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Efficacy and Risk Factors Associated to Resistance to Single-Agent Chemotherapy in Low-Risk Gestational Trophoblastic Neoplasia

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Open Journal of Obstetrics and Gynecology 2016年第1期6卷 50-55页

作者： Mamour Gueye mame diarra Ndiaye-Gueye Serigne Modou Kane-Gueye Fatou Niass Dia Aissatou thiam Sr. Elisabeth Diouf Jean Charles Moreau Gynecologic and Obstetric Clinic Aristide Le Dantec Teaching Hospital Cheikh Anta Diop University Dakar Senegal

Objectives: This study aimed to assess efficacy of intramuscular methotrexate 8-day protocol in the treatment of low-risk gestational trophoblastic neoplasia and also identify prognostic factors associated with treatment failure, necessitating second line chemotherapy. Methods: This study was performed at Gynaecologic and Obstetric Clinic of Dakar Teaching Hospital, the reference Centre of Gestational Trophoblastic Disease in Senegal. At the beginning of 2011, patients were followed according to FIGO’s recommendations. From 2011 to 2014, we diagnosed 88 low-risk gestational trophoblastic neoplasia (GTN) patients (WHO score < 7). Low-risk patients started their treatment with methotrexate (MTX) based on the 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day. Resistance to treatment was the main outcome. We studied the association of different prognostic factors included in the World Health Organisation (WHO) scoring system and resistance to the initial single agent chemotherapy. Results: Eighty-eight patients were diagnosed for GTN during the study period. Average age was 31 years. The antecedent pregnancy was molar in 98.1% of cases. Seventy-four patients underwent remission after single agent-chemotherapy. Resistance rate to single-agent chemotherapy was 15.9% (14 patients). Nine of them achieved remission after second line chemotherapy. WHO score was significantly associated with the risk of resistance to single-agent chemotherapy. Other variables included in the WHO as age, antecedent pregnancy, pre-treatment hCG, tumour size and FIGO stage were not significantly associated with resistance. We report five fatal cases. Conclusion: The 8-day protocol consisting of 1 mg/kg MTX in combination with 0.1 mg/kg folinic acid (FA) every other day is effective for women with LRGTN. The only significant prognostic factor for failure is pretreatment WHO score. We highly recommend the use of this protocol particularly in de

关键词： Gestational Trophoblastic Neoplasia Chemotherapy International Federation of Gynecology and Obstetrics Resistance

How to Avoid Primary Caesarean Section? A Five-Year Experience Report from a Level 2 Facility in Dakar Senegal

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Open Journal of Obstetrics and Gynecology 2017年第12期7卷 1174-1182页

作者： mame diarra Ndiaye Gueye Mamour Gueye Magatte Mbaye Abdelouahed Chraibi Aliou Diouf Mouhamadou Wade Moussa Diallo Omar Gassama Mor Cisse Youssoupha Toure Moustapha thiam Jean Charles Moreau Gynecologic and Obstetric Clinic Aristide Le Dantec Teaching Hospital Cheikh Anta DIOP University Dakar Senegal

Objectives: The aim of this study was to analyse key factors and main indications of primary caesarean sections and find out ways to reduce the rising rates. Patients and method: This was a longitudinal and retrospective study carried out from 1 January 2012 to 31 December 2016. The study included all patients in whom a primary CS was performed. A previous uterine scar was a non-inclusion criterion. We analysed the main indications and their trends during these five years, Apgar score at the 5th minute according to the course of caesarean section rate and the impact of daily audit. Data were collected retrospectively from 2012 to 2015, then prospectively in 2016 using a Filemaker database. Data were analysed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentage for qualitative ones. The statistical tests used were the Pearson Chi2 test. The differences observed were considered significant when the p value was less than 0.05. Results: During the study period, we registered 21.308 deliveries and 6.292 caesarean sections (29.5%). Primary CS concerned 72.5% of overall CS. The main indications were suspicious of fetal distress (29.1%), obstructed or prolonged labour (21.7%), breech and twin delivery with respectively 8.2% and 5.2%. We registered more vaginal deliveries with induction of labour: 81.4% versus 75.2%. An obstetrical audit allowed better management of labour and decrease of CS rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation in twin delivery and singleton. The induction of labour can be an effective alternative in some indications. An obstetrical audit is necessary to reverse caesarean section rate.

