Le Mali medical最新文献

Background: Progressive Myoclonic Epilepsy (PME) is a heterogeneous group of pathologies associating epileptic seizures and other neurological and non-neurological disorders.

Objectives: We aim to characterize patients with symptoms of PME and identify the underlying genetic disorder.

Methods: After informed consent, the patients seen in the protocol for hereditary neurological diseases and presenting signs of epilepsy without a secondary cause were clinically evaluated over a three-year period in the Department of Neurology of the CHU Point "G". EEG, brain imaging and laboratory tests were performed to consolidate our diagnosis. DNA was extracted for genetic analysis.

Results: 141 families including five families with PME totaling eight cases were enrolled. The predominant symptoms in our patients were myoclonus in 87.5% (N = 8), followed by GTCS and cognitive impairment in 50%, each. A notion of parental consanguinity was found in 60% and autosomal recessive transmission evoked in 80% (N = 5). The EEG was pathological in 62.5% and imaging showed ponto-cerebellar atrophy in 25% (N = 8). The combination of sodium valproate and clonazepam was the main treatment. One case of death was recorded.

Conclusion: We report cases of PME in Mali with a possibility of discovering new genes.

Aims: To determine the epidemiological profile of newborn dermatitis and to describe the different clinical aspects of the observed neonatal dermatitis.

Procedure: The study took place at the University Hospital of Cocody (Abidjan). The study was cross-sectional, descriptive and analytical, carried out on the basis of prospective recruitment. The study included newborns who were seen in outpatient or inpatient settings by 4 april 2018 to 23 August 2018 and in whom the pediatrician had observed cutaneous and/or mucosal lesions. The diagnosis was made with the collaboration of a dermatologist.

Results: During the study period, 116 newborns were identified. The age of the patients seen in pediatrics with dermatitis varied from 1 to 28 days, with a mean of 16.86 ± 8.4 days. The median age was 19 days. The most representative age range (32.8%) was 24-28 days. The sex ratio (M/F) was 1. In almost 2/3 of the cases, the children were born at term, 29.3% were premature and 5.2% were born after term. In almost 2/3 of the cases (63.8%), the newborns had a birth weight of more than 2500 g. Only 3.4% of newborns seen in pediatric consultations were referred for a dermatitis. The age of the lesions at the time of consultation varied from 1 to 26 days, with a mean of 06.19 days ± 5.13. In more than half (53.5%) of the cases, the lesions had evolved for less than 5 days. Transient dermatitis was more frequent (51.7%), followed by infectious dermatitis (32.8%). Transient dermatitis of the newborn was dominated by sweaty miliaria (40%). Infectious dermatitis were mainly represented by mycotic (68.4%) and bacterial (31.9%) infections. Bacterial dermatitis were composed of neonatal impetigo (83.3%) and folliculitis (16.7%). In almost half of the cases (46.1%) the mycotic dermatitis were represented by candidosis intertrigo and in 38.5% of the cases there was oral candidiasis. The other neonatal dermatitis observed were dominated by diaper rash (64.3%) (Photo 2) and congenital nevi (21.5%). More than half (57.1%) of the cases of toxic erythema neonatorum occurred between days 6 and 10 of life. Nearly half (41.6%) of the cases of sudoral miliaria occurred between birth and day 5 of life. More than half (57.1%) of the cases of sebaceous hyperplasia occurred before the 5th day of life. All cases of neonatal scaling and mongoloid spots were already present between birth and day 5 of life. The mean age of patients with transient dermatitis was 14.31 days compared with 19.41 days for those with the other dermatitis. The difference in age was statistically significant (p < 0.05). The transient dermatitis predominated in male neonates while the other dermatitis predominated in females, however the difference observed at the level of sex was not statistically significant (p > 0.05).

Conclusion: The diagnosis of neonatal dermatitis is not always obvious, especially on black skin where few

Acute bursa is a medico-surgical emergency because of its many etiologies threatening the functional prognosis of the testes and their appendages.

