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Contribution of Stress Testing to the Management of Ischemic Heart Disease in Mali

World Journal of Cardiovascular Diseases 2024年第2期14卷 77-87页

作者： Youssouf Camara Hamidou oumar ba Ibrahima Sangaré Boubacar Sonfo Coumba Adiaratou Thiam Mahamadou Sékou diakité Koniba Diarra Karamba Touré Massama Konaté Ichaka Menta Cardiology Department University Hospital Professeur Bocar Sidi Sall Kati Kati Mali Cardiology Department University Hospital Gabriel Touré Bamako Mali Cardiology Department Mali Hospital Bamako Mali

Introduction: Exercise stress testing (on a treadmill or ergometer bicycle) is an important test in cardiology for diagnosing myocardial ischemia. This test in Mali is still in its beginning compared to other countries in the sub-region. The lack of data in Mali prompted this study, which aimed to evaluate the indications of this activity and its diagnostic contribution to cardiology in Mali. Materials and Methods: This was a retrospective, descriptive study. The study was conducted at the “TouCAM” medical clinic in Kati based on the analysis of stress test reports between January 2016 and August 2022. Result: During the study period, we documented 73 patients who underwent exercise testing on a bicycle ergometer for suspected coronary heart disease. The mean age of our patients was 47.5 ± 13.8 years (14 and 79 years). Males accounted for the majority (78.1%). The sex ratio is 3.5. More than half of our patients were overweight or obese (77.1%). Hypertension and diabetes affected 52.1% and 25.8% of patients, respectively. 20.8% of patients had coronary artery disease. renin-angiotensin-aldosterone system blockers (56.8%) and beta-blockers (51.3%). The main indications were chest pain (63.0%) and ischemia detection (15.1%). A modified STEEP protocol was used. The majority of our patients (71.2%) achieved at least 85% of their maximum theoretical heart rate. The main reason for the termination of the study was fatigue (57.3%). The average duration was 11.3 ± 4.2 minutes. 24.7% thought the stress tests were positive and 17.8% thought they were controversial. Conclusion: This study demonstrates the importance of stress testing in the diagnosis and treatment of ischemic heart disease, especially in settings where we have very limited access to coronary angiography.

关键词： Stress Test Ischemic Heart Disease Mali

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Evaluation of Antibiotic Prescribing in the Pediatric Department of Gabriel TouréTeaching Hospital, bamako, Mali

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Open Journal of Pediatrics 2024年第3期14卷 645-656页

作者： Pierre Togo Hawa Konaré Mariam Maïga Karamoko Sacko Djénéba Konaté Abdoul Karim Doumbia Adama Dembélé oumar Coulibaly Aminata Sangaré Mohamed Elmouloud Cissé Fousseyni Traoré Belco Maïga Ibrahim Ahamadou Aminata Doumbia Lala N’Drany Sidibé Amadou Touré Yacouba Aba Coulibaly Kalirou Traoré Tati Simaga Souleymane Sagara Leyla bagna Maïga Bory Traoré Abdoul Aziz diakité Fatoumata Dicko Mariam Sylla Sounkalo Dao Boubacar Togo Paediatric Department Gabriel Tour&#233 Teaching Hospital Bamako Mali Pediatric Department Distric VI Reference Health Center Bamako Mali Infectious Diseases Department Point G Teaching Hospital Bamako Mali

Objectives: The main objective was to evaluate antibiotic prescribing in the Department of Pediatrics at Gabriel Touré teaching hospital. Methods: This was a prospective descriptive study conducted from September 1 to November 31, 2018, in the Department of Pediatrics at Gabriel Touré teaching hospital. All children aged 0 to 15 years hospitalized for any pathology during the study period and having received at least one antibiotic had been included. Results: We collected 445 children’s records out of 1032 admissions during the study period, representing a hospital frequency of 43.1%. The sex ratio was 1.3%. The 2 - 5 age group accounted for 48.1%. Fever was the reason for consultation in 45.6% of cases. Patients’ general condition was altered in 60% of cases. The fathers were blue-collar workers in 65.4% and the mothers housewives in 85%, and had no education in 42.9% and 64.5% respectively. Hepatomegaly was present in 18.2%, splenomegaly in 9.6% and peripheral adenopathy in 3.1%. The site of infection was pulmonary in 37.6% and ENT in 9.2%. bacterial infection was assumed on admission in 54% of cases, and meningitis in 57.7%. The discharge diagnosis was malaria in 54.6%, severe acute malnutrition in 18.6% and meningitis in 6.7%. The death rate was 3.8%. Neutrophilic leukocytosis was present in 47.3% of patients. CRP was positive in 85% of patients. Blood cultures taken in 27.6% of patients were positive in 5. CSF analysis in 30% of patients showed elevated leukocytes in 6.5%. No cultures were positive. Antibiotic prescription was justified by infectious hypotheses in 43.1% of patients. β-lactam antibiotics were prescribed in 98.6%. Antibiotic therapy was not adapted to national/international recommendations in 68.3% of cases, and was not justified in 16.3% of cases on D5 of hospitalization. Conclusion: Antibiotic use was justified in more than half of patients, but remained inadequate in almost two-thirds of cases, in line with national and international recommend

