Search

The main objective of this longitudinal and prospecting study from February 2013 to January 2014 was to analyze uper digestive tractus caustic injuries in adult patients at the service of gastroenterology of CHU Gabriel Touré Bamako-Mali.We include patients (age more than 16 years) hospitalized for digestive caustic injuries.During the period a hospital frequency was 2.1% (20/970). The mean age was about 33.1 ± 9 years. Over toxic substances was discovered in 45 % of patients. The caustic ingestion was intentional in 18 patients. Psychoaffective disorders were the main reason of caustic consumption. At the entry haematemesis was the main sign. The endoscopic lesions were in majority at stage IIIb of the Zargar et al classification. A case of inhalation pneumonia, a case of digestive perforation and 6 cases of digestive obstruction were the main complications of the caustics injuries. Early death was found in 3 patients.Upper digestive tractus caustic injuries are more and more met in our context. Preventive measures are necessary to prevent these serious lesions.Le but principal de ce travail longitudinal, prospectif s'étendant de Février 2013 à Janvier 2014 était d'étudier les brûlures caustiques du tractus digestif supérieur dans le service d'hépatogastroentérologie du CHU Gabriel Touré de Bamako-Mali.Cette étude a porté sur tous les patients âgés de 16 ans ou plus hospitalisés pour ingestion de produit caustique prouvée.Pendant la période d'étude une fréquence hospitalière de 2,1% a été retrouvée. La moyenne d'âge était de 33,05± 9,012 ans avec un sex ratio de 9. La prise de toxique a été retrouvée chez 45% des patients. L'ingestion était volontaire chez 18 malades. Un choc psychoaffectif était le principal motif de l'ingestion. A l'admission les signes étaient dominés par l'hématémèse. Les lésions endoscopiques étaient majoritairement au stade IIIb de la classification de ZARGAR. Un cas de pneumopathie d'inhalation, un cas de perforation digestive et 6 cas de sténoses ont compliqué les brûlures caustiques. Il y a eu 3 décès précoces.Les brûlures caustiques du tractus digestif supérieur sont de plus en plus rencontrées dans notre contexte. Des mesures préventives s'imposent pour espérer diminuer sa prévalence.

Voluntary or accidental ingestion of a caustic product is increasingly encountered in our country. Caustic esophageal stenosis is the most common sequel. Its treatment involves instrumental dilation and/or surgery which is particularly heavy. The aim of this study was to study the epidemiological, clinical and therapeutic aspects of caustic esophageal strictures in our context. The retrospective study took place from December 2013 to December 2017 in the Hepato-Gastroenterology department of the Gabriel Toure university hospital in Bamako. We included patients with caustic esophageal stenosis referred to the gastrointestinal endoscopy unit for dilation. 67 patients admitted for caustic stenosis were included. The mean age of our patients was 20.76 ± 19.9 years with extremes of 1 and 70 years and a sex ratio of 1.9. In 50.7% of cases, the product ingested was basic in nature. The clinical symptomatology was dominated by dysphagia (100%), vomiting (100%), the emaciated (60%) and cough (40%). In 59 (88%) patients, the stenosis was unique and multiple in 8 (12%). The KILLIAN mouth as the sole site of the stenosis was found in 40.3% of patients. The number of sessions was ≤ 3 in 16.4% and >3 in 83.6% with a mean of 4.59 ± 1.57 sessions. The evolution was favorable in 95.5% of our patients. However, we recorded three (3) cases of death all following a perforation. Conclusion: Caustic esophageal stenosis, a consequence of ingestion of caustics, is increasingly observed in our context. Endoscopic dilation occupies an important place in its management.

Digestive hemorrhage by rupture of esophageal Varices is common and has a pejorative prognosis in our context. Purpose: The main purpose of this work was to study the digestive bleeding by esophageal varices and prognosis value of blood transfusion in the Hospital of Gabriel Toure. Methodology: It was a prospective study that took place in the service of Hepato-gastroenterology of Gabriel Toure Hospital from June 2016 to May 2017 and from November 2017 to August 2018. Results: At the end of the study, 77 patients met the inclusion criteria out of 1396 patients hospitalized during the same period. Varices bleeding represented a prevalence of 5.5% among hospitalized patients during the same period. The average age of our patients was 46.58 ± 15.09 years. The male sex was more reported in our study with a prevalence of 67.5%. At admission, 63.2% had clinical anemia, 58.4% low arterial pressure and 50.6% hemoglobin rate less than 7 g/dL. Blood transfusion was indicated in 47 patients (61%). The mortality rate was 23.4% and was comparable in both groups (p = 0.0990). Early rebleeding was significantly observed in the case of transfusion (p = 0.0452). Hepatic encephalopathy was the leading cause of death of our patients with 72.2%. Conclusion: Digestive bleeding by esophageal varices is a worsen complication in cirrhosis in hospital setting. Transfusion has not significantly improved the prognosis of our patients.

