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

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.

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

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.

COVID-19 and the Vascular Elderly Subject: Illustration of Therapeutic Management with Corticosteroids in an Elderly Diabetic Patient with COVID-19

Introduction: The severity of Sars-Cov-2 infection is associated with the development of acute respiratory distress syndrome (ARDS). The progression to ARDS appears to be driven by a major inflammatory mechanism potentially sensitive to corticosteroids. Observation: This article describes the case of an elderly patient was admitted to emergency departments for intense asthenia, accompanied by motor diarrhoea, dyspnoea with desaturation in ambient air, in a context of strong suspicion of infection linked to COVID-19. The article also reviews the existing literature on the diagnosis and treatment of this severe form of the disease. Conclusion: Corticosteroids, and in particular dexamethasone, have been shown to be effective in the management of patients with COVID-19, an oxygen-releasing disease.

Profile of Radiological Examinations in the Radiology and Medical Imaging Department of the Medical Clinic “KALALE” in Mali

Introduction: Radiology and medical imaging examinations bring together the means of acquiring and restoring images of the human body from different physical phenomena such as the absorption of X-rays, nuclear magnetic resonance, reflection of ultrasound waves or radioactivity, with which we sometimes associate optical imaging techniques such as endoscopy. The objective of our study was to study the profile of radiological examinations in the radiology and medical imaging department of the “KALALE” medical clinic. Methodology: This was a descriptive, prospective study that took place over a period of six (6) months in the radiology and medical imaging department of the “KALALE” medical clinic and the centers of health of communes III and IV of Bamako in Mali. Data collection was carried out on a survey form. The parameters studied were sociodemographic data, clinical data, radiological data. Results: We recorded 6030 radiology examinations of which 19% of the examination frequency cases came from the “KALALE” medical clinic and 81% of the cases were referrals from the reference health centers of communes III and IV. There were 1500 X-rays or 24.9% of cases including 54% cases of bone X-rays;5% of cases of skull and face X-rays;5% of cases of Intravenous Urography (IVU);4% of cases of Hysterosalpingography (HSG);3% of cases of Retrograde Ureterocystography (UCR) and 1% of cases of X-ray of the Abdomen without preparation (ASP). We found 4530 ultrasounds or 75.1% of cases. Conclusion: Medical imaging has become essential in the study of the human body and now constitutes an essential tool for the detection and treatment of most pathologies, from simple fractures to the most serious tumors.

Pleomorphic Adenoma of the Salivary Glands: Two Atypical Locations

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.

Panorama of Autoimmune and Autoinflammatory Diseases in Internal Medicine at the University Hospital Center (UHC) of the Point G

Introduction: Panorama studies of autoimmune and auto-inflammatory diseases are still very little carried out in Africa and particularly in Mali. The objective of this descriptive study with retrospective collection was to describe the epidemiological and clinical profile of all autoimmune and auto-inflammatory diseases in the department of internal medicine at the University Hospital Center of the Point G. Methods: This was a descriptive study with a retrospective survey of the records of patients hospitalized for autoimmune and auto-inflammatory diseases in the department of internal medicine at the CHU of Point G for a study period of 15 years from January 1, 2005 to December 31, 2019. We included in the study all patients hospitalized for autoimmune and auto-inflammatory diseases. Results: During the study period (January 31, 2005 to December 31, 2019), 6383 patients were hospitalized in internal medicine at the University Hospital Center of the Point G, of which 317 patients presented with autoimmune and/or auto-inflammatory disease with an average annual hospital recruitment rate of 21 ± 7.87 cases per year. The female sex accounted for 64.98% with a sex ratio of 0.54. The mean age of patients was 35.27 ± 16.27 years and the extreme ages were 07 and 79 years. Out of the 317 medical records included according to our inclusion criteria, there were 07 cases of association between autoimmune disease and autoinflammatory disease, i.e. 14 cases of autoimmune and autoinflammatory diseases. A total of 331 autoimmune diseases and/or auto-inflammatory diseases were collected, i.e. a frequency of 5.19%, including 291 cases of autoimmune diseases (221 cases of organ-specific autoimmune diseases and 70 cases of systemic autoimmune diseases) and 40 cases of autoinflammatory diseases (no case of monogenic forms, 08 cases of “systemic” polygenic forms and 32 cases of “organ-specific” polygenic forms). Organ-specific autoimmune diseases were dominated by type 1 diabetes (141 cases), Graves’ disease (48 cases) and systemic autoimmune diseases by systemic lupus erythematosus (43 cases), rheumatoid arthritis (16 cases). Among the auto-inflammatory diseases, the “systemic” polygenic forms were dominated by Horton’s disease (02 cases) and the “organ-specific” polygenic forms by gout (16 cases), ulcerative colitis (08 cases). Conclusion: It appears from our study that autoimmune and autoinflammatory diseases are characterized in internal medicine by their frequent occurrence in women and preferably between 25 and 44 years of age with very disparate distribution. We also observed a predominance of organ-specific autoimmune diseases over systemic ones, and “organ-specific” polygenic autoinflammatory diseases over “systemic” ones.

