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Community-Based Diagnosis for the Improvement of Maternal and Child Protection in the ASACOSEKASI Health Area in the Urban Area of Bamako (Mali)

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Open Journal of Obstetrics and Gynecology 2023年第11期13卷 1859-1868页

作者： Fane Seydou Simpara Nouhoum Camara Daouda Sima Mamadou Kanté Ibrahim Bocoum Amadou Sylla Cheickna Traoré Oumar Soumana Abdoul Razak Dicko Ahmed Diallo Bokary Diallo Sissoko Abdoulaye Kanté Ibrahim Tegueté Ibrahima Traoré Youssouf Department of Obstetrics and Gynecology Gabriel Touré University Hospital Bamako Mali Referral Health Centre of commune 6 Bamako Mali Kati reference Health center Koulikoro Mali University Hospital center (CHU) of Point G Bamako Mali Referral Health Centre of commune 5 Bamako Mali District Hospital of commune 4 Bamako Mali Department of Obstetrics and Gynecology Luxembourg Mother-Child Hospital Bamako Mali

The community diagnosis is an essential approach to the resolution of health problems with the involvement of the communities concerned who become object and subject. Improvingmaternal and child health is a health priority for many developing countries, including Mali. The objective was to study the role of community-based diagnosis in improving maternal and child protection in a vulnerable urban community in a developing country. Methodology: This was a research-action integrating a community diagnosis conducted in March 2023. The involvement of several stakeholders, including social actors including ASACO, membership card holders, district chiefs, neighborhood delegates, local authorities, and health professionals, made it possible to provide curative, preventive and promotional care. The ASACOSEKA Health Area was used as a setting for the study. The methodology was the indicator approach, contact, document review, interview of CSCOM patients, observation of the structure, prioritization of problems, development of an action plan and restitution of the report. Results: The monograph consisted of describing the characteristics of the study setting. Indeed, the ASACOSEKASI area is located on the left bank of the Niger River, with a population of 34,497 inhabitants. The CSCOM presented to describe a medical unit, a maternity unit, a laboratory unit, an ultrasound room and a medication storage room. The main pathologies found were confirmed simple malaria (45.08%), high AKI: 20.43%, confirmed severe malaria: 19.85%, suspected diarrhoea: 3.43%, trauma related to road accidents: 3.36%, pregnancy-related disorders (1%). BCG, Penta3, VAR, and yellow fever vaccination rates were above 100%. It reflects the fact that the doses administered were higher than the target population. This was related to out-of-area vaccination and lost doses. CPN1, CPN4, tetanus vaccination (VAT2) and family planning (FP) consultations all have a proportion above 100%. Maternal care is increased

关键词： Community Diagnosis Reproductive Health Local Solutions ASACOSEKASI Bamako Mali

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Breast Cancer in Young Women about 87 Cases in the General Surgery Department CHU Gabriel Touré

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Surgical Science 2022年第11期13卷 506-517页

作者： Maïga Amadou Saye Zakari Sidibé Boubacar Yoro Diakité Ibrahima Bah Amadou Diallo Mahamadou Diallo Aly Boubacar Traoré Bathio Moussa Diassana Koné Tani Doumbia Arouna Adama Traoré Amadou Diallo Mamadou Traoré Djibril Konaté Moussa Saadé Oumou Hélène Kanté Lassana Konaté Madiassa Dembélé Souleymane Samaké Moussa Keita Mory Dembélé Bakary Tientigui Traoré Alhassane Togo Adégné Department of General Surgery University Hospital Bamako Mali Department of General Surgery Sikasso Hospital Sikasso Mali Department of Orthopedic Traumatology University Hospital Bamako Mali Department of General Surgery University Hospital Bamako Mali reference center of commune vi Bamako Mali General Surgery Department Mopti Hospital Mopti Mali

