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Management of Acute Myeloblastic Leukaemia (AML) Treated with Intensive Chemotherapy: Experience in a Single Centre

Open Journal of Pediatrics 2024年第2期14卷 401-411页

作者： Abdoul Karim Doumbia hawa konaré Tati Simaga Pierre Togo Oumoulkairi Nana Kouma hawa Gouro Diall Oumar Coulibaly Adama Dembélé Mohamed Elmouloud Cissé Karamoko Sacko Belco Maiga Aminata Doumbia Kalirou Traoré Ibrahima Cissé Boury Traoré Abdoul Aziz Diakité Fousseyni Traoré Boubacar Togo Department of Pediatrics University Hospital Gabriel Touré Bamako Mali

Introduction: Acute myeloblastic leukaemia (AML) is a haematological malignancy with a poor prognosis, despite significant therapeutic progress. This study presents the results of AML management in Mali according to GFAOP recommendations. Methodology: This was a retrospective, cross-sectional study. It included patients aged 0 - 15 years treated in the paediatric oncology unit for AML and followed up between January 2016 and December 2020. Results: During the study period, 85 cases of acute leukaemia were diagnosed in the paediatric oncology unit (including 51 cases of ALL), of which 34 cases of AML were included in this study. The majority were boys (59%). The mean age was 8 years, with extremes of 18 months and 15 years. The mean time to diagnosis was 68 days. In 79% of cases, patients were referred by 1st or 2nd level hospitals. Anaemia was observed in 91% of cases, an infectious syndrome in 68%, haemorrhage in 56% and a tumour syndrome in 85%. The haemogram showed hyperleukocytosis in 15% of cases, thrombocytosis in 22% and severe anaemia in 73%. Death occurred in 85% of cases, most often in the context of sepsis or haemorrhage. Conclusion: AML is probably underestimated in Mali and diagnosis delayed, which may be explained by patient-related factors (lack of knowledge, financial constraints) and a cumbersome referral system. These results suggest the need to implement an appropriate diagnostic and therapeutic strategy, with strong involvement of the political authorities.

关键词： Acute Myeloblastic Leukaemia Children 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 recommendations.

关键词： Antibiotic Prescription Hospitalization Child

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Enteropathica Acrodermatitis Complicated by Necrotising Fasciitis in an Infant Admitted to the Paediatric Emergency Department of the Gabriel Touré University Hospital

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Open Journal of Pediatrics 2023年第6期13卷 831-837页

作者： Aichata Keita Bory Traoré Adama Dembélé Rokiatou Diarra Mariam Diarra Elmouloud M. Cissé Mariam Kané Bakary Coulibaly hawa konaré Reference Health Center of the Commune VI Bamako Mali Department of Paediatrics CHU Gabriel Touré Bamako Mali Bamako Dermatology Hospital Bamako Mali

Acrodermatitis enteropathica is a rare autosomal recessive genetic disorder characterised by periorificial dermatitis, alopecia and diarrhoea. It is caused by a mutation in the gene that codes for a membrane protein that binds zinc. We report a case in a 7-month-old girl, admitted with altered general condition and scaly, pustular erythematous lesions, initially located in the occipital and cervical regions, and secondarily inguinal and on the knees. Management and outcome in this patient? Genetic assay was not available to confirm this rare genetic disease. A delay in establishing the diagnosis and a disastrous outcome did not save the patient despite the administration of zinc.

关键词： Enteropathica Acrodermatitis Necrotizing Fasciitis Infant

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Study of Cerebral Vascular Accidents in Children with Sickle Cell from 6 Months to 15 Years of Age at the Gabriel Toure University Hospital Center

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Open Journal of Pediatrics 2023年第6期13卷 852-861页

作者： Mohamed Elmouloud Cissé Abdoul Aziz Diakité Adama Dembélé Belco Maiga Moussa Diallo Abdoul Karim Doumbia Oumar Coulibaly Pierre Togo hawa Gouro Diall Abdoulaye Barry Karamoko Sacko Amadou Touré Issa Sanou Fousseyny Traore Djeneba Konaté Kalirou Traoré Lala N’Drainy Sidibé Bory Traoré Ibrahim Ahamadou Yacouba Aba Coulibaly hawa konaré Aminata Doumbia Department of Pediatrics Gabriel Toure University Hospital Bamako Mali

