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Epidemio-Clinical Characteristics of Perinatal Anoxia and Immediate Outcome of Patients at Hospital Teaching Gabriel Toure of Bamako

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Open Journal of Pediatrics 2019年第4期9卷 326-336页

作者： L.N.Sidibe H.Diall1,D.Konate O.Coulibaly F.L.Diakite K.Sacko F.Traore O.H.Diallo L.Maiga I.Ahamadou I.Traore I.Kone1,B.Maiga P.Togo A.K.Doumbia A.Toure E.M.Cisse A.Dembele Y.A.Coulibaly A.Doumbie A.Konare1,A.A.Diakite B.Togo M.Sylla F.DickoTraore Department of Pediatrics CHU Gabriel ToureBamakoMali faculty of medicine and odonto-stomatology of mali BamakoMali

Introduction: Neonatal asphyxia (NA) is one of the most likely causes of neuro-developmental abnormalities in children. In mali it is responsible for half of the early deaths and the third of neonatal mortality. Updated data would help understand and improve intervention strategies to reduce mortality. Objective: It is the study of epidemiological and clinical characteristics, the immediate outcome and the factors associated with newborn (NB) mortality with NA. Material and Methods: This was a prospective cross-sectional study from June 27th to September 3rd 2016 about the NBs admitted for NA in the Hospital Teaching Gabriel Touré of Bamako. The clinical and biological data including the prognosis were collected from the health records of women, the liaison sheets and the medical file. The analysis was done using the software Epi info version 3.5.1. Results: 76 NBs were included which represented 23.45% of hospitalizations. The majority (89.5%, n = 68) were admitted to less than 24 hours of life for NA grade III according to the Sarnat classification (43.4%, n = 33). The average age of mothers was 24.17 ± 5.5 years. Almost half (41.3%, n = 31) were primigravida. The most common obstetrical event was dystocia (64.5%, n = 49). The prognosis was poor in grade III anoxia in our patients (56%) of deaths. Conclusion: The périnatal anoxia (PA) is a major health issue in mali because of its frequency and severity. Monitoring of pregnancies, delivery assisted by skillful and qualified personnel, mastery of neonatal resuscitation techniques are good means of prevention.

关键词： Anoxia Newborn Epidemiology Clinical Outcome

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

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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 Diakité 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

Operating Site Infections at General Surgery Department of Gabriel Toure Training Hospital

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Surgical Science 2015年第2期6卷 59-64页

作者： Bakary Tientigui Dembélé Alhassane Traoré Adégné Togo Lassana Kanté Ibrahim Diakité Bourama Diarra Amadou Traoré Madiassa Konaté Boubacar Karembé Yacaria Coulibaly Mamby Keita Souleymane Diallo Souleymane Diallo Gangaly Diallo faculty of medicine and odonto-stomatology Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Biology and Laboratory CHU Gabriel Touré Bamako Mali

The operating site infections constitute the major postoperative issue in surgery. Our objectives were to determine the hospital frequency, the risk factors, the involved germs as well as the cost generated by the operating site infections. Method: Our three months prospective survey run from September the 1st to November the 30th 2013 has included all department patients being operated on and hospitalized. The criteria have been set by CDC d’Atlanta. Results: 374 files were involved, among them 229 (61.2%) were emergencies and 145 (38.8%) were scheduled. The average age was 41 (extremes 7 and 95 standard deviation 17.46), the sex ratio 1.67. The infective risk according to Altmeier has found 17.5% type 1, 25.1% type 2, 11.2% type 3 and 46.3% type 4;according to NNISS, 96 (25.7) were NNISS 0;94 (51.9%) NNISS 1;80 (21.4%) NNISS 2;and 4 (1.1%) NNISS. In the Altmeier class I have not got antibiotic before infection signs appearances. Our overall rate of operating site infections was 7.9% (29 cases), with 24 (82.8%) emergency cases. According to Altmeier’s class of infective risk, the rate of operating site infections was 1.54% making 1 out of 65 type I patients;4.3% making 4 out of 93 type II patients;11.9% making 5 out of 42 type III patients;10.9% making 19 out of 174 type IV patients. According to NNISS, the infective risk has been assessed and was 2.08% for score 0, we have got 8.25% score 1, and 12.5% for score 2, and 25% for score 3. The bacteriology has been dominated by Escherichia colii(51.7), Proteus mirabilisi(13.8), and Klebsiella pneumoniaei(10.34). The germs have been resistant to the combination Amoxicillin-clavulanic Acid between 50% and 87% of cases. The most active antibiotics on the germs have been Cephalosporin, Polypeptides, and aminoglycosides. The hospital stay has been delayed to 12 days on average by operating site infections, making 2.5 times greater than those uninfected. The infection has increased the cost of management around 600 Euro.

