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Acute otitis media (AOM) is a viral or bacterial infection of the middle ear most often following nasopharyngitis. It is seen at any age, but particularly common in children. The aim of this work is to describe the main clinical and therapeutic epidemiological aspects of acute otitis media.in the ENT department of Sikasso hospital. This is a prospective and descriptive study carried out in the ENT department of Sikasso hospital over a period of 04 months. Two hundred and ten patients were included in this study. The following variables: Ages, sex, residence, reason for consultation, time to consultation, risk factors, clinical and therapeutic aspects were collected. The study population consisted of patients seen in the service in whom the diagnosis of AOM was retained and who gave their verbal consent/assent. We identified 210 cases of AOM in 04 months out of 1716 consultations, i.e. a prevalence of 12.20%. The average age of the patients was 14 years old, with extremes of 24 days to 75 years old, children under 05 years old accounted for 46.02%. We recorded a female predominance of 51.90%. The majority of patients 82.90% resided in the city Sikasso. I'otalgia was the main reason for consultation with 50.48%, followed by otorrhea 25.24%, hearing loss with or without tinnitus in 17.61%, the presence of foreign bodies 5.71% and traumatic causes 0.96% of cases. The average consultation time was less than one week in 74.29% of cases. Among the predisposing factors, nasopharyngitis and purulent rhinitis were associated with AOM in 64.30% of cases, followed by adenotonsillitis in 23.33%, passive smoking in 4.76% and 1 case (0.47%) of soft palate. The AOM was congestive in 57.14%, suppurative in 42.86 of which 32.38% were perforated. Treatment was with antibioticsin 90.95% of cases. The evolution under treatment was favorable at 07 days in 81.42% of cases. Two cases of paracentesis were made. Acute otitis media affects all ages, particularly common in children under .....

The objective of this paper is to analyze the effects of climate change on maize production in Mali during the period 1990-2020. The unit root test (augmented Dickey-Fuller) was used to check the order of integration between the variables in the study. The ARDL (autoregressive distributed lag) approach to cointegration limits is applied to assess the association between the study variables with evidence of a long-term relationship. The unit root test estimates confirm that all variables are stationary at the combination of I(0) and I(1). The results show that precipitation and temperature in June and July have a negative and highly significant effect on maize production in both the short and long term analyses. Among other determinants, the area of land devoted to maize crops and GDP per capita have a positive effect on production. The estimated coefficient on the error correction term is also highly also highly significant As Mali's population grows, in the coming decades the country will face food security challenges. Possible initiatives are needed to configure the Malian government to address the negative effects of climate change on agriculture and ensure adequate food for the growing population.

Malaria transmission largely depends on environmental, climatic, and hydrological conditions. In Mali, malaria epidemiological patterns are nested within three ecological zones. This study aimed at assessing the relationship between those conditions and the incidence of malaria in Dangassa and Koila, Mali. Malaria data was collected through passive case detection at community health facilities of each study site from June 2015 to January 2017. Climate and environmental data were obtained over the same time period from the Goddard Earth Sciences (Giovanni) platform and hydrological data from Mali hydraulic services. A generalized additive model was used to determine the lagged time between each principal component analysis derived component and the incidence of malaria cases, and also used to analyze the relationship between malaria and the lagged components in a multivariate approach. Malaria transmission patterns were bimodal at both sites, but peak and lull periods were longer lasting for Koila study site. Temperatures were associated with malaria incidence in both sites. In Dangassa, the wind speed (p = 0.005) and river heights (p = 0.010) contributed to increasing malaria incidence, in contrast to Koila, where it was humidity (p &lt, 0.001) and vegetation (p = 0.004). The relationships between environmental factors and malaria incidence differed between the two settings, implying different malaria dynamics and adjustments in the conception and plan of interventions.