Sickle cell disease is a hereditary disease that remains a public health problem in Mali. Our objective was to study strokes in children with sickle cell disease aged from 6 months to 15 years in the pediatrics department of the Gabriel Toure university hospital center. This was a retrospective descriptive study from April 1, 2019 to March 31, 2021 and prospective from April 1, 2021 to April 30, 2022, i.e. 3 years, which took place in the Pediatrics department of the Gabriel Toure university hospital center. During this study, we identified 22 cases of stroke among 714 children with sickle cell disease. The frequency of stroke in this population is 3.08%. The age group from1 to 5 years was the most affected with 40.9%. The average age of the patients was 7 years with extremes ranging from 1 year to 15 years and a median of 5 years. The male gender was predominant with 54.5%, for a sex ratio of 1.2. Headaches were the most common neurological antecedents (63.5%). Half of the patients were diagnosed with sickle cell disease after the onset of the stroke. The installation of the deficit was progressive in 54.5% of cases. Consciousness disorders were the most frequent reason of consultation (27.2%), followed by convulsions (18.1%). The most common neurological signs were impaired consciousness and hemiparesis with 45.5% each. The stroke was ischemic in 100% of cases. There were 95.5% of SS forms and 4.5% of Sβ0thalassemia forms. Our patients had a hemoglobin level less than 7 g/dl in 57.1% of cases and between 7 and 9 g/dl in 42.8% of cases and hyperleukocytosis (leukocytes > 10,000/mm3) in 95.4% of cases. The Sylvian artery was the most affected (45.5%). The fatality rate was 22.7%.

关键词： Sickle Cell Anemia Vessels Brain Children

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Non-Chemotherapy Medullary Aplasia in the Pediatric Oncology Unit of the Gabriel Touré Teaching Hospital, Bamako

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Open Journal of Pediatrics 2023年第6期13卷 798-806页

作者： Pierre Togo Ibrahim Ahamadou Tati Simaga Abdoul Karim Doumbia Fousseyni Traoré Oumar Coulibaly Djénéba Konaté Salif Zigmé Adama Dembélé Mohamed Elmouloud Cissé Belco Maïga Karamoko Sacko hawa Gouro Diall Boubacar Ali Touré Amadou Touré Yacouba Aba Coulibaly Aminata Doumbia hawa konaré Kalirou Traoré Souleymane Sagara Abdoul Aziz Diakité Fatoumata Dicko Cheick Bougadari Traoré Boubacar Togo Department of Pediatrics Gabriel Touré Teaching Hospital Bamako Mali National Institute for Training in Health Sciences Bamako Mali Center for Research and Fight against Sickle Cell Disease Bamako Mali Pathological Anatomy Department Point G Teaching Hospital Bamako Mali

Objectives: The main objective was to study the epidemiological, diagnostic and therapeutic aspects of medullary aplasia (MA). Methods: This was a prospective and descriptive retro study conducted from January 1, 2008 to December 31, 2018 in the pediatric oncology unit of the pediatrics department of the Gabriel Touré teaching Hospital in Bamako. Results: We collected 29 children’s cases out of 1632 admissions during the study period, representing a frequency of 1.8% and an incidence of 2.6 cases per year. The sex ratio was 2.6. The 11 - 15 age group accounted for 45%, with an average age of 8.93 years. The majority of fathers (55.2%) and mothers (62.1%) had received no education;they were mainly farmers (62.1%) and housewives (86.2%). The average consultation time was 92.21 days. Anemia was the reason for consultation in 69% of cases. Pallor was present on admission in 96.5%;infectious syndrome accounted for 79.3%, anemic syndrome for 51.7% and hemorrhagic syndrome for 27.6%;the three syndromes were associated in 27.6%. Malaria was associated with bone marrow aplasia in 58.6%. Anemia was present in 93.1%, neutropenia in 65.5% and thrombocytopenia in 86.2%. All had received a labile blood product (LBP) transfusion, and 24 (83%) had received antibiotics. Patients were treated with corticosteroids (58.6%), androgens (20.7%) and immunosuppressants (20.7%). The death rate was 34.6%. At last count, 15 (83%) had discontinued treatment, 2 (11%) were undergoing treatment and 1 (6%) was in remission. Conclusion: Effective treatment of MA requires improved technical facilities and better economic conditions for parents.

关键词： Medullar Aplasia Children Bamako

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Clinical, Aetiological and Evolutionary Aspects of Respiratory Distress in Term Neonates: A Single-Centre Cross-Sectional Study

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Open Journal of Pediatrics 2023年第6期13卷 821-830页

作者： Abdoul Karim Doumbia Doumbia Aminata Coulibaly Oumar Pierre Togo Adama Dembélé Abdoul Aziz Diakité Mohamed Elmouloud Cissé hawa Diall Belco Maïga Aminata Coulibaly Mariam Kané Tati Simaga Karamoko Sacko Yacouba Aba Coulibaly Djéneba Konaté Ibrahima Ahamadou hawa konaré Lala Ndrainy Sidibé Kalirou Traoré Fatoumata Léonie Diakité Guédiouma Dembélé Fatoumata Dicko Fousseyni Traoré Boubacar Togo Department of the CHU Gabriel Touré Bamako Mali

