Search

Copyright of Mali Médical is the property of Mali Medical, Faculte de Medecine, de Pharmacie et d'Odonto-stomatologie and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Epilepsy remains a significant public health concern in Sub-Saharan Africa (SSA) where diverse etiological factors contribute to its prevalence. Among these factors are conditions originating from the neuroectoderm, such as tuberous sclerosis. Insufficient medical attention and a lack of comprehensive multidisciplinary care contribute to its under-recognition., Materials and Methods: We conducted a retrospective descriptive study, involving 12 patients admitted to the neurology and pediatric departments of the University Hospital Ignace Deen between 2010 and 2022 due to recurring epileptic seizures. Subsequently, these patients were diagnosed with Tuberous sclerosis using the Schwartz 2007 criteria. The aim of this study is to reassess this condition from a clinical and paraclinical point of view in a tropical environment., Results: Tuberous sclerosis, also known as Bourneville disease, was diagnosed in 12 patients exhibiting focal motor seizures and complex focal seizures likely associated with cortical and subcortical tubers detectable by EEG and neuroimaging, including CT and MRI. Delayed treatment resulted in varying degrees of mental decline. Additionally, some patients displayed cardiac hamartomas and intracranial posterior and anterior aneurysms as minor diagnostic indicators., Conclusion: The study reveals a consistent clinical presentation accompanied by deteriorating neurological and psychological symptoms attributed to delayed multidisciplinary management. These findings are utilized to assess therapeutic strategies and prognostic outcomes., Competing Interests: On behalf of all authors, the corresponding authors state that there is no conflict of interest. All authors have declared that they have no financial relationships at present with any organizations that might have an interest in the submitted work., (© 2024 Published by Elsevier B.V.)

Introduction: Hyperprolactinemia, which is a supra-physiological secretion of prolactin, is the most common anterior pituitary disorder encountered in clinical practice. Its incidence and prevalence are poorly defined in Africa and the rest of the world. The objectives were to study the clinical, paraclinical, etiological and therapeutic aspects of hyperprolactinemia at the Mali hospital., Methodology: This was a 5-year cross-sectional study. Data collection was retrospective (July 2011 to October 2015) and prospective (December 2015 to July 2016)., Results: We collected 37 cases of hyperprolactinemia. The sex ratio was 0.85. The average age was 37.32 years with extremes ranging from 15 to 74 years. The clinical picture was dominated in women by amenorrhea (80%), galactorrhea (70%), headache (55%), hypofertility (50%), visual disorders (25%) and in men by decreased libido (64.7%), gynecomastia (47.1%), headache (47.1%), visual disorders (41.2%) and erection disorders (29.4%). Basal prolactinemia was greater than 100ng/ml in 45.9% of patients. Cerebral CT had objectified: 11 cases of macroadenomas and 5 cases of pituitary microadenomas. The main causes of hyperprolactinemia were: prolactin pituitary adenoma (43.24%); hypothyroidism (5.40%) and estrogen-progestin use in 5.40%. For treatment, 64.9% of patients were placed on cabergoline; 27% on bromocriptine and 8.10% on simple clinical and biological monitoring., Conclusion: Hyperprolactinemia is a condition that exists in our health care facilities. Clinicians should consider this in the face of galactorrhea amenorrhea or decreased libido. It is also necessary to improve the technical platform for better care., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Objective: To analyze the management of obstetric vesico-vaginal fistula in the three sites of Engender Health in Guinea., Patients and Methods: It was a retrospective study of descriptive type having helped collect 450 cases of vesico-vaginal fistulas in three support sites engender health between January 2008 and December 2011. The variables studied were epidemiological, clinical and therapeutic reasons and treatment outcomes were evaluated after a decline of at least six months., Results: The mean age of onset of the fistula was 25years, ranging from 12 to 55years and 58.8% (n=265) of patients were aged between 18 and 30years. The mean duration of fistula was 11years, ranging from 1 to 38years. Eighty-two percent (n=416) of patients were housewives and 66.4% (n=299) off school. The complex fistula with 66% (n=297) was the most frequent. The treatment consisted of a fistulorraphie after splitting vesico-vaginal in 93.3% (n=420) of cases. Therapeutic results considered after a mean of 8months have resulted in a cure in 79.3% (n=357) of cases, improvement in 4.2% (n=19) of cases and failure in 16 4% (n=74) of cases., Conclusion: Vesico-vaginal fistula is a major cause of maternal morbidity in Guinea. The establishment of a real health policy based on sound medical and social structures contributes to its eradication., Level of Evidence: 5., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: To analyze in a retrospective way the clinical and therapeutical aspects of the testicular torsion in our service., Patients and Methods: It is a retrospective survey of 15 years, from June 1st, 1993 to May 31 2008 to the urology - Andrology service of Conakry. We have 27 files of patients with torsion of the spermatic cord confirmed to the intervention. A percentage of 70.30% patients were less than 25 years old., Results: The scrotal pain was the most frequent functional sign (96.3%). Only 11 patients (40.7%) have been received before the sixth hour. The swelling of the scrotum, ascended testis and the sign of Prehn were the dominant physical signs. All patients have been operated. The number of spire towers varied from 1 to 3. Twenty-two testes (81.5%) have been judged viable and fixed. With a median follow-up of 60 months, the testes volume of these patients was stable in 20 cases (90.9%). The postoperative course was simple in 96.3% of cases. Twenty-three patients (85.2%) were released within a week., Conclusion: Torsion of the spermatic cord remained a dangerous affection because putting in game the vital prognosis of the testis. The only justifiable attitude is the urgent surgical operation., (Copyright 2010 Elsevier Masson SAS. All rights reserved.)