Aggression to the liver by xenobiotic and endogenous agents essentially results in an increase in serum aminotransferases related to hepatic cytolysis, the diagnosis of which is not always easy due to the diversity of its causes. This was a cross-sectional study from April 2019 to March 2020 that took place in the Department of Hepato-gastroenterology of the Gabriel Toure University Hospital Center. This was a cross-sectional study from April 2019 to March 2020 which took place in the Hepato Gastroenterology department of the Gabriel Toure university hospital whose objective of which was to study the etiology of hepatic cytolysis. We included all patients with hepatic cytolysis resulting in increased aminotransferase alanine at a rate higher than the normal upper limit with or without an increase of aspartate aminotransferase. We collected 199/2800 patients who met our inclusion criteria, i.e., a frequency of 7.1%. The mean age was 44.06 years ± 16.4 years, the sex ratio was 1.73. The most common clinical signs were jaundice, ascites, hepatomegaly, asthenia and anorexia. Biologically, chronic cytolysis was noted with a moderate elevation of aminotransferase alanine in 77.9% and a significant elevation in 15.5% of cases. HBs antigen (HBsAg) was positive in 80 patients (40.2%) and anti-hepatitis C virus (HCV) antibody in 18 patients (9%). Abdominal ultrasound was the first-line morphological examination and hepatomegaly alone or associated with splenomegaly was the most common abnormality. The main causes of acute cytolysis were viral hepatitis B, bile duct obstructions, drug-induced hepatitis and malaria while chronic cytolysis was mainly due to cirrhosis and hepatocellular carcinoma (HCC).

Introduction: Upper gastrointestinal (GI) endoscopy is an examination that involves exploring the upper part of the digestive tract using an endoscope. Our study was aimed to evaluate the practice of Upper GI endoscopy at the mother-child hospital in Mali. Patients and Methods: This was a descriptive retrospective study on reports of Upper GI endoscopy results in the digestive endoscopy unit at the mother-child hospital in Bamako from January to December 2018. Results: Endoscopy was performed in 465 patients including 231 males and 234 females. The sex ratio was 0.98. Patients were aged 46.69 years old on average with the extremes of 8 and 90 years old. Epigastralgia was the main referral in 50.5%. Endoscopy was normal in 24.7%. The main diagnostics were duodenogastric reflux in 32.5% and gastritis in 14.4%. Conclusion: The practice of Upper GI endoscopy at the mother-child hospital in Mali has allowed the exploration of the upper digestive tract to contribute to the diagnosis of esogastroduodenal lesions.

Autoimmune pancreatitis is a distinct form of chronic pancreatitis. It is a chronic pancreatitis distinct from alcohol, genetic or idiopathic impairment and involves possible autoimmune mechanisms. The diagnosis of autoimmune pancreatitis is based on a body of biological, histological and radiological arguments. Also called sclerosing lymphoplasmacytic pancreatitis, it is one of the causes of chronic pancreatitis. The risk factor for the onset of cancer that it represents and its sensitivity to corticosteroids make it a pathology requiring special management. We report a case of autoimmune pancreatitis in a 35-year-old patient.

The objective of our study was to evaluate hepatitis B virus (HBV) infection in an urban population. This longitudinal study was conducted in Bamako District and Kati Commune. After a preparatory phase, the persons who accepted the protocol were assessed for HBsAg. HBsAg carriers had blood collection for HBeAg assay, viral load assessment, genotyping, DNA mutation testing, and severity of hepatic fibrosis and necrosis. At the end of this study, 1475 persons were included, of which 195 had HBsAg positive confirmed, that is to say 13.97%. The mean age of HBsAg positive patients was 35.11 ± 11.12 years with a sex ratio of 2.68. HBeAg was found in 8.9% of the patients tested for this antigen. The viral load was undetectable in 10.52% of patients and greater than 2000 IU/mL in 32.24% of cases. Fibrosis ≥ F2 and necrosis ≥ A2 were found in respectively 19.72% and 6.80% of cases. Genotype E was found in 91.6 patients and an R249S mutation observed in 39.04% of cases. Conclusion: HBV infection has a serious impact on socio-economic development in Mali because it affects mainly the young male population, hence the need to organize preventive measures effectively.

