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Introduction: RA©sultats: Conclusion: Pain is a frequent reason for medical consultation particularly among persons infected with HIV. In Mali very little work has been conducted on pain in HIV hence the aim of this work. The aims for this study were to determine the knowledge of medical staff dedicated to the management of HIV about pain to determine the frequency of pain in HIV and assess its impact on their quality of life. We conducted a descriptive study from June to August 2013. Medical staffs from departments of internal medicine and infectious diseases and hospitalized patients infected by HIV were included. We obtained verbal consent from patients before inclusion. A total of 50 health workers were interviewed including 29 physicians (doctors) 11 nurses and 9 students in medical theses. In practice they do not systematically evaluate pain (40%). When evaluating EVA and EVS were the main methods used. Prescription analgesic was not correct in 53.9% of cases. The prevalence of pain was 92.9% among hospitalized patients infected by HIV. Pain was level I (32.7%) II (48.1%) and III (19.2%). The majority of patients had a low CD4 count (73.3% had a CD4 below 200/mm3) with level 3 (60.7%) and 4 (25%) of WHO. The pain was acute (53.8%) and permanent or chronic (57.7%) in general. Impacts of pain were cognitive and motor. The high frequency of pain and its impact on the quality of life HIV require its systematic research and care at every visit. It is necessary to recycle the health staff on the assessment of pain and the correct prescription of analgesic.

We conduct a longitudinal descriptive study in the department of infectious diseases to CHU of Point G during 18 months. It concerned adult patients referred from another care center. All the patients underwent systematic clinical examination and complementary exploration. Our sample was 352 HIV+ patients, with a mean age of 37.8 ± 9.8 years and a sex ratio (M/F)=0.94 shared among patients receiving ARV treatment (ART-s) and not (n-ART). Delay of reference was 5 ± 4.4 days. All patients benefited from clinical and paraclinical examinations. In both groups patients were mostly from level II. On admission, 132 cases were ART-s (38%). The main reasons for consultation were mainly fever [87.9%, p

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

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

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

Resume Objectif Etudier entre 1996 et 2006, l’evolution des schemas therapeutiques et du profil clinique et immunologique des patients infectes par le VIH au debut du traitement antiretroviral (TARV) en Afrique de l’Ouest. Cadre et methode Les donnees issues de 12 centres cliniques adultes (IeDEA West Africa reseau collaboratif de prise en charge de l’infection a VIH) de cinq pays (Benin, Cote d’Ivoire, Senegal, Gambie, Mali) ont ete mises en commun et analysees. Les patients âges de 16 ans et plus dont le sexe, la date de naissance et la date d’initiation du TARV etaient connus ont ete inclus dans cette etude. Resultats Quatorze mille quatre-cent-quatre-vingt-seize patients avaient debute un TARV entre 1996–2006 avec 55 % des patients l’ayant debute entre 2005–2006. La proportion de femmes etait de 46 % en 1996–2000 et de 63 % en 2005–2006. L’âge median a la mise sous traitement etait constant : 35 ans chez les femmes et 40 ans chez les hommes. La proportion de patients qui ont debute le TARV avec un taux de CD4 inferieur a 200 cellules/μl etait de 54 % en 1996–2000 et de 64 % en 2005–2006. Les combinaisons therapeutiques les plus prescrites etaient : AZT/3TC (ou d4T/DDI)/IDV (27 %) en 1996–2000 ; d4T (ou AZT)/3TC/EFV (59 %) en 2003–2004 ; et d4T/3TC/NVP (49 %) en 2005–2006. Les traitements de premiere ligne recommandes par l’OMS etaient debutes dans 83 % de cas en 2005–2006. Conclusion De nouvelles approches pour debuter un TARV plus precocement doivent etre developpees pour ameliorer la survie des patients sous TARV.

Le but de notre etude etait d’etudier les aspects anatomo-cliniques des gastrites chroniques. Notre etude transversale s’est deroulee dans les centres d’endoscopie de l’hopital du Point «G» et de la Clinique du Farako. Tous les malades ont subi un examen clinique soigneux.

Pour evaluer la presence des residus de benzylpenicilline, antibiotique utilise dans le traitement des mammites chez le bovin, une methode d'analyse a ete proposee pour le controle en routine des laits commercialises en Cote d'Ivoire. Elle comprend une premiere etape d'extraction par partition liquide-liquide suivie de l'analyse par chromatographie liquide haute performance sur colonne en phase inverse. La detection s'est faite dans l'ultraviolet. La technique a ete validee et appliquee a des echantillons de lait de trois origines differentes. Sur les 120 echantillons de lait analyses, la benzylpenicilline a pu etre mise en evidence a des teneurs au dessus de la norme (4μg.L -1 ) dans 7 echantillons provenant tous des elevages traditionnels. Ces resultats traduisent probablement l'usage meconnu de cet antibiotique ou alors le non-respect du delai d'attente entre le traitement du bovin et la periode de la traite du lait.

Le but principal de notre travail etait d’etudier les aspects epidemiologiques, cliniques et evolutifs des cancers colorectaux (CCR) en milieu hospitalier.