Anatomical Dissection of the External Branch of the Superior Laryngeal Nerve to the Laboratory of Anatomy of the Faculty of Medicine of Bamako(Mali)

Aim: This study aimed at describing the anatomical variations of the external branch of the superior laryngeal nerve and at estimating the frequency of nerves at risk during the thyroid surgery. Methodology: We realized a forward-looking study from September, 2016 in May 31st, 2018 in the laboratory of anatomy of the Faculty of Medicine and Odontostomatology of Bamako in Mali. All the fresh anatomical subjects not carrying trauma and or a scar at the level of the previous region of the neck were held. The anatomical subjects were not included presenting a traumatic lesion and\or a scar of the previous region of the neck. Results: We realized 34 dissections of the external branch of the superior laryngeal nerve to 17 deathly subjects (11 men and 6 women with a sex-ratio of 1.8). The average age of the subjects was of 42 years (extremes: 18 and 70 years). Our study allowed highlighting in 100% of the cases, the external branch of the superior laryngeal nerve and the superior thyroid artery so to the right as to the left. On 34 dissected external branch of the superior laryngeal nerve, none had a previous route. However we found 28 nerves (82.4%) having a later route, stuck to the external face of the lower constrictor of the pharynx. These were not mixed with the superior thyroid artery and its branch of division and were situated outside the thyroid capsule. In 17.6% of the cases (6 cases), the nerve had a route mixed in the branch of the superior thyroid artery. These were found inside of the capsule (11.8% adhered to the artery and 5.8% crossed its branch of division). Conclusion: The risk of injury of the external laryngeal nerve during thyroid surgery procedure is never zero. It is more important on the left side.

Surgical Reports of the Inferior Laryngeal Nerve and the Inferior Thyroid Artery in General Surgery and in ENT

Aim: The purpose of this study was to determine the frequency of the hurts of the inferior laryngeal nerve, according to its anatomical reports with the inferior thyroid artery during the thyroid surgery. Methodology: We realized a forward-looking and retrospective study from January, 1979 till December, 2017 in the service of surgery “B” to the University hospital of the Point G of Bamako and in the service of ENT and cervico-facial surgery of the Teaching Hospital “Mother-Child”, the Luxembourg of Bamako (Mali). All the patients operated in both services for mild goiters were retained. Cancers and other thyroid pathologies were not included. The diagnosis of mild goiter was paused by the histological examination realized on all the surgical specimens. Results: On 2109 dissections of the inferior laryngeal nerve realized during the surgical operations on the thyroid, the frequency of lesion of the inferior laryngeal nerve was 1.09% (20 cases) when it passed dorsally with regard to the inferior thyroid artery (1837 cases) and when 4.04%, it was transvascular or prevascular (272 cases). Conclusion: The prevascular route or transvascular of the inferior laryngeal nerve favors its lesion per operating.