The use of ritonavir as a protease inhibitor boost is rare in sub-Saharan Africa because a heat-stable formula is not available. We report the results of an open-label pilot trial with unboosted atazanavir in combination with lamivudine and didanosine as first-line therapy conducted in Senegal. Treatment-naive HIV-1 infected adult patients without active opportunistic disease were included. The primary endpoint was the proportion of patients with plasma HIV-1 RNA <400 copies/ml at week 48. Forty patients (12 men and 28 women; mean age +/- SD: 40 +/- 9 years) were included. Treatment was changed during the study for two patients (pregnancy, tuberculosis); one patient was lost to follow-up and one patient died (gastroenteritis with cachexia). At week 48, 78% [95% confidence interval (CI): 65-90%] and 68% (95% CI: 53-82%) of the patients had HIV-1 RNA <400 and <50 copies/ml, respectively (intent-to-treat analysis; not completer = failure). Among the seven patients with HIV-1 RNA >or=400 copies/ml at week 48, five were not compliant; genotyping analysis (n = 4) did not reveal a major mutation for protease inhibitors. The mean CD4 cell count change from baseline to week 48 was +238 +/- 79 cells/mm(3). The combination of unboosted atazanavir with lamivudine and didanosine was efficient and well tolerated in HIV-1-infected patients with results similar to those observed in Northern countries. These results suggest that unboosted atazanavir with its high genetic barrier could be a valuable alternative to NNRTIs in resource-limited countries in some HIV-1-infected patients in case of compliance issues with NNRTIs, intolerance to NNRTIs, resistance mutations to NNRTIs, in women with childbearing potential, or as a maintenance therapy in patients with virological suppression.

Introduction: The epidemiological profile of urinary stones varies from region of the world to another according to food habit and certain enviromental factors. The aim of our study was to establish an etiological approach of the urinary lithiasis collected in Conakry by morphological and constitutional analysis., Materials and Methods: It was a prospective study from january 1 rst 2003 to january 1 rst 2004 concerning all the stones collected. They were analysed by binocular magnifying glass and infra red spectrophotometry of Fourier., Results: During the period, 18 patients were observed (14 male, 4 femele) of 27.4 +/- 4 years old (from 2 to 69) living mainly in urban environment. From these patients 28 stones were collected; 12 spontaneously and 16 surgicaly. Their composition were whewellite (36%), struvite (29%), carbapatite (14%), urates (14%) and weddellite (7%). In Conakry stones come mainly from hyperoxaluria and urinary tract infection; hypercalciuria is uncomon., Conclusion: The urinary calculations examined among patients show in the adult a prevalence of elements in favour of a hyperoxalurie and a notable context of urinary infections in particular in the child; the pure hypercalciurie remains negligible in Conakry, we plan to lead a thorough work to the national scales.

