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Progressive Characteristics of HIV Infection in the Elderly in the Cohort of the Internal Medicine Department of the Points G University Hospital, Bamako. Mali

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Advances in Infectious Diseases 2023年第1期13卷 109-116页

作者： Abdoulaye mamadou Traore Garan Dabo Mamadou Cissoko Charles Dara Djenebou Traoré Ibrahim Dollo Djibril Sy Assétou Soukho mamadou Dembélé Daouda Kassoum Minta Abdel Kader Traore Hamar Alassane Traore Department of Infectious Diseases CHU du Point G Bamako Mali Department of Medecine CHU “Hôpital du Mali” Bamako Mali Department of Internal Medicine CHU du Point G Bamako Mali

Few data are available on HIV infection in the elderly and they are an important population in our different cohorts in view of the improvement in the quality of care over the last ten years. Objective: to determine the clinical and immunovirological characteristics as well as the acceptance of antiretroviral drugs in this patient population. This is a cohort study of the files of PLHIV (People living with HIV) aged 50 years or more, followed in the Internal Medicine Department of the Point G University Hospital between January 2007 and December 2012. Results: Out of 161 HIV-infected patients in the cohort, 38 were aged 50 years or older, of whom 11 met the criteria and were included. The median age was 55 years, 90.9% of whom were in the [50 - 59 years] age group, with 63.6% being women (sex ratio = 0.57). At admission, 3 patients (27.3%) had prurigo and 2 (18.2%) had oral-pharyngeal candidiasis. At inclusion, 45.5% of patients were classified as WHO stage 2 and one as WHO stage 4. All were on ARVs, including 10 on 1st line HIV-1 and 1 on HIV-2. On triple therapy, the average weight gain was 5.1 kg at D15 and 6.84 kg at M6. However, at M12 there was a weight loss of 1.04 kg. The mean CD4 T cell gain was +102/mm3 at M6 and +188/mm3 at 12 months. At D0, mean viral load = 565024.75 copies/mm3 [99 - 1100000] in 4/11. At M12, two patients had undetectable viral loads. Conclusion: The prevalence of HIV in elderly subjects is certainly underestimated. Thanks to triple antiretroviral therapy, PLHIV are aging with HIV but screening is not systematically proposed during consultations in elderly subjects. It is necessary to reinforce communication about HIV at all ages.

关键词： HIV Elderly Clinical Immunovirology

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Clinical and Epidemiological Aspects of Hepatocellular Carcinoma at the Internal Medicine Department of Point “G” Teaching Hospital in Mali

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Open Journal of Gastroenterology 2023年第7期13卷 250-255页

作者： Ganda Soumaré Sanra Déborah Sanogo Abdoulaye Maiga Ouatou Mallé mamadou Mallé Ibrahima A. Dembélé Mamadou Cissoko mamadou M. Coulibaly Assétou Kaya Soukho mamadou Dembélé Abdel Kader Traoré Alassane Traore Hamar Alassane Traore Gastroenterology Department CHU du Point G Bamako Mali Internal Medicine Department CHU du Point G Bamako Mali

Liver cancer is the malignant transformation of liver cells. It develops in 90% of cases of cirrhosis, more rarely on chronic non-cirrhotic liver disease, and exceptionally in a healthy liver. This study aimed to investigate the clinical aspects of Hepatocellular Carcinoma (HCC). It was a retrospective descriptive study covering 10 years, focusing on HCC cases seen in outpatient and inpatient settings at the Internal Medicine Department. We recorded 153 cases out of 7021 patient records, resulting in a hospital frequency of 2.17%. The male-to-female ratio was 3.5. The mean age was 52.37 ± 14.34 years. The most common presenting complaint was pain in 16.3% of cases. A history of jaundice was found in 25.5% of cases. Alcohol consumption was observed in 15.38% of cases. The main physical sign found was hepatomegaly in 76% of cases. HBsAg was positive in 33.3% of cases. Alpha-fetoprotein levels were above 400 IU/ml in 50.81% of cases. Patients classified as CHILD PUGH A represented 39.72% of cases. Abdominal ultrasound revealed portal thrombosis associated with heterogeneous multinodular hepatomegaly in 11% of cases. Cytology confirmed HCC in four out of six patients who underwent the examination. We recorded 63 deaths out of 111 hospitalized patients. Complications included encephalopathy, hematemesis, and ascites in 48 patients. Hepatocellular carcinoma remains a significant public health issue. Its predominance in men and its occurrence in adults with factors such as viral infections and ethylism mean that prevention of this pathology could greatly reduce its incidence.

