RESUMELa cryptococcose neuromeningee est une infection fongique frequente chez les patients immunodeprimes au VIH. Sa survenue sur terrain immunocompetent au VIH doit faire rechercher systematiquement d’autres facteurs favorisants. Nous rapportons un cas de cryptococcose neuromeningee chez une patiente de 32 ans immunocompetente au VIH, sans aucun facteur d’immunodepression connu et sans antecedents medicaux notables qui a presente un tableau de meningo-encephalite subaigu et des troubles de la vision a type de diplopie. Le test au VIH etait negatif avec un taux de CD4 egal a 1367 cellules/mm3.La culture bacterienne du liquide cerebrospinal etait egalement sterile. Les virus responsables d’infection meningee n’ont pas ete recherches a cause de non disponibilite de ces analyses. L’evolution ete favorable sous fluconazole pendant la phase d’attaque du traitement puis les symptomes ont repris en debut de la phase d’entretien. Elle est decedee le 16eme jour du traitement. Le contexte de meningite bacterienne ou virale ne doit pas faire occulter la possibilite d’une meningite a cryptocoque quelque soit l’etat immunitaireABSTRACTNeuromeningeal cryptococcosis is a common fungal infection in HIV-immunocompromised patients. Its occurrence on immunocompetent patients to HIV should prompt to seek other predisposing factors. We report a case of neuromeningeal cryptococcosis in an immunocompetent 32-year-old female patient, without any known immunosuppressive factor and without a notable medical history. She presented with subacute meningoencephalitis and diplopia-type vision disorder syndrome. HIV serology was negative and the CD4 count was 1367 cells / mm3. The bacterial culture of the cerebrospinal fluid was sterile. Diagnostic tests for other virus responsible for meningeal infection were unavailable. Clinical course during the early days of initiation treatment with fluconazole was good. But, the symptoms and signs relapsed at the beginning of the maintenance phase. She died on the 16th day. A clinical picture of bacterial or viral meningitis should not overshadow the possibility of cryptococcal meningitis whatever the immune status.
Acute appendicitis is the most frequent abdominal surgical emergency in the world. The aim of this study was to analyse the results of surgical management of acute appendicitis. Methodology: This was a prospective study from January 2020 to December 2020 in the reference health centre in Commune I of Bamako. Results: During this period, we operated on 108 patients for acute appendicitis, including 78 men and 30 women, for a sex ratio of 2.5. The mean age was 26.92 years, ranging from 5 to 70 years. Abdominal pain was the main reason for consultation. Physical signs were dominated by a positive Blumberg's sign in 99.1% of cases, right iliac fossa defensiveness in 97.2% of cases, Rovsing's sign in 50% of cases, psoitus (Psoitis) in 18.5% and pain on the right in the cul de sac of Douglas in 69.4%. This physical examination enabled the diagnosis to be made in the majority of cases. In some doubtful cases, we requested an abdominal ultrasound scan. Locoregional anaesthesia was the most commonly used anaesthetic technique (63.9%). Classic Mac Burney appendectomy with burial of the stump was the surgical technique most frequently used. Postoperative recovery was straightforward in 97.2% of cases. However, we recorded one case of death. Conclusion: Acute appendicitis remains the most frequent abdominal surgical emergency in the community. Early diagnosis and rapid management improve prognosis. Treatment is essentially surgical.
Purpose: To analyze the outcomes of the management of open trauma to the abdomen by weapons. Methodology: This was a prospective, descriptive study from February 2019 to January 2020. Results: We performed 418 surgeries with 7.65% (32 cases) of open trauma to the abdomen by weapons. The average age was 31.38 years with extremes of 7 to 54 years. The male sex was the most represented 90% or a ratio of 9. The majority of our patients were injured overnight at home or in nightclubs. The assault was criminal with knives in the majority of cases. Abdominal pain and evisceration were the main reasons for consultation. Physical examination and X-ray of the unprepared abdomen (ASP) made the diagnosis. Laparotomy was performed in all our patients with simple consequences. Conclusion: Since the advent of the socio-political crisis in Mali, the proliferation of weapons has encouraged criminal attacks. Their management is complex often multidisciplinary is still controversial between laparotomy from the outset and non-operative treatment.
