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Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries

Surgical Science 2014年第8期5卷 363-367页

作者： Alhassane Traoré Bakary Tientigui Dembélé Adégné Togo Lassana Kanté Madiassa Konaté ibrahima diakit. Simo Notue Fabienne Laurence Boubacar Karembé Abdoulaye Diarra Amadou Traoré Mahamane Djibo Diango Gangaly Diallo Department of General Surgery CHU Gabriel Touré Bamako Mali Faculty of Medicine and Odonto-Stomatology Bamako Mali

Goal: To study the diagnostic difficulties and post-operative morbidity and mortality of peritonitis. Patients and Methods: Retrospective study about the records of adult patients operated on between 1999 and 2013 whose diagnosis of post-operative peritonitis was made. Results: We achieved 23,573 lanterns and recorded 148 cases of postoperative peritonitis or 0.62%. The medium age was 37.1 ± 17.7 years and the sex ratio was 1.2. The delay between the initial intervention and reoperation was less than 5 days. Factors occurrence of postoperative peritonitis were those related to the initial surgery: septic context 70.8%, emergency surgery 81.1% under the seat mesocolic 25% and 20.3% initial surgical technique. The diagnosis was made preoperatively in 62.2% (n = 92). Ultrasound has found an effusion in 29.7% (n = 44). Cytobactériologic review identified germs in 85.1% (n = 126) and sterile in 12.9% of patients (n = 22). The most frequent etiologies were: 22.9% anastigmatic leak (n = 34), the phoenix abscess in 17.6% (n = 26), iatrogenic perforation 13.5% (n = 20) and digestive fistula 25% (n = 37). Other causes were the stoical necrosis 12.2% (n = 18) and evisceration 8.8% (n = 13). We performed a digestive stoma in 61% (n = 89), a closure of the abdomen bolsters in 8.8% (n = 13), a suture in iatrogenic perforation in 13.5% (n = 20) and washing with drainage in patients with phoenix abscess in 17.6% (n = 26). Morbidity was 22.3% and 53.4% mortality. Conclusion: The diagnosis of post-operative peritonitis is difficult in a developing country. Morbidity and mortality is high. Improved diagnostic tools are needed.

关键词： Peritonitis Postoperative Morbidity and Mortality Surgery

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Takayasu Disease Revealed by Arterial Hypertension in a 47-Year-Old Man

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World Journal of Cardiovascular Diseases 2023年第7期13卷 341-348页

作者： Bah Mamadou Bassirou Baldé Thierno Hamidou Wann Thierno Amadou Baldé Elhadj Yaya Baldé Aissatou Tiguidanké Koné Alpha Doumbouya Amadou Diouldé Diallo Hafsatou Barry ibrahima Sory Samoura Sana diakit. Souleymane Béavogui Mariam Baldé Mamadou Dadhi Cardiology Department Ignace Deen Hospital Conakry Guinea Department of Imaging Ignace Deen Hospital Conakry Guinea Department of Internal Medicine Donka Hospital Conakry Guinea Cardiology Department Donka Hospital Conakry Guinea

Takayasu disease is a chronic vasculitis of the large vessels. It is rare in sub- Saharan Africa and probably under-diagnosed. Arterial hypertension (AH) is a frequent finding. We report the case of a 46-year-old man with Takayasu disease revealed by hypertension. The American College of Rheumatology (ACR) criteria were used for diagnosis, with 4 out of 6 criteria. Echodoppler and angioscanner showed signs of left subclavian stenosis and circumferential, regular arterial thickening. He had a biological inflammatory syndrome. He was treated with prednisone and amlodipine. After 6 months of follow-up, he was diagnosed with tuberculosis and put on anti-tuberculosis treatment.

关键词： Takayasu Disease Hypertension Man

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Epidemiological and Clinical Aspects of Abnormal Movements in Children from 2 Months to 15 Years in the Pediatric Department of Gabriel Toure University Hospital Centre of Bamako

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Open Journal of Pediatrics 2022年第1期12卷 170-178页

作者： Karamoko Sacko Djeneba Konaté Amadou Touré Belco Maiga Fousseyni Traoré Adama Dembelé Pierre Togo Abdoul Karim Doumbia Andoule Guindo Rokia Togola Oumar Coulibaly diakit. Fatoumata Léonie Francois ibrahima Ahamadou Kalirou Traoré Abdoul Aziz diakit. Boubacar Togo Gabriel Toure University Hospital Centre Bamako Mali University Hospital Centre Point G Bamako Mali