Au Mali, le répertoire des pesticides utilisés en agriculture est vaste et les études de leurs impacts sur la santé sont rares. Des travaux de recherche sur les impacts des pesticides utilisés en productions cotonnière, céréalière et maraîchère sur la santé des populations méritaient d’être conduits. Cette étude a été menée dans trois villages du cercle de Kita (Madina Malinké, Banfara et Toufinko). Soixante pesticides, dont 17 herbicides et 1 insecticide non homologués par le Comité ouest-africain d’homologation des pesticides (COAHP), ont été identifiés. Les pesticides utilisés sur le coton sont formulés à partir de 20 matières actives, dont 5 (soit 25,5 %) interdites en Europe. Les pesticides destinés au maraîchage sont formulés à partir de 16 matières actives, dont 5 sont aussi interdites en Europe (soit 31,25 %), comme par exemple le profenofos, la bifenthrine et la flubendiamide. Au cours du suivi médical d’une cohorte de 244 applicateurs, plusieurs signes d’intoxications aigües (cutanée, orale, oculaire, gastrique) ont été observés sur nos trois sites d’étude pendant la période de pulvérisation, essentiellement avec les herbicides. Les cas d’intoxication orale et par inhalation sont les plus nombreux, observés chez 21,5 % des applicateurs en juillet, coïncidant avec le pic d’utilisation des herbicides à Madina Malinké. Des cas de toxicité et d’irritation cutanée ont été relevés chez 18,5 % des applicateurs en juillet, correspondant à un pic de pulvérisation des herbicides à Banfara. Dans les trois villages, les quantités d’herbicides utilisées sont plus élevées que celles des insecticides. L’utilisation d’insecticides à base de matières actives interdites comme le profenofos, la bifenthrine et la flubendiamide induit à long terme des risques d’infertilité, de perturbations endocriniennes et de maladies neurodégénératives. Le suivi de cette cohorte et l’utilisation de biomarqueurs permettra d’étudier le lien entre l’utilisation de certains pesticides et le développement de maladies chroniques.

Summary Background Chloroquine was used for malaria treatment until resistant Plasmodium falciparum was identified. Because 4-aminoquinolines with modified side chains, such as AQ-13, are active against resistant parasites, we compared AQ-13 against artemether plus lumefantrine for treatment of uncomplicated P falciparum malaria. Methods We did a randomised, non-inferiority trial. We screened men (≥18 years) with uncomplicated malaria in Missira (northeast Mali) and Bamako (capital of Mali) for eligibility (≥2000 asexual P falciparum parasites per μL of blood). Eligible participants were randomly assigned to either the artemether plus lumefantrine group or AQ-13 group by permuting blocks of four with a random number generator. Physicians and others caring for the participants were masked, except for participants who received treatment and the research pharmacist who implemented the randomisation and provided treatment. Participants received either 80 mg of oral artemether and 480 mg of oral lumefantrine twice daily for 3 days or 638·50 mg of AQ-13 base (two oral capsules) on days 1 and 2, and 319·25 mg base (one oral capsule) on day 3. Participants were monitored for parasite clearance (50 μL blood samples twice daily at 12 h intervals until two consecutive negative samples were obtained) and interviewed for adverse events (once every day) as inpatients during week 1. During the 5-week outpatient follow-up, participants were examined for adverse events and recurrent infection twice per week. All participants were included in the intention-to-treat analysis and per-protocol analysis, except for those who dropped out in the per-protocol analysis. The composite primary outcome was clearance of asexual parasites and fever by day 7, and absence of recrudescent infection by parasites with the same molecular markers from days 8 to 42 (defined as cure). Non-inferiority was considered established if the proportion of patients who were cured was higher for artemether plus lumefantrine than for AQ-13 and the upper limit of the 95% CI was less than the non-inferiority margin of 15%. This trial is registered at ClinicalTrials.gov, number NCT01614964. Findings Between Aug 6 and Nov 18, 2013, and between Sept 18 and Nov 20, 2015, 66 Malian men with uncomplicated malaria were enrolled. 33 participants were randomly assigned to each group. There were no serious adverse events (grade 2–4) and asexual parasites were cleared by day 7 in both groups. 453 less-severe adverse events (≤grade 1) were reported: 214 in the combination group and 239 in the AQ-13 group. Two participants withdrew from the AQ-13 group after parasite clearance and three were lost to follow-up. In the artemether plus lumefantrine group, two participants had late treatment failures (same markers as original isolates). On the basis of the per-protocol analysis, the AQ-13 and artemether plus lumefantrine groups had similar proportions cured (28 [100%] of 28 vs 31 [93·9%] of 33; p=0·50) and AQ-13 was not inferior to artemether plus lumefantrine (difference −6·1%, 95% CI −14·7 to 2·4). Proportions cured were also similar between the groups in the intention-to-treat analysis (28 of 33, 84·8% for AQ-13 vs 31 of 33, 93·9% for artemether and lumefantrine; p=0·43) but the upper bound of the 95% CI exceeded the 15% non-inferiority margin (difference 9·1%, 95% CI −5·6 to 23·8). Interpretation The per-protocol analysis suggested non-inferiority of AQ-13 to artemether plus lumefantrine. By contrast, the intention-to-treat analysis, which included two participants who withdrew and three who were lost to follow-up from the AQ-13 group, did not meet the criterion for non-inferiority of AQ-13, although there were no AQ-13 treatment failures. Studies with more participants (and non-immune participants) are needed to decide whether widespread use of modified 4-aminoquinolones should be recommended. Funding US Food and Drug Administration Orphan Product Development, National Institutes of Health, US Centers for Disease Control and Prevention, Burroughs-Wellcome Fund, US State Department, and WHO.