关键词： Hepatocellular Carcinoma (HCC) Point G University Hospital Bamako Mali

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Serious Myasthenia at the Department of Internal Medicine of Point G University Teaching Hospital: A Clinical Case

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Neuroscience & Medicine 2019年第3期10卷 207-212页

作者： Assétou Kaya Soukho Djenebou Traoré Adramé Keita Djibril Sy Guida Landouré Seybou Hassane Diallo Youssouf Fofana Kaly Keita mamadou Mallé Ibrahima Amadou Dembélé Drissa Sangaré Mamadou Cissoko Barry Boubacar Sangaré mamadou Dembélé Abdel Kader Traoré Hamar Alassane Traoré Department of Internal Medicine Point G University Teaching Hospital Bamako Mali Department of Neurology Point G University Teaching Hospital Bamako Mali Department of Neurology GABRIEL TOURE University Teaching Hospital Bamako Mali Department of Internal Medicine Mother-Child Hospital “Luxembourg” Bamako Mali

Introduction: Myasthenia is a rare and disabling autoimmune disease. Few studies were devoted to this pathology. We report a clinical case of myasthenia in the Department of Internal Medicine at the Point G University Teaching Hospital. Observation: This is a 41-year-old patient of Malian origin, a trader with a history of hemorrhoidectomy in 2011 and familial hypertension, was admitted on August 19, 2014, for muscle weakness, dysphonia, and dysphagia. The disease started 1 year before admission at the department with progressive muscle weakness of the upper limbs aggravated by repetitive movements and spreading to the head “drooping head” and inferior limbs, associated with general fatigue, dysphonia and selective dysphagia for solid foods. The diagnosis of myasthenia was maintained based on the clinical signs such as ptosis, bilateral diplopia, and weakness with lower limbs muscle strength rated at 3/5, and confirmed with confirmatory exams;a positive anti-acetylcholine receptor antibody (RIA), the post-synaptic neuromuscular conduction block at ENMG and the positive neostigmine pharmacological test. The patient received Neostigmine (prostagmine) 0.5 mg one ampoule in IM/day and Prednisone at a dosage of 1 mg/kg/day. The evolution was marked by a moderate improvement of the symptomatology afterward the patient was evacuated to Tunisia on family request where he received a course of immunoglobulin 2 g/kg in 2 days. The evolution in Tunisia was favorable. The patient returned in Mali and death occurred after 2 months in a context of respiratory distress. Conclusion: Myasthenia is a rare but serious disease requiring careful management and monitoring to reduce respiratory complications.

关键词： Myasthenia Immunoglobulin Internal Medicine Point G Hospital

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Biermer’s Disease at the Donka National Hospital in Guinea—Epidemio-Clinical, Therapeutic and Evolutionary Aspect in the Internal Medicine Department

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Open Journal of Internal Medicine 2023年第3期13卷 218-224页

作者： Thierno Amadou Wann mamadou Sarifou Diallo Djenabou Diallo Kadiatou Diallo mamadou Lamine Yaya Bah mamadou Diakhaby Mohamed cissoko Amadou Kaké Djibril Sylla Department of Internal Medicine Teaching Hospital of Conakry Conakry Guinea Department of Hepato-Gastroenterology University Hospital of Conakry Conakry Guinea

Introduction: Biermer’s disease is an autoimmune disease characterized by a lack of absorption of vitamin B12 in connection with the production of antibodies (A) destroying the intrinsic factor (IF) which allows the absorption of vitamin B12 (cobalamin). These clinical manifestations are polymorphic and severe in our context. The objective of this work is to identify the epidemiological-clinical, therapeutic and evolutionary characteristics of Biermer’s disease in Guinean population. Materials and methods: This was a retrospective of patient files followed for Biermer’s disease at the internal medicine department of Donka National Hospital from January 2012 to December 2021. Results: Eight patients were included including 5 women and 3 men. The average age of the patients was 48 years old. The diagnostic delay was 3.6 years on average. All our patients had bioclinical anemia (8 cases, i.e. 100%) followed by epigastralgia in 4 cases (50%), neurological damage such as sensitive polyneuropathy in 3 cases (37.5%). Four patients had acquired melanoderma (50%). Hypovitaminosis B12 was found in 4 patients. The myelogram performed in three patients (37.5%) found medullary megaloblastosis. One patient had Hashimoto’s disease associated with Biermer’s disease in endoscopy, (FOGD) found fundica trophy on macroscopy in 4 cases (50%). Treatment consisted of B12 vitamin therapy in all cases with a favorable clinical and biological outcome. Conclusion: Biermer’s disease remains common in Africa and is characterized at a younger age in addition to the severity of clinical and biological manifestations. The care consists of taking vitamin B12 which remains accessible in our context.