Objectives: Identify the causes of acute bursaries in the child and describe their clinical and therapeutic aspects.

Materials and method: This was a retrospective descriptive study from January 1, 2010 to December 31, 2015 on all children aged 0 to 15 years received and treated for acute scholarship in the Pediatric Surgery department at the teaching hospital Gabriel Touré.

Results: In 6 years, we registered 42 patients, ie a frequency of 1.4% of surgical emergencies. The mean age was 2.98 years (24 days-14 years). Prematurity represented 11.9% of cases. Painful scrotal tumefaction was the main reason for consultation (76.2%), The main aetiologies were HISE (90.5%), scrotal trauma (4.7%), orchi epididymitis (2.4%) and testicular torsion (2.4%). The treatment was surgical in 97.6% of cases. The course after 3 months was simple in 97.6% of cases.

Conclusion: Acute bursa in children is an uncommon condition, especially affecting infants. Strangulated inguino-scrotal hernia was the main aetiology. The diagnosis must be early and the treatment adequate in order to reduce morbidity and mortality.

Introduction: Peritoneal tuberculosis is not uncommon in Chad. Its diagnosis of certainty is difficult and is based on the analysis of ascites fluid and abdominal ultrasound. Our aim was to contribute to the study of the various clinical, diagnostic and progressive aspects of peritoneal tuberculosis in the internal medicine department of the HGRN.

Methodology: This is a retrospective and prospective study spread over 39 months covering the period from January 2014 to March 2017 including all patients hospitalized for peritoneal tuberculosis in the internal medicine department of the HGRN. The diagnosis was made, on a bundle of anamnestic, clinical, ultrasound, cytological and evolutionary arguments.

Results: During the study period, 69 patients were included, or 9.77% of all hospital admissions. The average age was 42 years (range 18 to 83 years). The female sex represented 52.2% of the cases. The main reasons for hospitalization were ascites (87% of cases), associated with fever (92.5% of cases). The clinical signs were dominated by abdominal pain, deterioration of general condition and transit disorders. The ascites fluid was citrus yellow, rich in lymphocytes (81.6% of cases) and protein (94.2% of cases). Abdominal ultrasound, performed in all patients, demonstrated ascites with deep, mesenteric lymphadenopathy, portal in 62.3% of cases and compartmentalized in 37.7% of cases. Tuberculosis treatment was started in all patients and the outcome was favorable in 65.2% of cases. We deplored 20.3% mortality; all were patients who were severely immunosuppressed with HIV.

Conclusion: Peritoneal involvement in tuberculosis is common in Chad. The diagnosis is not always easy, but the clinic associated with the exudative and lymphocytic characters of the ascites fluid as well as the abdominal ultrasound are elements which can direct towards a peritoneal localization of tuberculosis. The course is generally favorable under early treatment and well conducted.

Objective: to report the epidemiological, clinical, paraclinical and therapeutic characteristics of the first COVID 19 patients in intensive care.

Patients and method: retrospective descriptive and analyticalstudy over 4 months, covering all adult patients tested positive for SARS-Cov-2 and admitted to intensive care.

Results: 49 patients, 35 men and 14 women (2% of cases) were admitted to intensive care. The median age was 64 years [26 - 92]. Hypertension (16; 32.6%), and diabetes (11; 22.4%) were the mostcommoncomorbidities. The most common symptoms on admission were cough (38; 80.9%), shortness of breath (35; 74.5%), and fever (33; 70.2%). The median time to onset of symptoms was 11 days. Non-invasive ventilation (NIV) was used in 21 patients (42.9%). Fourteen (28.6%) wereintubated and put onassisted ventilation. The mean hospital stay was 7.77 ± 7.30 days. We recorded 20 (40.8%) deaths. Factors associated with death were high blood pressure, onset of shock, and on mechanical ventilation.

Conclusion: Covid-19 remains a public healthproblemwith high morbidity and mortality. The morbidity and mortalityfactorsare: comorbidities and the severity of the clinicalpicture.