Introduction: Abnormal or involuntary movements correspond to a disorder in the programming and/or execution of movement. They have two characteristics;they are hardly or not at all controlled by the will and occur in the absence of any paralysis. Objective: To determine the epidemiological, clinical and etiological characteristics of abnormal (involuntary) movements in children aged 2 months to 15 years. Patients and Methods: This was a prospective, descriptive study from January 2016 to December 2018 of children aged 2 months to 15 years seen in neuropediatric consultations for abnormal movements. Results: During the study period 1920 children were seen in neuropediatric consultations and 57 presented with abnormal movements, i.e. a frequency of 2.96%. Children aged between 6 and 60 months were the most affected (54.4%). The sex ratio was 1.53. Movement abnormality was the most common reason for consultation (45.7%), followed by apyretic convulsions (28%), and laxity (5.3%). The onset was progressive in 68.4% of children. The main types of abnormal movements were chorea (31.6%), dystonia (26.3%), myoclonus (17.5%), tremor in 10.5%. The causes were infectious (73.68%). Conclusion: Abnormal movements are rare in paediatric practice. They have multiple causes and their management is urgent in certain situations that can jeopardise the future of children.

关键词： Abnormal Movements Convulsions Children Bamako

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Traumatic Perforation of the Small Intestine in General Surgery of the CHU Gabriel Touré

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Surgical Science 2017年第9期8卷 414-421页

作者： Alhassane Traoré Bakary Tientigui Dembélé ibrahima diakit. Adégné Togo Lassana Kanté Amadou Traoré Madiassa Konaté Boubacar Karembé Abdoulaye Diarra Amadou Bah Boubacar Sidibé Tany Koné Astan Koné Nouténé Koné Djibo Mahamane Diango Gangaly Diallo Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Anesthesia and Intensive Care CHU Gabriel Touré Bamako Mali

Goal: To determine hospital frequency, to describe the clinical and therapeutic aspects and to determine the prognosis. Patients and Methods: This was a retrospective and prospective study carried out in the General Surgery Department from 1 January 1999 to 31 December 2015. Inclusion criteria: 1) open or closed trauma of the abdomen with perforation of the small bowel;2) clinical examination (abdominal pain, vomiting, fever, abdominal contracture, evisceration, intraoperative findings);3) paraclinical examinations: pneumoperitoneum on the abdominal X-ray without preparation (ASP) and CT scan. Exclusion Criteria: Abdominal trauma without perforation of the small bowel. We selected 128 patients operated for traumatic perforation of the small bowel. The data was entered and analyzed using Word, Excel 2007 and Statistical Package and Social Science Windows 16.0. The statistical analysis consisted in the calculation of the different frequencies of the variables studied. We used the Khi2 test with significance level P Results: We recorded 119 men versus 9 women and the sex ratio was 13.22. The mean age was 25 years with extremes varying between 15 and 70 years. The majority of patients 57.7% (74 cases) came from the capital, 46.1% (59 cases) were workers, 26.6% (34 cases) of the students. The average time to admission was 29 hours. The main etiologies were road traffic accidents 36.7% (47 cases), stabbing 21.9% (28 cases), firearm 14.8% (19 cases), and sports accidents 10.1% (13 cases). The main clinical signs were abdominal pain 48.44% (62 cases), abdominal contracture 60% (76 cases), disappearance of pre-liver dullness 66.36% (84 cases), and Douglas painful 74.4% (94 cases). The abdominal X-ray without preparation (A.S.P) allowed to objectify a pneumoperitoneum in 45.31% and the scanner a liquid effusion in 45.31% with the associated lesions in 37.5% (48 cases). The surgical treatment consisted of 60.15% suture excision (77 cases), 25% anastomosis resection (32 cases)

关键词： Abdominal Trauma Small Perforation Surgery Mali

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Knowledge of Patients and Their Accompanying Persons about Obliterative Arteriopathy of the Lower Limbs at Conakry University Hospital in 2022

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World Journal of Cardiovascular Diseases 2023年第9期13卷 511-519页