关键词： Biermer’s Disease Donka Aspects Epidemiological-Clinical Therapeutics

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Metabolic Syndrome in the Internal Medicine Department of Chu Point G

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Open Journal of Internal Medicine 2023年第3期13卷 139-143页

作者： Djenebou Traoré Sy Djibril Nongoba Sawadogo Djeneba Sylla Sow Massama Konaté Nounga Romuald Nyanke Ayayi Edem D’Almeida Kaly Keita Sekou Landouré Nouhoum Koné Moussa Sangaré mamadou Mallé Ibrahima Amadou Dembélé Mamadou Cissoko Yacouba Koné Aoua Diarra Assetou Kaya Soukho Department of Internal Medicine University Hospital Center of Point G Bamako Mali Faculty of Medicine and Odontostomatology Bamako Mali Departement of Internal Medicine Kaya Regional Hospital Kaya Burkina Faso Department of Medical University Hospital Center from the Hospital in Mali Bamako Mali

Introduction: The metabolic syndrome according to the IDF (International Diabetes Federation) is at the origin of the double global epidemic of type 2 diabetes and cardiovascular diseases. This work aims to study the metabolic syndrome in the internal medicine department of CHU Point G. Methodology: This was a descriptive study of patients who presented a metabolic syndrome according to the definition of the IDF definition, hospitalized in the internal medicine department of the CHU du point G for the period from January 1 2010 to December 31, 2019. Results: During the study period, 4189 patients were hospitalized, including 60 with metabolic syndrome, representing a hospital frequency of 1.43%. The sex ratio was 0.36. The age group of 50 and 60 years accounted for 28.3%. Forty-six point six percent (46.6%) of our patients were diabetic, 45% obese, 60% hypertensive, 70% sedentary and 10% smokers. Our patients had in 53.3% of cases a blood pressure figure ≥ 130/85 mmHg, abdominal obesity in 100%, hypertriglyceridemia in 33.3%, HDL-C less than 0.40 g/l in 62.5% of men and less than 0.50 g/l in 77.27% of men, blood sugar ≥ 1 g/l in 88.3%. Conclusion: The metabolic syndrome, in view of the entities that compose it, is a real cardiovascular risk factor and therefore a major public health issue.

关键词： Metabolic Syndrome CHU Point G Internal Medicine

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Human Rabies Still Exists in Urban and Peri-Urban Areas in Mali—National Data-Base Analysis of the Capital of Mali from 2007 to 2017

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Open Journal of Internal Medicine 2019年第2期9卷 19-25页

作者： Abdel Kader Traore Assetou Soukho Kaya Ousmane Kone Youssouf Fofana Mamadou Cissoko Zakaria Keita Makan Fofana Aichatou Margueritte Diarra Department of Internal Medicine Universitary Hospital of Point GBamakoMali RIWA/REAO/MALI Rabies in West Africa(RIWA)Mali RIWA/REAO INTERNATIONALRabies in West Africa(RIWA)Mali PARACON Pan-African Rabies Control NetworkBamakoMali Service of Epidemiology-Department of Comunotary Health National Institute of Public HealthINRSPBamakoMali Department of Internal Medicine University Hospital Mother-Child LuxembourgBamakoMali Disease Prevention and Control Division National Directorate of HealthMinistry of Health and Social AffairsBamakoMali Management of Small and Medium Enterprises BamakoMali

From 2007 to 2017 sixty-three (63) new cases of human rabies have been identified in Mali on an estimated total population in 2017 of 17,650,195 inhabitants. This is an incidence of 0.32 cases for 100,000 inhabitants. All these cases occurred in urban areas and involved the two sexes. The age group most affected was the one less than 20 years old. The majority of the victims (73.1%) were pre-schools, school-aged pupils and housewives. In 97% of the cases, the animal in question was a dog and the type of exposure of the bite. Eighty-two percent (82%) of the victims had received no local medical treatment or the post exposure quasi prophylaxis treatment. The median duration between the first symptoms and death among the cases of human rabies was 3 to 7 days. The median duration between the occurrence of the first signs and death was four (4) days. No virological confirmation had been conducted on the patients. The rage disease is retained as a priority disease, since the adoption of the strategy of “integrated monitoring of the disease and response” in 2008. However, in spite of the efforts made, progress still remains to be effected to assess the actual impact of rabies in Mali.

