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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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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

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Urological Complications of Female Genital Mutilation: A Case Report of 15 Patients

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Open Journal of Urology 2024年第9期14卷 499-506页

作者： Mamadou Tidiani Coulibaly Issa Amadou Maimouna Traore Falaye Sissoko Dramane Cisse Urological Surgeon at the Urology department of CHU gabriel tour Bamako Mali

Objective background: This was a retrospective study of the clinical and therapeutic aspects of urological complications of female genital mutilation in the urology department of Bamako’s gabriel touré university hospital. Methods: Our study took place from 2002 to 2017 in the urology department of the gabriel touré university hospital in Bamako and concerned cases of complications of female genital mutilation. Our study included all girls or women presenting with urinary disorders related to complications of genital mutilation and received in urological consultation and surgical management. Results: The average age of our patients was 2.5 years, with extremes ranging from 3 months to 35 years. The oldest patient had presented with dystocia during both deliveries. Acute urine retention (n = 7) was the most frequent reason for consultation. Other signs included urinary incontinence, pollakiuria and burning. Physical examination revealed clitoridectomy and abrasion of the labia minora in 13 patients. Type III of the WHO classification of female genital mutilation was the most frequent and corresponded to infibulation.

关键词： Acute Retention of Urine Clitoridectomy Female Genital Mutilation

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Interest of Transcranial Doppler (TCD) in Emergency in Traumatic Brain Injury Patients at gabriel touré university hospital, Bamako, Mali

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Open Journal of Emergency Medicine 2024年第3期12卷 114-121页

作者： Abdoulhamidou Almeimoune Moustapha Mangane Madane Thierno Diop Mahamadoun Coulibaly Amadou Gamby Dramane Sanogo Alfousseini Soumare Adama Coulibaly Ababacar Salaha Harouna Sangaré Diango Djibo Mahamane department of intensive care Anesthesia and Emergency Medicine CHU Gabriel Toure Bamako Mali Faculty of Medicine and Odontostomatology University of Sciences Techniques and Technology of Bamako Bamako Mali department of intensive care Anesthesia CHU Luxembourg Luxembourg City Luxembourg

Introduction: Transcranial Doppler is a simple, non-invasive and inexpensive examination which allows the assessment of cerebral perfusion. In countries with limited resources, which do not have a means of monitoring intracranial pressure, this examination offers hope of survival for patients with traumatic brain injury. This study was designed to investigate the incidence of early cerebral circulation abnormalities after traumatic brain injury using transcranial Doppler (TCD). Methodology: A descriptive and analytical study was conducted over one year, including patients with traumatic brain injury and an initial Glasgow Coma Scale (GCS) score of less than 15. Non-inclusion criteria: Stroke, brain tumor, cerebral abscess. Exclusion criteria: Inadequate insonation window. Results: Out of 854 traumatic brain injury patients admitted to the emergency department, 112 were included in the study. The average age was 30.14 years, with a sex ratio of 4.1. Initially, 83.5% had moderate traumatic brain injury, and 12.1% had severe traumatic brain injury. Brain CT scans were performed in 95.7% of the patients. Edematous-hemorrhagic contusion was observed in 95% of the patients. On initial TCD, the pulsatility index in the middle cerebral artery was greater than 1.3 in 49.4% of the patients. Diastolic velocity was less than 20 cm/s in 46.4% of cases, and mean velocity was greater than 150 cm/s in 8.7% of cases. In this group, low diastolic velocity indicated cerebral hypoperfusion suggestive of intracranial hypertension. When the pulsatility index was greater than 1.9, no patient had a normal diastolic velocity. Among patients with severe traumatic brain injury, 61.5% had an abnormal pulsatility index compared to 42.3% of patients with moderate traumatic brain injury. Conclusion: TCD is a simple tool for analyzing intracerebral hemodynamics.

关键词： Traumatic Brain Injury TCD Neuroresuscitation Sub-Saharan Africa

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Opinions of Students on the Contribution of the DIVA 3D Virtual Dissection Table to the Teaching of Anatomy at the Faculty of Medicine and Odontostomatology of Bamako

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Forensic Medicine and Anatomy Research 2024年第2期12卷 13-25页

作者： Abdoulaye Kanté Tata touré Ousmane Toumany Chérif Haidara Uhl Jean François Mariam Daou Mamadou A. Keita Bakary Keïta Bréhima Bengaly Drissa Traoré Adégné Togo Nouhoum Ongoïba Faculty of Medicine and Odontostomatology of Bamako Bamako Mali university of Paris Descartes Paris France department of Neurology The Gabriel Tour&#233 University Hospital Bamako Mali department of General Surgery The Kati Health Center Bamako Mali Anesthesia-Resuscitation Service Commune I Reference Health Center Bamako Bamako Mali department of General Surgery The Gabriel Tour&#233 University Hospital Bamako Mali