Introduction: Respiratory distress is a frequent cause of morbidity and mortality in neonates. The aim of this study was to assess its frequency and describe its clinical and evolutionary characteristics in the neonatology department of the Gabriel Touré University Hospital in Bamako. Methodology: This was a prospective cross-sectional study conducted from 1 January 2021 to 30 June 2021. All term neonates aged 0 to 28 days hospitalised with signs of respiratory distress (tachypnoea, nasal flaring, expiratory whining, intercostal and subcostal indrawing, xiphoid funneling and cyanosis) were included. The sociodemographic and clinical variables of the newborns and their mothers were analysed using SPSS.20 software. Results: During the study period, 1272 newborns were admitted to hospital, including 705 born at term, of whom 188 were included in the study. The mothers’ ages ranged from 14 to 45 years, with an average of 24 years. The pregnancy was not followed up in 15% of cases. Newborns were resuscitated at birth in 51% of cases. The main clinical signs observed were hypoxia, neurological disorders and fever. Perinatal asphyxia (55%), neonatal infections (34%) and congenital malformations (6%) were the main causes of respiratory distress. Mortality was estimated at 37%. Conclusion: Neonatal respiratory distress is a major cause of death. Most causes can be avoided if pregnancy and delivery are properly managed.

关键词： Respiratory Distress Neonate Asphyxia

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Congenital Heart Disease in Newborns: Epidemiological and Clinical Particularities in a Neonatology Department in Mali

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Open Journal of Pediatrics 2022年第5期12卷 857-866页

作者： Abdoul Karim Doumbia Oumou Koné Adama Dembélé Noumou Sidibé Noel Banou hawa Gouro Diall Pierre Togo Oumar Coulibaly Karamoko Sacko Djéneba Konaté Tati Simaga Lala Ndrainy Sidibé Fatoumata Léonie Diakité Boubacar Diarra Guédiouma Dembélé Belco Maïga Mohamed Elmouloud Cissé hawa konaré Aminata Doumbia Ibrahim Ahamadou Abdoul Aziz Diakité Fatoumata Dicko Traoré Boubacar Togo Department of the CHU Gabriel Touré Bamako Mali

Introduction: Congenital heart disease is an important cause of mortality, chronic morbidity, and disability in children in poor countries. The objective of this study was to highlight the diversity of congenital heart defects in the neonatology department. Methodology: This work had taken place in a neonatology service over a period of six months from January 2019 to June 2019. It was a prospective descriptive study with information collected from the medical records of newborns with congenital heart disease. Results: Of 1478 neonates hospitalized during the study period, 41 had congenital heart disease, for a hospitalization rate of 2.77%. CHD accounted for 2.77% of neonatal hospitalizations. The sex ratio was 1.73 (26 boys/15 girls). Consanguinity was found in 19% of cases. The average time to consultation was 11 days. The main clinical signs were heart murmur (58%), respiratory distress (56%) and extracardiac malformations (54%). The main cardiac malformations found were atrial septal defect (46%), patent ductus arteriosus (44%), ventricular septal defect (17%), complete atrioventricular canal (15%), and transposition of the great vessels (5%). The case fatality rate was 29%. Conclusion: Delayed diagnosis, generally related to the long delay in consultation, and lack of surgical management partly explain this high case fatality.

关键词： Congenital Heart Disease Neonates Management

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Childhood Idiopathic Nephrotic Syndrome: A Single-Center Hospital Study

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Open Journal of Pediatrics 2022年第5期12卷 832-840页

作者： Abdoul Karim Doumbia Tati Simaga Adama Dembélé Mahamadou Salihou Baldé hawa G. Diall Pierre Togo Aminata Doumbia Belco Maiga Karamoko Sacko Fatoumata Léonie Diakité Oumou Koné Oumar Coulibaly Ibrahim Ahamadou Mohamed Elmouloud Cissé Guédiouma Dembelé Fousseyni Traoré hawa konaré Amadou Touré Djènèba Konaté Lala N’Drainy Sidibé Leyla Maiga Abdoul Aziz Diakité Boubacar Togo Department of Pediatrics of CHU Gabriel Touré Bamako Mali

Introduction: Idiopathic nephrotic syndrome (INS) is one of the leading causes of childhood morbidity worldwide. This study was undertaken to complete the epidemiological, clinical, therapeutic and evolutionary aspects of NIS in hospitalized patients. Methodology: We conducted a retrospective study of patients with childhood NIS who had been admitted to our department from January 2017 to December 2018. Diagnosis, remission and relapse of idiopathic NS were defined according to the recommendations of the French Society of Pediatric Nephrology. We included all patients aged 2 to 14 years presenting a NIS picture. Results: During the study period, 35 patients with idiopathic NS had been hospitalized, representing a frequency of 1% of patients hospitalized in the department. The sex ratio was 2.22. The average age of the patients was 7.5 ± 3.5 years. Generalized edema was observed in all our patients. Arterial hypertension (36%) and abdominal pain (24%), hematuria (9%) were the main associated signs. Malnutrition was present in 66%, urinary tract infection in 20% and malaria in 24%. Cortico-sensitivity was obtained in 86% of patients, 14% were cortico-resistant and 11% were cortico-dependent. Relapses (6%) had been observed among cortico-sensitive patients. The mortality rate was 11%. Conclusion: This study calls for more trials to better elucidate prognostic indicators and develop better therapeutic approaches adapted to epidemio-clinical contexts.

