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Profile of Urinary Tract Infections in the Elderly in the Internal Medicine department of the University Hospital Center of Point G, Bamako, Mali

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Open Journal of Nephrology 2021年第2期11卷 217-229页

作者： Drissa Sangaré Magara Samaké Nanko Doumbia Aboubacar Sidiki Fofana Sékou Mamadou Cissé Seydou Sy Atabième Kodio Moctar Coulibaly Sah dit Baba Coulibaly Djibril Sy Kaya Assétou Soucko Mamadou dembélé Saharé Fongoro department of Medicine and Medical Specialty The Fousseyni Daou Hospital Kayes Mali Faculty of Medicine of Bamako Bamako Mali Nephrology Unit of fousseyni daou Hospital Kayes Mali Medicine department of Mali Hospital Bamako Mali Nephrology department of the University Hospital Center of Point G Bamako Mali Nephrology Unit of Mali Gavardo Hospital Bamako Mali Nephrology Unit of Somino Dolo Hospital Mopti Mali Internal Medicine department of the University Hospital Center of Point G Bamako Mali

Introduction: Urinary tract infections (UTI) are frequent and of polymorphous clinical symptomatology in elderly subjects both in and out of hospital. In Mali, to our knowledge, no study concerning UTIs in the elderly has been conducted, hence the interest in this innovative work. Objectives: To determine the prevalence and clinical and paraclinical aspects of urinary tract infections in the elderly. Materials and Methods: This was a prospective descriptive and cross-sectional study from September 1, 2013 to August 31, 2014, i.e. duration of 12 months. All patients aged 65 years and over, hospitalized or ambulatory in the internal medicine department with a documented urinary tract infection were included. Results: We collected and examined 194 patients. The cytobacteriological study of urine (CBSU) was positive in 28 patients, i.e. a prevalence of 14.43%. The male sex represented 59.8% of the cases, the sex ratio was equal to 1.46. The age groups between 65 - 69 and 70 - 74 years were the most affected, respectively 28.57% and 39.28%. The main clinical signs were: asthenia, anorexia, dependence, fever, urinary burning, dysuria. Hospitalization was associated with urinary tract infection with P = 0.01. The group of enterobacteria were incriminated in 75% of cases. Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa represented 39.28%, 14.28% and 10.71% of cases. Urinary tract infections were represented by pyelonephritis, acute prostatitis, orchi-epididymitis and simple cystitis. Conclusion: Urinary tract infection is frequent in the elderly, its clinical presentation is polymorphic and enterobacteria are the most incriminated group of bacteria.

关键词： Urinary Tract Infection Elderly Subject Internal Medicine Point G Hospital Mali

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Maternal deaths in Patients Evacuated to the fousseyni daou Hospital in kayes over a decade

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Open Journal of Obstetrics and Gynecology 2023年第8期13卷 1389-1398页

作者： Mahamadou Diassana Sitapha dembele Ballan Macalou Alima Sibibe Falaye Keita Mamadou Haidara Famakan Kane Cheickna Sylla Amadou Bocoum Sanogo Siaka Amara Soumaila Traoré department of Gynecology and Obstetrics Fousseyni Daou Hospital Kayes Mali kayes Reference Health Centre Kayes Mali Reference Health Center of Kalaban-Coro Bamako Mali Bla Reference Health Centre Ségou Mali department of Gynecology and Obstetrics Gabriel Toure University Hospital Center in Bamako Bamako Mali department of Gynaecology and Obstetrics Regional Hospital of Sikasso Sikasso Mali

