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Tuberculosis in Children: Epidemio-Clinical Aspects in the Paediatric Department of the Gabriel TouréUniversity Hospital Center

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Open Journal of Pediatrics 2022年第2期12卷 376-388页

作者： Adama Dembélé Abdoul Aziz Diakité Mohamed Elmouloud Cissé Bassirou Diarra Belco Maïga Issa Sanou Pierre togo Abdoul Karim Doumbia Oumar Coulibaly Karamoko Sacko Djéneba Konaté Hawa Diall Lala Ndrainy Sidibé Bréhima Dégoga Fatoumata Léonie Diakité Guédiouma Dembélé Fatoumata Dicko Mariam Sylla Boubacar togo Department of Paediatrics University Teaching Hospital of Gabriel Touré Bamako Mali University Clinical Research Center University of Sciences Techniques and Technologies of Bamako Bamako Mali Department of Pediatrics CHU Gabriel Touré Bamako Mali

Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, or about 1 million with 250,000 deaths in 2016 (including children with HIV-associated TB). The signs of TB in children are not always specific and diagnosis remains difficult unlike in adults. According to a study conducted in 2011 in the paediatric department of the CHU-Gabriel Touré, only seventeen cases of all forms of tuberculosis were found, or approximately 0.2% of hospitalised children. The objective of our study was to investigate the epidemiological and clinical aspects of tuberculosis in children. Materials and Method: This was a prospective, cross-sectional and descriptive study that took place from 24 October 2017 to 23 October 2018, or 12 months in children aged 0-15 years. Data were collected from an individual medical record opened for each patient and an individual survey form established for each child. Results: During the study period, 40,434 children were consulted. Tuberculosis was suspected in 91 children, with a frequency of 0.22%. The age range of 1 to 4 years was 36.3% with a median age of 72 months. The sex ratio was 1.8. Chronic cough with 84.6% and malnutrition with 24.17% were the most frequent symptoms. Chest X-ray revealed bilateral pulmonary lesions in 52.7% and mediastinal adenopathy in 12.1%. TST was positive in 10.9% of patients, microscopy in 26.4%, Gene Xpert in 18.7%, and culture in 16.5%. The biological diagnosis of tuberculosis was retained in 48.4% of the patients, the pulmonary form represented 93.2%. The therapeutic regime (2RHZE/4RH) was used in 81.6% of cases and the evolution was favourable in 65.9% of patients. Conclusion: The diagnosis of tuberculosis in children remains difficult in our context. The clinical signs are not always specific, and further studies are needed to further elucidate this disease.

关键词： Child Clinic Epidemiology Gabriel Touré University Hospital Center Tuberculosis

The Polytraumatized in the Emergency Hosting Service and the Service of Resuscitation Gabriel TouréMali

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Surgical Science 2018年第4期9卷 157-163页

作者： Diop Thierno Madane Magane Moustapha Issa Almeimoune Abdoulhamidou Dembélé AlajiSeidou Dabo Aminata Ouattara Kassoum Dembélé Bakary Tientigui Traoré Alhassane togo Adegné Diango Mahamane Djibo Department Anesthesia-Intensive Care and Emergency Gabriel Toure University Hospital Bamako Mali Anesthesia Department Ophthalmological Institute West African University Hospital Bamako Mali General Surgery Department Gabriel Toure University Hospital Bamako Mali

Summary: Polytrauma is the leading cause of death in the under-40 population. They are accompanied by major morbidity with severe sequelae. The polytraumatized is defined as a serious trauma with several bodily injuries, at least one of which is life-threatening in the very short term. The initial hospital care must not barely delay and directly affect the prognosis. In developing countries, the absence of pre-hospital medicine means that mortality is still very high, which leads us to initiate this work, which aims to study the epidemiological and clinical aspects of polytrauma in emergency and in resuscitation of Gabriel Toure University Hospital. Material and Methods: This was a retrospective study that took place over a period of ten (10) months from February to November 2016. We included all patients received for polytrauma emergency hosting service. The data were collected using a surveycard. Results: During our study period, we collected a total of 200 polytraumatized cases out of a total of 16,141 patients admitted to the emergency hosting service, a prevalence of 1.3%. The age group of 20 - 29 years was the most represented with average age of 32.39 years. The male sex was predominant with 65% with a sex ratio of 1.9. The students were the most represented with 24%. The trauma occurred at 22.5% between 8:00 and 12:00 am, the public road was the main place of the trauma with 57.5% of the cases. Two-wheeled vehicles were involved in the accident in 68.9% of cases. The delay between trauma and admission was minus 6 hours in 70.5% of cases, 15.5% had a Glasgow lessthan 8% and 44.5% PAS Conclusion: The polytrauma is clinical situation putting the patients vital prognosis at stake. The haemorrhage is the origin of the student mortality. The installation of rigorous diagnostic system and a pre-hospital medicine will reduce the morbi-mortality.

