Introduction: Neonatal asphyxia (NA) is one of the most likely causes of neuro-developmental abnormalities in children. In Mali it is responsible for half of the early deaths and the third of neonatal mortality. Updated data would help understand and improve intervention strategies to reduce mortality. Objective: It is the study of epidemiological and clinical characteristics, the immediate outcome and the factors associated with newborn (NB) mortality with NA. Material and Methods: This was a prospective cross-sectional study from June 27th to September 3rd 2016 about the NBs admitted for NA in the Hospital Teaching Gabriel Touré of Bamako. The clinical and biological data including the prognosis were collected from the health records of women, the liaison sheets and the medical file. The analysis was done using the software Epi info version 3.5.1. Results: 76 NBs were included which represented 23.45% of hospitalizations. The majority (89.5%, n = 68) were admitted to less than 24 hours of life for NA grade III according to the Sarnat classification (43.4%, n = 33). The average age of mothers was 24.17 ± 5.5 years. Almost half (41.3%, n = 31) were primigravida. The most common obstetrical event was dystocia (64.5%, n = 49). The prognosis was poor in grade III anoxia in our patients (56%) of deaths. Conclusion: The périnatal anoxia (PA) is a major health issue in Mali because of its frequency and severity. Monitoring of pregnancies, delivery assisted by skillful and qualified personnel, mastery of neonatal resuscitation techniques are good means of prevention.
Introduction: Postpartum is a period of physical and psychological upheaval with the possibility of surgical complications. Objective: To analyze the epidemiological-clinical, therapeutic and prognostic profile of postpartum surgical emergencies. Methods: This was a descriptive, cross-sectional study over 8 months (from August 2022 to March 2023) including all patients admitted to the general surgery service for acute surgical abdomen in the postpartum period. Result: Seven patients were retained with an average age of 28.33 6.89years. We found 4 cases (57.1%) of post-operative peritonitis, 1cas (14.3%) of appendicular abscess and 1 case (14.3%) of strangled white line hernia. Clinical signs were dominated by abdominal pain, conjunctival pallor and fever. Anemia was confirmed in 5 (71.4%) patients and we found leukocytosis in all patients. Laparotomy associated with hysterectomy was performed in 2cas, laparotomy avively of the banks and uterine suture in 2 cases, washing of the peritoneal cavity associated with abdominal drainage in 1 case, hernia cure in 1cas, an appendectomy in 1cas and a sigmoidectomy in 1cas; abdominal drainage was performed in all our patients. Conclusion: The occurrence of an abdominal surgical emergency in postpartum is serious and may involve the obstetric and vital prognosis of the patient. The involvement of all actors (surgeon, obstetrician and anesthesiologist resuscitator) in the management, remains essential to secure the periartum period.
Le traumatisme crânio-encephalique(TCE) constituait une cause non negligeable d’epilepsie secondaire. Aucune etude n’avait etait menee sur l’epilepsie posttraumatique (EPT) au Mali. Les objectifs de ce travail sont: determiner la frequence cette affection, degager les principales lesions cerebrales responsables. Patients et methodes: il s’agissait d’une etude retrospective de janvier 2009 a decembre 2010. Resultat: l’etude a porte sur 31 cas d’EPT sur un total de 757 traumatismes crânio-encephaliques soit 4 ,10 % des cas. Le sexe masculin predominait avec 23 hommes (74,19%) contre 8 femmes (25,81%). Le maximum de cas etait enregistre dans la tranche de 21-25 ans, un âge moyen de 26 ans avec les extremes 4 et 60 ans. Les etiologies etaient dominees par les accidents de la voie publique avec 18 cas (58,06%) suivis par les coups et blessures volontaires avec 9 cas (29,03%) dont 6 par arme blanches et 3 par a feu. Les chutes et les coups de sabot representaient respectivement 3 cas (9,48%) et 1cas (3,23%) Le Glasgow etait inferieur ou egal a 8(traumatisme crânien grave) chez 54,84%. Les principales lesions responsables des cas d 'EPT etaient: les plaies