Introduction: Evacuation refers to the rapid transfer of a patient in an emergency, from one health center to another more equipped and better specialized. The objective of this study was to study maternal mortality in patients evacuated to the gynecology and obstetrics department at the fousseyni daou Hospital in kayes over a period of 10 years. Materials and Methods: This was a descriptive, cross-sectional, retrospective study over nine years from January 1, 2011 to december 31, 2019 and prospective over one year from January 1, 2020 to december 31, 2020 involving all patients or parturients evacuated for obstetrical causes and died in the gynecology-obstetrics department of the fousseyni daou Hospital. Confidentiality and anonymity were respected. The processing and analysis of the statistical data was carried out using SPSS 20.0 software. Results: during our study period we identified 38,854 obstetric admissions including 6758 evacuations or 17.4%, among the 6758 cases of obstetric evacuations 284 died, a frequency of 4.2%. The maternal death audit committee of the fousseyni daou hospital in kayes audited 101/284 cases (files) or 35.5% of which 64 maternal deaths (63.4%) were considered inevitable. In our study the 20 - 29 age group was more represented with 38%. 85% of the deceased patients lived in rural areas. In our series, 63.7% of the deceased patients had not had antenatal consultations (NPC). Eclampsia accounted for 26.8% of admissions diagnoses and 30.9% of causes of death. Seventy-two (72%) of deaths occurred postpartum, 15% perpartum and 13% prepartum. Direct obstetric causes were predominant at 65.1%. Conclusion: Indicators of maternal deaths among evacuated patients remain poor in our work. Maternal deaths were driven by socio-economic and cultural factors, but also by factors related to the health system.

关键词： Maternal Mortality Evacuation kayes Hospital

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Maternal-Fetal Prognosis of delivery in the Presentation of the Seat at the kayes Hospital (Mali)

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Open Journal of Obstetrics and Gynecology 2021年第5期11卷 578-590页

作者： Mahamadou Diassana Ballan Macalou Sitapha dembele A. Sidibe A. Hamido D. Konate Soumana Oumar Traore Mamadou Sima Cheickna Sylla Amadou Bocoum Seydou Fane Soumaila Traore Obstetrics and Gynecology department at fousseyni daou Hospital Kayes Mali kayes Reference Health Centre Kayes Mali Reference Health Centre in Bamako Commune V Bamako Mali department of Gynecology and Obstetrics at the G-Spot University Hospital Bamako Mali department of Obstetrics and Gynecology at GABRIEL TOURE University Hospital Bamako Mali department of Obstetrics and Gynecology at SIKASSO Regional Hospital Sikasso Mali

Objective: The purpose of this study was to assess the risk factors associated with seat presentation and to determine the maternal-fetal prognosis of delivery in the presentation of the seat. Materials and methods: This was a descriptive, cross-sectional and analytical case-control study with prospective data collection, from January 1, 2018 to December 31, 2019, a 12-month period at Kayes Hospital, Mali. Results: During our study period we recorded 3820 deliveries, including 120 breos;a frequency of 3.14% of all deliveries. The 20 - 35 age group was the most represented in cases 61.7%. Of the cases 66.7% (n-80) were out of school, we note 75.8% (n-182) of out-of-school controls. Primiparaes were the majority among cases 39.2% (n-47), as were 39.1% of the controls (n-118). The cases had a history of caesarean section at 15% (n-18);13, 3% (n-32). The most common mode of presentation was the 70% decomplete seat. It was mainly the anterior left sacro iliac variety (85.8%). The low pathway was preferred during these deliveries to 70% against 30% of caesarean section of which 28.3% of cases were carried out in

关键词： Siege delivery Obstetric Prognosis

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Diabetic Foot: Epidemiological, Therapeutic and Evolutionary Aspects in the department of Medicine and Endocrinology of the Hospital in Mali, Mali

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Journal of Diabetes Mellitus 2022年第1期12卷 18-27页

作者： Nanko Doumbia Adama Alexis Diarra Seydou Mariko Drissa Sangare Danfaga Bakary Nouhoum Ouologuem Samaké Magara Sekou Mamadou Cisse Mamady Coulibaly Mahamadou Saliou Bakary dembele Yacouba L. Diallo Amadou Kone Modibo Mariko Bah Traore Massama Konate Djenebou Traore Djeneba Sylla Kaya Assetou Soucko Assa Traore department of Medicine of the Mali Hospital Bamako Mali National Center for Scientific and Technological Research (CNRST) Bamako Mali Kati Reference Center Kati Mali Gynaecology department of the Mali Hospital Bamako Mali department of Medicine and Medical Specialty of the fousseyni daou Hospital Kayes Mali Nephrology Unit of the fousseyni daou Hospital Kayes Mali Health and Social Affairs department of the National Police Bamako Mali Internal Medicine department of the Gabriel Toure University Hospital Bamako Mali Faculty of Medicine Bamako Mali Internal Medicine Service of the Point G University Hospital Bamako Mali