关键词： Antibiotic Prescription Hospitalization Child

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Anatomical Study of MRI Optic Chiasm at the bamako Anatomy Laboratory

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Forensic Medicine and Anatomy Research 2020年第2期8卷 11-17页

作者： ba.ou ba.sia.a.diakité Abdoulaye Kanté Tata Touré Moumouna Koné Nouhoum Ongoiba Abdel Karim Koumaré siaka Sidibé Laboratoire d’Anatomie et de Morphologie Clinique FMOS BamakoMali Service de Radiologie CHU Point GBamakoMali Service de Chirurgie“B” CHU Point GBamakoMali

Roughly quadrangular, the chiasma presents many morphological variations. The optical chiasm, odd and symmetrical structure of the optical pathways, is a required passage of the axons of neurons for the visual pathways. Any modification of its morphology evokes a pathological process, generally tumoral. The quality of MRI images rivals that of anatomical slices. So the MRI is essential for the study of the chiasma. The aim of this work was to study the morphometry of the optic chiasm in patients addressed for cerebral MRI to the imaging department of the university hospital of the POINT-G, during the period from July 29, to November 30, 2016. All patients who had a normal examination of the optic chiasma, numbering 15, were included in this study. In 86.66% of cases the chiasma had a quadrilateral form. Its average length was 8.73 mm and its average width was 13 mm. The average thickness was 4.13 mm.

关键词： Optical Chiasma MRI Laboratory Anatomy

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Epidemiological Profile of Cyanotic Congenital Heart Disease in the “B” Surgery Department of Point G University Hospital, before the Advent of Extracorporeal Circulation

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World Journal of Cardiovascular Surgery 2023年第11期13卷 159-166页

作者： Abdoulaye Kanté Djénèba Konaté Mamadou A. Keita Mamadou diakité bakary Keïta Bréhima Bengaly Bréhima Togola Drissa Traoré Nouhoum Ongoïba Sadio Yena “B” Surgery Department of Point G University Hospital Bamako Mali Pediatrics Department of Gabriel Touré University Hospital Bamako Mali Cardiology Department of Point G University Hospital Bamako Mali Anesthesia-Resuscitation Service Commune II Reference Health Center Bamako Mali Thoracic Surgery Department of Mali Hospital Bamako Mali

Aim: Evaluate the epidemiological profile of cyanotic congenital heart disease in Mali before the advent of extracorporeal circulation in the “B” Surgery Department at the Pont G University Hospital. Patients and Methods: This was a retrospective and descriptive study that took place from January 1, 2011 to December 31, 2017. The records of patients with cyanotic congenital heart disease in the “B” surgery department of Point G University Hospital were collected. Patients operated on for cyanotic congenital heart disease were included in this study. Non-operated patients were not included. Results: The records of 17 patients operated on for cyanotic congenital heart disease were retained. The average age of patients at the time of surgery was 5.18 years with extremes of 2 and 18 years. Boys were in the majority with 59%, i.e. a sex ratio of 1.42. Patients resided in bamako in 82% of cases. Inbreeding was found in 35.3%. Eighty-eight percent of children were born at term and 94% had up-to-date vaccination status. The average duration of patient follow-up between diagnosis and surgical management was 5 years with extremes of 2 years and 12 years. Tetralogy of Fallot regular form was the most represented heart disease. Conclusion: Cyanogenic congenital heart disease remains the most frequent congenital pathologies in our country. They most often affect male children. Consanguinity is the most common etiological factor found. Tetralogy of Fallot regular form remains the most common.