关键词： Caesarean Section Rate Indications Apgar Score Obstetrical Audit

Report of a New Case of Interlocking Heads in a Breech-Vertex Twin Delivery: A Conversation with My Residents

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Open Journal of Obstetrics and Gynecology 2021年第1期11卷 40-47页

作者： Mamour Gueye Mouhamadou Wade Aissatou Mbodji mame diarra Ndiaye Ndiémé Mbaye Mor Talla Ndiaye Rahadat Ibrahim Amadou Lamine Cisse Aliou Djiby Dia Aliou Cisse Moussa Diallo Omar Gassama Ousmane thiam Magatte Mbaye Philippe Senghor Health Center Cheikh Anta Diop University Dakar Senegal

“Locked twins” is a rare event occurring in about 1 in every 1000 twin births. A 21-year-old primigravida with a 31-week twin pregnancy was admitted for delivery. The head of the first twin was locked to the chin of the second twin at the top of the symphysis pubis. Caesarean section was performed allowing the delivery of both dead twins. Twins gestations with first twin in the breech presentation raise index of suspicion of potential locked twin. However, management of such situation is controversial with most authors and colleges recommending caesarean section to avoid interlocking heads. We report another rare case of interlocking heads and bring up the topic about management of breech-first twin deliveries.

关键词： Interlocking Heads Breech Presentation Twins Recommendations

Therapeutic Compliance of Hypertensive Patients Followed in Ambulatory in the Cardiology Department of Kati University Hospital

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World Journal of Cardiovascular Diseases 2024年第5期14卷 333-342页

作者： Boubacar Sonfo Coumba thiam Mariam Sako Massama Konaté Youssouf Camara Mamadou Touré Boubacar diarra Diakaridja Sacko Samba Sidibé Bassan diarra Hamidou Camara Asmaou Keita Konimba diarra Hamidou Oumar Bâ Ibrahima Sangaré Youssouf Guindo Sanoussi Daffe Daouda Fofana Souleymane Coulibaly Ichaka Menta Department of Cardiology University Hospital Bocar Sidy Sall Kati Mali Department of Cardiology University Hospital of Point G Bamako Mali Department of Cardiology Mali Hospital Bamako Mali Department of Cardiology University Hospital Mother-Child Luxembourg Bamako Mali Department of Cardiology University Hospital Gabriel Tour&#233 Bamako Mali Department of Cardiology Kayes Hospital Kayes Mali

Introduction: High blood pressure is a major public health problem worldwide due to its frequency and cardiovascular complications. Adherence to treatment for chronic diseases is a global problem. The aim was to study therapeutic adherence in hypertensive patients followed in ambulatory. Materials and Methods: This was a cross-sectional, descriptive study with prospective recruitment that took place from July 1 to December 31, 2022 (6 months) in the cardiology department of the university hospital of Kati. The variables studied were sociodemographic data, cardiovascular risk factors, comorbidities, the possession of insurance and compliance (the Girerd questionnaire was used to assess adherence). Results: A total of 1182 patients were consulted, including 887 for hypertension, a frequency of 75%. Fifty-six patients were included in the study. The average age was 58.18 ± 13.25 years with extremes of 30 and 80 years. There was a female predominance (75%) with a sex ratio of 0.3. The majority of patients lived in urban areas (89.3%). Out-of-school patients accounted for 44.6%, more than half of patients or 55.4% had no income, patients with medical coverage accounted for 67.9% of cases. The main risk factors were physical inactivity (25%) followed by smoking 14.3%. More than 71% of patients had a compliance problem and the main reasons were forgetting to take the drug with 73.2%, followed by delayed treatment of 50% and drug discontinuation of 28.6%. Conclusion: Compliance is a real challenge and a major public health issue. This study allowed us to find a real problem of compliance in our hypertensive patients. There was a statistically significant relationship between drug adherence and forgetting to take the drug and drug discontinuation.