Objective: Study the contribution of the DIVA 3D dissection table in the teaching of anatomy at the Faculty of Medicine and Odontology of Bamako. Material and Methods: This was a qualitative study carried out from November 1 to December 30, 2023 at the clinical and morphological anatomy laboratory of the Faculty of Medicine and Odontostomatology of Bamako. Included in this study were students who participated in practical and tutorial sessions. The variables studied during this study were: the previous performance of dissection on a cadaver by the students, the opinion of the students on dissection on a cadaver, the replacement of dissection on a cadaver by virtual dissection in the absence of a body, the level student satisfaction. Results: We surveyed 130 participants. The average age was 22 ± 0.2 years with extremes of 17 and 29 years. 95.3% of participants were students. According to 66.7% of participants, virtual dissection is a good palliative in the absence of a corpse. 95.3% of participants found using the virtual dissection table easy with an average of 7.88 ± 1.4. The overall assessment was well rated by 99.3% of participants. Conclusion: According to the results of this study, the virtual dissection table should be improved by integrating commented videos. The use of the DIVA 3D virtual dissection table during practical and tutorial sessions is well appreciated by the students. We believe that the teaching of anatomy using 3D digital technology should be included in the study programs of the Faculty of Medicine and Odontostomatology.

关键词： Student Opinion Contribution DIVA 3D Virtual Dissection Table Anatomy Teaching FMOS

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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

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Pericarditis in Cardiology at a Regional hospital

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World Journal of Cardiovascular Diseases 2024年第9期14卷 581-587页

作者： Coulibaly Souleymane Traoré Djénébou Konaté Massama B. A. Hamidou Oumar Guindo Aissata Yves Roland Koumaré Sidibé Samba Sako Mariam Sanogo Alpha Kodio Aniéssa Mahamadou Yaya Kéita Diakité Mamadou Menta Ichaka department of Cardiology CHU Point G Bamako Mali department of Internal Medicine CHU Point G Bamako Mali Mali hospital Medical department Bamako Mali department of Cardiology Gabriel Tour University Hospital Bamako Mali department of Cardiology Nianankoro Fomba Hospital Sgou Mali

Introduction: Pericarditis is an inflammation of the pericardium with or without pericardial fluid effusion. Its prevalence is difficult to determine given the many forms that are not symptomatic. In Africa, its prevalence was 6.3% in Gabon in 2020 and 7.2% in Mali in 2022. In Europe, an Italian study estimates the incidence of acute pericarditis at 27.7 cases per 100,000 people per year. In another study conducted in Finland over a period of 9 years, the incidence of pericarditis requiring hospitalisation was 3.32 cases per 100,000 people per year. The aim of our study was to describe the clinical and paraclinical characteristics of pericarditis observed in the cardiology department of the regional hospital in Mali. Methodology: This was a single centre cross-sectional study from 30 January 2018 to 30 June 2020 in the cardiology department of the Ségou regional hospital. All consenting patients, regardless of age or sex hospitalised in the department for pericarditis confirmed on cardiac ultrasound were included. Data were collected using an individual patient follow-up form recording sociodemographic, clinical, biological, electrocardiographic and echocardiographic data, as well as the course of the disease. Results: Out of 879 patients hospitalized, the hospital frequency was 7.28%. Females predominated, with a sex ratio of 0.42. More than half the patients were aged 45 or younger (59.4%). The mean age of patients was 41.8 ± 18.1 years. Cardiovascular risk factors were dominated by hypertension and smoking (46.9% and 12.5% respectively). The reasons for consultation were dyspnoea (84.3%), chest pain (54.7%), cough (71.9%) and fever (34.4%). Physical signs included muffled heart sounds (76.6%), tachycardia (70.3%), pericardial friction (17.2%) and signs of peripheral stasis in 53.1% of cases. We observed elevated C-reactive protein (CRP) in 57.8% of cases, hypercreatininaemia in 37.5% and positive HIV serology in 3.1%. The major radiographic signs were cardiomegal

关键词： Pericarditis Epidemiology Clinic Nianankoro Fomba hospital Ségou

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Duplication of the Urethra in Boys: A Case Report

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Open Journal of Urology 2024年第6期14卷 353-358页

作者： Mamadou Tidiani Coulibaly Falaye Sissoko Moumine Diarra Adama Toutou Diallo Issa Amadou Amadou Berthé Sory Koné CHU gabriel tour Urology Department Bamako University of Science Technology and Engineering Bamako Mali Lafiabougou Reference Health Center Bamako University of Science Technology and Engineering Bamako Mali CHU gabriel tour Pediatric Surgery Bamako University of Science Technology and Engineering Bamako Mali Korofina Reference Health Center Bamako University of Science Technology and Engineering Bamako Mali Segou Regional hospital Bamako University of Science Technology and Engineering Bamako Mali

Supernumerary urethra in boys is a very rare anatomical entity. Sagittal urethral duplications are classified into four groups: epispadias, hypospadias, fusiform and Y-shaped urethra. The most widely used classification is that of Effmann and Lebowitz, which describes 6 types, one of the rarest being the ‘Y’ subtype IIA2, which corresponds to a duplicated urethral path from the vesical neck to an ectopic perineal or anal outlet. We report here the case of a 4-year-old child presenting with subtype IIA2 with a perineal orifice and no other urinary disorders.