crânio-cerebrales avec 9 cas (29,03%) suivi des embarrures (25,80%). Les autres lesions etaient les hematomes extraduraux avec 3 cas (9,68%), sous-duraux 4 cas (12,90%) les contusions et les hematomes intracerebraux chacun 1cas (3,23%) et les lesions mixtes 3 cas (9,68%). Conclusion: le TCE est une cause frequente d’epilepsie pouvant affecter la vie socioprofessionnelle des patients. La gravite du traumatisme, les lesions cerebrales a l’imagerie constituaient des facteurs de risque. Mots cles: epilepsie post-traumatique, lesions English Title: Posttraumitic epilepsia, our experience about 31 cases English Abstract The crânio-encephalic trauma constitutes a not insignificant cause of secondary epilepsy. The risk factors and the prevention are the object of controversy. No study had was led on the EPT to Mali. The objectives of our work are: the objectives of this work are: determine the frequency this affection, clear (release) the main responsible brain damages. Patients and methods: it was about a retrospective study from January 2009 till December 2010. Result: the study concerned 31 of the EPT on a total of 757 of the crânio-encephalic trauma that is 4, 10% of the cases. The male prevailed with 23 cases (74.19%) against 8 women (25, 81%). The maximum of case was registered in the edge of 21-25 years, an average age of 26 years with extremes 4 and 60 years. Etiology was dominated by the road traffic accident with 18 cases (58, 06%) followed by assault 9 cases (29.03%) among which 6 by Cold steels and 3 by guns. The falls and the knocks of clog represented respectively 3 cases (9.48%) and 1cas (3.23%). Glasgow was lower or equal to 8 (cranial trauma engraves (burns)) to 54.84%. The main responsible hurts were the close head injury with 9 cases (29.03%) depressed skull fracture (25.80%). Other hurts were extradural hematoma with 3 cases (9.68%), subdural hematoma 4 cases (12.90%) the bruises and intra parenchymal hematoma each 1cas (3.23%) and the mixed hurts 3 cases (9.68%). Conclusion: the TCE is a frequent cause of epilepsy which can affect the social and occupational life of the patients. The gravity of the trauma, the brain damages in the imaging constituted factors. Keywords: post-traumatic epilepsy, hurts
L’élevage urbain et périurbain en Afrique rencontre de nombreux problèmes, notamment en saison sèche. Le but de cette étude était de déterminer la teneur en composés phénoliques et d’évaluer l’activité antioxydante des extraits de feuilles de Afzelia africana et de Pterocarpus erinaceus afin de justifier leurs utilisations dans le milieu de l’élevage traditionnel au Nord de la Côte d’Ivoire. La macération à l’eau distillée et à l’éthanol 70 % a été la méthode d’extraction utilisée. Les extraits obtenus ont fait l’objet d’analyse phytochimique par dosage au spectrophotomètre. L’activité antioxydante des extraits a été évaluée par deux méthodes complémentaires, la réduction du fer (FRAP) et le piégeage du radical libre DPPH. Il ressort des investigations que les extraits aqueux de P. erinaceus et hydroalcoolique de A. africana possèdent les plus fortes teneurs en polyphénols totaux 268,7±6,4 mg EAG.g-1 et 242,7±8,0 mg EAG.g-1 respectivement. Les extraits aqueux de P. erinaceus et de A. africana possèdent les meilleurs pourcentages de réduction du fer allant de 51,56 à 67,96 %. L’extrait hydroalcoolique de A. africana a enregistré un bon pouvoir inhibiteur du radical DPPH (CI50 = 0,80±0,05 mg.ml-1), proche de celui de l’acide ascorbique (CI50=0,33±0,05 mg.ml-1). Les extraits étudiés sont donc de bons antioxydants. Ils peuvent donc être utilisés à des fins médicales, nutritionnelles et physiologiques des bovins. Cette étude justifierait l’engouement des éleveurs traditionnels à fournir des feuilles de A. africana et de P. erinaceus à leur bétail. Feeding, both qualitative and quantitative, constitutes a huge problem for traditional livestock farming, especially in dry season. The aim of this study was to determine phenolic compounds content and to evaluate the antioxidant activity of leaf extracts of Afzelia africana and Pterocarpus erinaceus in order to justify their uses in traditional livestock farming in the North of Côte d’Ivoire. The extraction method