关键词： Infections Operating Sites Bamako

Varicocele and Spermogram Abnormality: About 264 Cases at the Fertilia Medical Clinic in Bamako

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Open Journal of Medical Imaging 2023年第3期13卷 84-91页

作者： Mamadou Dembélé Alassane Kouma Ilias Guindo Souleymane Sanogo Zoumana Cheick Berete Ousmane Traoré Mamadou N’diaye Brahima Doumbia Oncoumba Diarra Issa Cissé Aboubacar Sidiki N’diaye Bandiougou Doucouré Youssouf Yalcouyé Adama Diaman Keita Siaka Sidibe faculty of medicine and odonto-stomatology of Bamako (FMOS) Bamako Mali Medical Imaging Department Kati University Hospital Kati Mali Department of Education and Research in Public Health (DERSP) Bamako Mali

Aims: To determine the impact of varicocele on the result of the spermogram in a group of hypo-fertile or infertile men. Patients and Method: This was a cross-sectional, descriptive study concerning 264 men collected between February 2020 and March 2022 at the Fertilia medical clinic in Bamako. The study population consisted of consenting male subjects presenting for infertility. All of our patients had already done a spermogram, they then benefited from a scrotal Doppler ultrasound. The scrotal echo-doppler was completed by an abdominal and pelvic echography in search of a possible etiology, in particular a renal cancer, a thrombosis of the renal or spermatic vein, a retroperitoneal mass or a nutcraker syndrome. Testicular volume was measured on ultrasound according to Lambert’s formula (length × width × height × 0.71). A volume = 16 ml was considered normal. Results: 264 patients were recruited in ours. The average age was 33 years with extremes ranging from 25 to 65 years. 149 patients or 56.44% were between 30 and 45 years old. 213 patients or 80.68% had primary infertility. All the patients, i.e. 100%, had a sperm anomaly and dilation of the pampiniform plexus veins. The most common sperm abnormalities were oligoasthenoteratozoospermia, which concerned 214 patients, or 81%, followed by azoospermia (40 patients, or 15%) and oligospermia (10 patients, or 4%). 213 patients or 80.68% had a Hirshen grade II varicocele, 45 patients or 17% had grade I and 06 patients or 2.27% had grade III. Among the 6 patients, 04 had left testicular atrophy and 2 bilateral atrophy. The venous reflux was more accentuated on the left than on the right. Conclusion: Varicocele is significantly found in men with infertility. Sperm alterations concern both the concentration of spermatozoa, their mobility and their vitality. Even if the mechanism of alteration of the sperm parameters is not well elucidated, our study made it possible to make the link between the dilation of the veins of th

关键词： Ultrasound Male Infertility Varicocele Oligoasthenoteratozoospermia

Fertility after Neosalpingostomy through Laparoscopic Way in Point “G” Teaching Hospital

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Surgical Science 2019年第2期10卷 49-58页

作者： Kéita Soumaila Traoré Youssouf Soumaré Lamine Koumaré Sekou Sacko Oumar Camara Aboubacar Camara Moussa Sissoko Moussa Abdoulaye Sissoko Koita Adama Sanogo Z. Zimogo Surgery Department “A” Point G Teaching Hospital Bamako Mali faculty of medicine and odonto stomatology of Bamako University of Science Technique and Technologies of Bamako (USTTB) Bamako Mali

The endoscopic surgery is actually the golden standard for the management of infertility. Its results look better than classical surgery. The aim of the study was to assess the fertility rate among infertile women who have undergone a laparoscopic distal tubal plasty and to estimate factors influencing this fertility. From January 2007 to December 2016 a descriptive and analytical cross sectional retrospective study was conducted in the departments of general and laparoscopic surgery of the Point “G” Teaching Hospital in Bamako, mali. Clinical records of 120 laparoscopic patients with distal tubal occlusion who have undergone a neosalpingostomy were collected. Average period of infertility was 6.7 years (from 1 to 25 years), and the average duration before laparoscopic surgery was 5 years. Main abnormalities were: 50 cases of bilateral tubal distal occlusion (41.7%), 14 patients with unilateral tubal distal occlusion (11.7%), 44 cases of bilateral hydrosalpinx (36.6%) and 12 cases with unilateral occlusion (10.0%). Seventeen patients had adhesions (14.1%) including 4.0% of tubo-peritoneal adhesions, 35.5% of tubo-ovary adhesions and Fitz Hugh and Curtis syndrom adhesions in 17.7% of cases. More than half of the patients (58.0%) had a grade II tubal score. Neosalpingostomy had led to bilateral tubal repermeabilization among 60.0% of the patients. Thirty two point five percent (39/120) pregnancies have been observed after the management. Conception probability was null after the 4th post operative year. The majority of pregnancies have been observed in the 11th month after laparoscopic management. During the follow-up, thirty one patients had intrauterine pregnancy (79.5%), four ectopic pregnancies and three miscarriages. The occurrence of pregnancy was influenced by the desire of the woman, the absence of co-morbidity, the tubal score, the result and the quality of the laparoscopic gesture and the duration of the fertility. Conclusion: In our working setting, neosalp