关键词： Polytraumatized Emergency Resuscitation Bamako Mali

Clinico-Pathological Profile of Malignant Abdominal Tumors in Children: Experience of the Pediatric Oncology Unit in Bamako

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Open Journal of Pediatrics 2021年第4期11卷 608-617页

作者： Abdoul Karim Doumbia Adama Dembele Pierre togo Oumar Coulibaly Arsene Dackono Mohamed Elmouloud Cissé Fousseyni Traoré Hawa Diall Boubacar togo Abdoul Aziz Diakité Yakaria Coulibaly Cheick Bougadary Traore Lala N’drainy Sidibe Belco Maiga Diakite Fatoumata Léonie Francois Karamoko Sacko Djeneba Konaté Guediouma Dembele Hacimi Poma Adama Bah Djibril Kassogue Oumar Keita Ibrahim Ahamadou Department of Pediatrics at CHU Gabriel Touré Bamako Mali Pediatric Surgery Department of the Gabriel Touré CHU Bamako Mali Pathological Anatomy and Cytology Department of the “Point G” CHU Bamako Mali

Introduction: the objective was to describe the epidemiological and histological aspects of malignant abdominal tumors in children. Methodology: This was a descriptive, cross-sectional study conducted from January 1, 2017 to December 31, 2018. We included all patients aged 0 to 15 years with histologically confirmed abdominal malignancies. Results: We collected 46 files of malignant tumors of the abdomen (35% of pediatric cancers). The majority of patients were under 5 years old (65%). The sex ratio was 1.7. They were generally from disadvantaged socio-economic backgrounds (67%). The average consultation time was 50 days. The main reasons for consultation were abdominal mass (48%), pain (17%) or distension (9%). The mass was large, hard (89%), immobile (71%) and painful (46%). Malnutrition was found in 80% of patients. The mass was retro-peritoneal in 63% of cases and renal in 54%. It was solid in 94% of cases and heterogeneous in 76% of cases. The assay for tumor markers was not performed. Anemia was present in all patients. Fine needle aspiration was performed in 43%, biopsy in 37% and myelogram in 15% of cases. spinal cord involvement was observed in 28% of Burkitt’s cases. The main cancers diagnosed were nephroblastoma (52%), Burkitt’s lymphoma (26%) and neuroblastoma (13%). Stage 1 and stage 2 were frequent in 20% and 22% of cases, respectively;36% of cases were not staged. The average duration of chemotherapy was 11 weeks. Total resection was performed in 30% of cases. The outcome of the patients was marked by total remission in 65%. Conclusion: Abdominal malignancies are very common in children. The diagnosis of certainty is late in our context.

关键词： Cancer Abdomen Child Sub-Saharan Africa

Intestinal Invagination in Adults: About a Case at the “Mother-Child” Hospital Le Luxembourg in Mali

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Surgical Science 2023年第9期14卷 583-589页

作者： Cheickna Tounkara Oumar Amadou Malle Amara Coulibaly A. Boubacar Maiga Sory Ibrahim Diawara Kassim Kayentao Bakary Tientigui Dembele Alhassane Traore Adégné Pierre togo Lassana Kante Department of general surgery of the Hospital “Mother Child” Le Luxembourg Bamako Mali University of Sciences of Techniques and Technologies of Bamako Mali (USTTB) Bamako Mali Department of General Surgery of the CHU Gabriel Touré Bamako Mali

Intussusception is a pathology of infants and young children. Its occurrence in adults is very unusual. In the vast majority of cases, it is secondary to a benign or malignant tumor. Small bowel malignancies are relatively rare, 1% - 5% of malignant tumors of the gastrointestinal tract. Acute intussusception, a rare pathology in adults, often presents with non-specific symptoms. Contrary to children, the organic origin remains preponderant in the elderly, where the origin of neoplasia must be suspected in first intention. We report the case of a 49-year-old patient admitted urgently from the Luxembourg “Mère Enfant” hospital center in Bamako, Mali, for an occlusive syndrome. Several abdomino-pelvic ultrasounds were performed in several clinics with mixed conclusions: Hydro-aeric distension and a cessation of matter and gas without a clearly visible mass (04/09/2022);Demonstration of the central hydro-aeric levels wider than high containing fine and regular folds corresponding to connivents whose aspect is in factor of left acute small intestine occlusion, to be completed by the surgical opinion (06/09/2022) and a third ultrasound showed a normal appearance of the liver, gallbladder, kidneys, pancreas, spleen, bladder and prostate;diffuse aero-colic distention without lesion of secondary appearance (21/11/2022). A frontal standing ASP dated 11/25/2022 showed hail-like hydro-aeric levels. Surgical management consisted of an open oncological resection of an obstructive bowel tumor with ileo-ileal invagination. The anatomopathological and immunohistochemical study of the surgical specimen concluded to diffuse small cell non-Hodgkin’s lymphoma, without vascular embolism. The resection limits pass into the healthy zone.