关键词： Epidemiology Congenital Heart Disease CHU Point G Mali

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Alkaline activation of endogenous latent TGFβ1 by an injectable hydrogel directs cell homing for in situ complex tissue regeneration

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Bioactive Materials 2022年第9期7卷 316-329页

作者： Sainan Wang Yuting Niu Peipei Jia Zheting Liao Weimin Guo Rodrigo Cotrim Chaves Khanh-Hoa Tran-ba Ling He Hanying bai Sam sia Laura J.Kaufman Xiaoyan Wang Yongsheng Zhou Yanmei Dong Jeremy J.Mao Department of Cariology and Endodontology Peking University School and Hospital of StomatologyBeijing100081China Department of Prosthodontics Peking University School and Hospital of StomatologyBeijing100081China Center for Craniofacial Regeneration Columbia UniversityNew YorkNY10032USA Department of Biomedical Engineering Columbia UniversityNew YorkNY10027USA Department of Chemistry Columbia UniversityNew YorkNY10027USA

Utilization of the body’s regenerative potential for tissue repair is known as in situ tissue ***,the use of exogenous growth factors requires delicate control of the dose and delivery strategies and may be accompanied by safety,efficacy and cost *** this study,we developed,for the first time,a biomaterial-based strategy to activate endogenous transforming growth factor beta 1(TGFβ1)under alkaline conditions for effective in situ tissue *** demonstrated that alkaline-activated TGFβ1 from blood serum,bone marrow fluids and soaking solutions of meniscus and tooth dentin was capable of increasing cell recruitment and early differentiation,implying its broad ***,we engineered an injectable hydrogel(MS-Gel)consisting of gelatin microspheres for loading strong alkaline substances and a modified gelatin matrix for hydrogel click *** vitro models showed that alkaline MS-Gel controllably and sustainably activated endogenous TGFβ1 from tooth dentin for robust bone marrow stem cell *** importantly,infusion of in vivo porcine prepared root canals with alkaline MS-Gel promoted significant pulp-dentin regeneration with neurovascular stroma and mineralized tissue by endogenous proliferative ***,this work offers a new bench-to-beside translation strategy using biomaterial-activated endogenous biomolecules to achieve in situ tissue regeneration without the need for cell or protein delivery.

关键词： Endogenous TGFβ1 Injectable alkaline hydrogel Cell homing Pulp-dentin complex In situ tissue regeneration

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Aortic Root and Ascending Aortic Aneurysm Related to One Case. Reimplantation of the Right Coronary Artery by 8 mm Dacron Tube (Cabrol Hemi Mustache) and Review of the Literature

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Open Journal of Thoracic Surgery 2021年第1期11卷 1-10页

作者： Abdoulaye Kanté Bréhima Coulibaly Mamadou diakité Samba Sidibé Drissa Traoré Bréhima Bengaly Mariam Daou Demba Yattera Nouhoum Ongoïba Department of Thoracic and Cardiovascular Surgery CHU Point G Bamako Mali Laboratory of Anatomy University of Sciences Techniques and Technologies of Bamako Mali Cardiology Department CHU Point G Bamako Mali Department of Neurology CHU Gabriel Touré in Bamako Mali

The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron® tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.

关键词： Aortic Root and Ascending Aortic Aneurysm Aortic Valve Replacement and Ascending Aorta Cabrol’s Hemi Mustache

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Left Atrium Emboligenic Myxoma: Case Report and Review of the Literature

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Open Journal of Thoracic Surgery 2021年第1期11卷 18-24页

作者： Bréhima Coulibaly Abdoulaye Kanté Mamadou diakité Samba Sidibé Drissa Traoré Bréhima Bengaly Mariam Daou Demba Yattera Nouhoum Ongoïba Department of Thoracic and Cardiovascular Surgery CHU Point G Bamako Mali Laboratory of Anatomy University of Sciences Techniques and Technologies of Bamako Bamako Mali Cardiology Department CHU Point G Bamako Mali Department of Neurology CHU Gabriel Touré in Bamako Mali

Introduction: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxoma of the left atrium and discuss its epidemiological and therapeutic aspects through a review of the literature. Observation: This was a 41-year-old female patient who presented with sudden rotational dizziness associated with vomiting. MRI revealed multiple punctiform bilateral supra and subtentorial strokes of different ages, recent and semi-recent, suggesting an embologenic etiology. Transesophageal echocardiography found a large pedunculated, homogeneous, avascular tumor hanging from the interatrial septum. The patient is operated on urgently under cardiopulmonary bypass for resection of a large tumor located in the left atrium. The pathological examination concluded with the diagnosis of myxoma of the left atrium. The postoperative follow-up was straightforward and the patient was discharged from the hospital via home hospitalization. Conclusion: The diagnosis of cardiac myxomas is suspected in the presence of symptoms associated with echocardiographic images of intracardiac masses and confirmed by histological study. Embolic accidents are one of the formidable complications of myxomas. Surgical management is urgent, especially in the presence of predictive morphological features of embolism on echocardiography.