Notre etude retrospective avait pour objectifs de determiner la frequence de la tuberculose peritoneale, d’en decrire les manifestations cliniques, laparoscopiques et les caracteristiques du liquide d’ascite. Ont ete inclus dans cette etude les dossiers des malades presentant a la laparoscopie des granulations et/ou des nodules peritoneaux. Dans tous les cas, l’examen anatomo-pathologique de ces lesions avait confirme le diagnostic de tuberculose peritoneale. 26 dossiers repondaient aux criteres d’inclusion (10 hommes et 16 femmes). La tuberculose peritoneale representait 4,13 % de l’ensemble des cas de tuberculose. L’âge moyen a ete de 37,7 ±15 ans avec des extremes a 12 et 65 ans. Les signes cliniques ont ete domines par l’ascite (88,5 %) des cas, l’amaigrissement (53,8 %), l’anorexie (53,8 %), la douleur abdominale (42,2 %), l’asthenie (42,3 %) et la fievre (42,3 %). L’association des granulations aux nodules a ete l’anomalie laparoscopique la plus frequente: 80,76 % (21/26). L’examen direct avec la coloration de Ziehl Neelson et la culture du bacille de Koch (BK) sur milieu de Lowenstein ont ete positifs respectivement dans 50 % (3/6) et 60 % (3/5) des cas. En Afrique, la laparoscopie demeure un examen de choix dans le diagnostic de la tuberculose peritoneale. Elle a permis la mise en evidence de granulations: lesions classiques, mais aussi de nodules peritoneaux pouvant faire discuter des metastases peritoneales. The objectives of our retrospective study were to determine peritoneal tuberculosis frequency, to describe its laparoscopic and clinical manifestations and the characteristics of the ascitis fluid. The included patients recorded forms were those presenting granulations and/or peritoneal nodules at laparoscopy. In all cases, the anatomical and pathological examination of these lesions confirmed the diagnosis of peritoneal tuberculosis. Twenty-six patients were included in the study: 10 men and 16 women. Peritoneal tuberculosis occurred in 4.13 % of the tuberculosis total case. The mean age was 37.7 ±15 years from 12 to 65 years. The most important clinical signs were ascitis (88.5 %), weight loss (53,8 %), anorexia (53.8 %), abdominal pain (42.2 %), asthenia (42.3 %) and fever (42.3 %). The association of granulations and nodules was the most laparoscopically frequent abnormality: 80.76 % (21/26). The direct examination with Ziehl Neelson coloration and the bacillus of Koch (BK) culture in Lowenstein media were positive in 50 % (3/6) et 60 % (3/5) respectively. In Africa, laparoscopy remains an examination of choice for the diagnostic of peritoneal tuberculosis. It allows the discovery of granulations: classical lesions but also peritoneal nodules that could be discussed as peritoneal metastasis.

Le but de cette etude etait d’etudier les caracteres non histologiques des ulceres malins. Nous avons effectue de janvier 1986 a decembre 1998 (soit 12 ans), une etude retrospective de dossiers de malades vus en endoscopie digestive haute dans le centre d’endoscopie de l’hopital du point « G ». Tous les malades ayant un ulcere gastrique avec un examen histo-pathologique ont ete inclus. Parmi les 914 ulceres gastriques diagnostiques, 241 ont ete biopsies sur lesquels 34 etaient malins soit 15,88 % (34/241). L’âge moyen des malades ayant un ulcere malin etait de 53,50 ± 3,15 ans. 76,47 % de ces ulceres avaient un diametre compris entre 10 et 110 mm. Les ulceres dont le diametre depassait 110 mm etaient tous malins. Les ulceres malins etaient situes sur la face anterieure de l’antre dans 67,64% des cas, dans 94,10% des cas, le fond sale etait necrotique et hemorragique; leurs contours etaient arrondis dans 82,36 % des cas. Ils etaient creusants dans 97,50 % des cas, durs dans 100 % des cas, avec un bourrelet epais dans 70,50 % des cas. La lesion histologique a ete exclusivement l’adenocarcinome gastrique: 100 % des cas. En l’absence d’examen anatomo-pathologique, les ulceres gastriques repondant a cette description doivent etre referes au chirurgien. The goal of this survey was to describe the non-histological characteristics of malignant ulcer. We conducted a retrospective survey of patients submitted to an endoscopic examination of the upper digestive tract in the endoscopy unit of the hospital “Point G” from January 1986 to December 1998 (12 years). Subjects with gastric ulcer and histopathological exam were included. A biopsy was performed on 241 of the 914 subjects with gastric ulcer. Of the 214 subjects who had biopsy and histological exam, 34 (15,88 %) were diagnosed with malignant ulcer. The mean age of subjects with malignant ulcer was of 53,50 ± 3,15 years. 76,47 % of these malignant ulcers have a diameter of 10 to 110 mm and all cases of ulcer with a diameter over 110 mm were malignant. The malignant ulcers were located on the anterior face of the stomach in 67,64 % of cases, the bottom was soiled with necrosis and hemorrhage in 94,10 % of cases. The contours of the malignant ulcers were of rounded shape in 82,36 % of cases, excavated in 97,50 %, hard in 100 %, with a thick pad in 70,50 %. The type of histolological lesions in all cases (100 %) was gastric adenocarcinoma. In the absence of anatomopathological exam, cases of gastric ulcers with the above characteristics should be referred to the surgeon.

