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Initial Experience with Open Heart Surgery in Sub-Saharan Africa:Challenges in Mali with Minimum Standards for Practice

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World Journal of Cardiovascular Surgery 2019年第9期9卷 108-118页

作者： Seydou Togo Moussa Abdoulaye Ouattara Abdoul Aziz maiga Moussa Bazongo Issa Boubacar maiga Cheik Ahmed Sekou Toure Ibrahim Coulibaly Sounkalo Diop Allaye Ombotimbe Sitta Illiassou Souleymane Coulibaly Mamadou Solo Koita Koumba Nelly Dora Ignanga Sanibe Dramane Kone Moussa Oscar Kamano Fatoumata Konate Adama Issa Kone amadou Sidibe Ahmadou Drame Nouhoum Oueloguem Bourama Kane Boubacar Drame Sekou Koumare Zimogo Zie Sanogo Sadio Yena Department of Thoracic and Cardiovascular Surgery Mali HospitalBamakoMali Department of Anesthesiology and Critical Care Mali HospitalBamakoMali Department of Cardiologie Mali HospitalBamakoMali Department of Pediatrics Mali HospitalBamakoMali Department of Biomedical Laboratory Mali HospitalBamakoMali Department of Surgery“A” Point G HospitalBamakoMali

Introduction: There has been limited experience with Open Heart Surgeries (OHS) in Sub-Saharan Africa. In west Africa especially in Mali, most fledgling centers are unable to overcome the myriad of challenges encountered in establishing OHS though there is a high prevalence of surgically correctable heart diseases. The aim of this paper is to review our initial experience of our first cases in developing OHS program and discuss the challenges and prospects that need to be overcome to further develop it. Methods: A total of 6 patients who underwent OHS during the first “cardiac mission” in July 2016 were included in this retrospective study. The medical records of the patients were examined and data on age, sex, diagnosis, EuroSCORE, type of surgery, cardiopulmonary bypass details, complications and length of hospital stay were extracted. Results: Six patients with a male to female ratio of 1, ages ranging between 12 and 35 years (mean of 22.5 ± 12 years) were studied. The mean of EuroSCORE was 6 ± 41. Pericardial patch closure of isolated atrial septal defect was performed in one patient. One patient had mitral valve repair for rheumatic mitral regurgitation consisting of chordal shortening with a tricuspid valvuloplasty. Three patients had mitral valve replacement with tricuspid valvuloplasty. Four patients had mitral valve replacement. Sixty-day mortality?was 0%. Conclusion: Safe conduct of open heart surgery in Mali Hospital setting is feasible. Grant financial aid is required for rapid growth of Open-Heart Surgery in this part of Sub-Saharan Africa.

关键词： Open-Heart Surgery Mali Africa

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Surgical Complications of Pica Syndrome: About 03 Cases

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Open Journal of Pediatrics 2020年第1期10卷 159-167页

作者： A. Doumbia Y. Coulibaly I. amadou M. Keita O. Coulibaly B. Kamaté M. K. Djiré M. Y. Coulibaly S. Camara H. Diall B. maiga D. Konaté K. Sacko Service of Pediatric Surgery Teaching Hospital Gabriel Toure Bamako Mali Service of General Pediatric Teaching Hospital Gabriel Toure Bamako Mali

The Pica syndrome is an eating disorder characterized by an excessive or abnormal desire to consume a non-nourishing substance which can be relatively harmless, or potentially harmful for the health. It is a rare affection secondary to the accumulation of diverse nature foreign bodies inside the digestive tract and more especially at the stomach level. Gastro-intestinal localization is the most frequent, and can remain long time asymptomatic. Treatment is surgical. We report 3 cases of digestive complication of Pica syndrome. The first one was operated for gastric perforation due to nail (53 nails, a pin and bands of tape recorder cassette ingested), the second one for trichobezoar and the last had a subocclusion by pieces of granite.