used, consisted of maceration with distilled water and 70% of ethanol. The extracts obtained were subjected to phytochemical analysis by spectrophotometer dosing. The antioxidant activity of the extracts was evaluated by two complementary methods, iron reduction (FRAP) and DPPH free radical scavenging. It appears from investigations that the aqueous extracts of P. erinaceus and hydroalcoholic extracts of A. africana have the highest contents of total polyphenols 268.7±6.4 mg EAG.g-1 and 242.7±8.0 mg EAG.g-1, respectively. Aqueous extracts of P. erinaceus and A. africana have the best reduction percentages of ferric iron from 51.56 to 67.96%. Hydroalcoholic extract of A. africana recorded a good inhibitory power of the DPPH radical (IC50 = 0.80±0.05 mg.ml-1), close to that of ascorbic acid (IC50=0.33±0.05 mg.ml-1). The studied extracts are therefore good antioxidants. They can be used for medical, nutritional and physiological purposes but also as an alternative in cattle feeding. This study would justify the enthusiasm of traditional breeders to provide leaves of A. africana and P. erinaceus to their livestock.
postoperative infection in neurosurgery is one of the dreaded complications that may compromise the results of the surgery.The objectives of this study were to find the factors favoring infection and germs responsible.This was a retrospective study of 12 months between January 2009 and December 2009 in the Department of Neurosurgery at the Gabriel Toure hospital. It involved all infections within three months after surgery. The average age of patients was 30.3 years with a male predominance. The mean operating time was 149 minutes 41 seconds . All patients received antibiotics in made intraoperatively and continued for two days.. Infections appeared before the Flanker postoperative week. All infections have involved the surgical site for 13 patients and were fresh purulent and serous purulent 3 cases . Infections were found in 62.5 % (12 patients) before the tenth day and 37.5% between the 11th and 20th day. After the sample of the abscess analysis to the laboratory, a DST was conducted for all germs, Escherichia coli and Staphylococcus aureus were the most frequently encountered microorganisms (56.25%).. The evolution was marked by one death. Postoperative infection is one of the complications that can affect the results of the surgery on the one hand but also to lengthen the duration of hospitalization with financial implications. Its occurred is the result of several factors, including the lack of respect of asepsis rules.
RESUMEBut. Faire le bilan de notre activite d’adenomectomie prostatique transvesicale. Patients et methodes. Il s’agit d’une etude transversale avec collecte prospective des donnees, allant de Fevrier 2007 a Decembre 2012. Les dossiers de tous les patients operes pour adenome de la prostate par la voie transvesicale dans l’unite de chirurgie generale du Centre de Sante de Reference de la Commune VI (CS Ref CVI) du district de Bamako, ont ete inclus dans cette etude. Resultats. Nous avons collige en 5 ans 133 dossiers soit 51,35% des pathologies urologiques et 14,3% de l’activite chirurgicale. L’âge moyen etait de 68 ans. Les patients venus spontanement representaient 97 cas (72,9%). Les pathologies associees etaient la hernie inguinale et la lithiase vesicale 3 cas (2,25%) chacune. Les circonstances de decouverte etaient la retention aigue d’urine 54 cas (40,6%) et la dysurie 41 cas (30,8%). Le globe vesical etait trouve dans 97 cas (72,9%). Le toucher rectal a trouve une augmentation de volume de la prostate ferme et reguliere dans 132 cas (99,24%). Le PSA etait eleve dans 7 cas (5,3%). L’adenomectomie etait effectuee dans 129 cas (96,99%). L’anatomie pathologie revelait 3 cas (2,3%) d’adenocarcinome. Les suites immediates ont ete simples dans 131 cas (98,5%). La duree d’hospitalisation moyenne a ete de 6 jours. La mortalite a ete de 1,5% (2 cas). Conclusion. Les adenomectomies prostatiques transvesicales realisees dans un hopital de seconde categorie par des chirurgiens generalistes ont eu des suites simples. Toutefois, cette technique pourrait etre reservee aux structures peripheriques et les techniques plus modernes aux centres