Le but principal de ce travail etait d’etudier les cancers de l’œsophage en milieu hospitaller. Notre etude, prospective cas-temoins s’est deroulee de decembre 1997 a decembre 1999 dans les hopitaux du Point G et de Gabriel Toure de Bamako et a la Clinique Farako. Tous les patients presentant une tumeur maligne histologiquement confirmee ont ete colliges. Les temoins ont ete constitues par des patients ayant une endoscopie digestive normale et ne presentant pas de signe evoquant un cancer d’un autre siege. Une enquete sur le mode de vie des deux groupes a ete realisee. En deux ans, nous avons collige 27 patients presentant un aspect macroscopique de tumeur maligne de l’œsophage, dont 16 cas ont ete confirmes par l’histologie. Ces cancers ont represente 0,2% de l’ensemble des endoscopies digestives hautes et 16% des cancers du tube digestif. Lesex-ratio a ete de 0,5 en faveur des femmes. L’âge moyen des cancereux a ete de 59,4 ans ± 7,4. Les couches socioprofessionnelles les plus representees ont ete les menageres avec 68,7% et les cultivateurs avec 31,3% (p=10−8 et 210−2). La consommation frequente de poissons fumes, de to avec potasse, de viande conservee naturellement et de tabac a chiquer etait significativement associee aux cancers de l’œsophage (p

Resume Objectif : L’insuffisance des services d’anatomie pathologique et leur concentration dans les seuls centres hospitaliers en pays d’endemie tuberculeuse, peuvent retarder le diagnostic de tuberculose ganglionnaire. Cette etude examinait la rentabilite de la ponction a l’aiguille fine (PAF) des ganglions lymphatiques dans le diagnostic des adenopathies mycobacteriennes de l’adulte a Bamako, Mali. Population : Cinquante-et-un patients d’âge moyen = 33,03 ± 11,45 ans etaient recrutes de juin 1997 a avril 1999. Resultats : La bacilloscopie des produits de PAF du ganglion etait positive chez 29 malades sur 45. Elle n'etait pas moins fructueuse que celle des crachats. Ces resultats bacilloscopiques concordants avec ceux de la cytologie dans 61,9 % des cas etaient rendus dans un delai plus court que ceux de l’histologie du ganglion et a un cout moindre. Conclusion : La pratique de la PAF des ganglions lymphatiques dans toutes les structures sanitaires des pays a forte endemie mycobacterienne et de VIH semble interessante.

Le but principal de notre etude etait d'evaluer la prevalence des signes endoscopiques de la cirrhose et d'en preciser la performance diagnostique pour celle-ci. L'etude prospective s'est deroulee de janvier 1997 a fevrier 1999 dans les hopitaux nationaux du Point «G» et Gabriel Toure de Bamako (Mali). Les criteres diagnostiques de la cirrhose etaient l'examen histologique ou l'association d'un gros foie a bord inferieur tranchant, d'un taux de prothrombine bas et d'un aspect echographique ou laparoscopique de cirrhose. Les hepatopathies chroniques sans cirrhose, prises comme temoins ont toutes ete histologiquement prouvees. Au terme de l'etude, 116 patients ont ete inclus dont 56 cas de cirrhose et 60 hepatopathies non cirrhotiques. Les varices œsophagiennes, la gastropathie d'HTP et les erosions etaient significativement plus frequentes dans le groupe cirrhose. Huit variables etaient significativement differentes entre les 2 groupes et ont ete incluses dans une analyse discriminante: l'antigene HBs, les varices œsophagiennes, les erosions et l'ictere avaient une valeur predictive independante avec une performance diagnostique de 89% pour la cirrhose. Notre etude, dont l'originalite est un diagnostic de reference reposant sur la laparoscopie, confirme que les signes endoscopiques ont une valeur independante dans le diagnostic de cirrhose.

SETTING: Drug resistance threatens tuberculosis (TB) control, particularly among human immunodeficiency virus (HIV) infected persons.OBJECTIVE: To describe practices in the prevention and management of drug-resistant TB under antiretroviral therapy (ART) programs in lower-income countries.DESIGN: We used online questionnaires to collect program-level data on 47 ART programs in Southern Africa (n = 14), East Africa (n = 8), West Africa (n = 7), Central Africa (n = 5), Latin America (n = 7) and the Asia-Pacific (n = 6 programs) in 2012. Patient-level data were collected on 1002 adult TB patients seen at 40 of the participating ART programs.RESULTS: Phenotypic drug susceptibility testing (DST) was available in 36 (77%) ART programs, but was only used for 22% of all TB patients. Molecular DST was available in 33 (70%) programs and was used in 23% of all TB patients. Twenty ART programs (43%) provided directly observed therapy (DOT) during the entire course of treatment, 16 (34%) during the intensive phase only, and 11 (23%) did not follow DOT. Fourteen (30%) ART programs reported no access to second-line anti-tuberculosis regimens; 18 (38%) reported TB drug shortages.CONCLUSIONS: Capacity to diagnose and treat drug-resistant TB was limited across ART programs in lower-income countries. DOT was not always implemented and drug supplies were regularly interrupted, which may contribute to the global emergence of drug resistance.

Schistosoma haematobium-related morbidity was studied in the perennial irrigation area of Office du Niger and the small reservoirs area of Plateau Dogon in Mali. Questionnaire, clinical, parasitologic, and ultrasound examination data were collected from 1,041 individuals at the baseline survey in 1991; 705 were re-examined one year after treatment. At baseline, the overall prevalence of S. haematobium infection was 55.2%; half of those infected had no clinical symptoms and 30% had pathologic lesions. Both infection and morbidity were more frequent in children than in adults, with a peak prevalence at 7-14 years of age. The rates of lesions were more than twice as high in those heavily infected as in lightly infected individuals. Reagent strip testing for microhematuria was more sensitive in detecting individuals with pathologic lesions than in detecting individuals with infection. One year after treatment with praziquantel, more than 80% of the urinary tract lesions had cleared. It is concluded that S. haematobium-related morbidity is frequent in Mali, but passive case detection for treatment would not cover a great deal of early stages of the disease; active intervention using reagent strip testing for microhematuria at the most peripheral levels would be an efficient system for morbidity control and monitoring of control operations.