关键词： Rabies Urban Area Mali

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Evaluation of the Frequency of Prolonged Fevers and Exploration of Their Etiologies in the Internal Medicine Department of the Point “G” University Hospital in Bamako from 2009 to 2013

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Open Journal of Internal Medicine 2019年第3期9卷 97-103页

作者： Abdel Kader Traoré Assétou Soukho Kaya Djenebou Traoré Djibril Sy Youssouf Fofana Ibahima Amadou Dembélé mamadou Saliou Boua Daoud Camara Karim Dao Mamadou Cissoko Kaly Ké ï ta Barry Boubacar Sangaré mamadou Mallé Alassane A. Doumbia Nagou Tolo Hadiza A. Kaï lou mamadou Dembélé Hamar Alassane Traoré Deparment of Internal Medicine University Hospital of Point “G” Bamako Mali Department of Internal Medicine of Children and Mothers Le Luxembourg University Hospital Bamako Mali Internal Medicine Service Nianankoro Fomba Hospital Ségou Mali

Objective: The aim was to evaluate the frequency of prolonged fevers and to determine their etiologies. Methods: We carried out a cross-sectional study extending from the period of 2009 to 2013 in the Internal Medicine department of the “G” Point University Hospital in Bamako. Included were all records of hospitalized patients with a central temperature greater than 37°C in the morning and 37°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment. We include all the patients of the study period with fever greater than 37.5°C in the morning and 37.8°C in the evening, resting for 15 minutes, fasting for more than 2 hours, and absence of antipyretic treatment, which have more than 21 days and measured on several occasions. The data were collected on a survey sheet. Data entry and analysis was done on SPSS software. Results: We recorded 243 fever cases out of 2155 hospitalizations, a prevalence rate of 11.2%. There were 128 men and 115 women with an average age of 43 years (range, 15 to 84 years), a modal class of 37 to 47 years, and a sex ratio of 1.11. The infectious etiologies accounted for 81% followed by neoplastic causes 09.6% and inflammatory 01.2% of cases. HIV infection was found in 26.4% of patients, malaria 13.5% and urinary tract infections 10.2%). Gram negative bacilli 88% consisted mainly of Escherichia coli (56%) and Klebsiella pneumoniae (20%).

关键词： Fever Acute Prolonged Fevers Frequency Etiologies Internal Medicine Mali

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Clinic Evaluation of Heart Failure of Old People in the Department of Internal Medicine of Point G University Hospital from 2008 to 2012

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Open Journal of Internal Medicine 2019年第3期9卷 83-88页

作者： Assétou Soukho Kaya Abdel Kader Traoré Djibril Sy Djenebou Traoré Ilo Diall Youssouf Fofana Ibahima Amadou Dembélé Boua Daoud Camara mamadou Saliou Karim Dao Mamadou Cissoko Kaly Kéï ta Barry Boubacar Sangaré mamadou Mallé Alassane A. Doumbia Hadiza A. Kaï lou mamadou Dembélé Hamar Alassane Traoré Department of Internal Medicine Point G University Hospital Bamako Mali Department of Cardiac Disease Point G University Hospital Bamako Mali Department of Internal Medicine of Children and Mothers Le Luxembourg University Hospital Bamako Mali Internal Medicine Service Nianankoro Fomba Hospital Ségou Mali

Justification: Heart failure (HF) is the evolutionary end of all cardiac diseases. Given the aging population, the rate of incidence is increasing among the elderly. Objectives: The study aims to determine the prevalence of heart failure in the elderly;to describe the clinical aspects;describe etiologies;describe the therapeutic aspects;and describe the evolution of heart failure among the elderly. Method: This was a retrospective study over five years on the operating records of patients hospitalized in the internal medicine department of Hospital Point G. Result: The study included records of 22 elderly patients who were with heart failure of a total of 595 patients hospitalized from 1st January 2008 to 31st December 2012. The prevalence rate was 3.7%, and the average age was 67 ± 7.79 years. The sex ratio was equal to 1. HTA accounted for the cardiovascular risk factors in 77.3%. 72.7% of patients had the symptom of dyspnea and 95.5% of patients had the symptom of IMO. According to the cardiac ultrasound, dilation of the OG represented 68.2% of cases, followed by impaired LVEF (63.6%). The etiologies of IC were represented by dilated cardiomyopathy (95.5%), followed by 13.6% in cardiothyreosis. Drug treatment was dominated by the use of diuretics, ACE inhibitors and sodium diet respectively 95.5%;81.8% and 45.5% of cases. The clinical outcome was favorable in 73%. We recorded four (4) cases of death, which accounted for 18% of patients.

