binka,4 Fati Kirakoya-Samadoulougou,1 Halidou Tinto2 1Center for Research in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium; 2Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso; 3Epidemiology and Disease Control Department, University of Ghana, Accra, Ghana; 4INDEPTH-Network, Accra, Ghana Purpose: In 2005, Burkina Faso changed its first-line treatment for uncomplicated malaria from chloroquine to artemisinin-based combination therapies (ACTs). Patient adherence to ACTs regimen is a keystone to achieve the expected therapeutic outcome and prevent the emergence and spread of parasite resistance. Eleven years after the introduction of ACTs in the health system, this study aimed to measure adherence level of patients in rural settlement and investigate the determinants of nonadherence.Patients and methods: The study was carried out at public peripheral health facilities from May 2017 to August 2017 in Nanoro health district, Burkina Faso. An electronic semi-structured questionnaire was used for data collection from patients with an ACT prescription at their medical consultation exit visit and during home visit at day 5±2. Adherence level was measured through self-report and pill counts. Logistic regression was performed to identify factors for nonadherence.Results: The analysis was conducted on 199 outpatients who received ACT as prescription. About 92.5% of ACT prescriptions included artemether-lumefantrine tablets. Adherence level was measured in 97.0% of included patients at day 5±2. Of these, 86.0% were classified as “complete adherent” and 14.0% as “nonadherent”. In univariate analysis, patients/caregivers who considered that affordability of ACTs was easy seemed to be less adherent to the treatment regimen (OR: 0.26; 95% CI: 0.07–0.70). In univariate and multivariable analyses, patients/caregivers who did not receive advices from health care workers (HCWs) were more likely to be nonadherent to the prescribed ACTs (adjusted OR: 3.21; 95% CI: 1.13–9.12).Conclusion: This study demonstrates that majority of those who get an ACT prescription comply with the recommended regimen. This emphasizes that in rural settings where ACTs are provided free of charge or at a subsidized price, patient adherence to ACTs is high, thus minimizing the risk of subtherapeutic concentrations of the drug in blood which is known to increase resistance and susceptibility to new infections. Therefore, to address the problem of patient nonadherence, strategy to strengthen communication between HCWs and patients should be given greater consideration. Keywords: malaria, hyperendemic area, drug prescription, artemether-lumefantrine, amodiaquine-artesunate &nbsp