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Cerebral Malaria: Epidemiological, Clinical and Prognosis Aspects in the Anesthesia-Resuscitation Department CHU Ignace Deen

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Open Journal of Emergency Medicine 2023年第4期11卷 162-173页

作者： Abdoulaye Touré amadou Yalla Camara Almamy Bangoura M’mah lamine Camara Mohamed Soumah Saramba Nabe Department of Anesthesia-Resuscitation University Hospital of Ignace Deen of Conakry Conakry Guinea Department of Medical and Surgical Emergency Donka University Hospital Conakry Guinea Department of Anesthesia-Resuscitation Donka University Hospital Conakry Guinea

Objective: To describe the epidemiological, clinical, paraclinical and prognostic aspects of cerebral malaria received in the anesthesia-resuscitation department. Methodology: This was a prospective descriptive type study carried out in the anesthesia-resuscitation department over a period of three (03) months (June 01 to August 31, 2022). All patients admitted for cerebral malaria were included. Sociodemographic, clinical and prognostic parameters were studied. Results: We collected 25 cases out of 105 admitted patients (23.8%). The average age was 27.6 ± 9.5 years with extremes of 11 and 50 years. The sex ratio was 0.7 (M/F). Students and housewives were in the majority, i.e. 52% and 24%. Neurological disorders were found on admission in all patients, dominated by impaired consciousness at 100% followed by convulsion (60%), prostration (44%), confusion (36%) associated with deep coma in (68%). Gross hemoglobinuria was present in (84%) of cases. On the blood count, anemia was present in (70%) of the patients followed by thrombocytopenia in more than half of the cases (60%) and transfusion was necessary in 19 cases. P Falciparum malaria was found in all patients (100%), the average parasite density was 60342.8 ± 30425.6 trophozoites/μl with extremes of 9000 to 100000 trophozoites/μl. All our patients were treated with intravenous injectable artesunate. Transfusion was performed in 76% of our patients. Eighty percent of the patients had benefited from dialysis. High oxygen therapy was performed in (92%) of cases. The average duration of hospitalization was 5.74 ± days with extremes of 1 to 17 days. Mortality was 48%. Conclusion: Cerebral malaria can take different clinical forms, the most important of which is cerebral involvement. Prompt initiation of appropriate resuscitation can reduce mortality.

关键词： Cerebral Malaria Mortality Resuscitation

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Epidemiology and Clinical Profile of Behcet’s Disease in a Sub-Saharan Country: About Five Observations

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Open Journal of Internal Medicine 2023年第2期13卷 120-125页

作者： Thierno amadou Wann Mamadou lamine Yaya Bah Mamadou Saliou Baldé Abdoul Karim Baldé Toumin Camara Ibrahima Kalil Shiaman Barro amadou Kaké Djibril Sylla Internal Medicine Teaching Hospital of Conakry Conakry Guinea Nephrology-Hemodialysis Department Teaching Hospital of Donka Donka Guinea Ophtalmology Department CADES/O CHU de Conakry Conakry Guinea

Behçet’s disease (BD) is a multi-systemic vasculitis characterized by a triad made up of oral aphthosis, genital aphthosis and uveitis which may or may not be associated with visceral involvement. Other times described in the ancient silk road, BD is increasingly found in countries south of the Sahara with the mixing of populations. Our objective was to describe the epidemiology and clinical characteristics of BD in an African country. Methodology: This was a five-year retrospective study in the internal medicine department of Donka National Hospital. We used international criteria finding BD. Urinary dipstick was use for finding kidney disease. Result: During the period, five cases of Behçet’s disease were collected. The average age was 35 years old. The male sex was more represented with 3 out of 5 cases. The most common clinical manifestation was oral aphthosis in all patients (100%), followed by genital aphthosis in 4 cases (80%). The other clinical manifestations observed were uveitis in 3 cases (60%), joint manifestations such as arthralgia in 3 cases (60%) and neurological manifestations such as chronic headache in one case (20%). HLA-B51 was found in two cases. The pattergic test done in two patients came back positive (100%). The patients received colchicine and oral corticosteroid therapy. Two patients were lost to sight. We deplored a death probably in a neuro-Behçet table before the rebellious headaches. Conclusion: Behçet’s disease is a multi-systemic vasculitis that must be evoked and managed quickly in a tropical environment, especially since the prognosis, vital and functional prognosis can be engaged.