Introduction: The diabetic foot remains a public health problem due to its high frequency, difficult and costly management. The aim of this study was to determine the epidemiological, therapeutic and evolutionary aspects of the diabetic foot in a hospital setting in Bamako. Methodology: This is a retrospective, descriptive, cross-sectional and monocentric study conducted between September 1, 2011 and december 31, 2015 on diabetic patients aged 14 years and older arriving in our department with a foot infection. Results: We identified 94 cases of diabetic foot infection out of a total of 828 hospitalized patients, a prevalence of 11.35%. The age range 41 - 60 years represented 57 cases (60.6%), the extreme ages were 14 and 81 years. Men (38.3%), women (61.7%) with a sex ratio of 0.62%. Housewives 50%, illiterate 51 cases (54.3%), low economic standard of living 40 cases (42.6%), presence of osteitis 40 cases (42.6%), foot at stage D Grade3 28 cases (29.8%). Management was medical in 48 cases (51.1%), treatment with insulin 58 cases (61.7%), Amoxicillin + Metronidazole used 36 cases (38.29%). Amputation was performed in 35 cases (37.2%). deaths concerned 5 patients (9.6%) with hypoglycemia as the main cause in 4 cases. Conclusion: Diabetic foot is a frequent complication of diabetes. The establishment of a multidisciplinary team should contribute to the improvement of the prognosis of the diabetic foot in a management center.

关键词： Diabetic Foot Epidemiology Therapeutics Evolution Mali Hospital

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Prevalence of Cardiovascular Risk Factors in Chronic Hemodialysis Patients at the University Hospital Center of Point G in Bamako, Mali

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Open Journal of Nephrology 2020年第2期10卷 125-134页

作者： Seydou Sy Magara Samaké Moctar Coulibaly Massama Konaté Djénèba Diallo Hamadoun Yattara Aboubacar Sidiki Fofana Atabieme Kodio Modi Sidibé Nouhoum Coulibaly Alkaya Touré Djibril Sy Moustapha Tangara Saharé Fongoro Nephrology and Haemodialysis department of the CHU of Point G Bamako Mali Faculty of Medicine University of Bamako Bamako Mali Nephrology Unit of the fousseyni daou Hospital of kayes Kayes Mali Nephrology Unit of Mali GAVARDO Hospital Bamako Mali Cardiology department of Mali Hospital Bamako Mali Internal Medicine Service at the University Hospital Center of Point G Bamako Mali

Introduction: A cardiovascular risk factor (FDRCV) is defined as a physiological, pathological or environmental attribute or characteristic that results in an increased likelihood of developing cardiovascular disease in the individual in whom it is detected. The objective of this study was to determine the prevalence of cardiovascular risk factors in hemodialysis patients on hemodialysis at the University Hospital of Point G. Patients and Methods: This was a cross-sectional descriptive study with prospective data collection from March 3, 2009 to March 5, 2010 (13 months). Included were all patients with end-stage renal disease (ESRD) receiving chronic hemodialysis in the Nephrology and Hemodialysis department of the University Hospital of Point G during the study period. Results: Eighty-eight patients were enrolled. The M/F sex ratio was 1.26. The mean age was 41.32 years with extremes of 17 and 81 years. The classic cardiovascular risk factors in order of frequency were: hypertension (90.9%), sedentary lifestyle (71.6%), male sex (54.5%), age ≥ 55 years (21.6%), obesity (13.6%), diabetes (8%), tobacco (8%), alcohol (3.4%). Cardiovascular risk factors related to CKD were: anemia (98.9%), phosphocalcic disorders (85.2%), arteriovenous fistula (AVF) (80%), lipid abnormalities (36.5%), hydrosodium inflation (29.5%). Predominant cardiovascular complications were hypertensive heart disease (62.5%), acute pulmonary oedema (APO) (50%), rhythm disorders (23.9%), coronary insufficiency (18.2%). The mortality rate was 17%. Conclusion: Cardiovascular risk factors are frequent in chronic hemodialysis. They contribute to the excess mortality of these patients. Adequate management of these risk factors can slow down serious cardiovascular complications and reduce the risk of mortality in this fragile population.