关键词： Heart Failure Clinic Etiology Therapeutics The Elder

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Hemoglobinopathy and Systemic Lupus: A Rare Association

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Open Journal of Internal Medicine 2019年第3期9卷 72-77页

作者： Assétou Kaya Soukho Ibrahima Amadou Dembele Djenebou Traore Nounga Romuald Nyanke Djibril Sy Abasse Sanogo Mamadou Cissoko Barry Boubacar Sangare mamadou Malle Sékou mamadou Cisse Abdramane Traore Mahamadou Saliou Nanko Doumbia Brehima Boly Berthe Kaly Keita Boubacar Zoumana Cisse Drissa Sangare Youssouf Fofana Kokou Tbah Tighankpa Adramé Keita mamadou Keita mamadou Dembele Abdel Kader Traore Hamar Alassane Traore Department of Internal Medicine Point G University Teaching Hospital Bamako Mali

The authors report a case of systemic lupus associated with a composite heterozygosis SC with thalassemic component in a 19-year-old patient hospitalized for anemia and polyarthralgia who has a staturoponderal delay, macular erythematous lesions in butterfly wings on the face and ears, photosensitivity, puffy face, alopecia, pubic and axillary hair loss, scalp dermatophytosis, painful swelling of the interphalangeal joints, wrists and knees. The hemoglobin electrophoresis showed a compound heterozygote SC associated with β thalassemia. Antinuclear antibodies were positive with an anti-Sm positive antibody. Conclusion: The diagnosis of both diseases can be difficult when symptoms are concomitant and look alike.

关键词： Hemoglobinopathy Lupus University Teaching Hospital Point G

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Anemia in the Elderly: Frequency and Etiologies at University Hospital Center of Point G

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Open Journal of Clinical Diagnostics 2019年第4期9卷 115-125页

作者： Sy Djibril Traore Abdel Kader Kaya Assetou Soukho Traore Djenebou Gozo Jean-Jonathan Cocou Keita Zakaria Dembele Ibrahima Amadou cissoko mamadou Keita Kaly Sangare Barry Boubacar Malle mamadou Sy Seydou Dembele mamadou Traore Hamar Alassane Department of Internal Medicine of University Hospital Center of Point G BamakoMali General Secretary of the Association“Rabies in West Africa—Mali” BamakoMali Department of Nephrology of University Hospital Center of Point G BamakoMali

Introduction: Older people are exposed to particular health problems that must be taken into account, including anemia defined by the World Health Organization (WHO) in people aged 65 and over hemoglobin < 13 g/dl in men and < 12 g/dl in women. Objectives: To determine the frequency of anemia, to describe its clinical and paraclinical aspects, and to determine the etiologies. Material and Methods: We conducted a cross-sectional study with prospective data collection that took place in the Department of Internal Medicine of the Point G CHU in Mali from January 1st, 2018 to August 31st, 2018, covering all elderly patients. At least 65 years old hospitalized and/or having consulted and presenting with anemia. Anemia was defined as Hb < 13 g/dl in men and < 12 g/dl in women (WHO definition). Biological markers were collected at admission. Results: Anemia was observed in 42 patients in 160 elderly patients, a prevalence of 26%, the age of our patients ranged from 65 to 90 years. The sex ratio was 1.33. Fifty percent (50%) of the patients had high blood pressure as antecedents. Weight loss was found in 69% of cases;47.6% of patients had dyspnea on admission. Tachycardia was the physical sign associated with anemia present in 85.7% of them. The mean hemoglobin level was 9.2 g/dl ± 2.03: thus 50% of the subjects had microcytic and or hypochromic anemia. The etiologies found were infectious in 31.0% of cases, inflammatory in 31.0% of cases, renal in 14.2% of cases. Chronic hemorrhage, acute haemorrhage, hemolysis accounted for 2.4% each. We observed 9.5% of unexplained causes. Conclusion: The frequency of anemia is high. Nearly half of the geriatric population has anemia. The lack of means and the nonperformance of the technical platform to perform all examinations in the etiological research of anemia have a significant impact on the rate of unexplained anemias.

关键词： Anemia Elderly Internal Medicine CHU Point G

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