关键词： Profile Epidemiological Clinical Behçet Sub-Saharan

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Complete Ureteral Duplicity Complicated by Lithiasis with Right Ureterohydronephrosis with Left Renal Excretion Defect: Apropos of a Clinical Case

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Surgical Science 2023年第9期14卷 575-582页

作者： Cheickna Tounkara amadou Maiga Boubacar Yoro Sidibe Tani Kone Hamidou Samake Kaloga Daye Bagayoko Oumar amadou Malle Jean Baptiste Honoré Berthe Mamadou lamine Diakite Department of General Surgery of the “Mother Child” Hospital Luxembourg Bamako Mali General Surgery Department of Gabriel TOURE Hospital Bamako Mali Urology Department of Point-G Hospital CHU Bamako Mali

Ureteral duplication is a congenital malformative uropathy that occurs most often in children. Complete ureteral duplication is defined by a kidney that has two ureters with two orifices that communicate to the bladder through two ureteral meati. It is an anatomical variant that remains rare. Its early discovery is due to a lack of diagnostic means, hence the occurrence of long-term complications. To this end, we observe an increased importance of the morbidity linked to the late diagnosis of this duplicity. Our objective was to show the importance of the morbidity linked to the late diagnosis of this anomaly, the incidence of the infection and the complications that this pathology poses as a problem. It was a clinical case of fortuitous discovery taken care of by a general surgeon in the general surgery department of the hospital “Mother Child” Le Luxembourg Bamako Mali. We report a case of complete ureteral duplication complicated by ureterohydronephrosis on a lithiasis wedged in the uretero-vesical junction of one of the left ureters in its lower portion which required a uretero-lithotomy with bladder reimplantation of the left ureters and secondly to a uretero-lithotomy with bladder reimplantation after two months. The postoperative course was simple.

关键词： Ureteral duplication Congenital malformation Duplicity Adult Bamako Mali

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Diagnosis of Male Hypogonadism: Experience of a Subsaharan African Endocrinology Department: Transversal Study from January 1^st, 2020 to July 31^st, 2022

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Open Journal of Endocrine and Metabolic Diseases 2023年第11期13卷 217-226页

作者： Nafy Ndiaye Ngone Diaba Diack Yakham Mohamed Leye Mouhamed Mbar Niang amadou lamine Cisse Yousra Benani Abdoulaye Leye Internal Medicine/Endocrinology-Diabetology Department Teaching Hospital of Pikine Cheikh Anta Diop University Dakar Senegal

Introduction: Hypogonadism should be suspected in a man who has symptoms and signs of testosterone deficiency. Clinical manifestations depend on the severity and duration of testosterone deficiency, whether the testicular deficit is concerning only androgen synthesis, spermatogenesis, or both. The objective of our study was to evaluate the clinical and aetiological characteristics of male hypogonadism in Dakar’s suburb. Patients and methods: We conducted a transversal study from January 1st, 2020 to July 31st, 2022. We included all male patients aged at least 14 years old with hypogonadism confirmed by a low level of early-morning free testosterone based on two different dosages. For all patients included, sociodemographic and diagnostic parameters were collected by using a pre-established registration form. Results: In total, 20 patients were selected. The average age was 36.3 years old [14 - 62 years old]. Half of the patients were overweight. Five patients had an abdominal circumference greater than 94 cm (37 inches). The other comorbidities found in our patients were type 2 diabetes (n = 1), hypertension (n = 1) and primary hypercholesterolemia in 2 patients. The functional signs reported by the patients were: couple’s infertility in 17 patients, decreased libido in 14 patients, erectile dysfunction in 13 patients, premature ejaculation in 2 patients and anejaculation in 4 patients. The physical examination revealed a bilateral testicular atrophy in 17 patients and a unilateral testicular atrophy in 2 patients;no patient had varicocele or urethral meatus abnormalities. Ten patients presented a micropenis. A eunuchoid morphotype was present in 6 patients and a short stature was noted in 2 patients. It was peripheral hypogonadism (HH) in 18 patients and hypogonadotropic hypogonadism (Hh) in 2 patients. The hypogonadotropic hypogonadism was isolated in both cases. The testicular echography confirmed testicular atrophy and showed cryptorchidism