关键词： Cardiovascular Risk Factors Haemodialysis Mali

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Kidney Damage during Sharp’s Syndrome: About Two Cases

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Open Journal of Nephrology 2020年第4期10卷 290-297页

作者： Saharé Fongoro Seydou Sy Magara Samaké Hamadoun Yattara Moctar Coulibaly Aboubacar Sidiki Fofana Brahima Dégoga Atabième Kodio Eyram Yoan Makafui Amekoudi Djénèba Diallo Djénéba Maiga Aboudou M. Dolo Moustapha Tangara Nouhoum Coulibaly Kalilou Coulibaly Ibrahima Koné Nephrology and Haemodialysis department of the University Teaching Hospital of Point-G Bamako Mali Faculty of Medicine of Bamako Bamako Mali Nephrology Unit of the fousseyni daou Hospital in kayes Kayes Mali Nephrology Unit of the Mali GAVARDO Hospital Bamako Mali Nephrology Unit of Sikasso Hospital Sikasso Mali Nephrology Unit of Somino DOLO Hospital in Mopti Mopti Mali

Context: The coexistence in the same patient of a mixed connectivitis or Sharp’s syndrome is a rare eventuality. Objective: To underline the presence of this mixed connectivitis in our practice, whose prevalence remains unknown, particularly in Africa and more precisely in Mali. Case Presentations: We report two cases of Sharp’s syndrome in a 48-year-old man and a 40-year-old woman with impaired renal function. The picture achieved associated massive proteinuria, hypoalbuminemia, moderate renal failure and edematous syndrome in men. In women, the picture was associated with accelerated to malignant hypertension and severe renal failure. There were no osteoarticular manifestations and the diagnosis of Sharp’s syndrome was based on the presence of high levels of antibodies to U1RNP. Therapeutic management has been that of predominantly associated connective tissue disease (systemic lupus erythematosus). Conclusion: Mixed connectivitis or Sharp’s syndrome is increasingly recognized as a separate entity thanks to advances in molecular biology. Its prevalence is low in sub-Saharan African countries with renal disease that manifests itself as proteinuria or nephrotic syndrome associated with microscopic hematuria, renal failure, and hypertension. This renal impairment is more likely to occur in severe forms of the disease.

关键词： Sharp Syndrome/Mixed Connectivitis Renal Failure Mali

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Prevalence and Etiologies of Obstructive Renal Failure in the Nephrology department of the University Hospital Center of Point G, Bamako, Mali

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Open Journal of Nephrology 2020年第3期10卷 187-198页

作者： Seydou Sy Magara Samaké Moctar Coulibaly Moussa Salifou Diallo Atabième Kodio Hamadoun Yattara Abdoul Aziz Mahamane Seribah Coulibaly Aboubacar Sidiki Fofana Djénèba Diallo Sah Dit Baba Coulibaly Modi Sidibé Moustapha Tangara Alkaya Touré Saharé Fongoro Nephrology and Haemodialysis department of the University Hospital Center (UHC) of Point G Bamako Mali Faculty of Medicine and Odontostomatology of Bamako Bamako Mali Nephrology Unit of the fousseyni daou Hospital in kayes Kayes Mali Nephrology Unit of the Mali Gavardo Hospital of Sébénikoro Bamako Mali Urology department of University Hospital Center of Kati Kati Mali