Our objectives were to determine the frequency of breast cancer in young women, to determine the risk factors for breast cancer in young women, to detail the diagnostic process of the disease, to determine the different therapeutic strategies. This was a retrospective and descriptive study going from January 2005 to December 2021, a period of 17 years. The study involved 87 women with an average age of 33.2 years. Patients consulted 66 times or 75.9% for breast mass. The size of the tumor was greater than or equal to 5 cm in 62 patients;it was localized in the supero external quadrant 41 times or 47.1%. Molecular classification revealed the following results: Luminal A 21.4%;receptive (HER2) positive 28.6%, and triple negative 42.9%. Stage II was the most represented with 47.4%. Histology found infiltrating carcinoma of non-specific type in 76 patients. The treatment was mastectomy axillary dissection in 66 patients, quadrantectomy + axillary dissection in 6 cases (6.9%) associated with radiotherapy in 6 patients, chemotherapy was performed in 79 of our patients and hormone therapy in 10 patients. Conclusion: Breast cancer is frequent in our country. Patients generally consult us at a late stage. The possibility of determining certain receptors and carrying out certain non-surgical treatments on site would improve the prognosis.

关键词： Breast Cancer Young Woman Receptors Diagnosis Prognosis Mali

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Endocranial Suppurations of Sinus Origin: Ratio of 3 Cases in Children at the Hospital in Mali

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Open Journal of Pediatrics 2021年第3期11卷 517-531页

作者： Bourama Kané Korotoumou Wélé Diallo Mohamed Maba Traoré Boubacar Mami Touré Mahamadou Dama Mody Abdoulaye Camara Guédiouma Dembélé Daouda Sissoko Oumar Coulibaly Mamadou Traoré Pediatrics Department of Mali Hospital Bamako Mali Medical Imaging Service Bamako Mali Neurosurgery Department of the Mali Hospital Bamako Mali Pediatric Service of the commune reference Health center V Bamako Mali

Introduction: Intracranial suppurations are neoformed purulent collections including, in decreasing order, cerebral abscesses, subdural empyemas and extradural empyemas. Otorhinolaryngologic infections are one of the main causes, especially in older children and adolescents. We report 3 clinical cases of endocranial suppurations treated at the Mali Hospital. Clinical Cases: 1) Observation 1. IK was a 14-year-old boy, who was hospitalized in our department for fever, headache and left hemiplegia. The emergency brain scan showed a right frontal and interhemispheric subdural empyema associated with multifocal sinusitis. Surgical drainage associated with ceftriaxone: 100 mg/Kg/d in direct intravenous (DI), metronidazole: 10 mg/Kgs/12hours in slow intravenous (SI) for 15 days, gentamycin: 3 mg/Kgs/d in SI for 3 days, paracetamol 15 mg/Kgs/6hours in SI, 10% glucose serum: 100 ml/Kg/d were given. The bacteriological analysis of the pus came back sterile. The postoperative period was calm. 2) Observation 2. This was a 14-year-old boy with a history of headaches who was admitted to our department for left hemiplegia. An emergency brain scan showed a right pre-suppurative encephalitis associated with a right fronto-ethmoidal and maxillary sinusitis. He was put on ceftriaxone 100 mg/kg/d in DI for 21 days, gentamycin: 3 mg/Kg/d in SI for 3 days;metronidazole: 10 mg/kg/12hours in SI for 21 days, paracetamol: 15 mg/kg/6hours in SI. After 3 weeks of medical treatment, a follow-up brain scan revealed an interhemispheric and right subdural empyema. Surgical drainage was associated with the triple antibiotic therapy initially instituted. The bacteriological analysis of the pus was sterile. The postoperative course was calm. 3) Observation 3. N.M was an 11-year-old boy, who was admitted with fever and left hemiplegi

关键词： Sinusitis Endocranial Suppurations Mali Hospital

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Acute Peritonitis at the CSRef of the commune I in the District of Bamako: Signs, Diagnosis and Treatment

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Surgical Science 2023年第10期14卷 626-636页