关键词： Diagnostic Hypogonadism Male Senegal

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Case of Incomplete Ureteral Duplication Complicated with Lithiasis and Right Uretero-Hydronephrosis

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Surgical Science 2023年第7期14卷 502-506页

作者： Cheickna Tounkara amadou Maiga Boubacar Yoro Sidibe Tani Kone Samake Hamidou Kaloga Daye Bagayoko Oumar amadou Malle Jean Batiste Honoré Berthe Mamadou lamine Diakite Department of General Surgery Luxembourg Hospital Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Urology Surgery CHU Point-G Bamako Mali

Ureteral duplication is congenital malformative uropathy that occurs most often in children. Complete ureteral duplication is defined by a kidney that has two ureters with two orifices that communicate to the bladder through two ureteral meati. It is an anatomical variant that remains rare. Its early discovery is due to a lack of diagnostic means, hence the occurrence of long-term complications. To this end, we observe an increased importance of the morbidity linked to the late diagnosis of this duplicity. We report a case of incomplete ureteral duplication complicated by ureterohydronephrosis on lithiasis wedged in the uretero-vesical junction of one of the ureters in its lower portion which required uretero-lithotomy with bladder reimplantation of the ureters. Our aim was to show the importance of the morbidity associated with late diagnosis of this anomaly and the incidence of infection and complications that this pathology poses as a problem. This was a clinical case of fortuitous discovery managed by a general surgeon in the general surgery department of the hospital “Mère Enfant” Le Luxembourg Bamako Mali. The suites were simple.

关键词： Ureteral Duplication Congenital Malformation Adult

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Acute Fevers in the Medical Unit of the Medical-Surgical Emergency Department of the Donka National Hospital

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Open Journal of Internal Medicine 2023年第2期13卷 95-103页

作者： Djibril Sylla amadou Kake Thierno amadou Wann Mohamed lamine Yaya Bah Akomou Lydia Koba Mohamed Cirékeita Mamadou Diakhaby Lansana Diaby Sèmèvo Claudiane Toffon Internal Medicine Department of the Donka National Hospital Conakry Guinea Medical and Surgical Emergency Department of the Donka National Hospital Conakry Guinea

Introduction: Fever is a high core temperature ≥ 37.5°C in the morning and 37.8°C in the evening. It is acute when it evolves from 0 to 20 days. Very common in clinical practice, the etiological diagnosis, particularly in developing and tropical countries, is often a challenge for clinicians due to their diversity and the limited availability of diagnostic tools. There is a wide spectrum of etiological diagnoses including infectious causes and non-infectious causes. The aim of this study was to investigate the etiology of fevers acute at the medical unit in the medico-surgical emergency department of the Donka National Hospital. Methods: This was a descriptive cross-sectional study lasting 03 months (January 01, 2022 to March 31, 2022). We included in this study all patients seen in the medical unit, whose age ≥ 18 years, without distinction of sex, from any origin, with an axillary temperature ≥ 37.5°C in the morning and 37.8°C in the evening, evolving from 0 to 20 days, hospitalized or followed on an outpatient basis, and having given verbal consent. Results: Of a total of 1087 patients seen, 466 had an acute fever. The mean age was 40.04 ± 18.91 years (18 and 96 years). The female sex (58.15%) was predominant with a sex ratio of 0.72. Malaria (50.86%) was the main diagnosis. The treatment consisted of compressed paracetamol (59.01%), arthemether + lumefantrine (50.85%). Conclusion: The incidence of acute fevers is high in the medical unit of the medico-surgical emergency department of the Donka National Hospital. Malaria was the main pathology. Treatment was etiological and symptomatic. This high incidence could be explained by the fact that Guinea is an endemic malaria zone. A study taking into account other etiological factors would be of great interest.