L’incidence de la tuberculose est elevee en Afrique. Le traitement fait appel a des molecules pourvoyeuses de neuropathies douloureuses susceptibles d’avoir un impact negatif sur la qualite de vie et sur l’observance du traitement. L’objectif de ce travail est d’etudier la douleur neuropathique due aux antituberculeux chez les patients non infectes par le virus de l’immunodeficience humaine (VIH). Methode. Il s’agit d’une etude prospective realisee dans le service de pneumo-phtisiologie du centre hospitalier universitaire (CHU) de Point G, au Mali. Ont ete inclus les malades sous antituberculeux ayant une serologie VIH negative, et qui n’avaient pas d’autre cause de douleur neuropathique. Le diagnostic s’est fait sur la base du questionnaire DN4 (pour « douleurs neuropathiques en quatre questions »), et l’evaluation a l’aide de l’EVA (echelle visuelle analogique) et du test Lattinen. Resultats. Pendant l’etude, 423 sujets furent admis, dont 103 (24,4 %) cas de tuberculose. Quatre-vingt patients repondaient aux criteres d’inclusion. Le sex-ratio (H/F) etait de 2,5. La moyenne d’âge etait de 39 ans avec des extremes de 13 et 80 ans. Sous traitement, treize patients presenterent une neuropathie douloureuse soit 16 %. Les sensations de brulure plantaire furent le mode revelateur, associees ou non a une paresthesie, chez dix patients sur treize. Un traitement associant amitriptyline, vitamine B6 et kinesitherapie fut initie chez tous les patients, avec succes apres deux mois. Conclusion. La douleur survient independamment de l’âge, du sexe et du regime antituberculeux – s’il contient de l’isoniazide. L’interruption ou la modification des protocoles n’est pas necessaire. Dans notre contexte, au vu des difficultes d’identification des acetyleurs lents, un traitement systematique par vitamine B6 merite d’etre discute.

The prevalence of epilepsy in Sub-Saharan Africa is about 15 per thousand; against 6 to 8 per thousand in industrialized countries. Health, social, economic conditions and misknowledge could explain this situation. The objective of this survey was to study the knowledge of parents of children with or without epilepsy about this disease in Mali. 423 adults were interviewed, 15% children with epilepsy. The mean age was 34 ± 9,3 years; females represents 60% of the population. 26% of interviewed subjects heard about epilepsy from their neighbourhood, 20% from traditional healers, 11% from health care professional; the tonic-clonic crisis was the most known form of the disease. 59% thought epilepsy to be contagious. The organicity of the disease was known by 51% of the population. 23 % of the population believed there was a link between the onset of the crisis and the presence of the hole moon. 78% of subjects have already seen at least one crisis of epilepsy, but only 33% have got an attitude of first help that was to pour fresh water on the face of the patient in 22% of cases. 57% of subject's acknowledge having as first recourse traditional medicine. The fight against epilepsy in Mali as in the others countries of the third world should go through information and education of the population, in particular parents.

Since the advent of HIV, Kaposi's sarcoma has become one of the most common opportunistic infections and the first cancer in patients with HIV. This cancerous disease occurs most often on the skin but also the viscera. Digestive localization was often observed during the search for other locations before the cutaneous form. No studies in Mali has focused on the upper gastrointestinal location.To describe the epidemiological and clinical aspects of Kaposi's sarcoma in the upper gastrointestinal endoscopy.This was a retrospective descriptive study from June 2005 to February 2009 in the center of endoscopy of the Point G Hospital including all patients seen in upper gastrointestinal endoscopy during the study period.20 cases were reported from a total of 5068 endoscopy performed during this period a frequency of 0.39% hospital. These 20 cases were identified in all 31 patients with cutaneous localization of Kaposi's sarcoma is a frequency of 64.5%. The sex ratio was equal to 0.81. The average age was 36.8 years ± 8.92 years. The stomach and esophagus were found most locations. All patients were HIV positive. The CD4 count below 200 cells/mm3 was observed in 95% of patients.

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.

Eight in 1,000 people in the world suffer from epilepsy, and 80 % of them are in the developing countries [1]. Sub-Saharan Africa and Latin America have higher median prevalence's 15.4 % and 12.4 %, respectively, compared to the prevalence in Europe, 5.4 %, and in North America, 5-10 % [2]. On this epidemiological inequality overlays a considerable disparity in the quality of care given to people with epilepsy, between developed and developing countries, and rural and urban areas. In this context, one of the most controversial subject regarding epilepsy is the care given to epileptic patients and their offspring. In fact, being a woman with epilepsy is not as being a man. The specific concerns about women with epilepsy are essentially sexual development, contraception, reproduction, fertility, and anatomic and cognitive teratogenicity of anti-epileptic drugs. The awareness campaign of women with epilepsy starts from puberty until menopause. About one third of epileptic women experience variations in their disease linked to menses, probably due to the neurotoxicity of oestrogens (not counterbalanced by progestatives). The problem with the teratogenicity of anti-epileptic drugs is not resolved yet despite the availability of new molecules. A close collaboration between health practitioners (obstetricians and neurologists) and an awareness of health professionals are essential for a global care of pregnant epileptic women or at age to conceive.