With the paradigm shift from the reduction of morbidity and mortality to the interruption of transmission, the focus of malaria control broadens from symptomatic infections in children ≤ 5 years of age to include asymptomatic infections in older children and adults. In addition, as control efforts intensify and the number of interventions increases, there will be decreases in prevalence, incidence and transmission with additional decreases in morbidity and mortality. Expected secondary consequences of these changes include upward shifts in the peak ages for infection (parasitemia) and disease, increases in the ages for acquisition of antiparasite humoral and cellular immune responses and increases in false-negative blood smears and rapid diagnostic tests. Strategies to monitor these changes must include: 1] studies of the entire population (that are not restricted to children ≤ 5 or ≤ 10 years of age), 2] study sites in both cities and rural areas (because of increasing urbanization across sub-Saharan Africa) and 3] innovative strategies for surveillance as the prevalence of infection decreases and the frequency of false-negative smears and rapid diagnostic tests increases.

The study sites for the West African ICEMR are in three countries (The Gambia, Senegal, Mali) and are located within 750 km of each other. In addition, the National Malaria Control Programmes of these countries have virtually identical policies: (1) Artemisinin Combination Therapies (ACTs) for the treatment of symptomatic Plasmodium falciparum infection, (2) Long-Lasting Insecticide-treated bed Nets (LLINs) to reduce the Entomololgic Inoculation Rate (EIR), and (3) sulfadoxine-pyrimethamine for the Intermittent Preventive Treatment of malaria during pregnancy (IPTp). However, the prevalence of P. falciparum malaria and the status of malaria control vary markedly across the four sites with differences in the duration of the transmission season (from 4-5 to 10-11 months), the intensity of transmission (with EIRs from unmeasurably low to 4-5 per person per month), multiplicity of infection (from a mean of 1.0 to means of 2-5) and the status of malaria control (from areas which have virtually no control to areas that are at the threshold of malaria elimination). The most important priority is the need to obtain comparable data on the population-based prevalence, incidence and transmission of malaria before new candidate interventions or combinations of interventions are introduced for malaria control.

The purpose of this prospective study conducted from January 2001 to December 2001 was to ascertain the value of computer tomography for evaluation of brain injuries. Computer tomography was performed using a Toshiba X VID system with contiguous 5 mm axial sections through the posterior fossa and 10 mm contiguous axial sections through the subtentorial region without contrast injection. A total of 107 patients with brain injuries were enrolled over the one-year study period. These patients accounted for 0.8% of all admissions to surgical emergency unit of Gabriel Toure Hospital in Bamako, Mali. The predominant age group for brain injuries was the 20- to 29-year-old group (35 cases). The male-to-female sex ratio was 5:1. Vehicular accident was the most frequent cause of brain injury (76 cases). Trauma was severe in 48 patients with a Glasgow score less than 8. Coma occurred immediately after injury in 90 cases. Ventricular hemorrhage led to coma in 100% of cases whereas brain hemorrhage and hematoma led to coma in 93.3% and 83.3% of cases respectively. Treatment was medical in 99 cases and neurosurgical in 8. The mortality rate was 34% and the morbidity rate (permanent sequels) was 36%. Computer tomography is a valuable tool for therapeutic decision-making in medico-surgical emergencies involving brain injuries.

Objectifs Preciser la frequence relative des differents types de lesions traumatiques crânio-encephaliques. Materiels et methodes De janvier 2001 a aout 2003, 107 patients consecutifs presentant au scanner une lesion crânio-encephalique d’origine traumatique ont ete inclus dans cette etude. Les examens scanographiques demandes en urgence ont ete realises en contraste spontane sur un appareil Toshiba Xvid corps entier sequentiel. Le test de Chi carre a ete utilise pour l’analyse statistique des resultats. Resultats L’âge moyen des patients etait de 27,45 ans (extremes 1 a 75 ans) et le sex ratio etait de 5,3. Si l’accident de la voie publique etait en cause dans 58,8 % (63/107) des cas, le traumatisme responsable de la lesion crânio-encephalique etait les coups et blessures volontaires dans 33 cas (30,8 %), suivis de loin par les accidents de travail, 8 cas (7,5 %) et les accidents domestiques, 3 cas (2,8 %). Une lesion cerebrale etait retrouvee dans 79,8 % avec dans 62,9 % une contusion hemorragique. Quant aux lesions hemorragiques pericerebrales (42,1 %), elles etaient dominees par l’hematome extra-dural (66,8 %), suivi par l’hemorragie meningee (35,7 %) et l’hematome sous-dural (20,2 %). Une association de lesions crânio-encephaliques etait retrouvee dans 80,4 % des cas. Conclusion Les lesions traumatiques crânio-encephaliques au Mali sont particulieres par la frequence elevee des hematomes extra-duraux.