MRI Contribution in the Diagnosis of Non-Traumatic Medular Compressions at the Mali Hospital of about 179 Cases

Slow spinal compressions are due to the development of an expansive process in the spinal canal. It is a very common pathology, the diagnosis of which is mainly clinical. However, magnetic resonance imaging occupies an essential place in the site diagnosis and etiological research in the management. Non-traumatic spinal cord compression is a diagnostic and therapeutic emergency, requiring early and appropriate management. MRI is the benchmark imaging examination for this pathology. No similar previous MRI study in Mali. We undertook this work with the aim to determine the place of MRI in the diagnosis of spinal cord compressions in Mali hospital. Method and Patients: This was a descriptive retrospective study, carried out at the hospital’s medical imaging department from January 1, 2017 to December 31, 2018 (02 years). It involved all patients, regardless of sex and age, sent for an MRI examination of the spine, and in whom spinal cord compression was diagnosed. We used a 0.35T low-field MRI machine with solid-state antennas. Results: We collected 179 cases of spinal cord compression MRI out of 585 spinal MRI performed, (frequency of 30.59%). The average age was 53.5 years with a male predominance (sex ratio 3.7). Motor disorders were the most common reason for examination (41%). We used the T1 T2 sagittal and T2 axial sequences. IV injection of gadolinium was performed in 48% of patients. The topographic lesions were: cervical (54.7%), thoracic (31.3%) and several segments (9.5%). The lesions concerned the compartments: extradural (79.3%), intradural (4.5%), and intramedullary (16.2%). The processes were degenerative (57.5%). tumorous (29.6%), infectious (12.3%) and vascular (0.6%). Conclusion: MRI is the benchmark imaging test for the management of non-traumatic spinal cord injury. Myelo-CT can be an alternative in the absence or in case of MRI contraindication.

Epidemioclinical Profile of Premature Infants at the Neonatology Unit of the Mali Hospital 2012-2015

Introduction: A newborn is preterm when it is born before 37 weeks of amenorrhoea. Preterm births account for 11.1% of live births worldwide, 60% of which are in South Asia and sub-Saharan Africa. Preterm birth is the leading cause of neonatal mortality and the second leading cause of mortality in children under 5 years of age. The aim of this study was to investigate prematurity in the neonatology unit of the Mali Hospital. Materials and Methods: This was a cross-sectional, descriptive study from January 2012 to December 2015 of premature newborns from 28 to 36 weeks of amenorrhea in the neonatology unit of Mali Hospital. Results: From January 2012 to December 2015, we recorded 1692 inpatient newborns, including 614 preterm newborns, a frequency of 36.29%. The sex ratio was 1.43 in favor of boys. The average age of the mothers was 23.9 years with a minimum of 15 and a maximum of 47 years. The majority were housewives (92.7%). The pregnancy was poorly monitored in 51.8% of the mothers. The average gestational age was 32.9 days with extremes of 25 and 36 days. The most frequent mode of delivery was vaginal delivery (93.2%), with late prematurity in 51.5%, moderate prematurity (24.4%), extreme prematurity (18.7%) and very premature (5.4%). The mean birth weight was 1464 g with a standard deviation of 485 g and 2751 g. Prematurity was associated with neonatal infection in 49.4% of newborns, perinatal anoxia (13.9%) and hypotrophy (2.6%). The most frequent maternal risk factors were fever (83.4%), twinship (38.9%) and high blood pressure (8.6%). The average length of hospitalization was 9.75 days with extremes of 0 and 68 days. We recorded a cure rate of 57.7%, a death rate of 35.7% and a dropout rate of 6.7%. Conclusion: Prematurity is frequent in the neonatology unit of the Mali Hospital. We observed a high frequency among women of extreme age and low socio-economic and educational level. In our study we also noted a high mortality rate proportional to gestational age.