Influence of Age on the Clinical and Prognostic Features of Tetanus in Mali

Background: The regression of post-vaccination immunity with age exposes elderly subjects to certain infectious diseases, in particular tetanus. The aim was to compare the clinical and prognostic features of tetanus according to the age of patients. Methodology: Analytical study of the files of patients hospitalized for tetanus in the Infectious Diseases Department at Point “G” University Teaching Hospital from 2013 to 2019 with retrospective collection. According to age, three groups of patients were formed: group I (<18 years), group II (18 - 59 years) and group III (≥60 years). The study variables were socio-demographic, clinical and prognostic. The One-way ANOVA and Chi-square statistical tests were applied with a significance level p = 0.05. Results: In total, 202 cases of tetanus were recorded or 7.3% of admissions. The mean age was 41.9 ± 15.6 years (range, 6 and 85 years) with a sex ratio of 19.2. According to the age grouping, group II was predominant (79.2%) followed by group III (14.9%) with respective mean ages of 39.2 ± 10.6 and 67.3 ± 6.5 and sex ratio of 39 and 29. Workers (33.3%), farmers (25.8%), traders (19.7%) and drivers (7.1%) represented the most important occupations most at risk. Clinically, bad general condition (p < 0.001), trismus (p = 0.001), dysphagia (p = 0.009) and complications during hospitalization (p = 0.028) were seen more frequently in group III patients compared to younger ones. From a prognostic point of view, patients in group III were at greater risk to develop a severe form of tetanus (p = 0.021) with higher mortality compared to other age groups (p < 0.001). Conclusion: Tetanus is more prevalent in men. Complications and mortality increase with age. It is important to include booster immunization of adults in existing national programs in order to reduce disease-related morbidity and mortality in this age group.

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

Renal Failure of Lithiasis Origin: Frequency and Management in the Nephrology and Haemodialysis Department of the Point G University Hospital in Mali

Background: The term urinary lithiasis (UL) from the Greek “lithos” refers to the disease characterised by the result of abnormal precipitation of normal constituents of the urine within the urinary tract. The aim of this work was to determine the frequency of obstructive renal failure (ORF) of lithiasis origin and to describe the therapeutic indications. Methods: This was a retrospective prospective study in patients hospitalised in the nephrology department of Point G University Hospital for ORF of lithiasis origin over a 26-month period from 1 January 2018 to 1 February 2020 inclusive. Results: Among 1898 hospitalized patients, 32 met the inclusion criteria, i.e. a frequency of 1.7%. The male sex was 68.75% with a sex ratio of 2.2. The mean age was 48.38 ± 13.423 years with extremes of 20 and 65 years. Dysuria and urinary bilharzia were the main uro-nephrological antecedents, accounting for 25% of the cases each. Pain syndrome was the main functional sign, accounting for 100%. Ultrasound of the urinary tract (n = 28) showed stones in 92.85%. These stones were bilateral in 22.22% of cases. The dilatation was pyelocalic in 14 cases (51.8%). The uroscanner showed a pyelic location of the stones in both kidneys;42.1% on the right and 33.3% on the left. Hydronephrosis was the most common dilatation: 37.8% on the right and 29.7% on the left. Renal lithiasis was complicated by acute kidney injury (ARI) in 17 cases (53.1%) versus 15 cases (46.9%) of chronic kidney disease (CKD). Urethral catheter was the means of drainage in 24 (75%) followed by nephrostomy in 8 cases (25%). Nephrolithotomy accounted for 9.4% of cases. The case fatality rate was 28.12% (9 cases). Deaths occurred in the context of uraemic coma 6 cases and cardiorespiratory arrest 3 cases. Conclusions: The management of urinary lithiasis complicated by renal failure calls for the correction of hydrolytic disorders, drainage of the excretory tract and treatment of the stone, of which percutaneous nephrolithotomy seems to be the modality of choice.

Epidemiological and Histopathological Aspect of Precancerous and Cancerous Lesions of the Cervix in the Health District of Commune 5 of Bamako, the CHU of Point “G” and the Gabriel TouréUniversity Hospital of Bamako in Mali

Objective: The aim was to take stock of the screening and treatment of precancerous and cancerous lesions of the cervix in the health district of commune V of Bamako, the “G” point and the Gabriel Touré University Hospital in Bamako, Mali. Patients and Methods: This was a descriptive, cross-sectional, analytical study with retrospective and prospective data collection over an 8-year period from January 1, 2010 to December 31, 2017. This was a multi-center study. Results: From January 1, 2010 to December 31, 2017, 42,492 women were screened, representing a frequency of 24.30%. The median age of the women screened was 32 years;25% were under the age of 25. Three-fourth of the women screened was in the 20 - 49 age group. Of the 22,842 women screened, 90.1% of them had a normal col to IVA/IVL. However, 4.1% of cervical positivity had with acetic acid and 5.1% of positivity to Lugol. 0.7% of the women screened clinically had cancerous lesions. Histologically, 96.5% of the women screened had a normal cervix with benign lesions. For pathological histological findings, we noted 2.6% of precancerous lesions and 0.8% of squamous cell carcinomas and 0.1% of adenocarcinoma. Conclusion: Improved screening indicators with IVA/IV reduce the rate of morbidity and mortality from cervical cancer.