作者： Cheickna Tounkara Oumar Amadou Malle Modibo Togola Hamidou Samake Lamine Soumare Sékou Koumare Zimogo Zié Sanogo Djibril Sangare Department of General Surgery of the reference Health center of commune I Bamako Mali Directorate of the Social Health Service of the Armed Forces of Mali Bamako Mali Department of General Surgery “A” of Point G Hospital Bamako Mali

Acute generalized peritonitis is an acute inflammation of the peritoneum. It is most often secondary to perforation of the digestive organ and/or the spread of an intra-abdominal septic focus. The absence of a study on peritonitis in a reference health center motivated us for this work. The aim of this study was to study the inadequacies that could be seen in the management of peritonitis in the CSRef(s). We carried out a retrospective study of 40 patients received at the CSRéf of commune I for acute generalized peritonitis from 2011 to 2012. The average age was 30.1 years with a standard deviation of 3.4;extremes ranging from 14 years to 60 years and a Sex ratio = 1.22 (22 men out of 18 women). Abdominal pain was the main reason for consultation (present in all our patients). In most cases, clinical examination alone made it possible to make the diagnosis. Surgical treatment depended on the etiology (appendectomy associated with washing-drainage was the most commonly performed surgical procedure). All our patients received general anesthesia. The average length of hospitalization was 7 days with extremes ranging from 1 to 15 days. We noted a Morbidity rate of 22.5%, dominated by wall abscesses and a mortality of 2.5%. The delay in consultation and referrals constitutes a factor in mortality and high morbidity.

关键词： Peritonitis Surgery Csref CI Bamako Mali

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Analysis of Maternal Mortality in Obstetrics and Anesthesia Resuscitation in 15 Years at Chu Point“G”about 389 Cases Bamako/Mali

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Open Journal of Obstetrics and Gynecology 2020年第2期10卷 243-253页

作者： I.Kanté M.Sima A.Coulibaly M.Traoré T.Théra A.Bocoum S.Z.Daou A.Kouma S.Fané A.Traoré O.Traore Y.Traoré I.Teguété B.Maiga Obstetric Gynecology Service of C.H.U Point“G” BamakoMali Obstetric Gynecology Service of C.H.U Gabriel TOURE” BamakoMali Common reference Health center commune II BamakoMali Obstetric Gynecology Service of C.H.U KATI BamakoMali Obstetrics Gynecology Service of CHU Hospital DU Mali BamakoMali Common reference Health center commune V BamakoMali

Objective: Analyze the maternal mortality in the two departments of CHU Point “G” in Bamako, because of high maternal mortality rate in our country. Material and Methods: This was an analytical cross-sectional study on maternal deaths from February 19, 2005 to November 19, 2019 for patients admitted in both departments and who died during the pregnancy-puerperal period at CHU Point “G”. All the patients who died outside this pregnancy-puerperal period were not retained. The data were entered and analyzed using SPSS 12.0 software. The statistical test used was that of Chi2, the statistical significance threshold was fixed at 5%. Results: During our study, we recorded 389 maternal deaths out of 16,033 admissions in 15 years and 18,060 live births during the same period making a maternal mortality ratio of 2153.931 and a frequency of 2.426. At the end of our study, we noted that the frequency of maternal deaths was higher in 2014: 12.9% (50/389). The maternal death predominantly affected women aged of 20 - 24 with a frequency of 22.4% (87/389). The multiparity (166/389 making 42.7%), illiteracy (341/389 making 87.7%), the poor evacuation conditions (non-medicalized transport): 263/389 making 67.6%;the evacuation without any evacuation sheet: 259/389 making 66.6%), poor CPN (Prenatal consultation) quality (undone CPN: 191/389 making 49.1%) and the poor monitoring of delivery works (no use of partograph in 343/389 making 88.2%) were the factors favoring maternal deaths. The main causes of maternal deaths were direct in 231/389 making 59.4% with hemorrhage in first line: 21.1% (82/389), infection (61/389 cases making 15.68%), dystocia: 50 cases making 12.85% and high blood pressure and complications (38/389 making 9.76%);indirect in 158/389 cases making 40.6% (Figures 1-3). The majority of women 65.8% (256/389) of our patients died in the gynecology and obstetrics department;in the Resuscitation department 73/389 making 18.8%;in the operating room 43/389 making 11.1% and