关键词： Fertility Laparoscopy Neosalpingostomy Pregnancy

Endometrial Status and Embryonic Implantation about 150 Cases at the Medically Assisted Procreation Laboratory “Le Diafounou”

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Open Journal of Medical Imaging 2023年第3期13卷 92-100页

作者： Mamadou Dembélé Alassane Kouma Ilias Guindo Souleymane Sanogo Zoumana Cheick Berete Ousmane Traoré Mamadou N’Diaye Brahima Doumbia Oncoumba Diarra Issa Cissé Aboubacar Sidiki N’diaye Bandiougou Doucouré Youssouf Yalcouyé Adama Diaman Keita Siaka Sidibe faculty of medicine and odonto-stomatology of Bamako (FMOS) Bamako Mali Medical Imaging Department Kati University Hospital Kati Mali Department of Education and Research in Public Health (DERSP) Bamako Mali

Background: The endometrium is the tissue that lines the inside of the uterus. It undergoes multiple changes during the menstrual cycle and prepares to welcome the fertilized egg. Endovaginal ultrasound is a first-line examination in the assessment of female infertility. Objective: We aimed to determine the impact of endometrial status by endovaginal ultrasound on the outcome of embryo transfers. Subjects and Methods: This was a prospective cross-sectional study of 150 women collected between January and October 2020 at the “Le Diafounou” medically assisted procreation laboratory. Were included in the study, women presenting for desire of pregnancy and having continued the treatment until the transfer of fresh or frozen embryos. An uterine score was used. This score took into account the thickness of endometrium, it is coffee bean aspect, the presence of the notch, the echogenicity of the endometrium, the pulsatility index, the presence of the flow at the end of diastole and sub-endometrial flow. Ultrasounds were performed using a General Electric logic 500, logic 9 and Voluson E8 device. The data was entered into Excel and then analyzed using SPSS version 21. Results: 150 women were selected for the study. 83 women or 55.3% were between 17 and 35 years old and 44.7% were over 35 years old with an upper limit of 50 years old. The number of women who became pregnant was 69% or 46%. The average thickness of the endometrium was 11.40 mm with extremes of 4.65 mm and 18.6 mm. There was a correlation between the thickness of the endometrium and obtaining a pregnancy (p i.e. 88.7%. The pulsatility index was relatively low for those who started a pregnancy, i.e. 90%. The high pulsatility index is one of the reasons for the failure of embryo implantation. The correlation was significant (p = 0.009). 141 women had no notch in the uterine arteries, i.e. 94%. 94 women or 62.7% had a triple line endometrium or typical coffee bean appearance. End-diastolic flow was observed in 12

关键词： Endometrial Status Embryonic Implantation Medically Assisted Procreation

Antibioprophylaxy by the Surgery Staff in the Teaching Hospital Gabriel Touréin mali

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Surgical Science 2015年第3期6卷 138-142页

作者： Bakary Tientigui Dembélé Alhassane Traoré Adégné Togo Lassana Kanté Ibrahim Diakité Amadou Traoré Bourama Emmanuel Cissoko Madiassa Konaté Boubacar Karembé Yacaria Coulibaly Soumeila Keita Mamby Keita Souleymane Diallo Gangaly Diallo faculty of medicine and odonto-stomatology Bamako Mali Department of General Surgery CHU Gabriel Touré Bamako Mali Department of Biology and Laboratory CHU Gabriel Touré Bamako Mali

This prospective survey was conducted from February to December 2014 about the use ceftriaxone (ceftriaz) for antibioprophylaxy concerning 300 patients by the surgery staff in the Gabriel Touré Teaching Hospital in mali. The quantity of drug used was based on the weight of the patient. One dose was administrated in intravenous at the anesthesiology induction time. For more than 2 hours of intervention time, 4 (1.3%) patients received a second dose. The majority of cases (189, 63%) were out of emergency (emergency cases—111, 37%). The mean age was 41.6 years (range: 3 - 95 years). The patients were classed Altmeir II 203 (67.7%) and Altmeir I 97 (32.3%). The NNISS score 0 concerned 101 (33.6%) and NNISS 1 in 180 (60%) patients. The factors of risky were anemia (38;12.7%), diabetes (6;2%), and HIV (3;1%). The mean of intervention duration was 56.8?±?27.5 minutes. Four cases of intervention site infection were encountered caused by?Pseudomonas?aeruginosa?in 2 patients;?Escherichia coli?(1 case), and?Staphylococcus aureus?(1 case). Conclusion: Antibioprohylaxy is not the only way to prevent infections but it stays necessary. The respect of hygien and aseptic measures should be used to reduce the rate of intervention site infection.