Sjögren’s Syndrome Revealed by Obstructive Renal Failure: A Case Report and Review of the Literature

Introduction: Primary Sjögren’s syndrome (SS) is the most common connective tissue disease after rheumatoid arthritis and affects mostly women between 30 and 40 years of age with an estimated prevalence between 0.1% and 0.6%. This observation illustrates an incidental finding of a case of SS in a young female patient in a context of obstructive renal failure (ARF) due to uterine fibroids. Observation: This was a 31-year-old woman hospitalized for anuric AKI (Acute Kidney Injury) with a creatinine level of 1247 μmol/l. Her history included sickle cell disease A/C and an unoperated uterine fibroid diagnosed 3 years ago. Approximately 2 months before her admission, her symptomatology was made of dizziness, physical asthenia, vomiting, poly-arthralgia, morning rash, pollakiuria and oral dryness. Abdominal examination showed a painless transverse mass in the pelvis. Biological examination showed a CRP (C-reactive protein) level of 488 mg/l. The cytobacteriological examination of the urine was normal and the proteinuria was 1.35 g/24 hours. The CT scan showed kidneys measuring 110 mm on the right and 113 mm on the left associated with bilateral pyelo-caliceal dilatation on a large polymyomatous uterus of interstitial and submucosal type. Immunologically, the anti-nuclear factor, the rheumatoid factor and the anti-SSA antibodies were positive. The resumption of the interrogation within the framework of the research of the subjective dry syndrome to find a notion of intermittent xerophthalmia 4 months ago. The Schirmer test was positive in the left eye. The initial management consisted of a polymyomectomy after 3 sessions of hemodialysis. Background treatment combining prednisone 5 mg/day and methotrexate 20 mg/week was started in parallel with the use of artificial tears. The evolution after twelve (12) months of treatment was favorable with a complete disappearance of the signs dry syndrome and full recovery of renal function. Conclusion: SS can have an insidious evolution and remain stable for many years, hence its fortuitous discovery in this case of obstructive ARF on uterine fibroid. In this context we insist on the interest of the immunological assessment in a patient in period of genital activity with a significant proteinuria and non-specific extrarenal signs.

Epidemio-Clinical Approach and Prognosis of Teenage Delivery in the Commune VI Du District of Bamako in Mali

Objective: To describe the epidemiological aspects, clinical characteristics, aspects of childbirth and to determine the maternal and perinatal prognosis during the delivery of adolescent girls at the reference health centre of commune VI of the district of Bamako in Mali. Materials and Methods: This was a descriptive, cross-sectional, analytical case-control study from January 1 to December 31, 2018, or 12 months with prospective data collection. Results: During the study period from January 01 to December 31, 2018, we recorded 1768 teenage deliveries out of a total of 9012 deliveries, a frequency of 19.61%. The average age of the cases was 17.4 ± 1 years. Single adolescent girls accounted for 14.67% (OR = 3.05, P = 0.001) unintended pregnancies (11.67% vs. 2.3%;P = 0.000007;OR = 5.52), the non-completion of the antenatal consultation (14.67% vs. 5.33%;P = 0.0001;preterm births (14.33% vs. 7.67%);P = 0.01;OR = 2.5), anaemia (7.33% vs. 3%;P = 0.009;OR = 2.01), instrumental extractions (P = 0.00008, OR = 2.87), perineal tears (P = 0.0016;OR = 3.05), mechanical dystocies (P = 0.0039);low birth weights (P = 0.039;OR = 2.2) were found to be significantly higher in adolescent girls than adults. Conclusion: Teenage versus adult births are associated with many more maternal-fetal complications.