关键词： INS Children Corticosteroids

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Systemic Lupus Erythematosus Complicated by Pericarditis: A Case Report from the Guindo Clinic in Bamako, Mali

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Open Journal of Pediatrics 2023年第1期13卷 16-20页

作者： Kalirou Traoré Karamoko Sacko Souleymane Mariko Belco Maiga hawa konaré Adama Dembélé Mohamed Cissé Fousseyni Traoré Ibrahim Dollo Fatoumata Traore Arouna Ouattara Aminata Doumbia Mamadou Traore Djeneba Konate Pierre Togo Abdoul Karim Doumbia Gassama Diaby Abdoul Aziz Diakité Ali Guindo Fatoumata Dicko Mariam Sylla Boubacar Togo Department of Pediatrics Gabriel TOURE University Hospital Bamoko Mali Guindo Clinic of Bamako Bamoko Mali Mopti Hospital Mopti Mali Reference Health Center of Commune V Bamoko Mali Bamako Dermatology Hospital Bamoko Mali

Juvenile systemic lupus erythematosus is a rare entity, affecting children under 16 years of age. Girls are more often affected than boys and the female predominance increases significantly with age. The initial manifestations are highly variable with an insidious and progressive onset. Non-specific symptoms include fever, anorexia, weight loss and asthenia. Pericarditis is the most common cardiac manifestation in systemic lupus erythematosus (SLE), occurring in 10% to 40% of cases. The biological elements of the diagnosis and follow-up of pediatric SLE are identical to those of adults and are based on regular measurement of complement, native anti-DNA antibodies, and inflammatory findings. Treatment is essentially based on corticosteroid therapy.

关键词： Lupus Child Pericarditis Clinic Guindo Bamako Mali

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Blood Count Characteristics of Children Hospitalized in General Pediatrics at the Gabriel Touré Teaching Hospital

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Open Journal of Pediatrics 2023年第4期13卷 543-552页

作者： Pierre Togo Abdoul Karim Doumbia Oumar Coulibaly Abdoul Aziz Diakité Moussa Tembély Adama Dembélé hawa Gouro Diall Mohamed Elmouloud Cissé Fousseyni Traoré Belco Maïga Karamoko Sacko Djénéba Konaté Ibrahim Ahamadou Fatoumata Léonie Diakité Lala N’Drainy Sidibé Guédiouma Dembélé Oumou Koné Amadou Touré Yacouba Aba Coulibaly Leyla Bagna Maïga Aminata Doumbia hawa konaré Kalirou Traoré Souleymane Sagara Tati Simaga Fatoumata Dicko Mariam Sylla Boubacar Togo Department of Pediatrics Gabriel Touré Teaching Hospital Bamako Mali National Institute for Health Science Training Bamako Mali Pediatrics Department Mohamed V Perinatal Clinic Bamako Mali Pediatrics Department DSSA Bamako Mali National Institute of Public Health “NIPH” Bamako Mali

Objective: The main objective was to study the disturbances of the Blood Count of children hospitalized in the general pediatric of the Gabriel Touré teaching hospital. Methods: This was a prospective and descriptive study conducted from September 1 to November 30, 2018 in the general pediatrics department of the Gabriel Touré teaching hospital in Bamako. Data were collected on patient records using a survey sheet. Results: We collected 512 files of children out of 1030 admissions during the study period;the rate of completion of the blood count is 50%. The male sex was predominant with a sex ratio of 1.3. The majority of patients were under 5 years old (58%). The majority of fathers (56%) and mothers (64%) of children had no education;they are mainly farmers (61%) and housewives (88%). Pallor was the reason for consultation in 29% of patients and present in 60%. On blood count, anemia was present in 92% of patients, half of whom (50%) had severe anemia with a hemoglobin level below 7 g/dL. The anemia was mainly microcytic (72%) and hypochromic (66%). Hyperleukocytosis (62%), eosinophilia (68%) and basophilia (58%) were the abnormalities observed in the white line. Thrombocytopenia accounted for 40%. Severe malaria (53%) was the main discharge diagnosis and almost all patients (99%) were alive at discharge. Conclusion: The characteristics of anemia require a study of the complete blood count in healthy children with dosage of serum iron and ferritin for a better understanding of the phenomenon.

关键词： Characteristic Blood Count Child

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