Tenofovir reduces viral load during viral cirrhosis B and improves prognosis. The aim of this study was to evaluate the effectiveness and safety of Tenofovir during the treatment of viral B cirrhosis. The study was retrospective and prospective on patients with viral B cirrhosis treated with Tenofovir in the Hepato-Gastroenterology Department of University Hospital Gabriel Toure in Bamako (Mali) and evaluated between three and six months after the start of treatment. We included 89 patients. The mean age was 44.5 ± 16 years with extremes of 18 and 90 years. The sex ratio was 1.2. At inclusion all patients had a detectable viral load with an average of 2651.96 ± 1495.85 IU/ml. Follow-up viral load was undetectable in 84.3% with patients between 3 and 6 months of treatment. The average detectable viral load was only 27.04 ± 21.05 IU/ml. There was also an improvement in hepatocellular function and few side effects. Conclusion: This study shows the interest of Tenofovir in the treatment of viral cirrhosis B with very few adverse effects.

Hepatocellular carcinoma (HCC) is a leading cause of cancer in West Africa where HBV infection is endemic. However, limited information is available on other risk factors such as alcohol use, HCV and HIV infection. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire), Bamako (Mali) and Lome (Togo). Cases were matched with controls on age, gender and participating site. The diagnosis of HCC relied on the combination of one or more space-occupying lesions suggestive of an HCC on a standardized abdominal ultrasound and an α-fetoprotein level ≥400 ng/ml. HIV, HBV and HCV serology were performed. Hazardous alcohol use was assessed using the AUDIT questionnaire. A conditional logistic regression model was used to measure odds ratio (OR) with their 95% confidence intervals (CI). A total of 160 cases and 320 controls were included. Cases were predominantly men (80.0%) with a median age of 47 years (IQR 38-57). Hazardous alcohol use (OR = 4.5 [CI 1.1-18.5]), HBV infection (OR = 62.5 [CI 20.5-190.7]) and HCV infection OR = 35.9 [CI 10.0-130.3]) were independently associated with HCC. Combining the effect of HBV infection and alcohol, HBV-infected hazardous drinkers had an OR = 149.8 (CI 13.5-1 667.0), HBV mono-infected had an OR = 57.4 (CI 18.8-175.3) (ref: HBV-negative). Aside the independent association of alcohol use and HBV and HCV infection with HCC, a synergic effect between alcohol use and HBV infection was identified. Timely screening and care of HBV infection and hazardous drinking might prevent a significant number of HCC in West Africa.

The main objective of this work was to update the data on the epidemiological, clinical, etiological and prognostic aspects of these acute upper digestive hemorrhages. It was a prospective study for a period of 11 months (from March 2013 to January 2014) at the digestive endoscopy center of Gabriel Toure University Hospital in Bamako. At the end of this study, 63 patients had acute upper digestive bleeding (AUDB) among 954 hospitalized patients, that is to say a frequency of 6.7%. The sex ratio was 3.5. The average age of our patients was 45 ± 16.57 years with extremes of 15 and 84 years. A notion of smoking, epigastralgia and none steroid anti-inflammatory drugs (NSAIDs) were more reported in the history with respectively 14 patients (22.3%), 10 patients (15.9%) and 4 patients (6.3%), but haematemesis had occurred in 24 (38.1%) patients without any antecedent. The main causes of hemorrhage were rupture of oesophageal varices in 34 (57.6%) patients and peptic ulcers in 18 (30.5%) patients. Early recurrence occurred in 7 (11.1%) patients resulting in the death of 5 patients for an overall mortality of 9 patients among 63 (14.3%). Acute high digestive hemorrhages are always serious. The correct management of the hemorrhagic episode by haemostatic gestures when available and the causes of haemorrhage improve the prognosis.