Sexual dysfunction is frequent in the diabetic population. In Africa, medical care for erectile dysfunction is underprovided, profoundly altering the quality of life of the patients. We report the prevalence of erectile dysfunction in 187 diabetic patients followed in the department of Endocrinology of the Conakry teaching hospital. Prevalence was estimated from the French version of the International Index of Erectile Function (IIEF). Erectile dysfunction concerned 90 patients (48%) of whom a severe form was observed in 54%, a moderate form in 35% and a mild form in 12%. The patients who presented erectile dysfunction were significantly older, displayed longer duration of diabetes with more complications (sensorial neuropathy and macroangiopathy) and often took drugs for associated cardiovascular diseases. In 28% of the cases, erectile dysfunction was associated with a decline in libido and in 26% with ejaculation disorders. In conclusion, erectile dysfunction is frequent and severe among diabetic patients in Guinea. The medical staff plays an essential role to initiate early diagnosis, promote psychological support and provide medication, if possible.

It is a retrospective study of descriptive type on a 4 years period, from April 1, 1999 to March 31, 2003. The aim was to determine factors bound to morbidity and mortality of renal affections in the Conakry University Hospital Center Nephrology Unit. The study was based on 606 hospitalized patients of whom 21 dialysed. The study's references were age, sex, renal affections frequency, mortality, associated pathologies, hospitalization period, death hours and other factors of cardio-vascular risks (tobacco, alcohol). Patients having answered to the selection criteria were 365 men (60.23%) and 241 women (39.77%) with a sex ratio of 1.51. The average age was 44 +/- 17 years old with extremes of 15 and 95 years old; 16.34% of the patients were aged less than 25 years and 14.03% were more than 65 years old. According to the charge taking, 462 (76.24%) were at their neighbors' charge, only 144 (23.76%) could take themselves in charge for their medical care. According to the received treatment before hospitalization, 357 had consumed decoctions of leaves and roots, 86 consulted a health center. The average period of hospitalization was 13 +/- 9 days with extremes of 1 and 80 days. Nicotine addiction was observed with 183 patients of whom 181 were men and alcoholism with 134 patients of whom 122 were men. Renal affections were chronic renal failure (51%), arterial hypertension (30.36%), chronic kidney disease (8.09%), intense renal failure (7.59%), urinary infections (1.65%), intense kidney disease (0.99%) and kidney cancer (0.33%). Among them, 130 deaths were observed (21.45%). According to the period going on before the medical check up, 24 death occurred 2 weeks after the first symptom, and 106 after more than a month. Considering the hours, 33 death (25.38%) occurred between 8 a.m. and 4 p.m. and 63 deaths (48.47%) between 4 p.m. and 8 a.m.; in 34 cases, the hour was not specified. Mortality was due to chronic renal failure in 97 cases (74.61%), to arterial hypertension in 19 cases (14.62%) and to other affections in 14 cases (0.77%). Infections, diabetes, arterial hypertension and anemia sickle cells were renal risk factors. Morbidity and mortality factors were numerous and varied: medical check up delay, traditional cure, patients 'weak turnover, lack of medical care, lack of required equipment and the absence of popular health education.

We conducted a multi-centre study in West African hospital wards to document accidental blood exposure (ABE) risks in these settings, and assessed the incidence of ABE in participating healthcare workers (HCWs) retrospectively. In total, 1241 HCWs participated in the survey from 43 hospital wards. Among them, 567 (45.7%) had sustained at least one ABE with an estimated incidence of 0.33 percutaneous injuries (PCIs) and 0.04 mucocutaneous contacts (MCCs)/HCW/year in medical or intensive care personnel and 1.8 PCIs/HCW/year in surgeons. The ABE was a needlestick in 454 (80.1%) of 567 cases, a cut in 19 cases (3.4%), a splash or contact with non-intact skin in 87 cases (15.3%), and was undocumented in seven cases (1.2%). The source patient's human immunodeficiency virus (HIV) serostatus was positive in 74 cases (13.1%), negative in 65 cases (11.5%), and unknown in 416 cases (73.4%). The ABE was not notified in the ward in 392 cases (69.1%). Healthcare structures can improve HCWs' safety and reduce the stigma against HIV-infected patients by improving access to training, information, primary prevention (ABE prevention equipment) and secondary prevention (postexposure prophylaxis) of occupational infection risks.