关键词： Acute Intestinal Intussusception Organic Etiology Digestive Lymphoma Mali

Fortuitous Discovery of a Case of Situs Inversus Totalis on Acute Intestinal Occlusion at the Fousseyni Daou Hospital in Kayes

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Surgical Science 2022年第12期13卷 551-560页

作者： Sangare Sidy Traore Lamine Issaga Kouyate Mamaye Sogoba Gaoussou Katile Drissa Guindo Youssouf Traore Djibril Traore Allassane Dembélé Bakary Tientigui togo Adégné Traore Drissa General Surgery Department of the Fousseyni DAOU Hospital Kayes Mali Pediatric Surgery Department at Fousseyni DAOU Hospital Kayes Mali Gastroenterology Department of the Fousseyni DAOU Hospital Kayes Mali Cardiology Department of the Fousseyni DAOU Hospital Kayes Mali General Surgery Department of the Somine DOLO Hospital Mopti Mali General Surgery Department of Gabriel TOURé Hospital Bamako Mali General Surgery Department of Point G Hospital Bamako Mali

Situs inversus is a rare congenital anomaly referring to the mirror image of the abdominal and thoracic viscera. It can be discovered routinely or on the occasion of a complication related or not to situs inversus. We report a case of Situs inversus discovered incidentally during surgery for acute intestinal obstruction caused by an iatrogenic uterine perforation.

关键词： Situs Inversus Incidental Finding Intestinal Obstruction Iatrogenic Uterine Perforation

Ainhum (Or Dactylolysis Spontaneous) at the Fousseyni Daou Hospital in Kayes about a Case

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Surgical Science 2022年第8期13卷 367-373页

作者： Sangare Sidy Traore Lamine Issaga Sogoba Gaoussou Kouyate Mamaye Katile Drissa Toure Hamidou Ababa Cisse Abdoulaye Traore Allassane Dembélé Bakary Tientigui togo Adégné Traore Drissa General Surgery Department Fousseyni Daou Hospital Kayes Mali Pediatric Surgery Department Fousseyni Daou Hospital Kayes Mali Gastroenterology Department Fousseyni Daou Hospital Kayes Mali Dermato-Venereology Department Fousseyni Daou Hospital Kayes Mali General Surgery Department Gabriel Toure Hospital Bamako Mali General Surgery Department Point G Hospital Bamako Mali

Aïnhum or spontaneous dactylolysis is a progressive constriction of the digito-plantar fold of the fifth toe which leads after several years of evolution to a spontaneous amputation of the toe. Classically, a distinction is made between “true Aïnhum” of unknown cause, which affects only blacks and those of African (sub-Saharan) descent;“pseudo-Aïnhum”, which follows various causes such as an inflammatory flange or foreign body constriction;and finally, palmo-plantar keratoderma, of genetic origin, such as Vohwinkel disease. We report a case of Aïnhum received at stage III of the pathology and who benefited from an amputation of the fifth toe.

关键词： Aïnhum Spontaneous Dactylolysis Idiopathic Amputation

Acute Appendicities in the Reference Health Center of Municipality II of Bamako District

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Surgical Science 2022年第5期13卷 251-257页

作者： Idrissa Tounkara Boubacar Karembe Sayon Diakite Abdoulaye Diarra Amadou Traore Konimba Keita Oumar Ongoiba Madiassa Konate Moussa L. Coulibaly Bakary Coulibaly Bakary Tientigui Dembele Adegne togo Reference Health Center of the Municipality II Bamako Mali Reference Health Center of the Municipality III Bamako Mali University Hospital of Kati Kati Mali University Hospital Gabriel Touré Bamako Mali Timbuktu Regional Hospital Timbuktu Mali

This was a prospective study from January 2019 to December 2019 in the reference health center of municipality II of the Bamako district. During this period, we operated on 73 patients for acute appendicitis, including 51 men and 22 women, for a sex ratio of 1.7. The average age was 25.5 with extremes of 1 and 40 years. Abdominal pain was the main reason for consultation. The physical signs were dominated by the positivity of the Blumberg sign in 97.3% of the cases, the defense of the right iliac fossa in 79.5%, and the Rovsing sign in 61.6% of the cases. This physical examination made it possible to make the diagnosis in the majority of cases. In the face of some doubtful cases, we requested an abdominal ultrasound. Locoregional anesthesia was the most used anesthesia technique at 72.6%. The classic anterograde appendectomy with stump burial by Mac Burney was the most commonly used technique, respectively. The postoperative consequences were straightforward in 87.6%. Anatomopathology examination was performed on 69 surgical specimens and 4 appendectomy specimens were not subjected to an anatomo-pathological examination. Phlegmonous appendicitis was the most common at 63% of cases. Appendicitis remains the most common surgical emergency in a community setting. The early diagnosis and the speed of treatment guarantee improvements in the prognosis. The treatment is mainly surgical.