关键词： Hypertensive Therapeutic Adherence University Hospital of Kati

Double Discordance with Pulmonary Stenosis: About a Clinical Case

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World Journal of Cardiovascular Diseases 2020年第12期10卷 825-830页

作者： Asmaou Keita Maiga Boubacar Sonfo Daffé Sanoussi Fofana Daouda Diallo Souleymane Terra Abdoul Wahab thiam Coumba Ba Hamidou Touré Mamadou Camara Youssouf Mamadou Bocary diarra Cardiology Department CHU Mère - Enfant Bamako Mali Cardiology Department of CHU Kati Bamako Mali Cardiology Department CHU Gabriel Touré Bamako Mali

Introduction: Double discordance or corrected transposition of the great vessels is a rare congenital heart disease. It is an atrioventricular and ventriculo-arterial mismatch. It is a complex and unusual form of congenital heart disease. Often asymptomatic, in its isolated form, bradycardia, murmur and cyanosis can be a mode of revelation. Case presentation: We report the case of an 11-year-old child, asymptomatic at birth, after he started to have dyspnea on exertion, recurrent bronchitis, motivating a cardiological consultation. On cardiac physical examination, the heart sounds regular, not rapid at 81 BPM with a grade 3-4/6 systolic murmur at the 4th left EIC (Intercostal space). EKG (electrocardiogram) shows PR interval at 0.20 seconds. Cardiac ultrasound reveals atrioventricular discordance, vascular malposition, anterior aorta, the two vessels placed side by side, minimal pulmonary insufficiency, a small leak at the levels of the mitral and tricuspid valves, dystrophic pulmonary valves with an average gradient of 91 mmHg, max at 158 mmHg. Regular follow-up has been recommended through the performance of a clinical examination and cardiac ultrasound. Conclusion: The double discordance can be asymptomatic, and survival can be long in the isolated forms, but the evolution is not always benign, especially in the associated forms. It depends on the function of the systemic right ventricle and associated abnormalities.

关键词： Double Discordance CHU ME Luxembourg Bamako

Contribution of Stress Testing to the Management of Ischemic Heart Disease in Mali

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World Journal of Cardiovascular Diseases 2024年第2期14卷 77-87页

作者： Youssouf Camara Hamidou Oumar Ba Ibrahima Sangaré Boubacar Sonfo Coumba Adiaratou thiam Mahamadou Sékou Diakité Koniba diarra Karamba Touré Massama Konaté Ichaka Menta Cardiology Department University Hospital Professeur Bocar Sidi Sall Kati Kati Mali Cardiology Department University Hospital Gabriel Touré Bamako Mali Cardiology Department Mali Hospital Bamako Mali

Introduction: Exercise stress testing (on a treadmill or ergometer bicycle) is an important test in cardiology for diagnosing myocardial ischemia. This test in Mali is still in its beginning compared to other countries in the sub-region. The lack of data in Mali prompted this study, which aimed to evaluate the indications of this activity and its diagnostic contribution to cardiology in Mali. Materials and Methods: This was a retrospective, descriptive study. The study was conducted at the “TOUCAM” medical clinic in Kati based on the analysis of stress test reports between January 2016 and August 2022. Result: During the study period, we documented 73 patients who underwent exercise testing on a bicycle ergometer for suspected coronary heart disease. The mean age of our patients was 47.5 ± 13.8 years (14 and 79 years). Males accounted for the majority (78.1%). The sex ratio is 3.5. More than half of our patients were overweight or obese (77.1%). Hypertension and diabetes affected 52.1% and 25.8% of patients, respectively. 20.8% of patients had coronary artery disease. renin-angiotensin-aldosterone system blockers (56.8%) and beta-blockers (51.3%). The main indications were chest pain (63.0%) and ischemia detection (15.1%). A modified STEEP protocol was used. The majority of our patients (71.2%) achieved at least 85% of their maximum theoretical heart rate. The main reason for the termination of the study was fatigue (57.3%). The average duration was 11.3 ± 4.2 minutes. 24.7% thought the stress tests were positive and 17.8% thought they were controversial. Conclusion: This study demonstrates the importance of stress testing in the diagnosis and treatment of ischemic heart disease, especially in settings where we have very limited access to coronary angiography.