关键词： Acute Fever Medical Unit Emergency Department Donka National Hospital (HND)

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Acute Peritonitis at the CSRef of the Commune I in the District of Bamako: Signs, Diagnosis and Treatment

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Surgical Science 2023年第10期14卷 626-636页

作者： Cheickna Tounkara Oumar amadou Malle Modibo Togola Hamidou Samake lamine Soumare Sékou Koumare Zimogo Zié Sanogo Djibril Sangare Department of General Surgery of the Reference Health Center of Commune I Bamako Mali Directorate of the Social Health Service of the Armed Forces of Mali Bamako Mali Department of General Surgery “A” of Point G Hospital Bamako Mali

Acute generalized peritonitis is an acute inflammation of the peritoneum. It is most often secondary to perforation of the digestive organ and/or the spread of an intra-abdominal septic focus. The absence of a study on peritonitis in a reference health center motivated us for this work. The aim of this study was to study the inadequacies that could be seen in the management of peritonitis in the CSRef(s). We carried out a retrospective study of 40 patients received at the CSRéf of commune I for acute generalized peritonitis from 2011 to 2012. The average age was 30.1 years with a standard deviation of 3.4;extremes ranging from 14 years to 60 years and a Sex ratio = 1.22 (22 men out of 18 women). Abdominal pain was the main reason for consultation (present in all our patients). In most cases, clinical examination alone made it possible to make the diagnosis. Surgical treatment depended on the etiology (appendectomy associated with washing-drainage was the most commonly performed surgical procedure). All our patients received general anesthesia. The average length of hospitalization was 7 days with extremes ranging from 1 to 15 days. We noted a Morbidity rate of 22.5%, dominated by wall abscesses and a mortality of 2.5%. The delay in consultation and referrals constitutes a factor in mortality and high morbidity.

关键词： Peritonitis Surgery Csref CI Bamako Mali

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Kohonen’s Algorithm Applied to the Scintigraphic Image for an Aid in the Diagnosis of Prostate Cancer Metastasis

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Open Journal of Medical Imaging 2022年第2期12卷 37-47页

作者： Boucar Ndong El Hadji amadou lamine Bathily Mamoudou Salif Djigo Mamadou lamine Mboup François Kaly Kanta Ka Ousseynou Diop Ibrahima Thiam Gora Mbaye Omar Ndoye Mamadou Mbodj Biophysics and Nuclear Medicine Laboratory Cheikh Anta Diop University Dakar Senegal Sustainable Development and Society Doctoral School Thies University Thies Senegal Laboratoire du traitement de l’information/ESP/UCAD Senegal Radiotherapy Department of the National Hospital University Center Dalal Jamm Guédiawaye Dakar Sénégal Physics Pharmaceutical Laboratory Cheikh Anta Diop University Dakar Senegal

To partition the scintigraphic image, several methods are used, among which is Kohonen’s self-organizing map algorithm. The objective of this study was to perform an ascending hierarchical classification (HAC) on the results of the Kohonen self-organizing map. This makes it possible to carry out the second phase necessary for the elaboration of the classifier by grouping the neurons as well as possible into 3 classes then by reconstituting the scintigraphic image from the 3 classes. This partition proceeds by successive groups, thus merging at each iteration two subsets of neurons using a measure of similarity which is Ward’s method. In this method, the algorithm aggregates the nearest neurons into classes. This allows us to obtain a dendrogram that looks like a tree. And this one needs to be cut. And to have an adequate cut-off level, we have established the variation of the Davies Bouldin index as a function of the number of classes. The minimum value of this index gave the optimal number of classes which corresponded to 3 in the study. These three groups A, B, C have a variable intensity. This intensity can be high, it can be medium or low. The high, medium and low intensities corresponded respectively to metastases for class A, to degenerative or inflammatory phenomena for class B and to normal radiopharmaceutical uptake for class C. To confirm this strong suspicion, we performed reconstructions using a filter. And after this reconstruction, we had images like at the entrance. And for the interpretation of these images, we used a visual metric. This enabled us to note that for the interval [0 - 50[, the image is not contrasted and no lesion could be detected. Over the interval [50 - 200[, we observed the distribution of the radiopharmaceutical over the entire skeletal whole body. On this reconstruction interval, the visual metric shows hypofixation in the bladder and areas suspected of metastases. Over the interval [200 - 250[, we detected hyperfixations linked

关键词： Neural Networks Hierarchical Ascending Classification Scintigraph

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Evaluation of the Effectiveness and Nature of Analgesia in the Medical-Surgical Emergency Department of CHU-Donka

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Open Journal of Emergency Medicine 2023年第4期11卷 155-161页