关键词： Hemorrhage High Blood Pressure Maternal Death Partographe Prenatal Consultation

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Inguinal Hernia in Adults: Diagnostic and Therapeutic Aspects at Cs Ref CI Bamako Mali

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Surgical Science 2023年第7期14卷 507-516页

作者： Cheickna Tounkara Amadou Maiga Bessy Samake Boubacar Yoro Sidibe Tani Kone Samake Hamidou Kaloga Daye Bagayoko Oumar Amadou Malle Alhassane Traore Bakary Tientigui Dembele Pierre Adégné Togo Zanafon Ouattara Department of General Surgery of the reference Health center of commune I Bamako Mali Department of General Surgery CHU Gabriel TOURE Bamako Mali Department of Urology Surgery Point G University Hospital Bamako Mali

The inguinal hernia is a very frequent surgical pathology in the world and it represents 95% of the hernias of the groin. This work aimed to determine the frequency of inguinal hernias, describe the clinical and therapeutic aspects of inguinal hernias, describe the morbidity and mortality related to inguinal hernias and evaluate the cost of treatment. Our study was conducted from January 2010 to December 2010 in the general surgery department of the reference Health center of commune I in the district of Bamako. We collected 130 cases of inguinal hernias with a sex ratio of 15.25 in favor of the male sex. The mean age was 48.02 years (standard deviation: 17.53 years). Strangulated inguinal hernias accounted for 4.9% of abdominal surgical emergencies and 14.6% of all operated inguinal hernias. More than half of the patients (82%) were operated under local anesthesia. Clinical signs were marked by painless or irreducibly painful inguinal swelling. The diagnosis was clinical in all patients. Some patients benefited from a minimum blood assessment (rhesus grouping, glycaemia, hemoglobin level and hematocrit). The Shouldice technique was performed in 68% of patients. One case of organ resection was performed, i.e. 0.8% of cases. Morbidity was 4.6% due to wall abscess;0.8% scrotal hematoma type. We have not recorded any recurrence or death.

关键词： Inguinal Hernias Surgery Cs Ref CI Bamako (Mali)

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Epidemiological and Therapeutic Aspects of Proctological Pathologies in Pregnant and Postpartum Women at the reference Health center of commune IV of Bamako District

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Open Journal of Obstetrics and Gynecology 2023年第4期13卷 752-766页

作者： Seydou Mariko Amaguiré Saye Dessé Diarra Sirima Diarra Mariam Tangara Brahima Dembélé Fanta Doumbia Moussa Samaké Abdou Guiré Yéli Dianessi Abdoul Razakou Dicko Amadou Bocoum Youssouf Traoré Adégné Togo Gynecology Department of Mali Bamako Hospital Bamako Mali Department of Gynecology and Obstetrics Reference Health Center of Commune IV Bamako Mali Department of General Surgery Centre de Santé de Référence de la commune IV Bamako Mali Department of Public Health Centre de Santé de Référence de la commune IV Bamako Mali Department of Gynecology and Obstetrics Center Hospitalier Universitaire (CHU) Gabriel TOURE Bamako Bamako Mali