Le but principal de ce travail etait d’etudier l’encephalopathie hepatique sur cirrhose dans le service d’hepatogastroenterologie du CHU Gabriel-Toure, Bamako, Mali. Il s’agissait d’une etude longitudinale, prospective qui s’est deroulee sur une periode de 14 mois allant de janvier 2013 a fevrier 2014. Pendant cette periode, une frequence hospitaliere de 6,5 % de l’encephalopathie hepatique a ete observee. La moyenne d’âge etait de 46,4 ± 15 ans (extremes: 13 et 84). Le sex-ratio etait de 1,42. Un antecedent d’ictere, d’hemorragie digestive et d’encephalopathie hepatique etaient observes respectivement chez 23, 13 et 6 patients. A l’admission, 74,6 % des malades etaient en encephalopathie. L’encephalopathie hepatique etait au stade II dans 65,1 % des cas et a son premier episode dans 65,1 % des cas. La mortalite immediate a ete de 66,7 %. L’encephalopathie hepatique est une complication redoutable des hepatopathies chroniques. Sa prise en charge reste complexe dans notre contexte.

The goal of this study was to investigate internal hemorrhoid disease. This cross-sectional study was conducted at the digestive endoscopy center of the Gabriel Toure University Hospital from December 2011 to December 2012. Sixty cases of internal hemorrhoid disease were found - 36 men and 24 women and an average age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pains (58.3%) and prolapsed hemorrhoids (18.3%). The rectoscopy found isolated internal hemorrhoids in 78.4% of cases and stage I of the illness in 81.7% of cases. All patients were given medical treatment.Hemorrhoid disease is a frequent pathology in the general population mainly around the third decade of life.Le but de ce travail était d'étudier la maladie hémorroïdaire interne. Il s'agissait d'une étude transversale déroulée au centre d'endoscopie digestive du CHU Gabriel Touré de Décembre 2011 à décembre 2012.Nous avons colligé 60 cas de maladie hémorroïdaire interne dont 36 hommes et 24 femmes avec un âge moyen de 47 ±14,4 ans. Le tableau clinique était dominé par le saignement (66,7 %),la constipation (58,4 %), la douleur anale (58,3%) et le prolapsus hémorroïdaire (18,3%). L'anorectoscopie réalisée objectivait des hémorroïdes internes isolées dans 78,4% des cas et le stade I de la maladie était observé dans 81,7% des cas. Tous les patients ont bénéficié d'un traitement médical.La maladie hémorroï-daire est une pathologie relativement fréquente dans la population générale surtout vers la troisième décade.

Les hemorragies digestives par rupture des varices œsophagiennes et/ou gastriques, sont de constatations frequentes dans nos contrees. D’importants progres ont ete faits dans leur prise en charge par les traitements endoscopiques. Le but principal de notre etude etait de rapporter notre experience et de faire etat de la morbidite liee a la ligature des varices œsophagiennes (LVO) dans notre contexte. Il s’agissait d’une etude longitudinale prospective et descriptive qui a porte sur les patients admis au centre d’endoscopie digestive pour hemorragie digestive haute et s’est deroulee de mai 2012 a juin 2014 dans le service de medecine du CHU Gabriel Toure. Quarante patients admis pour hemorragie digestive par rupture des varices œsophagiennes ont ete inclus. L’âge moyen de nos patients etait de 40,8 ±10,9 ans avec des extremes de 7 et 53 ans. Le sex-ratio (H/F) etait de 1,85. 30% de nos patients avaient des VO grade II et 70% des VO grade III. Les etiologies etaient dominees par la cirrhose post virale B (92,5%), la cirrhose post-virale C (5%) et dans 2,5% des cas on ne retrouvait pas d’etiologie. Trois seances de ligatures ont pu etre effectuees chez 22 patients soit 55%. L’intervalle moyen entre les seances de ligatures etait de quatre semaines. Une patiente est decedee par suite de recidive hemorragique apres une seule seance de ligature non imputable a la technique. L’eradication des VO etait obtenue dans 62,5%.