关键词： Stress Test Ischemic Heart Disease Mali

Clinical and Therapeutic Aspects of Inguinal Hernia at the Reference Health Centre of Commune II of the District of Bamako

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Surgical Science 2022年第5期13卷 265-271页

作者： Idrissa Tounkara Boubacar Karembe Souleymane thiam Sayon Diakite Abdoulaye diarra Amadou Traore Konimba Keita Oumar Ongoiba Moussa Sanogo Moussa L. Coulibaly Bakary Tientigui Dembele Adégné Togo Reference Health Center of Commune II Bamako Mali Commune III Reference Health Centre Bamako Mali University Hospital Center of Gao Gao Mali University Hospital Center of Kati Kati Mali University Hospital of Gabriel Touré Bamako Mali Regional Hospital of Tombouctou Tombouctou Mali

Objective: To study the diagnostic and therapeutic aspects of uncomplicated inguinal hernias in the general surgery unit of CSRéf CII. Method: This was a prospective, descriptive, single-centre study from 1 January 2016 to 31 December 2016 of 84 patients operated on for inguinal hernias in the general surgery unit of CSRéf CII. Results: Inguinal hernia accounted for 8% of surgical consultations and hernia repair accounted for 30.22% of surgical procedures. Hernia repair accounted for 30.22% of surgical procedures. The male sex was the most represented with a ratio of 7.40. The average age of our patients was 43.19 years. Recurrence occurred in 10% of cases. The right side was most affected in 71.43% of cases, 19.05% on the left side in;it was bilateral in 09.52%. Local anaesthesia was used in 67.86% of our patients, general anaesthesia in 13.09% of cases and locoregional anaesthesia in 19.05% of cases. The hernia was external oblique in 75% of cases. Shouldice’s technique was the most used with 88%;Bassini’s technique was used in 7% and Mac Vay’s in 5% of cases. The postoperative course was simple in 96.43% of cases, with an early postoperative morbidity rate of 3.57%, one case of wall abscess and two cases of parietal haematoma. No deaths were observed during our study. Conclusion: The new methods of tension-free cure should be used more and more by our users in our facilities.

关键词： Inguinal Hernias Strangulation Management CSRéf CII

Prevalence, Pattern and Evolution of Rheumatic Heart Disease: About 120 Cases at Mother-Children University Hospital Luxembourg (MC UHL), Bamako (Mali)

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World Journal of Cardiovascular Diseases 2018年第7期8卷 319-327页

作者： Ba Hamidou Oumar Maiga Asmaou Kéita Doumbia Coumba thiam Maiga Salma Souleimane Sidibé Noumou Sangaré Ibrahima Camara Youssouf Sidibé Salimata Diallo Souleymane Menta Ichaka diarra Mamadou Bocary CHU Gabriel Touré Bamako Mali CHU Mère Enfant le Luxembourg Bamako Mali CHU Sidy Bocar Sall Kati Mali