Introduction: Obstructive renal failure (ORF) or obstructive uropathy is defined by the simultaneous presence of impaired renal function and urinary excretory tract dilatation on medical imaging. It accounts for 2% to 10% of the causes of acute renal failure (ARF). Objective: To determine the prevalence and etiologies of ORF in the nephrology department of the University Hospital Center of Point G. Methodology: This was a descriptive study with retrospective data collection conducted from January 1, 2017 to June 30, 2018. All patients hospitalized with renal failure due to urinary tract obstruction were included. The parameters studied were age, gender, etiology, type of renal impairment, procedures performed, surgical outcomes of the procedure, pre-and post-management creatinine levels. Information on these clinical and paraclinical variables was collected from individual hospitalization and patient follow-up records. Results: Among 1133 patients, 83 had obstructive renal failure, a prevalence of 7.32%. The sex ratio was 1.86. The mean age was 48.99 ± 6.81 years with extremes of 7 and 102 years. Signs suggestive of lower urinary tract obstruction were, in order of frequency: dysuria (50.6%), urinary burns (44.6%), urinary frequency (44.6%), pollakiuria (44.6%), macroscopic hematuria (25.3%), low back pain (21.6%), total anuria (18.1%). The etiologies were dominated by lithiasis 36 cases (43.4%), tumours 32 cases (38.55%) followed by sequelae of bilharziasis 12 cases (14.50%). Conclusion: Obstructive renal failure is becoming more and more common. The etiology is essentially of lithiasic and tumor origin. It must be treated early to allow total or partial recovery of renal function.

关键词： Prevalence Etiologies Obstructive Renal Failure Mali

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Bacteriological Profile of Pneumopathies in Chronic Renal Failure at the University Hospital Center of Point-G in Mali

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Open Journal of Clinical Diagnostics 2020年第1期10卷 18-28页

作者： Seydou Sy Magara Samaké Hamadoun Yattara Moctar Coulibaly Ba Oumou Diallo Aboubacar Sidiki Fofana Djénéba Diallo Atabieme Kodio Modi Sidibé Nouhoum Coulibaly Alkaya Touré Djibril Sy Moustapha Tangara Saharé Fongoro Nephrology and Haemodialysis department of the University Hospital Center (CHU) of Point G Bamako Mali Faculty of Medicine of Bamako University of Bamako Bamako Mali Nephrology Unit of the fousseyni daou Hospital of kayes Kayes Mali Nephrology Unit of Mali GAVARDO Hospital Bamako Mali Internal Medicine Service of the University Hospital Center of Point G (CHU du Point-G) Bamako Mali

Introduction: Chronic renal failure (CKD) is defined as a glomerular filtration rate (GFR) of less than 60 ml/min/1.73m2 for more than 3 months [1]. Infectious complications are a major source of morbidity in patients with chronic renal failure. In Mali, we have no data on pneumopathies in this population, hence the interest of this study. The objective of this work was to determine the frequency of pneumopathies in patients with chronic renal failure, describe the clinical radio-types, identify the microorganisms involved, and assess the renal prognosis of pneumopathies. Materials and Methods: This was an 18-month prospective and descriptive study from January 1, 2018 to June 30, 2019 conducted in the nephrology and hemodialysis department of the University Hospital of Point G. Included were patients hospitalized during our study period with CKD associated with pneumopathy on a chest X-ray. Not included were all patients hospitalized outside the study period, all CKD cases without pneumonia, patients with incomplete records, and non-consenting patients. Results: We examined 1111 patients, 35 of whom presented an image on chest X-ray related to pneumopathy, a frequency of 3.15% of cases. Twenty-one men (60%) and 14 women (40%) with a sex ratio of 1.5. The mean age was 46.8 ± 13.9 years with extremes of 23 and 76 years. The types of pneumopathy on the chest X-ray were: alveolar pneumopathy: 23 cases (65.7%), pleuropneumopathy: 10 cases (28.6%) and cavitary pneumopathy: 2 cases (5.7%). Cytobacteriological sputum examination was positive in 65.7%;leukocytes (68.6% of cases). The germs found were: Klebsiella pneumoniae (25.7% of cases), Escherica coli (11.4%), Pseudomonas aeruginosa (5.7%), Staphylococcus aureus (5.7%), Citrobacter freundi (5.7%), Enterococus sp. (2.9%), Enterobacter cloacae (2.9%), Candida albicans (5.7%). The search for acid-alcohol-resistant bacilli (BAAR) in sputum was positive in 4 cases (11.4%). There was an association between the results of cyto

