Le Mali medical最新文献

Introduction: Sickle cell disease is the most common hemoglobinopathy in the world. Serious in its major form (SS), it exposes the sickle cell subject to osteoarticular complications that can be early and disabling.

Objective: The objective of this study was to contribute to a better understanding of the osteoarticular complications of hemoglobinopathy S and C in pediatric settings.

Material and method: It was a retrospective cross-sectional study, conducted over a period of 3 years, from January 1, 2017 to December 31, 2019. Were included, children aged 0 to 15 years with hemoglobin S or C confirmed by electrophoresis and having an osteo-articular complication.

Results: The analysis focused on 42 cases including 24 boys and 18 girls. The median age was 7.5 years. Functional impotence and fever were the main clinical signs observed. Osteomyelitis was the majority diagnosis (59.6%). Hemoglobin electrophoresis found 33.3% SS hemoglobin and 21.4% SC hemoglobin. Staphylococcus aureus was the main germ isolated from the samples. Radiological lesions were multifaceted and dominated by the periosteal reaction. Management based mainly on orthopedic treatment allowed a favorable evolution in 69% of cases. The average length of hospitalization was 23.78 days.

Conclusion: Osteoarticular complications of hemoglobinopathies S and C are not exceptional. Of chronic and sometimes disabling course, their management requires a preventive approach of primary and secondary type of sickle cell disease.

Goal: To assess knowledges and practices on iron prescription in pediatric ward in CHU Gabriel Touré of Bamako, Mali.

Tools and methods: It was a prospective and transversal study canied out. We submitted questionnaire and analyzed the case history of to the children aged 1-60 months old who received iron during the study period from 1^rst to 30 July 2012. The prescriptators' consent were solicited and obtained at first of all.

Results: Fifty prestators were interviewed among them 10 pediatricians (20%), 31 pediatrics' resident (62 %), 2 generalists physicians (4%), 7 medical student (14%). One hundred 100 were analyzed medical records. More than half of the prestators known the need of iron in children. Thirty percent have received iron at 8 to 10mg/kg. The medication duration wasn't indicating in 92% of patients. In our context prestators well know about meaning and the needs of iron in children bout they're limited on iron food sources and iron storage.

Conclusion: The well theorical knowledge on indications and prescription roules on iron in children didn't escape from miss practices in its prescription. Moreover works should analyze the reasons of discrepancies.

Introduction: The health district of Mopti is confronted with factors that influence its vaccination coverage [1]. The aim of the study was to study the factors influencing the low BCG vaccination coverage in VAR1 and Penta3 in children aged 0 to 23 months in the health district in 2021.

Methodology: We carried out a descriptive cross-sectional study, collected information from 280 mothers questioned on the services provided by the vaccination service for children before the age of two, the reasons for incompleteness using a questionnaire. Univariate and multivariate logistic regression analysis was done for the variables using SPSS software. An association was significant when p < 0.05.

Results: Vaccination completeness was 53.08%, varying from 94% BCG, 79% VAR1 and 83% Penta3. The analysis showed that mothers who spent more time at the vaccination center (P=0.098, Chi-square=18.617), who missed certain sessions (P=0.174, Chi-square=13.371) and who were informed of missed consumables (P=0.278, Chi-square= 7.485) are significantly associated with vaccine incompleteness.

Conclusion: Vaccination completeness was insufficient despite good knowledge of the mothers on vaccination.

Objectives: To identify the factors of poor prognosis of ventilator-associated lung disease (VAP) in order to improve their management.

Patients and method: Prospective, descriptive and analytical study of patients admitted to intensive care at the Angré University Hospital from November 1, 2019 to July 31, 2021 and having presented VAP.

Results: We collected 43 patients out of 625 admissions, i.e. 6.88%. The average age was 49.06 years. The sex ratio was 0.38. The main reason for admission was coma with 88.37%. Hypertension and diabetes were the main antecedents. Early VAP accounted for 53.49%. Klebsiella pneumoniae was the main germ. Patients intubated on admission accounted for 79.07%. The average duration of ventilation was 26.95 days and the average duration of hospitalization was 30.8140 days. Probabilistic antibiotic therapy was performed in 75.76% of patients. Mortality was 76.74%. The mortality factors were duration of mechanical ventilation greater than 15 days and age greater than 50 years.