Uro-Scanner Aspects of Bladder Tumours at the Mali Hospital about 17 Cases

Introduction: Bladder tumours are frequent, have a poor prognosis and are the second most common genitourinary tumour in men. In Mali, recent statistical data on the prevalence of bladder tumours show a progression with 6.71% in 2006. The euro scanner is used in the diagnostic workup. The work was initiated in order to specify the role of the scanner in the diagnosis of these tumors. Patients and Methods: Prospective descriptive study was carried out in the medical imaging department of Mali Hospital from February to November 2018. Were included any patient with a bladder tumour on euro scanner. The patients had benefited from a preliminary preparation and a renal biological assessment in order to eliminate renal insufficiency. Our examinations were performed with a Siemens 16-slice scanner. These were axial slices performed without, with iodine injection from the pulmonary base to the pubic bones. Results: We had collected 17 patients out of 541 scans i.e. a frequency of 3.76%. The age range of 21 to 40 years was 58.8% with an average age of 25 years. The antecedents (ATCD) found were urinary bilharzia (47%) and smoking (17%). The clinic was dominated by haematuria. It was associated with a bladder mass (52%) and dysuria (23.52%). The CT scan showed a budding appearance, a size greater than 3 cm (82%), infiltration of peri-vesical fat (47.05%), and adenopathy (94%). Associated lesions were: utero-hydronephrosis (58.82%) and metastases (bone and liver in 11.76% of cases each). Conclusion: They are frequent and the history of urinary bilharziasis remains the main risk factor in endemic countries. CT scans are essential in the management of this disease. The diagnosis of certainty remains histology.

Epidemiological Profile of Newborns Who Died during Their Hospitalization in the Neonatology Unit, Mali Hospital

Introduction: Neonatal mortality is a serious problem, particularly in developing countries. Objective: To study the epidemiological and clinical profiles of newborns who died during their hospitalization in the neonatology unit of the hospital in Mali. Methodology: This was a prospective study over a 12-month period (January 1 to December 31, 2020) including all newborns aged 0 - 28 days who died during their hospitalization. Results: A total of 424 neonates were hospitalized in neonatology, 54 died, or 12.73%. Newborns aged 0 - 7 days at admission were the most represented at 79.63% and 94.4% were full-term babies. The male gender was dominant with a ratio of 1.17. The following characteristics were frequently observed in the mothers: not educated (46.3%), poor 75.9%, living in urban areas (68%), housewives 75.4%, and having had less than 4 antenatal care visits (53.7%). For babies, respiratory distress and hyperthermia were the most common reasons for hospitalization (37% and 22.2%, respectively), with 40% being resuscitated at birth. Infection and perinatal anoxia were the most frequent diagnoses, respectively 96.3% and 37%. The death occurred within the first three days of hospitalization in 60% of cases. Conclusion: In order to reduce the mortality rate in our facilities, monitoring of pregnancy and delivery, and correct management of newborns both at birth and in the pediatric wards are important.

Pneumothorax in Children: A Study of 47 Pediatric Cases at Mali Hospital 2017-2020

Objectives: Pediatric pneumothorax, whether primary or secondary (infection, trauma, or iatrogenic), is sometimes life-threatening. We tried to determine the clinical characteristics of pediatric pneumothorax in Mali. Materials and Methods: We collected all pediatric patients (0 - 15 years) admitted for pneumothorax in the pediatric department of the Mali Hospital from January 2017 to December 2020. Results: During this period, a total of 5569 children aged 0 - 15 years were hospitalized, of whom 47 had pneumothorax or 0.84%. Children under 5 years of age were the most affected (80%). Dyspnea was the most common reason for hospitalization (95.7%). The causes of pneumothorax were (in order): infectious causes dominated by bullous dystrophies (70.2%), traumatic (25.5%), and iatrogenic (4.2%). Pneumothorax was compressive in 42.6%. The frequency of anemia was 79.3%. Surgical drainage was performed in 87.2% and almost all (97.6%) were treated with amoxicillin/clavulanic acid. The mean duration of hospitalization was 10.06 days (range: 0 - 35 days): 74.5% were cured while 25.5% died. Conclusions: We reconfirmed that pneumothorax is a pediatric emergency. Children under 5 years of age are the most affected. The main etiologies are infectious bronchopneumonia. The prevention and treatment of respiratory infections, the implementation of good bacteriological diagnostic tools, and the use of surgical video-thoracoscopy will reduce its mortality rate.