Introduction: Acute rheumatic fever (ARF) and its complications including rheumatic heart disease (RHD) remain one of the leading causes of cardiovascular disease worldwide. In our setting with no cardiac surgery, data on RHD are therefore important to point out the need for such structure. In this study, we therefore describe rheumatic disease in terms of prevalence, patients’ characteristics and management of patients. Methods: We performed a retrospective study from May to September 2012, involving children aged 3 to 15 years old and seen at the Mother and Child University Hospital Luxembourg (MC UHL). Included were all children diagnosed with RHD. The diagnosis of rheumatic fever (RF) was defined using the revised Jones criteria from 1992 and RHD defined according to the WHO/NIH joint criteria. Data of interview, clinical examination, complementary and those on evolution were recorded. Results: We found an hospital prevalence of 6.2%. Mean age was 15.33 years ± 6.005 (3 to 36), females representing 54.2% and students 70%. Mitral regurgitation (MR), Mitral Stenosis (MS) and concomitant MR + MS were most found RHD with resp. 43.3%, 15% and 13.3%. Complications occurred in 74.1% before surgery. An operative indication was set in 90% of all cases whereas only 36% underwent surgery. After surgery immediate complications were dominated by anemia (11.6%) and late ones by heart failure in 18.5% of cases. Conclusion: Despite advances in medical diagnostic approach and therapeutical progress which partly explained the relatively high prevalence, the evolution of rheumatic heart disease in our context is unfavorable due to the lack of a surgical management structure. While waiting for a cardiology institute, the focus should be on information and awareness in primary prevention.

关键词： Retrospective Acute Rheumatic Fever Rheumatic Heart Disease Bamako

Epidemioclinics, Etiologies and Prognosis of Cardiogene Shock State in the Intensive Care Unit of the Cardiology Department of the G-Spot Hospital

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World Journal of Cardiovascular Diseases 2021年第1期11卷 20-24页

作者： Mariam Sako Massama Konaté Boubacar Sonfo Samba Sidibé Nouhoum Diallo Fatoumata diarra Mamadou Diakité Coumba Adiaratou thiam Asmao Keita Ibrahima Sangaré Hamidou Omar Bâ Youssouf Camara Yves Roland Koumaré Alou Sangaré Boureïma Dembélé Ami diarra Souleymane Coulibaly Ichacka Minta Cardiology Department Point “G” Hospital University Center Bamako Mali Cardiology Department Hospital MALI Bamako Mali Cardiology Department Hospital KATI Bamako Mali Cardiology Department Hospital LUXEMBOURG Bamako Mali Cardiology Department Gabriel Touré Hospital University Center Bamako Mali

Objective: The work aimed to describe the etiological and evolutionary aspects of cardiogenic shock in the intensive care unit of the cardiology department (USIC) of the G-spot hospital in Bamako, Mali. Materials and Methods: This was a descriptive cross-sectional study from January 1, 2018 to April 30, 2019 that included all patients admitted to the USIC during this period. Each patient benefited from individual data support with systematic recording of socio-demographic, clinical, complementary and therapeutic data and analyzed with the SOFTWARE SPSS 20.0 French version. Results: The study involved 40 patients out of 311 patients hospitalized in USIC, representing a hospital frequency of 12.86%. Males were the most affected (60%) with a sex ratio of 1.50. The modal class was 41 - 60 years with extremes at 18 years and 89 years. Cardiovascular risk factors were dominated by HTA (27.50%), diabetes and tobacco, each with 22.50%. The general signs were tachycardia (90%), oxygen desaturation (77.50%), impregnable blood pressure (62.50%), agitation (52.50%) and an oliguria (70%). At the electrocardiogram the rhythm was sinus (80%), it was an atrial fibrillation (15%), a ventricular tachycardia (10%) and signs of coronary ischemia (necrosis in 35% and ST over shifted in 20% of cases). At cardiac doppler ultrasound,the left ventricle was dilated (50%), the right cavities dilated (30%), segmental kinetic disorder (40%), the left ventricular systolic function (FEVG) impaired (75%) and valve disease (10%). Biology noted hyper-creatinemia (65%), hyper-glycemia (12.50%), anemia and hyponatremia with 20% frequency each. Among etiology, ischemic heart disease accounted for 57.50% followed by pulmonary embolism 20%, dilated valve cardiomyopathy 7.50% and chronic pulmonary heart 2.50%. The trend in the majority of cases was unfavorable with 60% of deaths. Chronic pulmona

关键词： Cardiogenic Shock Etiology Prognostic USIC Hospital Point G