作者： Alpha Koné Alpha Mamadou Diallo Sana Samoura Ibrahim Sory Barry Diane Kapché Mamadou Bassirou Bah Mamadou Saliou Diallo Souleymane diakit. ibrahima Sory Sylla Elhadji Yaya Baldé Zézé Onivogui Nicolas Zoumanigui Mariame Beavogui Mamadou Dadhi Baldé Faculty of Health Sciences and Techniques Gamal Abdel Nasser University of Conakry Conakry Guinea Department of Cardiology Sino-Guinean Hospital Conakry Guinea Department of Diabetology and Endocrinology National Hospital Donka Conakry Guinea Department of Cardiology National Hospital Ignace Deen Conakry Guinea Department of Cardiology Mountain University of Bangangte Cameroon Bafousam Cameroon Department of Surgery Cardiovascular National Hospital Donka Conakry Guinea

Introduction: Obliterative arterial disease of the lower limbs is a marker of advanced atherosclerosis. It is one of the world’s most common cardiovascular diseases, present in one in five people over the age of 60, and carries an increased risk of morbidity and mortality. The aim of this study was to assess the knowledge of patients and their carers about obliterative arteriopathy of the lower limbs at Conakry University Hospital. Material and Methods: We conducted a descriptive cross-sectional study lasting 3 months, from March 12 to June 12, 2022 in the hospitals of the University Hospital of Conakry (Donka and Ignace Deen). Following free and informed consent, they were interviewed on the basis of a pre-established questionnaire. Socio-demographic data (age, gender, level of education) were collected, and knowledge of obliterative arterial disease of the lower limbs. Results: The study involved 159 people, comprising 106 patients (66.66%) and 53 accompanying persons (33.34%) in the hospitals of the University Hospital of Conakry (Donka and Ignace Deen). The 60 to 79 age group was the most represented (44.7%), with an average age of 55.4 ± 15.9 years and extremes of 20 to 84 years. Half (47.8%) had not attended school, and almost all (96.4%) of those who had attended school had a low level of education (primary and secondary). Almost all of them (91.2%) had never heard of AOMI. Only 5% identified at least one risk factor, diabetes, hypertension and smoking. Amputation was the most frequently identified complication. About 98% did not know that AOMI is associated with myocardial infarction and stroke, and 93.7% did not know of any complications. Almost all the participants (99.4%) had poor knowledge of the following complications. Conclusion: Obliterative arterial disease of the lower limbs could be prevented or delayed by screening and controlling risk factors. Our results show a huge deficit in knowledge of this pathology, including risk factors, preventive meas

关键词： Obliterative Arterial Disease of the Lower Limbs Knowledge Patients

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Cardio-Renal Syndrome: Epidemiological, Clinical, Paraclinical, Etiological Aspects and Prognostic Factors in the Cardiology Department of the CHU Ignace Deen in Conakry

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World Journal of Cardiovascular Diseases 2023年第4期13卷 189-197页

作者： Barry ibrahima Sory diakit. Foussény Fofana Fatoumata Baldé El Hadj Yaya Bah Mamadou Bassirou Mariama Béavogui Mariam Soumaoro Morlaye Camara Abdoulaye Samoura Aly Koïvogui Diarra Koïvogui Kokoulo Diallo Salématou Baldé Mamadou Dadhi Cardiology Department CHU Ignace Deen Conakry Guinea CHU Donka National Hemodialysis Center Conakry Guinea

Introduction: Heart and kidney diseases are common among patients admitted to hospital and they coexist in a significant number of cases. The interactions between the cardiovascular system and the kidney have been known and described for many years and have led to the description of cardio-renal syndrome. The objective of this study was to determine the frequency;to describe the clinical, etiological and prognostic aspects of acute renal failure in patients hospitalized for chronic congestive heart failure. Method: This was a descriptive retrospective study from January 2, 2018 to December 31, 2022. Included in this study were all the complete records of patients hospitalized for chronic congestive heart failure with serum creatinine ≥120 μmol/I. We’re not included in this study, incomplete files, records of patients hospitalized for other pathologies, records of patients hospitalized for chronic congestive heart failure with normal renal function. Our study variables were qualitative and quantitative divided into clinical, paraclinical and prognostic data. Our data were analyzed using the EPI-info 7.***.2.6 software. Data entry and presentation were carried out using Word, Excel and PowerPoint from the 2016 Office Pack. Results: We collected 830 files of which 114 met our selection criteria, a frequency of 13.73%. The mean age of the patients was 47 ± 19 years. The F/M sex ratio was 1.23. The dominant etiologies were hypertension followed by diabetes with respectively 60.5% and 23.7%. Toxic factors including tobacco accounted for 7.9% of cases. Dyspnea accounted for 86.8%. Most of our patients were grade 3 or 36% based on systolic blood pressure on admission with an average of 164.16 ± 33.95 mmHg and an average diastolic blood pressure of 93.24 ± 20.40 mmHg. Biologically, the serum creatinine revealed a high frequency of 201 - 400 μmol/l (33% of cases) with an average value of 586.49 ± 631.44 μmol/l with the extremes 2.960 and 2448.68 μmol/I. Anemia was moderate in 3