Laboratory Confirmation of Human Rabies by RT-PCR and qRT-PCR Bamako: Report of a Case in a 4-Year-Old Girl at the Mali Hospital

Rabies is a zoonotic disease of viral origin transmitted mainly to humans by biting or licking the injured skin of sick animals. It is an untreatable disease that is fatal once it has been declared. Worldwide, 59,000 cases of rabies-related deaths are recorded each year. The diagnosis of rabies is clinical, biological, and anatomopathological. The aim was to establish the laboratory confirmation capacity for human rabies in Mali. The patient, a Malian female, aged four years, was bitten by a dog around her house in district sixth of Bamako near national road number six in 2020. The patient visited the doctor after a two-month bite. However, she was neither referred to the health center for an effective therapeutic measure nor vaccination (post-exposure prophylaxis). The patient was presented with psychomotor excitation, hypersalivation, aerophobia, and hydrophobia symptoms and visited a Malian hospital named “Hospital of Mali”. The patient was admitted with a history of animal bites and symptoms of rabies, and the patient was classified as a probable rabies case. The patient was then referred to an infectious disease physician and hospitalized. After referring the patient to the infectious disease physician, the physician sent oral swab and cerebrospinal fluid (CSF) samples to confirm to the Laboratory of Applied Molecular Biology. Human rabies was confirmed (RT-PCR) by the zoonotic unit of the Laboratory of Applied Molecular Biology. Diagnosis and therapy of human rabies without post-exposure management after a dog bites were still challenging. It was possible to confirm the human rabies case in Mali by RT-PCR and qRT-PCR.

Epidemiological, Clinical and Coronary Angiography Aspects of Acute Coronary Syndrome in the Cardiology Department of the Hospital Mother-Child “Le Luxembourg”Mali

Introduction: Cardiac catheterisation plays a fundamental role in the management of acute coronary syndrome. These explorations require heavy, complex and costly equipment and a large team of doctors, nurses and technicians with highly specialized training. Aims: To describe epidemiological, clinical and coronary angiography aspects of patients with acute coronary syndrome. Patients and Methods: Descriptive study from September 2019 to December 2023 in the Cardiology Department of the Hôpital Mère-Enfant of Bamako. Inclusion criteria were patients admitted for coronary angiography with the diagnosis of acute coronary syndrome. Results: During the study period, 1253 patients underwent coronary angiography, 596 of whom had acute coronary syndrome as an indication, representing a hospital frequency of 47%. Sex-ratio was 2.10. Mean age of patients was 58.5 ± 11.39 years. ST elevation acute coronary syndrome was the most common indication with 63.92% of cases. High blood pressure was the main cardiovascular risk factor with 58.7% of cases, and radial access approach was used in 98% of cases. Coronary angiography was pathological in 91.70% of cases (n = 548). Patients with lesions of anterior interventricular artery were 73.73% of cases. Tritruncal lesions accounted for 40.63% of cases. Conclusion: ST elevation acute coronary syndrome is the most frequent manifestation of acute coronary syndrome. Anterior interventricular artery is most often the culprit lesion for our patients.

Congenital Lobar Emphysema in an Infant: A Case Report from the University Hospital of Mali

Congenital lobar emphysema is characterized by distress due to hyperinflation of the affected lung lobe(s). We report the case of a 2-month-old infant with congenital left lower lobe emphysema. A 2-month-old female infant, born at term without incident, was hospitalized for respiratory distress. On a postnatal day 15, respiratory distress occurred. On admission, he weighed 3400 g and was apyretic. He had a polypnea of 58 cycles/min and a oxygen saturation of hemoglobin of 90% on room air. A chest radiograph revealed hyperclarity of the left lung. Chest CT revealed left lower lobe emphysema. He underwent a left lower lobectomy. The postoperative course was uneventful. He was discharged from the hospital 7 days after surgery without sequelae. Physicians should be aware that congenital lobar emphysema can present with respiratory distress in infants. A chest CT scan confirms the diagnosis. Surgical treatment is effective.