Despite the efforts made to fight the tuberculosis, Mycobacterium tuberculosis still remains a public health problem, particularly for low-income countries. According to the World Health Organization data, our country, Mali has detected only half of the 10,385 cases of tuberculosis expected for 2014 for a population of 17,309,000 inhabitants. The objective of this present work was to describe the different clinical aspects and the epidemiology of tuberculosis at Hospital Sominé Dolo in Mopti. We performed a retro-prospective and descriptive of tuberculosis cases diagnosed in our department of medicine between May 2016 and August 2018. A total of 96 tuberculosis cases were recorded, i.e. 4.6% and 1.0% for hospitalizations and consultations patterns, respectively. The median of age was 41 with extremes from 5 to 80 years. The age group [31 - 40 years] was the most affected with 20.8%. Men and women were affected in identical proportions, i.e. 50%. Pulmonary locations were the most frequent with 55.2%. Pleural tuberculosis was far the most frequent of the extra-pulmonary forms with 24.0% followed by the peritoneal and bone localization with 6.3% each. The majority of patients were followed on an outpatient basis, i.e. 90.6%. The disease lethality was 7.3%. Our data show that the cases of extra-pulmonary tuberculosis are in an increasing proportion and their diagnosis confirmation remains difficult in our context.
Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.
RESUME Le carcinome epidermoide in situ de la peau (maladie de Bowen) est une tumeur maligne intra epidermique courante a faible potentiel invasif se presentant comme une lesion plane rosee, parfois pigmentee, erythemateuse ou erythemato-squameuse. Toutefois, lorsque le papillomavirus humain (HPV) est responsable d’un carcinome epidermoide du canal anal et/ou de la marge anale, il peut prendre l’aspect d’une ulceration ou d’une fissure atypique a bord irregulier, infiltree et inflammatoire, ou d’une lesion bourgeonnante plus ou moins ulceree. Nous decrivons le cas d’une patiente seropositive au VIH de type 1, presentant une ulceration anogenitale evoluant depuis quatre mois chez qui nous avons retenu le diagnostic d’une maladie de Bowen non invasive sur la bse de l’aspect histologique, malgre indisponibilite de la recherche de comorbidites (HPV et de mycobacterie). La patiente etait sous antiretroviraux (Tenofovir + Lamivudine + Efavirenz). La modification de schema en association Abacavir/Lamivudine/ (ABC/3TC), associee aux soins locaux, a permis une cicatrisation totale des lesions. Ce cas suggere que la restauration de l’immunite associee aux soins locaux peut entrainer une cicatrisation des lesions de la maladie de Bowen chez les immunodeprimes au VIH. ABSTRACT Bowen's disease (in situ epidermoid carcinoma of the skin) is a common intra-epidermal malignant skin tumor with low invasive potential. It presents as a pinkish, sometimes pigmented, erythematous or erythematous-scaly lesion. However, when human papillomavirus (HPV) is responsible for squamous cell carcinoma of the anal canal and / or anal margin, the lesion may appear as an atypical ulceration or fissure with an irregular, infiltrated and inflammatory edge, or a more or less ulcerating budding lesion. We report the case of a patient with HIV type 1 who had an anogenital ulceration evolving for four months. Based on the histological findings, our working diagnosis was non-invasive Bowen's disease, although we could not obtain results for comorbidity (HPV and mycobacteria). We modified the previous HAART regimen (Tenofovir + Lamivudine + Efavirenz) to a new one including Abacavir / Lamivudine / (ABC / 3TC). The new treatment, combined with local care, enabled total healing of lesions. This case suggests that restoration of immunity associated and local care can lead to cure of Bowen's disease lesions in immunocompromised HIV patients.