关键词： Cardio-Renal Syndrome Ignace Deen

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Epidemiologic Features of the First Flare of Ne-phrotic Syndrome in Children in Bamako Pedi-atric Hospitals

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Open Journal of Pediatrics 2022年第2期12卷 389-395页

作者： Djeneba Konaté Lala Ndrayni Sidibé Amadou Touré Adama Fomba Abdoul Karim Doumbia Karamoko Sacko Aminata Doumbia Oumar Coulibaly Mohamed Elmouloud Cissé Pierre Togo Adama Dembélé Awa Konaré Belco Maiga Harber Balilé Fatoumata Léonie Françoise diakit. Fousseyni Traoré Hawa Gouro Diall ibrahima Ahamadou Guédiouma Dembélé Abdoul Aziz diakit. Fatoumata Dicko Traoré Boubacar Togo Department of Pediatrics CHU Gabriel Touré Bamako Mali

Introduction: The most frequent glomerular pathology in children, nephrotic syndrome (NS) is a cosmopolitan affection. It is an immunological disease and certain environmental factors, in particular viral infections and allergens, influence its occurrence. The climatic and environmental differences coupled with the frequency of infectious pathologies signing the African particularity and the absence of data in Mali on this affection, motivated us to carry out this work. Objective: To study the epidemiological aspects of nephrotic syndrome in hospitalized children aged 0 - 15 years. Patients and Methods: This was a descriptive prospective study from January 1 to December 31, 2021 in the Pediatrics Department of the University Teaching Hospital (UTH) Gabriel Touré, anational pediatric reference service in Mali. Diagnostic confirmation was provided by biology. Results: In one year, 120 children were hospitalized for nephrotic syndrome with a sex ratio of 2.75. Male exclusivity was observed at the ages of one year, eight years and 14 years and a reversal at 13 years (sex-ratio = 0.33). The median age was 6 years for an average age of 6.4 years ± 2.4 years with extremes ranging from one year to 14 years. The first attack of nephrotic syndrome occurred outside the classic age (>10 years) in 16.67%. Nephrotic syndrome is observed throughout the year with two peaks in summer (July to September) and winter (December to February). Many ethnic groups were affected by this condition with a high frequency among ethnic groups where endogamy is common. All patients were melanoderms. No cases of NS were recorded in Caucasian children from Northern Mali. The patients came from Bamako in 47.5% of cases. Two brothers from the same siblings had had their first attack of nephrotic syndrome the same year, ten months apart. Conclusion: Nephrotic syndrome in pediatric hospitals of Bamako occurs at a median age of six years all along the year with a summer and winter peaks. It is more obser

关键词： Epidemiology Nephrotic Syndrome Child University Teaching Hospital Ga-briel Toure

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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 diakit. 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 diakit. 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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Epidemiological and Clinical Aspects of Congenital Hydrocephalus in the Neonatal Department of Gabriel TouréTeaching Hospital Bamako Mali

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Open Journal of Pediatrics 2022年第1期12卷 1-11页

作者： Hawa G. Diall Oumar Coulibaly Youssouf Sogoba Hatouma Sylla Yacouba A. Coulibaly Fatoumata L. diakit. Lala N. Sidibé ibrahima Ahamadou Leyla Maiga Abdoul K. Doumbia Pierre Togo Adama Dembélé Mohamed E. Cissé Fousseini Traoré Belco Maiga Karamoko Sacko Djeneba Konaté Bourama Kané Oumou Koné Guedjouma Dembélé Abdoul A. diakit. Drissa Kanikomo Fatoumata D. Traoré Mariam Sylla Boubacar Togo Department of Pediatrics CHU Gabriel Touré Bamako Mali Department of Neurosurgery CHU Gabriel Touré Bamako Mali Department of Pediatrics Hospital Mali Bamako Mali National Institute of Public Health Bamako Mali