Le diabete et l’infection par le VHC constituent de veritables problemes de sante publique mondiaux. Le but principal de notre etude etait d’etudier la prevalence du VHC dans la population diabetique. Il s’agissait d’une etude observationnelle prospective qui s’est deroulee de juin 2009 a mai 2010 au CHU Gabriel Toure et au Centre de lutte contre le diabete de Bamako. Le dosage des transaminases et la recherche de l’Ac anti VHC ont ete effectues chez tous les malades. La recherche des signes d’hypertension portale par l’endoscopie digestive haute, l’echographie abdominale, la PCR quantitative et les autres bilans biologiques de l’hepatite C ont ete systematiquement proposes aux patients porteurs des Ac anti VHC. 25 patients diabetiques sur 250 (10%) ont ete retrouves porteurs du virus HCV. L’âge moyen des patients etait de 49,5 ± 17, 6 ans avec un sex-ratio de 0,38. L’infection par le VHC n’etait pas significativement associee au type de diabete (p = 0,54). La majorite des patients avaient un diabete de type 2 mal equilibre, et le genotype 2 etait le plus frequent. Une correlation positive est observee entre la prevalence du diabete sucre et l’infection par le VHC dans notre region. Cette elevation de prevalence est une donnee importante, permettant un meilleur depistage et une meilleure prise en charge de ces deux maladies.

We describe the outcomes of second-line drug resistance profiles and predict the efficacy of drugs for third-line therapy in patients monitored without the benefit of plasma HIV-1 RNA viral load (VL) or resistance testing.We recruited 106 HIV-1-infected patients after second-line treatment failure in Mali. VL was determined by the Abbott RealTime system and the resistance by the ViroSeq HIV-1 genotyping system. The resistance testing was interpreted using the latest version of the Stanford algorithm.Among the 106 patients, 93 had isolates successfully sequenced. The median age, VL and CD4 cells were respectively 35 years, 72 000 copies/mL and 146 cells/mm(3). Patients were exposed to a median of 4 years of treatment and to six antiretrovirals. We found 20% of wild-type viruses. Resistance to etravirine was noted in 38%, to lopinavir in 25% and to darunavir in 12%. The duration of prior nucleos(t)ide reverse transcriptase inhibitor exposure was associated with resistance to abacavir (P 0.0001) and tenofovir (P = 0.0001), and duration of prior protease inhibitor treatment with resistance to lopinavir (P 0.0001) and darunavir (P = 0.06).Long duration of therapy prior to failure was associated with high levels of resistance and is directly related to limited access to VL monitoring and delayed switches to second-line treatment, precluding efficacy of drugs for third-line therapy. This study underlines the need for governments and public health organizations to recommend the use of VL monitoring and also the availability of darunavir and raltegravir for third-line therapies in the context of limited-resource settings.

Le but de notre etude etait d’inventorier les atteintes hepatiques medicamenteuses dans les services d’hepatogastroenterologie du CHU Gabriel-Toure et de medecine interne du CHU du Point « G ». Notre etude a ete longitudinale et prospective de janvier a decembre 2006. Elle a porte sur des patients ayant presente une hepatite apres une prise medicamenteuse en l’absence de toute autre cause d’hepatopathie. Les patients ont ete examines et ont beneficie d’examens paracliniques pour confirmer l’atteinte hepatique et eliminer une cause autre que medicamenteuse. Au terme de cette etude, 27 patients ont repondu a nos criteres d’inclusion, dont 9 hommes et 18 femmes d’âge moyen de 36,7 ± 11,9 ans (extremes: 16–75 ans). Une notion de prise reguliere de medicament a ete retrouvee chez 81,5 % des patients. Les signes cliniques etaient domines par la fievre (70,4 %) et les arthralgies (62,9 %). L’ictere etait constate chez 77,8 % des patients. L’association lamivudine, stavudine et nevirapine (Triomune®) a ete la plus incriminee (48,1 %). La mortalite a ete de 25,9 %. Les atteintes hepatiques medicamenteuses ne sont pas exceptionnelles au Mali. Elles doivent etre recherchees a cause de leur potentiel evolutif vers une insuffisance hepatocellulaire.

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.