Introduction: Painful proctological conditions that are far less pleasant can mar pregnancy and childbirth. In Mali, few studies have been carried out on proctological pathologies in pregnant women and in the postpartum period. Objective: To determine the frequency and identify the risk factors of anal pathologies during pregnancy and in the postpartum period in the obstetric gynecology department of the Centre de Santé de Référence de la comme IV du District de Bamako. Mali. Methods and Materials: Our observational study, a cross-sectional cohort survey over a period of nine (09) months from January 1, 2020 to September 30, 2020, was conducted in the obstetrics and gynecology department of the Health center of reference of Type IV of the District of Bamako. Results: The frequency of anal pathologies during pregnancy and in the post partum period was 24% (36/150). The different anal pathologies found were anal fissures, hemorrhoidal disease, anal incontinence and multiple anal pathologies with respectively 10%;6.67%;5.33%;2%. Chronic constipation (p = 0.003), a newborn weight > 3500 g (p = 0.000) to the occurrence of hemorrhoidal disease. For anal fissures, risk factors were noted such as (weight of the newborn > 3500 g (p = 0.002) and duration of fetal expulsion > 20 minutes (p = 0.000). Finally, a newborn weight > 3500 g (p = 0.000) and a maternal age of up to 30 years (p = 0.001) were associated with the occurrence of anal incontinence. Conclusion: Our study shows that anal pathologies affecting women's intimacy are frequent during pregnancy and in the postpartum period and are part of the many taboos difficult to address in our society.

关键词： Anal Pathologies Delivery Pregnancy

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Study of Malaria in Patients Operated on at the reference Health center of commune I Bamako

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Surgical Science 2023年第9期14卷 598-607页

作者： Tounkara Cheickna Samaké Hamidou Koné Abdoulaye Maiga Boubacar Diarra Yaya Kayentao Kassoum Dolo Amadou Diallo Mouctar Department of General Surgery of the reference Health center of commune I Bamako Mali Directorate of Social and Health Services of the Armed Forces of Mali Bamako Mali University of Sciences Techniques and Technologies of Bamako (USTTB) Mali Bamako Mali

Malaria is a febrile and hemolyzing erythrocytopathy due to the development and multiplication of one or more of the five plasmodial species dependent on humans: Plasmodium falciparum, P. malariae, P. ovale, P. vivax and P. knowlesi. These parasites are inoculated into humans by the infective bite of a female mosquito, female anopheles of the genus Anopheles, during a blood meal. The study aimed to: determine the frequency of fever due to malaria after surgery;describe malaria symptomatology and clinical evolution after surgical intervention;determine the average length of hospital stay for operated patients with malaria;evaluate the average cost of malaria treatment. This was a prospective study which involved 110 operated patients, which took place over a period of 12 months from March 2017 to February 2018 in the general surgery department at the reference Health center of commune I of the Bamako district. The frequency of malaria was 11.82% before the intervention and 3.64% after the intervention, with an average age of 29.80 years;extremes of 2 years and 76 years and a sex ratio of 1.5 in favor of the male sex. The main clinical signs were fever (38.18%), headache (20.91%) and vomiting (36.36%) and physical asthenia (18.18%). Diagnosed and treated early, malaria progressed favorably. The outcome was simple for all our patients and we did not record any deaths. The cost of treatment was borne by the patients and/or their families. The average cost of treatment was 7915 CFA francs, significantly below the Malian minimum wage which is around 30,000 FCFA. The implementation of preventive measures is necessary to reduce the importance of malaria in hospitals: staff awareness, indoor spraying, use of impregnated mosquito nets.

关键词： Malaria Plasmodium Surgery Fever Thick Gout Rapid Diagnostic Test

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Become Immediate of Newborns Operated in the Neonatology Department of the Hospital and University center Gabriel Toure of Bamako (Mali)

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Open Journal of Pediatrics 2022年第1期12卷 12-18页

作者： Oumar Coulibaly Hawa Gouro Diall Pierre Togo Hawa Camara Fatoumata Léonie Françoise Diakité Lala Ndrayni Sidibé Leyla Maiga Ibrahima Ahamadou Abdoul Karim Doumbia Adama Dembelé Belco Maiga Karamoko Sacko Mohamed Elmouloud Cissé Djeneba Konaté Fousseyni Traoré Yacouba Aba Coulibaly Issa Amadou Touré Hamadi Sissoko Mariam Maiga Alou Samake Bourama Kané Guédiouma Dembelé Abdoul Aziz Diakité Fatoumata Dicko Traoré Mariam Sylla Boubacar Togo Neonatology Department of the Gabriel Touré CHU Bamako Mali Pediatric Surgery Department of the Gabriel Touré CHU Bamako Mali reference Health center of the Municipality III Bamako Mali reference Health center of the Municipality vi Bamako Mali Mali Hospital Bamako Mali