关键词： Duplicity Ureter Malformation

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Pleomorphic Adenoma of the Salivary Glands: Two Atypical Locations

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International Journal of Otolaryngology and Head & Neck Surgery 2024年第3期13卷 251-257页

作者： Sidibé Youssouf Diarra Abraham Samaké Djibril Sanogo Boubacar Traoré Abdoul Moumine Diarra Kassim Coulibaly Bourama Diakité Youssouf Keita Mohamed Amadou department of ENT and Head and Neck Surgery Mother-Child university hospital “ Le Luxembourg&#8221 Bamako Mali Faculty of Medicine and Odontostomatology Bamako Mali department of ENT and Head and Neck Surgery The Mali-Gavardo Hospital Bamako Mali Ministry of Higher Education and Scientific Research Bamako Mali ENT and Head and Neck Surgery department of the Commune V Reference Health Center (CSRef CV) Bamako Mali department of ENT and Head and Neck Surgery at CHU gabriel touré Bamako Mali department of Anatomy and Pathological Cytology Gabriel Tour&#233 University Hospital Center Bamko Mali department of Oral Surgery Sikasso Regional Hospital Sikasso Mali

Pleomorphic adenoma is the most common tumor of the salivary glands, accounting for approximately 50% of salivary gland lesions. It develops mainly in the salivary glands: parotid (80%), submaxillary (10%), sublingual (1%) and in the accessory oral-pharyngeal glands (9%). The aim of this work was to report 2 cases of pleomorphic adenoma of atypical location and then to discuss the difficulties linked to its diagnostic and therapeutic management in the Malian context. They were a 40-year-old man and a 72-year-old woman. They were admitted to the ENT department of the “Luxembourg Mere-infant” hospital for oropharyngeal swelling for the first and swelling of the palate for the second. The clinical expression was a swelling in both cases, of a hard, mobile consistency with healthy mucosa on their surface. The remainder of the physical examination was unremarkable. The diagnosis of a tumor of the oropharynx and palate was made following clinical radiological examinations. The histopathological examination of the surgical specimen made it possible to make the diagnosis of pleomorphic adenoma of the palate and the left palatine tonsil. The follow-up surgery was straightforward, with a favorable outcome. Pleomorphic adenomas are relatively rare benign tumors of the accessory salivary glands;their clinical expression remains swelling. Therapeutic management is surgery and the diagnosis is confirmed by histopathological examination.

关键词： Pleomorphic Adenoma Palate Tonsil Mali

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Therapeutic Profile and Prognostic Factors of Patients Suffering from Upper Digestive Bleeding at Sikasso Regional hospital

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Open Journal of Gastroenterology 2024年第9期14卷 300-312页

作者： Oumar Traoré Abdoul Salam Diarra Dramane touré Tawfiq Abu Amadou Boubeye Maïga Kadiatou Cissé Saïdon touré Mohomedine touré Aboudou Dolo Youana Koné Madou Traoré Mamadou Togo Kalba Péliaba Mamadou Samaké Hamadoun Sangho Service of Internal Medicine Regional Hospital Sikasso Mali National Center for Scientific and Technological Research Bamako Mali department of Pediatric Health Referral Center of Kalaban Coro Koulikoro Mali Private Practice for Family and Emergency Medicine Casablanca Morocco Service of Nephrology Regional Hospital Sikasso Mali department of Infectious Disease Regional Hospital Sikasso Mali Service de Mdecine Interne CHU Gabriel Tour Bamako Mali Service dHpato-Gastro-Entrologie CHU Gabriel Tour Bamako Mali department of Public Health Faculty of Medicine and Odontostomatology University of Sciences Techniques and Technologies of Bamako Bamako Mali

Introduction: Upper digestive hemorrhage is one of the main digestive emergencies and remains a major cause of morbidity and mortality in Mali. The aim of this study was to describe the therapeutic profile and outcome of patients suffering from upper digestive haemorrhage. Methodology: This was a prospective study carried out in the internal medicine department of the Sikasso Regional hospital from August 2022 to July 2023. All adult patients presenting with upper digestive haemorrhage and having given their consent, were included. Data were analyzed using SPSS version 21 software. Results: Sixty-three patients were enrolled. The mean age was 49.7 ± 18.99 years, with a male-female sex ratio of 2.2. Ruptured esophageal varices (37.5%) and peptic ulcer (25%) were the main etiologies. Pharmacological treatment was dominated by proton pump inhibitors (85.7%). Hemostasis endoscopy accounted for 3.17%. The evolution was marked by hemorrhagic arrest (69.84%), recurrence of hemorrhage (11.11%) and death (19.04%), the main cause of which was hemorrhagic shock (58.3%). We found no statistically significant relationship between prognosis and etiologies (P = 0.11), and length of hospital stay (P = 0.18). Conclusion: Hemostasis endoscopy remains a challenge for Sikasso hospital. A holistic strategy of communication and community awareness-raising, combined with adequate technical facilities, will help to improve patient care and outcomes.

关键词： Digestive Hemorrhage Digestive Endoscopy Treatment Outcome

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