关键词： Pica Syndrome Complications Bezoar Child Mali

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Study of the Management of Children with Major Sickle Cell Disease in Pediatric Emergencies at the Gabriel Toure University Hospital

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Open Journal of Pediatrics 2023年第2期13卷 244-252页

作者： Mohamed Elmouloud Cissé Abdoul Aziz Diakité Adama Dembélé Belco maiga Fatoumata Nampomo Diarra Oumar Coulibaly Hawa Diall Pierre Togo Abdoul Karim Doumbia Abdoulaye Barry Karamoko Sacko Fousseyny Traore Djeneba Konaté Kalirou Traoré Lala N’Drainy Sidibé Ibrahim Ahamadou amadou Touré Fatoumata Dicko Boubacar Togo Mariam Sylla Department of Pediatrics Gabriel Toure University Hospital Bamako Mali

Objective: To study the epidemiological, clinical and therapeutic aspects of sickle cell disease in children admitted to the pediatric emergency department of the Gabriel Toure University Hospital. Materials and methods: This was a prospective study over 12 months in sickle cell children aged 6 months to 15 years. Results: The frequency of sickle cell disease was 4.67% with 71.1% of SS form. The age range of 60 - 120 months predominated with 43.4% and the sex ratio 1.4. Vaso-occlusive crises (VOC) were the most frequent reason for consultation (50.6%) and osteoarticular pain was the main symptom followed by fever and pallor with respectively 67.5%, 60.2%, 39.8%. The pain subsided in less than 72 hours in 39.8% and hyper hydration was performed in 85.1% of patients. Analgesic treatment was given in 90.4%, antibiotic therapy in 51.8% and phenotyped red blood cells transfusion was performed in 36.1%. The average duration of treatment was 10 days. Conclusion: Vaso-occlusive crisis remains the main reason for consultation in sickle cell disease children at Gabriel Toure University Hospital. The management consisted, in addition to the correction of the triggering factors, of hyper hydration and the administration of analgesics and blood products.

关键词： Sickle Cell Disease Pediatrics Emergencies

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Bilharzia Appendicitis: Incidence in a Commune in Mali, about 3CAS

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Surgical Science 2024年第5期15卷 321-329页

作者： Souleymane Bingue Dembélé Yely Dianessy Moussa Samake Abdou Guiré Siaka Konaté Ousmane Sy Boubacar Yoro Sidibé amadou Maïga Thiorno Nadio Boubacar Karembe Amaguiré Saye Sirama Diarra Dorcas Sodjiné Yede Issiaka Diarra Ibrahima maiga Mahamane Dicko Moussa Konaté Aliou Bina Diarra Bakary Tientigui Dembélé General Surgery Department of the District Hospital of Commune IV of Bamako Bamako Mali Kolondié ba Reference Health Centre Sikasso Mali Epidemiology and Clinical Research Bamako Mali General Surgery Department of Gabriel Touré University Hospital Bamako Mali Ophthalmology Department of the District Hospital of Commune IV of Bamako Bamako Mali Gynecology and Obstetrics Department of the District Hospital of Commune IV of Bamako Bamako Mali Commune I of the District of Bamako Reference Health Centre Bamako Mali Imaging Department of the District Hospital of Commune IV of Bamako Bamako Mali Commune VI of the District of Bamako Reference Health Centre Bamako Mali Anotomy-Pathology Department of the G Point University Hospital Bamako Mali

Appendicitis bilharzia is a very rare condition and we report 3 cases of this pathology that sense clinical and biological similarities with bacterial appendicitis. The etiological diagnosis was exclusively histopathological, this allowed to highlight eggs of Schistosome in the appendicular wall in the three patients. The surgical treatment was supplemented by a specific medical treatment based on praziquantel. The surgical suites were simple for 2 patients, complicated by superficial parietal suppuration in a patient.