Objective: The aim of our work was to access the epidemiological and clinical aspects of congenital hydrocephalus in the pediatrics department of Gabriel Touré teaching Hospital Bamako. Methods: We conducted a retro and prospective study that ran from January, 1st 2018 to July, 30, 2019. All newborns of 72 hours of life or less with hydrocephalus confirmed by sonography or CT scan were enrolled in this study. Results: During the study period, 5416 patients were hospitalized in the neonatology department. Among them, 39 patients (0.72%) presented congenital hydrocephalus and congenital infectious causes accounted for 25.6%. The sex ratio (M/F) was 1.78. Mothers were housewives and not educated in 79.5% and 64.1% respectively. The parents resided outside Bamako in 61.5% of cases. Prenatal consultations were conducted in 32 patients (82%). Consanguinity between the 2 parents was present in 38.5%. The antenatal diagnosis was made in 8 patients (20.5%). Vaginal delivery was the main mode of birth (67%). The average birth weight was 2930 g (1000 to 5400 g) and the average head circumference was 37.82 cm (26 - 55 cm). In 87.2% of cases, newborns were eutrophic. The main clinical signs were bulging anterior fontanel (46.2%), sunset gaze (20.5%), prominent forehead (48.7%), reduced face (20.5%), enlarged cranial sutures (43.6%), macrocrania (25.6%). Transfontanellar ultrasound and CT scan were performed in 51.3% and 48.7% of cases respectively. Associated malformations were spina bifida in 30.8% of cases followed by Dandy Walker malformation (5.1%), and omphalocele (2.5%). The neurological signs were diminished neonatal reflexes (51.3%), hypotonia (30.8%), motor deficit (38.4%), intracranial hypertension (25.6%), seizures 10.25% and psychomotor delay (43.6%). Surgery was performed in 8 neonates (20.5%). Ventriculo-peritoneal shunt (VPB) was the main treatment. Postoperative complications were infectious (37.5%) and mechanical complications (12.5%). The postoperative mortalit

关键词： Newborn Congenital Hydrocephalus Mortality Gabriel Toure

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Become Immediate of Newborns Operated in the Neonatology Department of the Hospital and University Center Gabriel Toure of Bamako (Mali)

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Open Journal of Pediatrics 2022年第1期12卷 12-18页

作者： Oumar Coulibaly Hawa Gouro Diall Pierre Togo Hawa Camara Fatoumata Léonie Françoise diakit. Lala Ndrayni Sidibé Leyla Maiga ibrahima Ahamadou Abdoul Karim Doumbia Adama Dembelé Belco Maiga Karamoko Sacko Mohamed Elmouloud Cissé Djeneba Konaté Fousseyni Traoré Yacouba Aba Coulibaly Issa Amadou Touré Hamadi Sissoko Mariam Maiga Alou Samake Bourama Kané Guédiouma Dembelé Abdoul Aziz diakit. Fatoumata Dicko Traoré Mariam Sylla Boubacar Togo Neonatology Department of the Gabriel Touré CHU Bamako Mali Pediatric Surgery Department of the Gabriel Touré CHU Bamako Mali Reference Health Center of the Municipality III Bamako Mali Reference Health Center of the Municipality VI Bamako Mali Mali Hospital Bamako Mali

Neonatal surgical pathologies in developing countries are characterized by high mortality. The aim of this work was to describe the characteristics of the newborn and its surgical pathologies treated in the neonatal department of the Gabriel Touré University Hospital in Bamako (Mali). Patients and method: This is a retrospective study of 626 files of newborns hospitalized over a period of 3 years (January 2016 to December 2018) for a surgical pathology, whether operated on or not. We have studied the etiological, therapeutic and evolutionary aspects. Results: During the study period, we collected 626 patients who had surgical pathology, i.e. a frequency of 5.35%. The average therapeutic consultation time was 2 days with extremes (1 and 30 days). Pathologies of the abdominal wall and digestive tract represented 57.9% (n = 84) followed by pathologies of the spine 26.9% (n = 39). The mean treatment time was 4.5 days. Twenty-three point sixteen (23.16%) newborns could be operated on. The neonatal mortality rate was 12.4% (n = 18). Mortality was postoperative (100%) with a mean time to onset of 5 days. Abdominal wall pathologies were responsible for 8.7% (n = 13) of deaths. Conclusion: Surgical pathologies of the newborn are characterized by delayed treatment with high mortality. Improving their prognosis requires early diagnosis (prenatal diagnosis) and adequate management.

关键词： Newborn Surgical Pathologies Mortality

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