We conducted a prospective survey from January 2001 to March 2002. Our objective was to study etiologic, clinic, and prognostic aspect of lymphocytic meningitis in hospital of Point G to Bamako. We included 35 patients with 25 male (71. 4%) and 10 female (28. 6%), sex - ratio (M / F) equal 2. 5. The median age was of 35 ± 25.4 years (range, 16 - 66 years). HIV serology was positive 26 cases (83. 9%). Clinical presentations were different. We observed 15 cases of encephalitis, 12 cases of meningoencephalitis, 2 cases of meningitis and 6 cases of febrile syndrome. Mean duration of hospitalization was 32. 6 ± 68 days. Mean of lymphocyte was 85.3 ± 25.9% among leukocytes in cerebrospinal fluid of 31 patients. Analysis of cerebrospinal fluid (CSF) identified in 9 cases Cryptococcocus neoformans. In 16 cases etiology was determination based on indirect arguments. In 9 cases viral meningoencephalitis diagnosis was made by exodiagnosis. It concerned 2 cases of TB meningitis, 1 case of cerebral toxoplasmosis, 1 case of decapitate bacterial meningitis and 1 case of cerebral tumor. Malaria thick smear permits to diagnosticate 1 case of cerebral malaria and 1 case of uncomplicated malaria. There are still 10 cases in which the cause remained unknown during study. HIV infection provides principally lymphocytic meningitis. Co morbidity with HIV is associated to lethality at 75%. But no statistical difference with patients without HIV (p = 0.52). Our work puts in exergue all problematic and hold correct of lymphocytic meningitis in our country.

Background As access to antiretroviral drugs increases in developing countries, it will become increasingly important to monitor the emergence of resistance and to define the molecular pathways involved to identify optimal therapeutic regimens. Methods We performed genotypic resistance testing on plasma obtained from 101 HIV-infected treatment-naive individuals from Mali. Genotyping was carried out using the Virco protocols and HXB2 was used as the reference strain. Results CRF02_AG was the most common subtype, present in 71.3% of our patient population. Other subtypes included B, C, G, CRF06_CPX, CRF09_CPX, CRF01_AE, A2/CRF16_A2D, A1 and CRF13_CPX. A total of 9.9% [95% confidence interval (CI) 6.9–12.9%] of patients had at least one resistance mutation. The prevalences of mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 5% (95% CI 0.7–9.2%), 6% (95% CI 1.3–10.6%) and 0%, respectively. The most frequent mutations were T215A/Y for NRTIs and K103N/T for NNRTIs. One patient harboured three NRTI resistance mutations and one NNRTI mutation. This is the first reported case of multi-drug-resistant viral transmission in Mali. Polymorphisms at protease codons 10I/V and 33F potentially associated with resistance were observed in 18.8% and 1% of patients, respectively. Several polymorphisms in the C-terminal domain of reverse transcriptase were observed: A371V (in 63.4% of patients), G335D (76.2%), E399D (10.9%) and G333E (1%). Conclusion Primary resistance was seen in 9.9% of subjects, which is higher than previously reported in Mali. Taking into consideration other polymorphisms in protease such as L10I/V and 33F, primary resistance could reach 28.7% (95% CI 19.9–37.5%). Our study reflects the need to monitor the evolution of resistance on a regular basis and trends of transmitted resistance.

In order to determinate the prevalence of hepatitis B virus and hepatitis C virus among patients infected by the HIV, We realized a transverse survey case--control in hepato-gastro-enterological ward and serology unity of National Institute of Research in Public health (INRSP). Our sample was constituted with 100 patients HIV positive compared to 100 controls HIV negative. The viral markers research has been made by methods immuno-enzymatiqueses of ELISA 3rd generation. Tests permitted to get the following results: Hepatitis B surface antigen (HBs Ag) was positive among 21% with patients HIV positive versus 23% among control (p = 0,732); Antibody to hepatitis C virus (anti-HCV ab) was present among 23% with patients HIV positive versus 0% among control (p0,05). Female was predominant among co-infections patient, but without statistic link (p = 0,9 and p = 0,45); The co-infection HBV- HCV was significatively linked to age beyond 40 years (p = 0,0005). Co-infections with HIV infection and hepatitis virus are not rare and deserve to be investigated.

The objective of this work was to evaluate peritoneum attack in AIDS affected patients. IT was a cross sectional descriptive study from October 2000 to May 2003 in services of Internal Medicine of the Hospital of the Point G and Hepato-Gastro-enterology of the Hospital Gabriel Touré and that concerned patient hospitalization files, registers of laparoscopy and registers of anatomopathology results. Have been included in this study, patients HIV positive presenting an abdominal symptomatology as abdominal pain, ascite, hepatomegaly, splenomegaly and that benefitted a laparoscopy with oriented biopsies of lesions. Anatomopathology exam of biopsy fragments has been made in the National institute of Research in Public Health (INRSP) of Bamako, Mali and in Pharo, Marseille in France. In term of this study 20 patients have been included. The mean age of our patients was 40.1 +/- 11 years with a sex ratio equal 1. Married women were the socio-professional category the most affected (45%). The clinical symptomatology was dominated by ascite (70%), abdominal pain (45%), abdominal meteorism (40%), hepatomegaly (35%), splenomegaly (30%). Peritoneal localization was the most frequent (50%). Granulations were the laparoscopic aspect the most met (80%) and confirmed in 80% cases by histology. Hepato-peritoneal tuberculosis was the most frequent etiology (60%) come then the non specific inflammations (30%), the lipophagic granulome (5%), and non specific granulomatose inflammations (5%). This study is characterized by an increased frequency of hepato-peritoneal tuberculosis during the pathology of peritoneum in AIDS affected patients. It deserves to be searched and treated for patients' survival.