作者： amadou Yalla Camara Abdoulaye Touré Almamy Bangoura M’mah lamine Camara Thierno Sadou Diallo Boubacar Atigou Dramé Joseph Donamou Department of Medical and Surgical Emergency CHU-Donka National Hospital Conakry Guinea Anesthesia and Intensive Care Unit Ignace Deen National Hospital Conakry Guinea Department of Anaesthesia and Intensive Care Donka National Hospital Conakry Guinea

Introduction: Pain assessment is an essential step towards pain relief. In our context, however, it is insufficient in emergency departments. The aim was to assess the nature and effectiveness of the analgesia used in the emergency department of the CHU-Donka. Method: This was a single-centre prospective observational study conducted over one month (November 2020) in the medical-surgical emergency department of CHU-Donka. All patients aged 18 or over admitted to the emergency department with moderate to severe acute pain were included. Results: We enrolled 880 patients, 615 of whom (69.88%) were in pain. Males predominated (65.2%), with a sex ratio of 1.87. The average age was 44.78 ± 16.41 years, with extremes ranging from 18 to 85 years. The most represented age group was 18 - 34 years, with 66.18%. Initial assessment of pain by nursing staff in 3 cases. Initial assessment of pain by the investigator was 100%, 74% moderate and 26% severe. No reassessment of pain by nursing staff. Reassessment by the interviewer was 100% and found 5% no pain, 61% mild pain, 24% moderate pain and 10% severe pain. With an average numerical scale of 3.77 ± 2.61 and extremes from 0 to 10. Average length of stay was 2.85 ± 1.48 hours, with extremes ranging from 45 minutes to 8 hours. Analgesia was administered with paracetamol alone (43.58%), combined with tramadol or nefopam. No patient received morphine. Conclusion: This study revealed a lack of pain assessment in our department.

关键词： Pain Assessment Emergencies Numerical Scale CHU-Donka

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Contribution of <sup>99m</sup>Tc-DPD Scintigraphy in the Diagnosis of Cardiac Amyloidosis in Black Africans

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Open Journal of Biophysics 2022年第1期12卷 27-37页

作者： Djigo Mamoudou Salif Ndong Boucar Bathily El Hadji amadou lamine Diop Ousseynou Gueye Kalidou Thiaw Gora Ndoye Oumar Mbodj Mamadou Department de Medecine Nucleaire Hô pital General Idrissa Pouye Dakar Senegal Department de Medecine Nucleaire Hô pital Dalal JAMM Dakar Senegal

Cardiac amyloidosis presents a picture of hypertrophic cardiomyopathy with heart failure with preserved ejection fraction. It is largely underdiagnosed, especially in black Africans, and therefore falls under the category of heart disease classified as idiopathic. Light chain amyloidosis (AL) is mainly found in Caucasian subjects and the mutant variant of transthyretin (TTRm) in negroid subjects. Numerous studies have shown that ATTRm was found predominantly in black American and black British patients. In African countries the entity of idiopathic heart failure is quite important because of lack of diagnosis, ETT, MRI and immuno-histochemistry are expensive or not available. We can probably assume that the proportion of cardiac amyloidosis is quite important in black Africans. The question is if 99mTc-DPD really easy to perform, can probably help to investigate in the nuclear medicine department in Africa. No large-scale study has been able to demonstrate the prevalence or not of cardiac amyloidosis in black-African subjects and by extension reduce this nosological entity of idiopathic heart disease. The 99mTc-DPD scintigraphy using Perrugini’s visual sore allows localization and classification of amyloid damage. The mechanism of binding of 99mTc-DPD to amyloid fibril deposits is not well known, its binding to TTR-type (mutated or wild type) amyloidosis is greater than the AL variant. In the diagnostic algorithm, endomyocardial biopsy is the gold standard but remains invasive, ETT with the strain allows a presumptive diagnosis and remains an operative examination dependent and is not reproducible. Cardiac MRI allows some localization of amyloid deposits but still remains less sensitive than scintigraphy. In addition, performing the whole-body MRI is very restrictive (time, antenna change and cost). The aim of this literature review was to show the superiority of 99mTc-DPD scintigraphy compared to other diagnostic modaliti

关键词： Amyloidosis TTRm AL 99mTc-DPD Bone Scintigraphy

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