Neonatal surgical pathologies in developing countries are characterized by high mortality. The aim of this work was to describe the characteristics of the newborn and its surgical pathologies treated in the neonatal department of the Gabriel Touré University Hospital in Bamako (Mali). Patients and method: This is a retrospective study of 626 files of newborns hospitalized over a period of 3 years (January 2016 to December 2018) for a surgical pathology, whether operated on or not. We have studied the etiological, therapeutic and evolutionary aspects. Results: During the study period, we collected 626 patients who had surgical pathology, i.e. a frequency of 5.35%. The average therapeutic consultation time was 2 days with extremes (1 and 30 days). Pathologies of the abdominal wall and digestive tract represented 57.9% (n = 84) followed by pathologies of the spine 26.9% (n = 39). The mean treatment time was 4.5 days. Twenty-three point sixteen (23.16%) newborns could be operated on. The neonatal mortality rate was 12.4% (n = 18). Mortality was postoperative (100%) with a mean time to onset of 5 days. Abdominal wall pathologies were responsible for 8.7% (n = 13) of deaths. Conclusion: Surgical pathologies of the newborn are characterized by delayed treatment with high mortality. Improving their prognosis requires early diagnosis (prenatal diagnosis) and adequate management.

关键词： Newborn Surgical Pathologies Mortality

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Thrombosis of the Transverse Sinus: About a Clinical Observation and Review of the Literature

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第3期12卷 180-186页

作者： Harouna Sanogo Kassim Diarra Nfaly Konate Mohamed Saydi Ag Med Elmehdi Elansari Drissa Kaloga Bagayogo Kalifa Coulibaly Dembele Yaya Kone Fatogoma Issa Boubacary Guindo Siaka Soumaoro Doumbia Kadidiatou Mohamed Amadou Keita reference Health center Kalaban Koro Bamako Mali ENT Head and Neck Surgery Department University Hospital Gabriel Toure Bamako Mali reference Health center Common vi Bamako Mali Department of Anesthetist Resuscitation University Hospital Mother-Child Luxembourg Bamako Mali

Cerebral venous thrombosis has an unfavorable prognosis. It is a rather rare pathology concerning 3 to 5 cases per million inhabitants. The clinical symptomatology also varies according to the topography of the venous thrombosis and, in some cases, the CVT can have an unusual presentation. Progress and accessibility of non-invasive imaging currently allow early diagnosis of CVT. Brain MRI is the reference method for the diagnosis of CVT. We report a case of transverse sinus thrombosis in a 32-year-old male patient who consulted for headaches through which we want to study the etiological, clinical, paraclinical, therapeutic aspects as well as the evolutionary profile. The clinical history dates back to 2 weeks ago with frontal headaches radiating to the occipital region, throbbing of severe intensity, progressive onset and permanent evolution associated with right unilateral anterior purulent rhinorrhea. He had no nasal obstruction, epistaxis, hearing loss or other otological symptoms;no neurological deficit or notion of head trauma. Cerebral and maxillofacial computed tomography showed right maxillary sinusitis and right transverse sinus thrombosis. We carried out medical treatment based on antibiotics and analgesics without the use of anticoagulants. The evolution was favorable after four weeks of treatment. Conclusion: Transverse sinus thrombosis has a non-specific and heterogeneous clinical presentation. Headaches are the first sign. MRI and CT can help establish the diagnosis. The treatment is both etiological and symptomatic.

关键词： Transverse Sinus Thrombosis Headache Non-Surgical Treatment

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