关键词： Bilharzial Appendicitis Endemic Histopathology Specific Antiparasitic Treatment

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Seizures in Children under Five in a Pediatric Ward: Prevalence, Associated Factors and Outcomes

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Open Journal of Pediatrics 2021年第4期11卷 627-635页

作者： Abdoul Karim Doumbia Oumou Koné Guédiouma Dembélé Adama Dembelé Oumar Coulibaly Hawa Gouro Diall Karamoko Sacko amadou Touré Pierre Togo Abdoul Aziz Diakité Mohamed Elmouloud Cissé Belco maiga Djeneba Konaté Fatoumata Léonie Diakité Lala N’drainy Sidibe Fousseyni Traoré Adama Bah Djibril Kassogue Boubacar Togo Madou Traoré Department of Pediatrics at CHU Gabriel Touré Bamako Mali National Institute of Public Health Bamako Mali Mohammed VI Perinatal Clinic Bamako Mali

Introduction: convulsion is a frequent cause of neurological and cognitive sequelae and then of epilepsy. The objective of this work was to describe the socio-demographic, clinical, therapeutic, and evolutionary aspects. Methodology: This was a descriptive retrospective study carried out in the general pediatrics department of CHU-Gabriel Touré. It took place over a period of 02 years from January 2017 to December 2018. We included all children aged 1 to 59 months hospitalized in the ward for convulsion. Results: During the study period, 2653 children aged 2 months to 59 months were hospitalized in the general pediatric ward. We included 288 medical records of children who presented with a seizure on admission. Convulsions represented 11% of pediatric hospitalizations from 1 month to 59 months. The average age was 29 months. Fever was present in 86% of patients. The cerebrospinal fluid (CSF) test was positive in 38 patients. Hypoglycemia was present in 14 patients. Serum calcium was low in 3 patients. The most implicated etiologies were malaria 70%, meningitis 20%, and dehydration 13%. Management consisted of airway clearance, oxygen therapy as needed, and administration of diazepam (54%). Antibiotics were prescribed in 77% of cases and antimalarials in 70%. The average length of hospital stay was 8 days with extremes of 1 and 30 days. The outcome was favorable in 95% of cases. Sequelae were observed in 5% of cases and one case of death was observed. Conclusion: Acute convulsions are one of the most common causes of hospitalization in children under 5 years old. The causes were dominated by infectious diseases (mal

关键词： Convulsions Child Infant Prognosis Sub-Saharan Africa

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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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Pulmonary Embolism: Epidemiological, Clinical, Therapeutic and Evolution Aspects in the Medicine Department of Hospital of Mali Bamako

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World Journal of Cardiovascular Diseases 2021年第4期11卷 242-248页

作者： Massama Konaté Mariam Sako Boubacar Sonfo Samba Sidibé Souleymane Mariko Djeneba Sylla Sow Coumba Adjaratou Thiam Djenebou Traoré Hamidou Oumar Ba Asmaou Keita maiga Ibrahima Sangare Mamadou Toure Souleymane Coulibaly Nouhoum Diallo Bah Traoré Modibo Mariko Nouhoum Ouologuem amadou Koné Youssouf Camara Yacouba Lazare Diallo Nanko Doumbia Mahamadoun Coulibaly Ichaka Menta Faculty of Medicine and Dentistry (FMOS) of the University of Sciences Technique and Technology of Bamako (USTTB) Bamako Mali Medicine Department Hospital of Mali Bamako Mali Cardiology department CHU Point G Bamako Mali Cardiology Department Hospital of Kati Kati Mali Medicine Department Hospital of Tombouctou Tombouctou Mali Internal Medicine Department CHU Point G Bamako Mali Cardiology Department CHU Gabriel Toure Bamako Mali Cardiology Department CHU Mère Enfant Bamako Mali