Analysis of 92 cases of quadriceps fibrosis following intramuscular injection into the thigh showed that the most affected age group was 3- to 7-year-old preschool children with a male predominance (68.7%). The most implicated drug (81.7% of cases) was quinine salts after of mean of 2 injections. Stiffness of the knee was the most outstanding clinical sign. In our series, the efficient technique for prompt functional recovery consisted of lengthening the quadriceps tendon by isolated "Z" plasty (56.5% of cases). Administration of drugs in oral, rectal or intravenous forms is the most effective means of prevention.

From 16 cases collected in eight years (January 1991-December 1999) in the I. Deen Teaching Hospital Department of Urology, the authors study the gynaecological and obstetric surgery urological complications. They noted that these complications interest in 80% of cases the 18-47 years old woman with a high parity in 70% of cases. Hysterectomy, whatever the indication is the main etiology: 62.50%, caeserean takes the second place with 25%. The anatomic lesions are ureteral in 68.75% of cases and bladder in 31.25%. In the 14 cases treated, in the department, uretero reimplantation has been done in 46.66%, bladder suture in 40% and nephrectomy in 6.66%. Thirteen women were healed and one died.

The authors report a series of 157 stenoses of the urethra treated by endoscopic urethrotomy between 1991 and 1997. After a first urethrotomy the success rate is 51.8%, with a decline of one year. Mortality is zero, and the morbidity assessed at 9%. For these authors, the result is better when the urethrotomy concerns an uninfected, one-time, short (less than 2 cm) stenosis, whatever the etiology, located on the proximal urethra. The duration of the postoperatory catheter has been fixed at three days. Poor results (35.20%) have been reported in stretched stenoses located on the distal urethra. These poor results have been treated by another urethrotomy, with 25% good results. The remaining 10.2% have needed sessions of urethral dilatation, even a plasty.

Objective: It was to compare picture and results of anatomopathological exams of the operated organs, given the individualization of new procedures in recent years., Methods: One hundred and eighty-two patients, aged from 50 to 98 years, were hospitalized for prostatic tumors. After a complete clinical exam followed by surgery, the operated organs were the subject of a conventional histological study. Data from the rectal touch (RT) were compared with the histological results., Results: In the diagnosis of benignancy, RT and the histology are in agreement in 93% of the cases, though only in 75% of the cases of suspected malignancy. Seven percent of the occult cancers are observed, of which ten cases (6%) are adenocarcinoma at Stage A, and two cases (1%) of carcinoma in situ. We observe as well one case of prostatic localization of leukemia and one case of leiomyosarcoma. Prostatitic-type inflammatory lesions and malpighian metaplasias are very frequent 18 and 7%, respectively). Basal cell hyperplasia is rare., Conclusion: The RT keeps its place in the exploration of the prostate, within the framework of individual screening and patient follow-up. Transrectal echography and protein-specific antigen (PSA) dosing are certainly necessary but expensive in our country. Histology, which remains irreplaceable, allows us to make a definitive diagnosis at low cost.

Hryntschak Technic is the most common method in the prostatic hyperplasia surgical treatment in the Ignace Deen Urological Department. The aim of the authors in this paper is to study the epidemiological aspects of hryntschak early complications from january 1994 to December 1998. They found, from 96 cases that 41.70% are specific complications and 58.30% are non specific complications. Wound infection (35.40%), bladder fistula (15.60%) and epididymitis (11.50%) are the most frequent complications. The 61 to 80 years old rural man, with a urethral catheter placed before operation is the first interested by Hryntschak early complications.

From January 1st 1993 to December 31st 1998, 28 cases of bladder diverticula have been collected in Ignace Deen teaching hospital department of urology. The purpose of authors is to study the epidemiological aspects of diverticula of the bladder. They noted that bladder diverticula in 96.40% of cases are male disease, diagnosed by cystography, intravenous urography, ultrasonography or cystoscopy in 86%; and the etiology of bladder diverticula is a prostatic tumor in 68% of cases. A diverticulectomy is done by open surgery, associated to relieving outlet obstruction in 42.90%.