Introduction: Bronchiolitis is a common respiratory disease in pediatrics. Its acute onset manifestations are most often observed in infants under 24 months of age, but at this age the respiratory system remains immature. The main pathogen of acute bronchiolitis in infants is respiratory syncytial virus (RSV). Materials and method: This is a descriptive and prospective study of the acute bronchiolitis in infants aged 0 to 24 months received at the pediatric consultation of the Reference Health Center of the Commune I of Bamako de Mars 2019 to February 2020. Results: In 12 months, 167 cases of acute bronchiolitis were seen at the pediatric consultation. The prevalence of bronchiolitis was 1.85%, the average age of infants was 8 months, and the boy/girl sex ratio was 1.6. The month of September represented the peak (31.1%). Infants aged 1 to 10 months accounted for 60% of hospitalizations. Mortality was 5.4%. Conclusion: bronchiolitis is a common pediatric consultation pathology, it remains worrying for parents with a more or less negligible mortality rate.
Abstract: Despite access to ARVs, HIV-infected patients are not immune to opportunistic infections. The aim of this study was to identify the causes of the deaths of people with HIV on ARVs, hospitalized in the Sikasso hospital, in order to improve the preventive and curative management of these opportunistic infections. From 1 July 2014 to 31 December 2015, we conducted a retrospective and descriptive study of 35 patients on antiretroviral treatment who died at the Sikasso hospital. Type 1 HIV infection was predominant with 94.2% of cases. Low socioeconomic status, poor adherence to ARVs and severe immunosuppression were the contributing factors in the development of opportunistic infections. Chronic cough and altered general status were the most incriminating reasons for hospitalization, with 20% of cases each. All patients received primary chemoprophylaxis with cotrimoxazole. Tuberculosis was the most opportunistic infection associated with deaths with 57.1% of cases in its multifocal form and 2.9% of cases in its pulmonary form, followed by mycotic esophagitis, cerebral toxoplasmosis and gastroenteritis (Cryptosporidiosis and isosporosis) with respectively: 17.1%; 11.2% and 8.6% of cases. The CD4 cell counts of the patients were much collapsed with a death rate of 100% at less than 50 cells / mm3. The combination of zidovudine + lamivudine + efavirenz was the most widely used ARV regimen in 37.1% of cases. Tuberculosis remains the first infection, causing deaths of patients living with HIV on ARVs, and good adherence to therapeutics will help reduce the death rate.
Key words: cause-death-patients-antiretroviral-Sikasso
Heterotopic pregnancy is no more a medical breakthrough. It combines intrauterine pregnancy and extra-uterine pregnancy regardless of location. We report a case of intra-uterine pregnancy associated with a ruptured abdominal ectopic pregnancy located on the pelvic colon in a 29-year-old patient, third gestation, primigravida, having a live baby and a prior history of two abortions. She has blood group O negative of Rhesus. It has been diagnosed at the stage of the rupture of ectopic pregnancy. An emergency laparotomy performed under blood transfusion has revealed heavy hemoperitoneum (1100 ml), a ruptured abdominal extra-uterine localized on the pelvic under blood transfusion and a bulging uterus. We have proceeded with the aspiration of hemoperitoneum, the ablation of the extra-uterine pregnancy and the hemostasis of the section part. The post-operative follow-up has been easy. The intra-uterine pregnancy has developed normally and has given birth to a full-term live, and healthy baby.
The survey of the primary resistances of tuberculosis bacilli to drugs is not only important epidemiologically speaking, but also for its use as a guideline to defining programs, to assessing the quality and the practical development of chemotherapy in a country, to measuring the propensity of the resisting tuberculosis bacilli to infect a given population within some time and to taking the necessary remedial measures. The object of this study has been to compare the rate of initial drugs' resistances of tuberculosis bacilli in Mali between 1980-1982 and 1989-1990. The results, which show a fall in the primary resistances due to drugs and to the combination of antibiotics as well, are being discussed while taking account various factors related to the organization.
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