Background: Pulmonary embolism (PE) is a severe form of venous thromboembolic disease. In Africa, prevalence of PE in hospitalized medical patients varies among studies. Objective: Aim of this work was to study the epidemiological, clinical, therapeutic and evolution aspects of PE in the medicine department of Mali’s Hospital Bamako-Mali. Methodology: This was a retrospective cross-sectional study carried out from January 01, 2017 to December 31, 2020 in the medicine department of Mali’s hospital Bamako, including all inpatients admitted for PE during the study period. Results: Of 1814 hospitalized patients, 54 patients had pulmonary embolism. Hospital frequency of pulmonary embolism was 2.97%. Predominance was female and sex-ratio M/F was 0.38. Mean age in our series was 54.24 ±1.19 years. Predisposing factors to pulmonary embolism were dominated by obesity 37%, high blood pressure 35.2% and history of cardiovascular disease 20.4%. Dominant signs were dyspnoea and chest pain in 83.3% and 70.4% of cases respectively. Probability of pulmonary embolism was high in 40.7% according to Wells score. Patients with right heart failure were 22.2%. EKG showed sinus tachycardia70.4% and S1Q3 aspect 7.4%. Heart right chambers were dilated at transthoracic echography 42.6%. Obstruction was bilateral at chest angio CT for 51.9% and proximal for 42.6%. Deep venous thrombosis was associated at EP in 16.6%. Treatment was low weight molecular heparin followed by vitamin K antagonist or direct oral anticoagulant. One patient was successfully treated by thrombolysis. Hospital mortality was 16.7%. Conclusion: PE is a serious disease probably underdiagnosed. It is responsible of important mortality.

关键词： Pulmonary Embolism Epidemiology Mali’s Hospital

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Pulmonary Complications in Children with Sickle Cell Disease Followed at the Pediatric Department of Gabriel Toure University Hospital

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Open Journal of Pediatrics 2022年第1期12卷 89-99页

作者： Mohamed E. Cissé Abdoul A. Diakité Adama Dembélé Belco maiga Pierre Togo Nicole A. Kpakoutou Oumar Coulibaly Karamoko Sacko Tiaria M. Sanogo Hawa Diall Fousseyni Traoré Abdoul K. Doumbia Djenèba Konaté Fatoumata L. Diakité Ibrahim Ahamadou Lalla N. Sidibé amadou Touré Fatoumata Dicko-Traoré Boubacar Togo Mariam Sylla Pediatric Department of Gabriel Toure University Hospital Bamako Mali

Objective: To study the pulmonary complications of major sickle cell syndromes in children aged 6 months to 15 years followed at the Department of Pediatrics of Gabriel Toure University Hospital. Materials and methods: This was a retrospective study from January 1st, 2017 to February 28, 2018 and a prospective study from March 1, 2018 to December 31, 2019, concerning sickle cell disease children followed at the Gabriel Touré University Hospital. All children with sickle cell disease confirmed by hemoglobin electrophoresis, aged 6 months to 15 years with a pulmonary complication and admitted to pediatrics were included. Were not included: 1) Infants and children with sickle cell disease not presenting a pulmonary complication coming only to their routine follow-up. 2) Sickle cell patients over 16 years of age and those whose parents do not consent. 3) Those who have not done electrophoresis. Results: During the study period, we were able to include 45 sickle cell children with a pulmonary complication. The frequency of pulmonary complications was 13.76%, involving homozygotes in 91.11% of cases. The age group 6 - 10 years predominated with 46.66% and the sex ratio was 0.45. Vaso-occlusive crisis was the most frequent reason for consultation with 35.56%. Respiratory distress (80%), fever (66.67%), crepitus rales (64.44%) and chest pain (60%) were the most frequent clinical signs. The main pulmonary complication was acute chest syndrome with 86.67%. Treatment was based on hydration (91.91%), analgesics (91.91%) and antibiotics (73.33%). Lethality was 4.44%. Conclusion: Pulmonary complications of sickle cell disease are serious and constitute the main cause of mortality in our context.

关键词： Sickle Cell Disease Children Lungs Complications

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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 Diakité Fousseyni Traoré Hawa Gouro Diall Ibrahima Ahamadou Guédiouma Dembélé Abdoul Aziz Diakité 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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