关键词： Acute Appendicitis Clinical Aspects Appendectomy Postoperative Effects

Epidemiological and Clinical Study of Cardiac Diseases in the Pediatric Department of the University Hospital Gabriel Touré(UH GT), Bamako (Mali)

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World Journal of Cardiovascular Diseases 2018年第7期8卷 328-336页

作者： Maiga Belco Ba Hamidou Oumar Sacko Karamoko Dembélé Adama Sanogo Nouhoum Cissé Mohamed Elmouloud togo Pierre Diakité Abdoul Aziz Dicko-Traoré Fatoumata Sylla Mariam Pediatric Department UH GT Bamako Mali Cardiology UH GT Bamako Mali

Introduction: Children’s heart disease is a major public health problem in developing countries and especially in Mali. The purpose of our work was to determine frequency, different types of heart disease and their short term evolution in the pediatric department. Methods: We performed a retrospective study among children aged 0 to 15 years, hospitalized in the pediatric department from January to December 2015 and whose diagnosis was confirmed using trans-thoracic echocardiography. Results: We included 103 cases of heart disease out of a total of 8613 admissions in the pediatric department, giving an hospital prevalence of 1.2%. Mean age was 4.1 years (from 1 day to 15 years) and children under 5 years were the most affected with 73.80% of cases. Male predominance was noted (sex ratio = 1.2). Respiratory distress was the most common circumstance of discovery (93.20%). Cardiac murmur and tachycardia were the most common cardiac signs with respectively 88.35% and 83.50%. Congenital heart disease accounted for 70.87% and was dominated by ventricular septal defect (VSD) with 30.13%. Acquired heart disease (29.13% of the sample) was dominated by mitral regurgitation (MR) with 56.67%. Mortality rate was 31.9% for congenital heart disease and 11.1% for acquired heart disease. Conclusion: children’s heart disease is responsible for high mortality. Early detection improves the management of this pathology, which remains frequent.

关键词： Cardiac Disease Congenital Acquired Pediatric Bamako

Acute Peritonitis at the Reference Health Center of Commune I of the District of Bamako: Epidemiological, Clinical and Therapeutic Aspects

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Surgical Science 2023年第12期14卷 728-737页

作者： Tounkara Cheickna Samake Hamidou Maïga Amadou Cisse Alou Hamadoun Diarra Issaka Sanogo Modibo togola Modibo Dembele Bakary Tientigui Traore Alhassane togo Pierre Adegne Kante Lassana Department of General Surgery Cs Ref of Commune I of Bamako Bamako Mali Central Directorate of Social Service of Army Health Bamako Mali Department of General Surgery Gabriel Toure University Hospital Bamako Mali

Acute peritonitis is most often secondary to perforation of the digestive organ and/or the spread of an intra-abdominal septic focus. The objectives of this work were to study acute peritonitis in the general surgery department of the Cs ref of commune I in Mali, to determine the frequency of peritonitis, to describe the epidemiological, clinical and therapeutic aspects in order to analyze the surgical consequences and to assess the additional cost of treating acute peritonitis. This study was prospective, descriptive, cross-sectional involving 40 patients received in the surgery department of the Cs ref of commune I for acute peritonitis from January 1, 2018 to December 31, 2018. There were 40 patients among whom 28 (70%) were men and 12 were women (30%), i.e. a sex ratio = 2.3. The average age was 25 years with extremes varying between 16 and 54 years and a standard deviation of 11.78. Abdominal pain was the main reason for consultation. Clinical examination alone made it possible to make the diagnosis in 75% of cases. Surgical treatment depended on the intraoperative etiology. The clinical diagnosis was supported by ASP and abdominal ultrasound;performed respectively in 10% and 90% of patients. Appendiceal peritonitis was the intraoperative diagnosis observed in 50% of cases. All our patients benefited from a peritoneal toilet with drainage. We noted a morbidity rate of 5% dominated by parietal suppuration. The average cost of care was 175,000 FCFA.

关键词： Acute Peritonitis Epidemiology Diagnostic Therapy Surgical Emergencies Cs Ref CI Bamako Mali