We gathered 14 clinical observations of urinary track infections in AIDS patients in Internal Medicine wards from August 1, 1998 to July 31, 1999. Urinary track infection and HIV were both present in 1.75% of 797 hospitalized patients. The specific prevalence was 14.43% among AIDS patients. The sex ratio (female/male) was 1.33. The mean age of patients was 37.2 years with ranges between 25 years and 59 years. Urinary symptoms were discret. Urinary tract infection was primarily evidenced by urine leucocytes10(4) organism/ml and a bacteriuria10(5) colony-forming units/ml. The main pathogenswere Escherichia coli (42.85%), Klebsiella pneumoniae (28.57%), Colibacilles app. (21.42%) and Enterobacter cloacae (7.14%). All isolated germs were sensible to the gentamicin, to the amikacin, to the nalidixic acid, to the cefoxitine, to the ceftazidime to the cefotaxime and the ciprofloxacin. Cephalosporin of 3rd generation, aminoglycosides, and fluoroquinolone can be used like treatment of first line in urinary tract infection suspicion case in Bamako. Our patients were highly immunosuppressed with the majority of them being in class IV C of CDC of Atlanta (90%) and CD4 count constantly bellow 200 cells/mm3. The main opportunistic affections were non bacilar bacterial pneumopathies (28.57%), oesophagal mycosis (71.42%), the association of cerebral toxoplasmosis and pulmonary tuberculosis (35.71%). All urinary infections were cured by mean of 5 days of treatment. Very few recidivism was found (1 case).

Our main objective was to study gastritis associated to duodeno-gastric reflux. It is about a longitudinal study case/witness, paired according to the sex and the age. It was unrolled from February 2005 to January 2006 in the digestive diseases department of the hospital Gabriél Touré, and endoscopic centers of Promenade des Angevins, and clinique Farako. The patients profited from an upper digestive endoscopy to appreciate endoscopic aspect of gastritis associated to bile in the stomach mucus lake. The gastric biopsies were systematic. This study included 50 patients having gastritis associated to bile in gastric mucus lake compared to 50 patients having gastritis associated to clearly gastric mucus lake. The sex-ratio was 1.26 in favour of men. The average age of the patients was of 41.30 +/- 15.43 years. On the symptomatic hand, fetid breath was significantly met in duodeno-gastric reflux (p = 0.013). Potash consumption in the "tô" (millet cake) was significantly reported in gastritis associated to bile in gastric mucus lake (p = 0.042). The endoscopic aspects were comparable. Histological aspects of nonatrophic chronic gastritis were significantly mint in witnesses as well into the antrum as into the fundus (p = 0.0001 and p = 0.00023). The reactional gastritis aspect was the prerogative of duodenogastric reflux (p ranging between 10(-6) and 3.10 (-6). Helicobacter pylori infection was found comparable in the two groups (p = 0.297). Dysplasia although rare was found only in gastritis associated to duodeno-gastric reflux. Gastritis associated to bile in gastric mucus does not se,nm to have specific clinical, endoscopic and histological presentation. However the presence of dysplasia must have an attentive monitoring.

The frequent localization of the infection to the hand to ours diabetic patients oppositely to the classic description of diabetic foot leds us to initiate this work, which had the objectif to determine the prevalency and to describe the "diabetic hand" to our patients. For that we have conducted a descriptive retrospective and prospective study in the internal Medecine Service of the National Hospital of Point G (NHPG) and in Traumato Orthopaepics Service of Gabriel Touré Hospital (G.T.H.) in Bamako. In 341 diabetic examined patients 158 infections of soft areas have been listed (46.33%) with a localization on the foot in 87 among them (25.51%) and the hand in 55 (16.13%). The female sex has been the most affected with an average of 52 years old and recent discovered diabetes. The diabetes was of type I in 54.54% of cases and of type II in 45.46%. The reaching of hand was following upon a traumatism (7.28%), a burn (3.63%), an ingrown mail (3.63%); but in 85.46% of cases any front door hasn't been found. The type of damage observed has been the abscess (49.09%), the whitlow (25.46%), the gangrene (21.82%) and the burn (3.63%). We have noticed an ostect in 41.81% of cases. In bacteriologic field, the staphylocoque was the prevailing germ in relating to the negative gram (25%). The curring has required an amputation in almost a third of patients (30.9%) the healing has been gained in 76.3% of cases with sometimes some fonctional important after effects. On death has been noticed in 9.09% of cases.

The main goal of this work was to study the parasitic infections during AIDS diarrhoea. A longitudinal study was carried out from October 2000 to November 2001 in the Hepato-Gastro-Enterology department of Gabriel Toure Hospital and in the Department of Epidemiology and Parasitic infections of Faculty of Medicine, Pharmacy and Odonto-stomatology of Bamako (Mali), concerning HIV positive patients suffering from diarrhoea. Detecting microbes in stools has been done through direct microscopic examination and according to procedures of Henricksen Poblenz Baerman, Kato Katz and the PCR. Among the 70 patients involved, the sex-ratio was 53%, the average age was 35 +/- 8.4 years. Fever weight loss, skin affections and digestive mycosis were often associated. Opportunistic infections have been relatively frequent with Cryptosporidium parvum with 20%, Isospora belli with 8.5% and Microsporidium with 11.5% of cases. Other non-opportunistic microbes were found. Death within the first two weeks seems more important in case of infection by Cryptosporidium parvum. The frequency and the danger of those opportunistic infections require their efficient diagnosis and care management.

A prospective study carried out in Bamako, Mali between July 1998 and January 1999 has assessed the seroprevalence of hepatitis C virus (HCV) in 91 carrier patients of chronic hepatopathy at a cirrhrosis stage (53) or of hepato-cellular carcinoma (38) and to compare with in 92 blood donors as a control population. Only seroprevalence confirmed by a complementary test has been taken into account (RIBA). HCV seroprevalence reached 25% including all hepatopathies, 24% in cirrhrosis and 26% in hepato-cellular carcinomae (HCC) versus 4% in blood donors. Antigen HBs of hepatitis B virus has been found in 55% of patients, versus 25% of the control cases (p = 0.0006). On the whole, the two markers have been notified a little more often in HCC than in cirrhosis and the combination of the two markers has been more frequent during cirrhosis as well. The role of HCV played in cirrhosis and HCC onset in Mali appears to be important.