关键词： Renal Failure Dialysis Pneumopathy Mali

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Parathyroidectomy in Chronic Haemodialysis in the Nephrology and Haemodialysis department at the University Hospital Center of Point G in Bamako, Mali

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Open Journal of Nephrology 2020年第2期10卷 135-143页

作者： Saharé Fongoro Hamadoun Yattara Seydou Sy Magara Samaké Djénèba Diallo Moctar Coulibaly Fatoumata Modjéré Doumbia Djibril Samaké Moustapha Tangara Alkaya Touré Atabième Kodio Nouhoum Coulibaly Nephrology and Haemodialysis department of the University Hospital Centre of Point G Bamako Mali Faculty of Medicine University of Bamako Bamako Mali Nephrology Unit of the fousseyni daou Hospital in kayes Kayes Mali Nephrology Unit of the Mali Gavardo Hospital in Sébénikoro Bamako Mali ORL Unit Reference Health Center of the Municipality V Bamako Bamako Mali

Introduction: Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. Objective: To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. Results: We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis t

关键词： Chronic Renal Failure Secondary Hyperparathyroidism Dialysis Parathyroidectomy

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Erectile Dysfunction in Chronic Hemodialysis Patients at the University Hospital Center of Point-G in Mali

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Open Journal of Clinical Diagnostics 2020年第1期10卷 29-40页

作者： Seydou Sy Magara Samaké Hamadoun Yattara Moctar Coulibaly Ibrahima Koné Aboubacar Sidiki Fofana Djénèba Diallo Atabieme Kodio Modi Sidibé Nouhoum Coulibaly Alkaya Touré Djibril Sy Moustapha Tangara Saharé Fongoro Nephrology and Haemodialysis department of the CHU of Point G Bamako Mali Faculty of Medicine University of Bamako Bamako Mali Nephrology Unit of the fousseyni daou Hospital of kayes Kayes Mali Nephrology Unit of Mali GAVARDO Hospital Bamako Mali Nephrology Unit of the Regional Hospital of Mopti Mopti Mali Internal Medicine Service at the University Hospital Center of Point G Bamako Mali

Introduction: Erectile Dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual intercourse. The frequency of erectile dysfunction in patients with kidney failure is estimated at 50% to 70%. The objective of this work was to determine the frequency of sexual dysfunction in chronic hemodialysis patients, to evaluate the psycho-social impact and to describe hormonal disturbances. Patients and Methods: This was a descriptive prospective study carried out from 3 April to 31 August 2017 in the nephrology and haemodialysis department of the Point G University Hospital. She has been interested in men over the age of 18 who have been on chronic hemodialysis for more than a year. Sexual dysfunction was assessed using the questionnaire: International Index of Erectile Function (IIEF-5). Results: Sixty-five patients were included. Forty-six (70.8%) had severe (30.8%), moderate (13.8%) and mild (26.2%) ED. 56.9% of patients had libido disorders, with decreased sexual desire (38.5%);absent sexual desire (18.5%). Sexual desire was normal in 43.1% of patients. Sexual activity was absent in 20 patients (30.8%). Sexual rigidity was reduced in 28 patients (43.1%) and normal in 24 patients (36.9%). The mean age of our patients was 42.55 years with a median age of 40 years and extremes of 23 and 74 years. Eighty percent were married. Nine patients (13.8%) were using sildenafil-based medications. Antihypertensives were prescribed in 93.9% and erythropoietin in 30.8% of patients. The main impact groups were anxiety (53.8%), fear of failure (27.7%), insomnia (7.7%) and anxiety (6.1%). And defence mechanisms included: understanding (54.7%);isolation (24.6%);repression (7.7%);quarrel (7.7%);and divorce in 1 case (1.5%). The occurrence of ED was related to hypotestosterolemia (p = 0.030), and between low libido and testosterone (p = 0.001). Nutritional status was satisfactory in 78.4% of our patients. Moderate and at and severe undernutrition was

关键词： Erectile Dysfunction Renal Failure Dialysis Mali

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