hospitalo-universitaires.ABSTRACTObjective. To report our activity of transvesical prostate adenomectomy. Patients and methods. This was a cross sectional prospective study, covering the period from February 2007 to December 2012 (5 years). All patients operated on prostatic adenoma within the general surgical unit at commune VI’s referral health center were included. Results. We studied 133 cases of prostatic adenoma. The average age of patients was 68 years. Prostatic adenoma (133 cases; 51.35%) was the most common uropathy. Inguinal hernia (6 cases; 4.5%) and vesical lithiasis (6 cases; 4.5%) were the most common pathologies associated with adenoma. Urine retention (54 cases; 40.6%) and dysuria (41 cases; 30.8%) were the most common reasons of consultation. On palpation, 97 patients (72.9%) have presented urinary bladder retention. Moreover, 132 patients (99.24%) had the prostatic hypertrophic on digital exam. Only 3 patients (2.3%) had associated adenocarcinoma. PSA level was abnormal in 7 cases (5.3%). Adenomectomy was done for 129 patients (96.99%). The histological analysis found 7 associated adenocarcinomas (5.26%). 131 patients (98.5% had no immediate complication. The average duration of hospitalization was 6 days. The mortality rate was 1.5% (2 patients). Conclusion. Prostatic adenomas may be operated in a secondary category hospital by general surgeons, with few complications. This technique should be limited to peripheral sanitary structures. The modern techniques will be performed by urologist in first category hospitals.
Healthcare-associated infections or nosocomial infections are a public health problem due to their frequency, severity and economic impact. They cause an increase of the morbidity, the mortality, the hospital stay and the expenses of taking care of the patients. According to the WHO, 7.1 million people are affected each year, of which about 100,000 die.The aim of this study was to determine the frequency of healthcare-associated infections in the Neurosurgery Department of Gabriel Touré University teaching Hospital and to identify the risk factors associated with these infections.This was an epidemiological, descriptive, analytic, cross-sectional and prospective study lasting 6 months from May 29 to November 30, 2016. The study focused on patients who stayed more than 48 hours in the Neurosurgical department Gabriel Touré teaching hospital. The collected data focused on the clinical and biological characteristics of the patients during their hospitalization. The maximum size of the sample was 200 patients. A sample was taken for each type of infection. The criteria used for the diagnosis of Healthcare-associated infections were those of the CDC (Center for Disease Control) and the realization of a thick drop in our context. The chi-square test was used for the comparison of qualitative variables and Kruskal Wallis and Anova for quantitative variables. The materiality threshold has been set to a value of p less than 0.05.At the end of our study, we had 34 infected patients out of 200, a rate of 17%. The significant risk factors found in our study were: high age (p = 0.04), ASA class (p = 0.002), pre-surgical shaving (p = 0.02), long duration surgical intervention (p = 0.002) and long hospital stay (p = 0.004). The types of infections associated with the care found were: urinary in 18 (53%) cases, respiratory in 9 (26%) cases, operative site in 6 (18%) cases and 1 (3%) cases of bacteremia. The bacterial spectrum of these infections was dominated by Negative Gram Bacilli, among which Escherichia coli in 11 (32.3%) cases. The clinical course of patients treated for these infections was marked by healing in 31 (91.2%) cases, complications in 2 (5.9%) cases, and death in 1 (2.9%) case.The prevalence of Healthcare-associated infections in our department remains high compared to that found in developed countries. This study allowed us to identify the main risk factors associated with these infections. A stricter adherence to the rules of hygiene and prevention of Healthcare-associated infections is needed to reduce this rate.Les infections associées aux soins (IAS) ou infections nosocomiales constituent un problème de santé publique par leur fréquence, leur gravité