Aim To investigate the association between alcohol use and adherence to highly active antiretroviral treatment (HAART) among human immunodeficiency virus (HIV)-infected patients in subSaharan Africa. Design and setting Cross-sectional survey conducted in eight adult HIV treatment centres from Benin, Cote d'Ivoire and Mali. Participants and measurements During a 4-week period, health workers administered the Alcohol Use Disorders Identification Test to HAART-treated patients and assessed treatment adherence using the AIDS Clinical Trials Group follow-upquestionnaire.Findings Atotalof 2920patientswereenrolledwithamedianageof 38years(interquartile range (IQR) 32-45 years) and a median duration on HAART of 3 years (IQR 1-4 years). Overall, 91.8% of patients were identified as adherent to HAART. Non-adherence was associated with current drinking (odds ratio (OR) 1.4; 95% confidence interval (CI) 1.1-2.0), hazardous drinking (OR 4.7; 95% CI 2.6-8.6) and was associated inversely with a history of counselling on adherence (OR 0.7; 95% CI 0.5-0.9). Conclusions Alcohol consumption and hazardous drinking is associated with non-adherence to HAART among HIV-infected patients from West Africa. Adult HIV care programmes should integrate programmes to reduce hazardous and harmful drinking.

Summary Objective To study factors associated with the probability of retention in antiretroviral therapy (ART) programmes in West Africa. Methods The International epidemiologic Databases to Evaluate AIDS (IeDEA) in West Africa is a prospective, operational, observational cohort study based on collaboration between 11 cohorts of HIV-infected adult patients in Benin, Cote d’Ivoire, Gambia, Mali and Senegal. All patients aged 16 and older at ART initiation, with documented gender and date of ART initiation, were included. For those with at least 1 day of follow-up, Kaplan–Meier method and Weibull regression model were used to estimate the 12-month probability of retention in care and the associated factors. Results In this data merger, 14 352 patients (61% female) on ART were included. Median age was 37 (interquartile range (IQR): 31–44 years) and median CD4 count at baseline was 131 cells/mm3 (IQR: 48–221 cells/mm3). The first-line regimen was NNRTI-based for 78% of patients, protease inhibitor-based for 17%, and three NRTIs for 3%. The probability of retention was 0.90 [95% confidence interval (CI): 0.89–0.90] at 3 months, 0.84 (95% CI: 0.83–0.85) at 6 months and 0.76 (95% CI: 0.75–0.77) at 12 months. The probability of retention in care was lower in patients with baseline CD4 count 200 cells/mm3, in men (aHR = 1.17; 95% CI: 1.10–1.24; P = 0.0002), in younger patients (

Le but principal de notre etude a ete de determiner l’apport de l’echographie dans le diagnostic de la cirrhose. Il s’agissait d’une etude prospective cas-temoins sur 32 mois. Les malades etaient recrutes selon les criteres histologiques de cirrhose et d’hepatopathies chroniques et ont egalement beneficie d’un examen echographique de l’abdomen. Les principales anomalies significatives rencontrees au cours de la cirrhose ont ete les suivantes: 1) l’atrophie hepatique: sensibilite 33,7 %, specificite 80,3 %, valeur predictive positive 69 %; 2) l’irregularite des contours hepatiques: sensibilite 79 %, specificite 84,8 %, valeur predictive positive 87,1 %; 3) l’heterogeneite de l’echostructure: sensibilite 73,2 %, specificite 81,1 %, valeur predictive positive 97,8 %; 4) une veine porte superieure a 15 mm de diametre: sensibilite 36,1 %, specificite 98,4 %, valeur predictive positive 97,8 %; 5) une vitesse maximale du flux sanguin portal inferieure a 15 cm/s: sensibilite 54,6 %, specificite 77,2 %, valeur predictive positive 75,8 %; 6) une vitesse moyenne inferieure a 12 cm/s: sensibilite 66,2 %, specificite 81,8 %, valeur predictive positive 82,6 %; 7) une veine splenique superieure a 10 mm de diametre: sensibilite 30,2 %, specificite 100 %, valeur predictive positive 100 %; 8) la presence de shunts: a) veine splenorenale gauche (shunt 1): sensibilite 34,8 %, specificite 100 %, valeur predictive positive 100 %; b) veine ombilicale (shunt 2): sensibilite 34,8 %, specificite 100 %, valeur predictive positive 100 %. L’echographie peut s’integrer dans une strategie de diagnostic non vulnerant de la cirrhose a cause de la valeur des signes rencontres.

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.

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

Le syndrome d’hypertension portale (HTP) est frequemment rencontre dans les services de Medecine a Bamako. Cependant, aucune etude au Mali ne lui a ete consacree; d’ou l’interet de notre etude dont l’objectif etait de determiner la frequence de l’HTP et ses differentes etiologies.