Conclusion: Secondary mortality from VAP remains high. The identification of the two prognostic factors should improve the subsequent management of all new cases.

Introduction: Sickle cell disease is the most common hemoglobinopathy in the world. Serious in its major form (SS), it exposes the sickle cell subject to osteoarticular complications that can be early and disabling.

Objective: The objective of this study was to contribute to a better understanding of the osteoarticular complications of hemoglobinopathy S and C in pediatric settings.

Material and method: It was a retrospective cross-sectional study, conducted over a period of 3 years, from January 1, 2017 to December 31, 2019. Were included, children aged 0 to 15 years with hemoglobin S or C confirmed by electrophoresis and having an osteo-articular complication.

Results: The analysis focused on 42 cases including 24 boys and 18 girls. The median age was 7.5 years. Functional impotence and fever were the main clinical signs observed. Osteomyelitis was the majority diagnosis (59.6%). Hemoglobin electrophoresis found 33.3% SS hemoglobin and 21.4% SC hemoglobin. Staphylococcus aureus was the main germ isolated from the samples. Radiological lesions were multifaceted and dominated by the periosteal reaction. Management based mainly on orthopedic treatment allowed a favorable evolution in 69% of cases. The average length of hospitalization was 23.78 days.

Conclusion: Osteoarticular complications of hemoglobinopathies S and C are not exceptional. Of chronic and sometimes disabling course, their management requires a preventive approach of primary and secondary type of sickle cell disease.

Introduction: Hip prosthetic surgery is a commonly performed procedure in orthopedic trauma. It has changed the prognosis of traumatic, degenerative and inflammatory hip diseases.

Objective: The aim of this work was to evaluate the functional and anatomical results of a series of total hip replacements in our department in the short and medium term and to compare them with the literature.

Patients and methods: This was a retrospective descriptive and analytical study of a series of 96 total hip replacements performed at the University Hospital of Kati, from January 2019 to December 2021. Functional discomfort was assessed in all patients before and after surgery. The prostheses used were of the Aston, AK, Surgival, Evolutus and Sharma types. The anatomical results were assessed by radiological criteria and the functional results by Postel Merle d'Aubigné criteria.

Results: In our study, 96 hips were operated on by total prosthesis in 91 patients, including five bilateral cases. The patients were 49 men and 42 women. The average age was 46.9 years. Coxarthrosis associated with necrosis of the femoral head was the most frequent indication for arthroplasty (n=51), followed by femoral neck fracture (n=26). The inclination of the cup was anatomical in 73.3% of cases. The mean femoral offset was 44.1 mm with extremes of 26 and 59 mm. Cup anteversion was normal in 79.4% of cases. The mean preoperative PMA score increased from 5.2 (0 and 15) to 16.9 (4 and 18) late postoperatively. Our results were satisfactory in 89% of cases.

Conclusion: Total hip arthroplasty allows, in the vast majority of cases, to recover indolence and perfect functionality of the hip.

Objective: It consisted in evaluating the cardiovascular risk factors and the overall cardiovascular risk among the personnel of the company of the breweries of Mali.

Methodology: This was a cross-sectional, descriptive, analytical study. It was conducted from November 2020 to May 2021 as part of routine consultations and periodic medical visits. The overall cardiovascular risk was estimated by the new Framingham model and the WHO/ISH predictive diagram.

Results: A total of 257 workers were included. The average age was 41.2 years. Cardiovascular risk factors listed were, smoking (18.7%), hypercholesterolemia (17.1%), obesity (15.6%), alcoholism (8.6%), age over 50 years (14%). Work-related cardiovascular risk factors were also collected. These were the practice of shift work (58.8%), exposure to noise (44%), sedentary behavior at the workstation (25%). The risk of developing cardiovascular disease in the next 10 years was high in 3.11% and very high in 0.78% of respondents.