关键词： Myxoma of the Left Atrium Cerebral Embolism Interest of Trans-Esophageal Ultrasound Surgery

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Acute Myocardial Infarction: Mode of Revelation of a Left Atrium Myxoma

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World Journal of Cardiovascular Surgery 2023年第3期13卷 55-60页

作者： Bréhima Coulibaly Abdoulaye Kanté Mamadou A Keita Mamadou diakité bakary Keita Drissa Traoré Nouhoum Ongoïba Patrice Binuani Christophe baufreton Department of Thoracic and Cardiovascular Surgery CHU Point G Bamako Mali Cardiac Surgery Department of the University Hospital of Angers Angers France Cardiology Department CHU Point G Bamako Mali Commune II Reference Health Center Bamako Mali

True, cardiac myxoma is a benign tumor. On the other hand, it is serious by its complications, in particular embolic. The diagnosis of acute coronary syndrome in connection with a myxoma of the left atrium is retained before the association of an emboligenic intracardiac myxoma and an acute coronary syndrome in the absence of atherosclerotic lesions and the absence of intracardiac thrombus. We report a case of left atrium myxoma complicated by acute coronary syndrome in a 50-year-old patient operated on in our department and we will review the literature.

关键词： Cardiac Myxoma Embolism Acute Coronary Syndrome Cardiac Surgery

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Assessment of Common Dental Indices and Need for Periodontal Treatment in the Cardiology outpatients Unit at the University Hospital Gabriel Touré(UH-GT) in bamako

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World Journal of Cardiovascular Diseases 2020年第3期10卷 131-143页

作者： Hamidou oumar ba Ibrahima Sangaré Youssouf Camara Sidibé Noumou Daou ousmane Maiga Asmaou Kéita Touré Mamadou Coulibaly Souleymane Sidibé Samba Konaté Massama Doumbia Coumba Thiam Sonfo Boubacar diakité Mamadou Menta Ichaka Ilo Bella Diall Ahmed ba Boubacar ba Sanogo Kassoum Mamourou Service de Cardiologie CHU Gabriel Touré Bamako Mali Service de Cardiologie CHU Kati Bamako Mali CHU Odontostomatologie Bamako Mali Service de Cardiologie CHU Mère-Enfant Bamako Mali Service de Cardiologie du CHU Point G Bamako Mali Service de Médecine Interne et d’Endocrinologie Hôpital du Mali Bamako Mali

Introduction: Little is known through the literature about dental status of patients seen in cardiology department, motivating this study which aims to assess most dental indices of outpatients and the need for periodontal treatment. Methodology: It was a cross-sectional study from November 2016 to April 2017 in the cardiology outpatient unit of the University Hospital Gabriel Touré (UH-GT) in bamako. Included were all patients with minimum 24 teeth and willing to be involved in the study. History, cardiovascular parameters and dental examination by a resident in Odontostomatology were performed for each patient. Data were analyzed using SPSS 18, quantitative as means and standard deviation (SD) and categorical as proportions. Khi-2 Test, analysis of variance were applied with a significance level set at 0.05. All patients give their verbal consent after being informed about the procedures in the study. Results: our sample involved 100 patients (66% female, mean age of 54.12 ± 16.150 and patients ≥ 60 years most represented with 50% for male and 37.9 for female patients. Tooth brush use was practiced by 100% and 98.5% respectively for male and female patients and twice daily brushing by 97.1% of male and 97% of female patients. Brushing duration was less than 3 minutes for 35.3% and 31.8% of respectively male and female patients. Plaque index and calculus index were in the male group with respectively 0.79 and 1.06 for male and 0.63 and 0.79 for female (p = 0.047 and 0.020). Mean Decayed Missed and Filled Teeth (DFMT) index showed a significantly increase from 0.22 in the age group under 30 to 0.68 for that other 60 years. Only 2.9% and 9.1% of respectively male and female patients had community paradontal index for treatment needs (CPITN) classe 0. The need for treatment was TN1 meaning instruction to an oral cavity hygiene, similar for both sex (55.9 and 57.6 respectively for male and female patients) and highest in the age-group 30 - 44 increased to 70%. The need

关键词： Dental Indices Cardiology outpatients bamako

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Impact and Management under Extracorporeal Circulation of a Patient with Renal Insufficiency on Dialysis with a High-Flow Arteriovenous Fistula in the Cardiac Surgery Department of the Angers Teaching Hospital about a Case and Review of the Literature

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Open Journal of Thoracic Surgery 2023年第1期13卷 1-5页

作者： Abdoulaye Kanté Bréhima Coulibaly Mamadou diakité Mamadou A. Keita bakary Keita Drissa Traoré Nouhoum Ongoïba Patrice Binuani Christophe baufreton Department of Thoracic and CardiovascularSurgery CHU Point G Bamako Mali Cardiac Surgery Department of the University Hospital of Angers Angers France Cardiology Department CHU Point G Bamako Mali Commune II Reference Health Center Bamako Mali

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.

关键词： Coronaryartery by Pass Grafting High Flow Arteriovenous Fistula Extracorporeal Circulation Hypothermia

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