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 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

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.

L’ascite chyleuse est rare, secondaire a une obstruction des voies lymphatiques. Nous rapportons un cas d’ascite chyleuse chez une jeune femme operee pour tumeur de la vulve. La malade presentait au decours de cette chirurgie une ascite, des adenopathies inguinales, des formations nodulaires sous-cutanees. L’echographie objectivait l’ascite et les adenopathies profondes. Un tel tableau avait fait evoquer la diffusion d’un processus malin favorisee par une agression chirurgicale. Le diagnostic d’une tuberculose ganglionnaire etait confirme par l’histologie qui rapportait un granulome avec necrose caseeuse. Le traitement antituberculeux a permis une evolution favorable. Nous recommandons, devant une ascite chyleuse en milieu tropical, la recherche d’une tuberculose en raison du benefice du traitement specifique.

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.

The main goal of our study was to evaluate cirrhosis course on one year. The study was prospective and longitudinal from January 2005 to December 2006 in the center of hepatology and gastro-enterology of CHU Gabriel Touré. The patients had one year follow up and examinated every three months. In this study 57 patients were included. Mean age was 41,5 + 15,3 years. Ascite and jaundice were the main clinical signs respectively 70.2% and 54.4%. Ascite or its increase was the most complication in 67.5% of cases (p = 0.002). The global mortality was 82.5% and it was high in the three first months, caused by hepatocellular carcinoma, digestive bleeding and hepatic encephalopathy respectively 33.3%, 27.3% and 15.2%. Abdomen pain, ascite and jaundice have an predictive value for high mortality (p between 3.10-3 et 10-7). Early examination, therapeutic observance and good management of cirrhosis complications could reduce the mortality.

As of 2007, it was estimated that the rapid scale-up of antiretroviral therapy (ART) in West and Central Africa had resulted in 430 000 patients with advanced HIV disease receiving treatment of a total in need of 1.7 million [1]. Although the prevalence seems to be declining [2-4], West Africa remains the epicentre of the HIV-2 epidemic. Compared to HIV-1, HIV-2 infection is characterised by a longer latency period [5] and a slower T Lymphocyte CD4+ (CD4) depletion with a lower plasma viral load [6, 7], but nonetheless leads to clinical AIDS in some instances [8, 9]. Unfortunately data on the ART response in HIV-2 and dually positive patients are sparse [10-19]. There is clear evidence that non nucleoside reverse transcriptase inhibitors (NNRTI) are inappropriate for the treatment of HIV-2 infection [20]. However, this type of regimen remains the first line treatment of choice in resource-limited countries [1]. Even where a protease inhibitor (PI) regimen has been used results have not always been encouraging [12, 14], perhaps due to HIV-2 having a decreased susceptibility to several, especially unboosted PIs, [21] or to the presence of viral resistance mutations prior to the onset of an effective PI-based therapy [13, 15, 22-25]. In Abidjan, a lower CD4 response at six months has been reported in HIV-2 and dually positive patients compared to HIV-1 infected patients [26]. In this context of a rapid scale-up of ART delivery, a consortium of leading clinicians and clinical epidemiologists from five major cities around West Africa, representing 11 adult clinic cohorts has been assembled in West Africa in the context of the global International Epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration of the US National Institutes of Health [27, 28]. Using this international database, we describe the case management of HIV-2 infected or dually positive patients and their response to treatment compared to HIV-1 infected patients in West Africa.

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.

The goal of our study was to describe the epidemiologic , clinical and endoscopic aspects of gastroduodenal ulcers at the regional hospital of sikasso (HRS). This prospective study was held from january 2002 to december 2003.All of the patients underwent an upper digestive tract endoscopy. Gastroduodenal ulcers comprised 10.88% of all of the digestive tract endoscopies. The average age of patients was 42.51 + 14.60 years with a gender ratio of 1.88 in favor of men. The overwhelm patients were lower middle class income. The main clinical symptoms were epigastric pain and dyspepsia. The ulcers were most often found in the duodenum (DI).