Meigs' syndrome is a benign tumor of the ovary with recurrent serous effusion which can resorb however after surgery. It is rarely seen. Its physiopathology remains obscure. Presently, our concern is a 34-year-old woman, admitted in an abdominal tension board, seriously affected by dyspnoea and whose state revealed a malignant process. The pelvic abdominal echography and the thoracic radiography have played a prominent role in the diagnostic approach. Ablating the ovarian tumor leads to a quick recovery. The histological nature of this tumor reveals a huge mucinous cystadenoma.

Iron overload augments diseases of the liver and microorganism infection as well as deregulates the immune system. In vitro analysis of the effects of iron loading and its chelation involves determining the amount of iron constituting overload, which metal sources and cell lines to use and reliable assay methods. The uptake of 500 microM FeSO4 or FeEDTA by CEMss, U937 or leukocytes was confirmed by inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Excess iron increased CEMss viability (assessed by MTT, XTT, Trypan- and Alamar Blue) by an average of 18% (P = 0.034). Flow cytometry indicated dye-viable cells to be undergoing apotosis/necrosis while still confirming an increase (9%, P0.001) in excess iron-induced viability. The iron chelator desferioxamine (DFO) when added in addition to Fe, reversed the effects of excess iron (and vice versa) and had detrimental effects when used on its own (33% inhibition of viability as measured by dyes and 10.85%; P = 0.0427 assessed by flow cytometry). The 4 dyes demonstrated different levels of sensitivity in detecting the influence of iron or DFO but gave a related, qualitative picture while flow cytometry and ICP-AES data was more quantitative.

Introduction L’association Diabete et grossesse constitue une situation gestationnelle de haut risque aussi bien pour le foetus que pour la mere. Sa prise en charge est un defit medical constant dans les pays a ressources medicales limitees. Le but est d’evaluer les risques de cet etat. Materiels et methodes Etude retrospective descriptive de 5 ans de femmes en grossesse avec diabete pregestationnel de type 1 ou type2 ou gestationnel dans le CHU du Point G (service de medecine interne et de gynecologie obstetrique) et le CHU Gabriel Toure (service de gynecologie obstetrique). Des variables cliniques (socio-demographiques, facteurs de risque de diabete, facteurs de risque associes) et paracliniques (echographie obstetricale, microalbuminurie, glycemie, fond oeil) ont ete analyses. Resultats Une prevalence globale de 0,94 % a ete notee. Le nombre de cas etait en constante progression : 8 % en 2003,19 % en 2005, 26 % en 2006 et 39 % en 2007. Plus des 2/3 des femmes avaient des entecedants familiaux d’avortement spontane : 41,4 % (n = 29/70), de mort fœtal in utero : 32.8 % (n = 22/70), et de macrosomie fœtale : 25,7 % (n = 18/70). Les multipares occupaient le premier rang avec 46 %, les primipares le 3e rang avec 11 % et les nullipares le 4e rang avec 6 %. Le diabete etait gestationnel dans 13 % et pre gestationnel dans 87 % dont 30 cas de DT1 et 57 cas de DT2. Au court de l’evolution le pronostic foeto-maternel a ete greve par une pre eclampsie : 7 %, un avortement spontane : 4 % une mort foetale in utero : 18 % et un accouchement premature : 5 %. Au premier rang des complications neonatales on notait la macrosomie fœtale : 67,5 % (n = 23/43), la dystocie des epaules, la detresse respiratoire, et la malformation congenitale ont occupe le 3e rang avec respectivement 2.32 % (n = 1/43) les femmes ont accouche entre le 38e SA dans 49,31 %. Conclusion Conclusion la grossesse sur diabete constitue une situation gestationnelle a haut risque aussi bien pour le fœtus que pour la mere. Une planification et un encadrement optimises reduisent les risques tout en necessitant une collaboration multidisciplinaire etroite impliquant : diabetologue, neo natologiste, et gyneco obstetricien. Ces conditions sont rarement reunies dans nos pays a ressources limitees.

Eighteen patients hospitalized with intestinal parasitic infections associated with diarrhea and dehydration completed a study of nitazoxanide in the treatment of Cryptosporidium parvum and other intestinal parasitic infections. Seventeen of the 18 patients were positive for human immunodeficiency virus. Twelve patients were diagnosed with clinical Stage 4 acquired immunodeficiency syndrome (AIDS) according to the 1990 World Health Organization proposed clinical classification system and cryptosporidiosis. Nitazoxanide (500 mg tablets) were administered orally, one tablet twice a day for seven consecutive days. Cryptosporidium parvum oocysts were eradicated or reduced by more than 95% in seven of the 12 Stage 4 AIDS patients who completed the study based upon two post-treatment fecal examinations conducted on days 7 and 14 following the initiation of treatment. The elimination or reduction of C. parvum oocysts was associated with a complete resolution of diarrhea in four of the seven patients. The test drug was also effective against cases of Isospora belli, Entamoeba histolytica, Giardia lamblia, Ascaris lumbricoides, Enterobius vermicularis, Hymenolepis nana, and Dicrocoelium dentriticum. Treatment with nitazoxanide was well tolerated by the patients. There were no abnormalities in blood chemistry or hematology data that were considered to be attributable to nitazoxanide therapy. Transient episodes of vomiting were observed in four patients, all with Stage 4 AIDS and cryptosporidiosis, which resolved spontaneously without discontinuation of treatment and were not considered to be related to administration of nitazoxanide.The effectiveness of nitazoxanide in the treatment of Cryptosporidium parvum and other intestinal parasitic diseases was assessed in 18 patients hospitalized at Point G. National Hospital in Bamako, Mali, with parasite-related diarrhea, dehydration, and weight loss. 17 of the 18 patients were infected with HIV, and 12 of these had progressed to clinical stage 4 AIDS. 500 mg tablets of nitazoxanide were administered twice a day for 7 days. After completion of treatment, Cryptosporidium parvum oocysts were eradicated or reduced by more than 95% in 7 of the stage 4 AIDS patients; diarrhea was completely resolved in 4 of these patients. Nitazoxanide was also effective against other parasites common in AIDS patients, including Entamoeba histolytica, Giardia lamblia, and Isospora belli. The test drug was well tolerated by all recipients, with no blood chemistry abnormalities.