External Branch of the Superior Laryngeal Nerve: Anatomy and Operating Hurts

Purpose: Our purpose was to describe the anatomy of the external branch of the upper laryngeal nerve and to estimate the frequency of nerves at risk during the total thyroidectomies sub. Methodology: We realized in the CHU Point G in Bamako a forward-looking study over a period going from September 1st, 2016 till December 31st, 2017. All the patients operated by thyroidectomies subtotals for mild goiters were included to whom a systematic location of the external branch of the superior laryngeal nerve in the space avascular of Reeve was realized. Cancers and other thyroid pathologies were not included. Results: We counted and operated 120 cases of mild goiters. The external branch of the superior laryngeal nerve was seen and dissected in 80.8%;it was not seen in 19.2%. According to the classification of Cernea: the type 2 was found in 80.8% of the cases with him under typical 2b in 47.5% and under type 2a in 40 (33.3%). The global frequency of lesion of the external branch of the upper laryngeal nerve was 10.8% at 9 patients among whom 6 who presented a BENLS of Type Ni. Conclusion: The external branch of the upper laryngeal nerve of type 2 presents a risk of wound because the surgeon treats the upper pedicle at the level of the critical centimeter place over the upper pole of the thyroid. The identification of the nerve during the thyroid surgery is the solution of choice.

Ectopic Pregnancy Combined with Intra-Uterine Pregnancy with a Full-Term Live Baby: A Case Report and Review of Literature

Heterotopic pregnancy is no more a medical breakthrough. It combines intrauterine pregnancy and extra-uterine pregnancy regardless of location. We report a case of intra-uterine pregnancy associated with a ruptured abdominal ectopic pregnancy located on the pelvic colon in a 29-year-old patient, third gestation, primigravida, having a live baby and a prior history of two abortions. She has blood group O negative of Rhesus. It has been diagnosed at the stage of the rupture of ectopic pregnancy. An emergency laparotomy performed under blood transfusion has revealed heavy hemoperitoneum (1100 ml), a ruptured abdominal extra-uterine localized on the pelvic under blood transfusion and a bulging uterus. We have proceeded with the aspiration of hemoperitoneum, the ablation of the extra-uterine pregnancy and the hemostasis of the section part. The post-operative follow-up has been easy. The intra-uterine pregnancy has developed normally and has given birth to a full-term live, and healthy baby.

Epidemiological, Clinical and Echocardiographic Aspects of Non-Obstructive Hypertrophic Cardiomyopathy in the Nephrology and Haemodialysis Department of the POINT G University Hospital

Introduction: LVH is the earliest cardiovascular abnormality in CKD. It is a significant risk factor for mortality and cardiovascular morbidity in patients with chronic kidney disease. The objective of this study was to investigate non-obstructive hypertrophic cardiomyopathy in CKD patients hospitalised in the nephrology and haemodialysis department of the POINT G University Hospital. Methods: This is a prospective study carried out from January 1, 2021 to December 31, 2021 and concerned chronic renal failure patients with non-obstructive hypertrophic cardiomyopathy. Results: During our study, we recorded 89 cases of non-obstructive hypertrophic cardiomyopathy, a prevalence of 42.8%. The sex ratio was 1.2 in favour of men. The average age of the patients was 45 ± 14.4 years with extremes of 16 and 78 years. The risk factors frequently found were anaemia (100%) and hypertension (92.1%). The clinical picture was dominated by the left heart failure syndrome (66.3% of cases). The different types of echocardiographic hypertrophy found were concentric (72%), eccentric (18%) and septal hypertrophy (10%). Conclusion: Non-obstructive hypertrophic cardiomyopathy is the early cardiovascular abnormality encountered in CKD. It is associated with cardiovascular risk factors such as hypertension, anaemia and phosphocalcic disorders.