Conclusion: This study highlights several cardiovascular risk factors, some of which are specific to the professional environment. The implementation of preventive measures is a necessity.

Objective: to determine the indications and results of upper digestive endoscopy (EDH) at the Zinder National Hospital.

Materials and methods: this is a retrospective analysis of EDH reports, from digestive endoscopy registers from January 1, 2020 to February 28, 2021, covering 667 examinations, or a monthly frequency of 48 EDH.

Results: the average age of patients was 38.98±14.84 (13-80 years) with a sex ratio of 1.02. Epigastralgia represents 42.8% (n = 363) of indication of EDH, dyspepsia 15.2% (n = 129), diffuse abdominal pain 11.9% (n = 101), vomiting 8.1% (n = 69), search for endoscopic signs of portal hypertension 5.1% (n = 43), dysphagia 4.9% (n = 42) and digestive hemorrhages 3.2% (n = 27 Depending on the anatomical segment concerned, the stomach accounted for 55.51% (n=419), the esophagus 19.6% (n=148) and the duodenum 6.68% (n=50). Inflammatory lesions account for 63.04% (n=475), ulcers 6.65% (n=50), tumours 3.03% (n=23) and miscellaneous lesions 27.28% (n=205). The biopsy was performed in 22 patients (3.46%) and 10 histological reports were obtained, divided into 06 gastric adenocarcinomas, 02 chronic gastric with intestinal metaplasia, 01 epidermoidal carcinoma of the esophagus and 01 hyperplastic gastric polyp.

Conclusion: Epigastralgia dominates the indications of HRE. Upper digestive pathology is certainly dominated by inflammatory lesons, but ulcers and tumors are increasingly diagnosed. These lesions would be better evaluated if systematic biopsies were performed in our patients.

Postpartum family planning is the prevention of pregnancy during the 12 months following childbirth.

Objective: To study the use of contraceptive methods in the postpartum period in the obstetrics gynecology department of the district hospital of the commune II of Bamako.

Materials and methods: We conducted a descriptive and analytical cross-sectional study with prospective data collection from January 1, 2019 to December 31, 2020. All women who had given birth who had chosen and benefited from a contraceptive method were included. The statistical test used was Fisher's test with a significance level set at 5%.

Results: In 2 years, the contraceptive prevalence in the postpartum was 26.1%. More than 2/3 of counseling (61%) was done during prenatal consultations, 8% during the latency phase, 26% in the immediate postpartum and 5% during the postnatal visit. The most chosen methods were implants (47.1%), intrauterine device (29.6%), miro-progestin pills (12.5%), injectable progestogens (8%) and condoms (3.2%).

Conclusion: Postpartum family planning contributes to increasing contraceptive prevalence.

Introduction: Congenital malformations of the larynx in children are often manifested by laryngeal noise (stridor), dyspnea, dysphonia and sometimes swallowing disorders. Laryngomalacia is the most common anomaly, but it is necessary to know how to look for laryngeal paralysis, congenital subglottic stenosis, sometimes a subglottic angioma or a laryngeal diastema. Endoscopy is the master examination for confirming the diagnosis and guiding the management, which may be medical and/or surgical depending on the case [1].

Objective: Aim: The aim of our work is to study the diagnostic and therapeutic particularities of a congenital malformation in an infant in a context of insufficient materials.

Observation: We report an observation of an infant aged 06 months, who was referred to us from pediatrics for chronic dyspnea with dysphonia dating back to birth without other congenital anomalies after multiple treatments without improvement based on nebulization, corticoids and antibiotics. Nasofibroscopy revealed a laryngeal web-like larynx connecting the two vocal cords on its anterior two-thirds leaving a small respiratory tract (Figure 1). The diagnosis of laryngeal palmaris was retained. Management consisted of resection during panendoscopy. Nasofibroscopy at regular intervals of up to twelve months were performed without particularity.

Conclusion: Dyspnea in infants can be frequent and have many causes. Only a thorough clinical and paraclinical examination can help to diagnose laryngeal palmaris. They are confusing to all laryngeal malformations. The prognosis can be serious if management is not carried out as soon as possible.