Introduction La frequence du diabete de l’enfant et de l’adolescent est fonction dans nos pays de la facilite d’acces aux centres de soins, sa mortalite est encore forte a cause du defaut d’education et de pris en charge adequate. Patients et methodes Etude retrospective descriptive sur 10 ans (de Janvier 1999 a Decembre 2008) concernant les enfants de moins de 20 ans hospitalises ou vus en consultation externe. Des variables cliniques et paracliniques d’evaluation du diabete ont ete analysees. Resultats La frequence hospitaliere a ete de 1,92% (n = 32/1823). l’echantillon etait composee de 18 garcons : 51,4% et 17 filles : 48,6%, avec un sexe ratio de 1,05. la moyenne d’âge des patients etait 13 ans avec des extremes a 5 ans et 19 ans. Le pic d’incidence etait 14-19 ans. Le mode de decouverte du diabete a ete la cetoacidose : 51,5% (n = 18/35) avec coma dans 44% (n = 8/15). Aucun antecedant familial n’a ete retrouve dans 68,6% (n = 24/35). Le diabete etait de type 1 : 94,3% et de type 2 : 5,7%. L’evolution a ete emaillee de complications metaboliques aigues a type de coma acido cetosique : 40% (n = 14/35) et de coma hypoglycemique : 31,4% (n = 11/31). Des complications degeneratives sont apparues plutot que classiquement admis ; une retinopathie est decouverte avant 5 ans d’evolution dans 5,7% et une nephropathie avant 7 ans d’evolution dans 2,86%. Plus de la moitie des enfants : 54,3% ont ete irregulier dans leur suivi ou perdu de vue. Le traitement aussi etait fait de maniere irreguliere dans 54,3%. Conclusion le diabete chez l’enfant est une realite medicale dans nos hopitaux. Des actions de prevention pour certains et d’education therapeutique pour tous permettront un meilleur control de la maladie dans les pays a ressource limitee.

Our main objective has been to study the prevalence of oesophagitis by upper digestive endoscopy. Within 12 months, we have registered 228 cases of oesophagitis out of 612 oesophagean anomalies (37.25%) during 3019 fibroscopies. Oesophagitis has been found to 63.59% in cases in young adult men. Peptic oesophagitis has been most frequent and its congestive aspects most current. The main indication of endoscopy in patients suffering of oesophagitis has been epigastralgies.

Ten cases of hepatic amoebiasis are notified in Bamako during 14 months among hospitalized adults. The diagnosis has aimed from clinical signs, specific antibodies seen through hemagglutination and echography. These patients are treated by tinidazole: 2 g/day in unique dose during 3-9 days. The duration of treatment depends on clinical evolution. In any cases the recovery is obtained within subsequent range from 1 to 9 months. This leading is compared with other treatments proposed in the literature. The briefness of treatment, its quick efficacy and the absence of secondary effects have helped to reduce the duration of stay in hospital and its cost. A short recovery by tinidazole is proposed as tentative treatment against hepatic amoebiasis in rural area's medicine.

Etiologies of infectious diarrhoeas in hospitalised adults have been studied during one year; research of cryptosporidium and isospora oocysts is being made with Henriksen-Pohlenz and Kato methods. Diarrhoea is associated with a positive HIV serology in 40% cases. Cryptosporidium spp is found in 38% of cases. In 91% cases of cryptosporidiosis HIV serology is positive. Cryptosporidiosis is the main cause of AIDS diarrhoeas in Mali. 3 cases of isosporiasis are associated with cryptosporidiosis in AIDS patients. Emaciation and dehydration are the main signs of severity. Diarrhoea's profusion, its chronicity and inefficiency of the treatments explain the heavy death rate of cryptosporidiosis among seropositive patients, which reaches 40% during the first two weeks of hospitalisation.

Many drugs have been used for prevention and treatment of vaso-occlusive attacks in sickle cell anemia. Pentoxifylline is one of the most recent. It increases deformability and filtrability of normal or sickled red cells. In this double-blind study it is compared with a placebo for treatment of 20 osteoarticular crisis during SS or SC sickle cell anemia in Mali. Pentoxifylline did not decrease intensity nor duration of crisis. On the other hand the clinical assessment used for testing drugs efficiency over pain seemed effective and reproducible.

Paraneoplasic syndromes an unusual cause of eosinophilia in tropical countries. We report a case of major eosinophilia in a black Malian's bronchopulmonary cancer. A decrease of eosinophilia under antineoplastic chemotherapy is noted. Several physiopathologic hypothesis have been propounded in the literature, particularly the secretion by the tumour of a stimulating hormone for the production of eosinophil cells by the bone marrow.