Neuropsychic Disorders Unmasking the Coexistence of Fahr Syndrome and Neuromeningeal Cryptococcosis

Background: Fahr syndrome associates a set of neuropsychiatric manifestations with bilateral calcifications in the basal ganglia and phosphocalcic disorders. Neuromeningeal cryptococcosis can be present in its manifestations, neuropsychic disorders with or without meningeal signs. The objective was to describe a rare association between Fahr syndrome and neuromeningeal cryptococcosis which can be expressed by the same clinical symptomatology in the context of co-infection with the human immunodeficiency virus (HIV) and the hepatitis B virus (HBV). Presentation: A 37-year-old patient without pathological history, who presented behavioral disorders that led to a fight with those around her and a psychiatric consultation. Then, she was hospitalized in the infectious diseases Department upon discovery of her HIV status and viral hepatitis B. She was logorrheic with behavioral disturbances and subsequently presented with tonic-clonic convulsions. Laboratory tests and imaging have concomitantly discovered Fahr syndrome due to pseudohypoparathyroidism and neuromeningeal cryptococcosis. The correct management of these two pathologies enabled stabilization of the patient’s clinical condition with regular monitoring for HIV-HBV coinfection. Conclusion: Farh syndrome and neuromeningeal cryptococcosis are two different entities but sometimes similar symptoms and risk factors. Treatment of metabolic disorders combined with anticryptococcal therapy improved the prognosis.

Kangaroo Mother Care and Neonatal Outcomes in the Pediatric Department of CHU Gabriel Toure

Introduction: In Mali, prematurity is currently the leading cause of neonatal morbidity and mortality at the Gabriel Toure Hospital. Kangaroo Mother” care is an efficient and effective alternative care strategy for preterm and low birth weight babies. This study aimed to evaluate the epidemio-clinical and therapeutic profile of premature/hypotrophic newborns admitted to the “Kangaroo-mother” care unit. Material and method: It was a retrospective study from 01/01/2010 to 31/12/2012. Were included all stable preterm with gestational age between 28 - 37 weeks and hypotrophic newborns with a birth weight 10th percentile for gestational age. Results: One thousand and eighty-four patients (n = 1084) were included. The sex ratio was 1.2 (F = 592;M = 492). The mean birth weight was 1300 g (600 g - 2000 g). The mean gestational age was 32.69 (28 - 37). The mean age of the mothers was 24 years (13 - 45 years). Single pregnancies accounted for 85.1%. Discontinuation of care was 56%. Follow-up to 24 months was effective in 14% of patients. Sixteen percent of the patients died (n = 176). The mothers’ lack of schooling (p = 0.03) and birth weight < 1000 g (p = 0.003) were the major factors in the patients’ mortality. Conclusion: The kangaroo-mother care is an alternative means to improve the survival of preterm and low birth weight babies in Mali.

Contribution to the Study of Hemorrhages in the Third Trimester of Pregnancy, Etiology and Management

Third trimester bleeding is a common concern in obstetrics. The main objective of this work was to study the management of hemorrhages in the third trimester of pregnancy in the maternity ward of the Sominé Dolo hospital in Mopti. Our prospective descriptive cross-sectional survey type study conducted at the maternity ward of Sominé Dolo hospital in Mopti over a period from January 1, 2017 to December 31, 2017 included 94 cases collected. During this period we had performed 1485 deliveries including 94 cases of pregnancies complicated by 3rd trimester hemorrhage, a frequency of 6.33%. The main cause of hemorrhage in the third trimester was represented by placenta preavia 42.6% followed by retroplacental hematoma 28.7%, uterine rupture 26.6% and association Placenta preavia and retroplacental hematoma 2.1%. The type of intervention depended on the cause of the hemorrhage and the maternal and fetal condition. More than half of the cases of uterine rupture 52% had benefited from a hysterorrhaphy during a laparotomy (n = 13/25) against 48% from hysterectomy (n = 12/25). Caesarean section was performed in 87.5% (n = 35/40) against 12.5% vaginal delivery (n = 5/40) in case of placenta preavia. In the end, in 74% of cases (n = 20/27) of retroplacental hematoma, first-line cesarean section was performed. The maternal prognosis was represented by a mortality rate of 12% (n = 11/94) and morbidity dominated by hypovolemic shock 48.9% (n = 22/94), infections 28.8% (n = 13/94) and coagulopathy 11.1% (n = 5/94). The fetal prognosis was very poor. More than half (55%) of the newborns had succumbed against 45% of the newly born. In 55.3% of cases neonatal mortality occurred antenatally. Neonatal morbidity was represented by prematurity, i.e. 20.2% (n = 19/94) and low birth weight, i.e. 22.3% (n = 21/94).