The aim of this study was to analyze digestive hemorrhage by oesophageal varicose vein bleeding, were pharmacological and endoscopic treatments suitable are not available.This prospective study related to 50 patients admitted for oesophageal varicose vein bleeding in the service of hepato-gastro-enterology of the hospital Gabriel Touré (MALI), from June 2003 to December 2005.The patients underwent clinical examination and upper digestive endoscopy to appreciate oesophageal varicose vein and marks of bleeding. Some biological examinations (haemoglobin, hematocrit, prothrombin time) were carried out in emergency to appreciate systemic repercussion of the haemorrhage.Our results showed that by oesophageal varicose vein bleeding represented 2.5% of the hospitalizations during the period of study.The average age of the patients was 37 years with, a sex ratio of 6.1% in favour of men. Antecedent of jaundice was frequently found (54%). The main cause of the varicose vein was cirrhosis. Mortality was 48%. The prognosis was not significantly improved by blood transfusion.At the end of this study, the stress must be laid on the HBV prevention because HBV is the main cause of chronic liver diseases.

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.

We conducted a prospective study in internal medicine and infectious diseases wards of the hospital of Point " G " in Bamako, Mali from January to December 2002. Overall 112 patients HIV positive, thirty-five patients (31,25%) had at least a digestive parasitic disease. We found that the most frequent parasite in stools sample were protozoa (82,85%). The second most frequent parasites were helminthes (20,33%). HIV/AIDS opportunistic parasites represented 40% of all parasites found. These included 25,71% cases of Cryptosporidium sp, 8,57% cases of Isospora belli and 5,71 % for microsporidia. The functional signs of our patients were mostly asthenia and weight loss. The physical signs were conjunctive pallor (71, 42%) and diarrhea (85, 71%). Generalized itching was present in 54, 28% of cases and abdominal pains in 25, 71% of cases. The global lethality was 37, 14% (13/35). The deaths were due to the HIV infection. The parasites appear even frequent at patients infected by HIV/AIDS, in spite of the advent of antiretroviral therapy. The efficient molecule research against the opportunist parasite must constitute one of our priorities in tropical area.

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.

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 goal of this study was to appreciate principal affections and mortality and in gastroenterology service of Gabriel Touré Hospital. It is about a survey longitudinal that has permit to analyze patients who have been care. During study, 766 patients were unregistered. Mean age of patient was 45.17 years and a sex ratio (M/F) = 1.10. The rate of reference was 13.85%. The morbidity was dominated by HIV infection (29.90%) followed by Hepato-cellular Carcinoma (7.83%) and cirrhosis (4.05%). Mortality (18.41%) was dominated by the VIH infection, HCC and Cirrhosis. The precocious recourse to cares, the improvement of work conditions, the sensitization, the infectious illness prevention is factors that will permit a reduction of morbidity and hospital mortality.

Background: Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa. Methods: We describe the prevalence of inadequate virological response (IVR) to ART (viral load $ 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou and information was collected using medical charts and interviews. Results: The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39] those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15) had increased odds of IVR. Immune suppression (OR = 3.32 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR. Conclusions: Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings. (authors)

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.

Our main objective consists in evaluating the frequency of digestive signs and digestive opportunistic infections in AIDS patients with diarrhea. The prospective study occurred from January 1997 to July 1998 in Bamako hospitals. The patients underwent a clinical examination, blood and stools tests, and sometimes upper digestive endoscopy. Among 434 cases of AIDS, 426 patients (98%) had at least one digestive sign. The main digestive signs were diarrhea (80.1%), abdominal pains (62.2%), vomiting (47.2%) and dysphagea (36.6%). Isospora belli and Cryptosporidium parvum have been pointed up in respectively 9% and 16.3% of examined specimen. Echerichia coli was found in 8.6% of stool cultures and in 2.9% in the case of Salmonella Arizonae. Twenty cases of Kaposi's sarcoma were diagnosed and mycosis was found in 71.9% of patients. In conclusion, digestive change is a constant phenomenon in AIDS patients. Patients survival could be improved by early management, improvement of diagnosis and provisioning of medicines.

L’evolution naturelle de l’amibiase hepatique se fait dans la grande majorite des cas vers l’augmentation progressive du foyer de necrose exposant ainsi au risque de rupture dans les organes de voisinage, en particulier le peritoine, la plevre et les bronches, le pericarde ou un autre viscere creux. La fistulisation cutanee spontanee est rare. Nous rapportons un cas d’amibiase hepatique non traitee, compliquee par une fistulisation a la peau.