et leur retentissement économique. Elles causent une augmentation de la morbidité, la mortalité, le séjour hospitalier et les frais de prise en charge des malades.Selon l'OMS, 7,1 millions de personnes seraient affectées par les IAS chaque année parmi lesquelles environ 100000 meurent de suites de ces ISA.Le but de cette étude était de déterminer la fréquence des infections associées aux soins dans le service de Neurochirurgie du CHU Gabriel Touré et d'identifier les facteurs de risque associés à ces infections.Il s'agissait d'une étude prospective d'une durée de 6 mois allant du 29 Mai au 30 Novembre 2016. L'étude a porté sur les patients ayant séjourné plus de 48 heures dans le service de Neurochirurgie du CHU Gabriel Touré.Les données collectées ont porté sur les caractéristiques cliniques et biologiques des patients au cours de leur hospitalisation.La taille maximum de l'échantillon a été de 200 malades. Un prélèvement a été fait pour chaque type d'infection.Les critères utilisés pour le diagnostic de l'IAS étaient ceux du CDC (Center for Disease Control) d'Atlanta ainsi que la réalisation d'une goutte épaisse dans notre contexte.Le test de khi2 a été utilisé pour la comparaison des variables qualitatives et Kruskal Wallis et Anova pour les variables quantitatives. Le seuil de signification a été fixé à une valeur de p inférieure à 0,05.Au terme de notre étude nous avons eu 34 patients infectés sur 200, soit un taux de 17%. Les différents facteurs de risque significatifs retrouvés dans notre étude ont été : l'âge élevé (p=0,04), la classe ASA (p=0,002), le rasage pré-chirurgical (p=0,02), la longue durée de l'intervention chirurgicale (p=0,002) ainsi que la longue durée d'hospitalisation (p=0,004). Les types d'infections associées aux soins retrouvés ont été : urinaires dans 18 (53 %) cas, respiratoires dans 9 (26%) cas, site opératoire dans 6 (18%) cas et 1 (3%) cas de bactériémie. Le spectre bactérien de ces infections était dominé par les Bacilles Gram Négatifs parmi lesquels l'Escherichia coli dans 11 (32,3%) cas.L'évolution clinique des patients traités pour ces infections a été marquée par la guérison dans 31 (91,2%) cas, les complications dans 2 (5,9%) cas et le décès dans 1(2,9%) cas.La prévalence des infections associées aux soins dans notre service reste élevée par rapport à celle retrouvée dans les pays développés. Cette étude nous a permis d'identifier les principaux facteurs de risque associés à ces infections. Une observance plus stricte des règles d'hygiène et de prévention des IAS s'impose pour faire baisser ce taux.
Introduction: Acute lower respiratory infections (ALRIs) in paediatrics include a heterogeneous group of conditions affecting the lower respiratory tract in children. They constitute a real public health problem, particularly in developing countries. Patient and Method: This was a retrospective, descriptive study from 1 January to 31 December 2018, i.e. 2 years. All children aged 2 months to 15 years hospitalized for ARFU were included. Results: In our study, the prevalence of ARBI was 14.47%. The sex ratio was 1.16 in favour of boys. The under-5s were the most represented 97.5%. The peaks of hospitalizations were found in October 18.2%, November 16.5% and August 14%. According to the Expanded Programme on Immunisation, 12.5% of the children were not correctly vaccinated. The reasons for consultation of our patients were respiratory distress with 25.6% followed by cough and cold 24.5%. Fever was associated with 70.2%. The clinical forms were dominated by: pneumonia 47.9% followed by superinfected bronchiolitis 33.1% and acute bronchitis 19%. The majority were treated with the combination of Ceftriaxone and gentamycin, i.e. 62.8% as first-line treatment. The evolution was favourable in 90.9% of cases with 5% death, 2.5% discharge against medical advice and 1.6% referral to higher level. Conclusion: Low-grade ARI is a public health problem in commune II of Bamako. Raising public awareness of the early signs of low-grade ARI, strict adherence to the expanded programme of immunisation, and upgrading of community and hospital health staff will help to reduce mortality from low-grade ARI.
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