关键词： Antibioprophylaxy Infection Risky Factors Surgery

Ultrasound Causes of Female Infertility at the Fertilia Medical Clinic in Bamako

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Open Journal of Medical Imaging 2023年第3期13卷 107-113页

作者： Mamadou Dembele Alassane Kouma Ilias Guindo Zoumana Cheick Berete Souleymane Sanogo Mamadou N'diaye Brahima Doumbia Oncoumba Diarra Ousmane Traore Issa Cisse Aboubacar Sidiki N’ Diaye Badiougou Doucoure Youssouf Yalcouye Adama Diaman Keita Siaka Sidibe Radiology Department Faculty of Medicine and Odonto-Stomatology of Bamako (FMOS) Bamako Mali Radiology Unit Fertilia Medical Clinic Bamako Mali Department of Education and Research in Public Health (DERSP) FMOS Bamako Mali

Aims: Infertility is a major problem in our current societies and the Fertilia medical clinic in Bamako is a center for medical assistance in procreation (MAP) where there is an increasingly growing demand for ultrasound. The objective of our study was to investigate the ultrasound causes likely to prevent the occurrence of pregnancy in a group of infertile and subfertile women. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between January 2017 and January 2022, which involved 250 women wishing to become pregnant (infertile or subfertile), who came for pelvic ultrasound or follicular monitoring and who agreed to participate in our study. The parameters used were ultrasound reports including uterine, ovarian and tubal pathologies. It should be noted that in some cases no ultrasound cause of infertility was found. Data were entered and analyzed in SPSS. Results: 250 women were recruited into our. The average age was 32 years with extremes ranging from 17 to 51 years. 179 patients or 71.6% were between 17 and 35 years old. 139 patients or 55.6% had secondary infertility against 44.4% primary infertility. 202 patients or 80.8% had at least one ultrasound lesion and 48 patients or 19.2% had no significant ultrasound abnormality. The most represented ultrasound lesions were of uterine origin with 72.20%, 23.7% ovarian lesions and 04% tubal lesions. Uterine lesions were dominated by myomas, adenomyosis, endometrial polyps, uterine malformations and synechiae. As for ovarian lesions we noted cysts, polycystic ovary syndrome (PCOS), ovarian endometriosis, non-follicular ovaries and tubal ultrasound lesions showed unilateral or bilateral hydrosalpinx. Conclusion: In our study, ultrasound was an invaluable contribution to the diagnosis of the causes likely to explain subfertility and infertility in our respondents. She highlighted uterine, ovarian and tubal lesions, some of which could be corrected and pregnancies ensued.

关键词： Ultrasound Female Infertility Myomas Polycystic Ovaries Hydrosalpinx

Pericardial Drainage by Xyphoidian Route at the Chu Point G

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Open Journal of Thoracic Surgery 2021年第1期11卷 11-17页

作者： Mamadou Diakité Abdoulaye Kanté Bréhima Coulibaly Mamadou Almamy Keita Mariam Daou Demba Yattera Samba Sidibe Souleymane Coulibaly Boureima Dembele Alou Sangaré Mariam Sacko Nouhoun Diallo Ilo Bella Diall Cardiology Department University Hospital Center (CHU) Point G Bamako Mali faculty of medicine of odonto-stomatology (FMOS) Bamako Mali Department of Surgery B University Hospital Center (CHU) Point G Mali

Tuberculosis is a public health problem in mali. Pulmonary localization is the most frequent and extra-pulmonary involvement, in particular serous, is possible. In this study, we analyze our results of surgical pericardial drainage in tuberculous pericarditis. Methodology: We carried out a retrospective study at the CHU Point G over a period of five years from January 2012 to December 2017. The histological examination carried out on all the surgical specimens made it possible to retain the diagnosis of tuberculous pericarditis. Results: We identified and operated on 49 cases of tuberculous pericarditis, i.e. 70% of the pericardial drainage performed during the same period. The average age was 31.5 years (28 men and 21 women). The most common clinical signs were dyspnea (61.2%), chest pain (26.6%) and fever (12.2%). Pericardial drainage with pericardial biopsy was performed by xiphoid route in all of our patients. The mortality and morbidity rates were 4.1% and 8.2%, respectively. Conclusion: Pericardial tuberculosis attacks are frequent in mali. The etiological diagnosis is based on the histology of the pericardial biopsy which can only be obtained surgically.

关键词： Tuberculous Pericarditis Pericardial Biopsy Surgical Drainage