We have registered 2,064 cases of cancer among the inhabitants of Conakry, Guinea, during 1992-1994, corresponding to age-standardized incidence rates (ASRs) of 83.3 per 100,000 in men and 110.5 per 100,000 in women. As elsewhere in West Africa, the principal cancer of men was liver cancer (ASR 32.6), with modest rates of stomach (ASR 6.2) and prostate (ASR 8.1) cancers. In women, cervix cancer was the dominant malignancy (ASR 46.0), followed by liver cancer (ASR 12.5) and breast cancer (ASR 10.9). In contrast to contemporary East and Central Africa, Kaposi's sarcoma remained rare (only 4 cases). In the childhood age group, relatively high incidence rates were found for Hodgkin's disease, Burkitt's lymphoma and, especially, retinoblastoma.

Objective: The authors analyse the epidemiological and therapeutic aspects of 186 cases of urogenital fistulas and attempt to define a preventive approach to these lesions., Methods: From January 1986 to December 31, 1993, 186 patients were admitted to the urology department of Ignace Deen hospital for urogenital fistulas. Each patient was submitted to the following assessment: complete clinical examination, laboratory examination, endoscopic examination, radiological examination. A therapeutic classification was established on the basis of this assessment: Group 1: complex fistulas. Group 2: difficult fistulas. Group 3: simple fistulas., Results: Urogenital fistulas were predominantly observed in young primiparous women living in rural zones and the principal cause was a dystocic delivery: 179 cases (96.23%), while only 7 cases (3.7%) were due to gynaecological lesions. 246 primary and secondary repair operations were performed, corresponding to an average of 1.3 operations per patient. Cure was obtained in 131 patients (70.43%) including 37.63%) in Group 1, 8.61% in Group 2 and 21.19% in Group 3. In three cases of partial success, the fistulas were closed; two patients have persistent dysuria with reduced bladder capacity and one patient suffers from dyspareunia with impossibility of coital penetration. Finally, the 49 failures (26.34%) concerned 34 type 1 fistulas; 5 type 2 fistulas and 10 type 3 fistulas., Conclusions: In the light of our eight-year experience, urogenital fistula still appears to be a real problem in Guinea, where it represents a public health problem for which surgical cure still raises technical difficulties. In the fight for eradication of urogenital fistula in developing countries, emphasis must be placed on prevention with a just and equitable distribution of health care personnel in rural zones which are often underprivileged: constant improvement of the road network to allow rapid transfer of cases of foetomaternal dystocia to a reference centre; improvement of health structures; urological and obstetric surveillance of any woman operated for urogenital fistula.

The authors report the efficacy of a transvaginal approach in the ventral supine position for repair of vesicovaginal fistula based on a series of 34 consecutive patients. 34 patients, between the ages of 15 and 60 years, with vesicovaginal fistula (cervicotrigonal in one half of cases) of obstetric origin (73% of dystocia) in multiparous women (62% were treated by transvaginal closure of the fistula in the ventral supine position). 29 complete successes were obtained with 5 residual fistulae which were lost to follow-up. The use of the ventral supine position is valuable in the transvaginal repair of vesicovaginal fistulae.

The authors are reporting a case of lumbar pain secondary to a retrocaval ureter. Pathogeny, diagnostic implications and treatment of this entity is discussed.

A study of tuberculous disease was carried out in children aged 5 to 13 years old who were first year pupils in primary schools in the town of Conakry (Republic of Guinae) with a view to determining the annual risk of tuberculous infection. In total 4,198 children distributed throughout 15 schools were tested after first looking for BCG vaccination scars. In the sample tested 1,444 children (34.4%) had vaccination scars and 2,754 (65.6%) did not. Amongst the 1,444 children with BCG scars, 1,367 (94.7%) were reviewed 72 hours after one unit of tuberculin RT 23 to have the skin reaction RDI read. Amongst these 210 (15.4%) had an area of induration greater than 6 m.m. diameter. Amongst 2,754 children who did not have BCG scars 2,655 (96.4%) were reviewed for the reading of the IDR: 330 children (12.8%) had an area of induration greater than 6 m.m. diameter. The percentage of children with an IDR greater than 6 m.m. as well as the mean diameter of induration was significantly greater in the group with a vaccination scar. The age of the children influenced the size of the induration. A factorial analysis revealed at the same time an age factor and a significant scar factor. Calculations from the prevalence of areas of induration with diameter greater than 6 m.m. in non-vaccinated children revealed an annual risk of infection of 1.52. A number of cases of pulmonary tuberculosis with positive microscopy in Conakry town is estimated at 90 per 100,000 inhabitants.