Objective: Todescribe the different psycho-physiological repercussions of night work among female health professionals subject to numerous socio-cultural constraints.

Material and methods: This was a cross-sectional and descriptive study including female professionals performing night work, conducted between July 1 and July 30, 2018 at the Kolda Regional Hospital Center.The study was carried out using anonymous questionnaires. The data collected was entered and analyzed with Microsoft Excel version 2013.

Results: A total of 41 women participated in the study. The average age was 30.9 years old. The average night work was 5.9 years. 51.2% of the workers felt comfortable with this type of schedule, compared to 48.8% feeling disrupted. 73.1% preferred daytime work. 36.5% wanted to stop this type of schedule. Several impacts of night work were identified.Physiologically, poor sleep quality (36.6%), insufficient sleep duration (36.6%), menstrual disorders (29.2%) were noted. On the psychological level, stress (48.8%), temperamental disorders (17.5%), anxiety and depression (10.7%) were found.

Conclusion: A regular medical and psychological follow-up should be necessary for these professionals.

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.

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.

Aims: The goal of our work was to clarify the epidemiologicals, clinicals, etiologicals and prognostics of upper gastrointestinal bleeding at Segou Regional Hospital.

Patients and methods: This cross-sectional study, which took place from October 1, 2017 to September 31, 2018, involved patients hospitalized for digestive hemorrhage.

Results: Upper gastrointestinal bleeding represented 9.7% of all hospitalizations. The mean age of the patients was 50, 94 ± 21, 6 years with a sex ratio of 1.6 in favor of men. Housewives and farmers were represented in 37.7% and 34% of cases. The main modes of disclosure were hematemesis and melena. Evolution was favorable with a mortality of around 34%.

Conclusion: upper gastrointestinal bleeding is relatively common in our context. High mortality is linked to delayed treatment.

Objective: The objective of this work was to study the place of ultrasound in the positive diagnosis, etiology and choice of the therapeutic modality of acute intestinal intussusception.

Material and methods: This was a retrospective, descriptive, cross-sectional, multicenterstudy, carried out over a period of 18 months (January 1, 2016 to June 30, 2017) on 45 patient files collected in the radiologydepartments (Aristide Le Dantec and Albert Royer). Were included all patients aged less than 14 years, admitted with acute abdominal pain, whose diagnosis of IIA was retained on ultrasound. Pneumatic disinvagination was performed in patients without signs of severity. We studied the time of management, the ultrasound aspects of the invagination puddles, the therapeutic choice but also the radiosurgical concordance and the factors of failure of the pneumatic enema. Statistical analysis was done by SPSS version 21.0 software.

Results: Ultrasound was used to make the diagnosis of IIA in 43 cases (95.5%). The sonographic characteristics were as follows: 27.9% of the IIA were located in the right hypochondrium, 19 cases were ileo-caecal, 10 (22.2%) ileo-caeco-colic, 9 (20%) ileo-colic, 4 (8.9%) colo-colic and one (2.2%) gregelic; 44 cases were idiopathic and one case was a Meckel's diverticulum The management time was less than 48 hours in 34% of cases and 66% more than 48 hours. Pneumatic reduction was performed in 18 cases (40%), with success in 14 cases (77.8%) and one case of pneumoperitoneum complication. Surgery was performed in 31 cases (68.8%). The sensitivity and specificity of ultrasound in the diagnosis of signs of severity were 77.7% and 78.9%. Good agreement was observed between the results of the Doppler ultrasound and the intraoperative findings. Ultrasound parameters associated with failed pneumatic deinvagination were: outer cylinder thickness ≥10 mm, adenopathy at the level of the small-axis bladder ≥10 mm, effusion in the bladder, and hypovascularization of the bladder head. Hypovascularization of the boudin head was the only factor independently associated with failure of pneumatic disinvagination.

Conclusion: Ultrasound is a powerful imaging modality in the positive diagnosis, etiology, severity and therapeutic choice of IIA.