Endocranial Suppurations of Sinus Origin: Ratio of 3 Cases in Children at the Hospital in 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 hemiplegia. An emergency brain scan revealed a right hemispheric subdural empyema associated with an intracerebral abscess and pansinusitis. Surgical drainage associated with ceftriaxone 100 mg/kg/d in DI for 15 days, gentamycin;3 mg/kg/d in SI for 3 days, metronidazole: 10 mg/kg/12hours in SI for 15 days and paracetamol: 15 mg/kg/6hours in SI were instituted. Staphylococcus aureus was isolated in the pus of the abscess. The postoperative course was calm. Conclusion: Endocranial suppurations of sinus origin are serious and frequent infections in children in developing countries. Its diagnosis must be evoked in front of any hemiplegia associated with a fever or headache and confirmed by a cerebral scanner.

Study of Tuberculosis in Children Aged 1 Month to 15 Years in the Pediatric Ward of the Hospital of Mali 2015-2021

Introduction: In 2020, an estimated 9.9 million people are living with tuberculosis worldwide, including 1.1 million children. Tuberculosis is the 2nd leading cause of death from infectious disease after COVID-19 and the 13th leading cause of death worldwide. Objective: To collect cases of tuberculosis in children aged 1 month to 15 years in order to study the epidemio-clinical aspects in the pediatric department of the Mali Hospital during the period 2015-2021. Materials and Methods: This was a descriptive, retrospective study from January 1, 2015, to December 31, 2020, and a prospective study from January 1 to December 31, 2021, among children aged 1 month to 15 years admitted for suspected tuberculosis in the pediatric ward of the Mali Hospital. Results: From January 2015 to December 2021, we collected 69 cases of tuberculosis among 9438 hospitalized children, i.e. a frequency of 0.73%. The average age was 6.16 years with extremes of 3 months and 15 years. The sex ratio was 1.1% in favor of boys. The majority of children were vaccinated against tuberculosis (88.4%). The most frequent symptoms were fever (76.8%) and weight loss (73.9%). The pulmonary form was the most frequent (54.9%). Bacteriological confirmation was done in 43.5% of our children. It was Mycobacterium tuberculosis in all confirmed cases. More than half of our children (65.2%) were treated with first-line anti-tuberculosis drugs for 6 months. We observed a cure in 42.0% of our patients and a case fatality rate of 39.1%. Conclusion: Tuberculosis in children is frequent in Mali Hospital despite good BCG vaccination coverage. Its mortality remains high and is maintained by malnutrition, HIV, and the emergence of resistant strains of bacilli.

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

Profile of Urinary Tract Infections in the Elderly in the 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.

Isolated Right Pulmonary Agenesis in a 2-Month-Old Infant in the Pediatric Ward of Hospital of Mali

Introduction: Pulmonary agenesis is a rare congenital abnormality defined by the absence of parenchyma, bronchi and pulmonary vessels, frequently associated with other malformations. We describe a case of isolated right pulmonary agenesis diagnosed in the pediatric ward of the Mali Hospital. Clinical case: He was a month-old baby boy, born at term by cesarean section of a well-followed pregnancy. He was not resuscitated. He developed dyspnea after a cold. An emergency chest X-ray revealed a right opaque lung. He was referred to the hospital for the exploration of this opacity. At the entrance, it weighed 3910 g, size: 54 cm and the temperature was 36.9°C. He had a polypnea, an intercostal print. The sounds of the heart were diverted to the right. The rest of the clinical examination was without much particularity. The chest CT scan confirmed the right pulmonary agenesis. Abdominal and cardiac ultrasound was normal. A healing includes oxygenotherapy, serum glucose 10% minding 100 ml/ Kg/day and amoxicillin minding 100 mg/ Kg/day at 3 times by oral way. After 24 hours of treatment, we observed an improvement in dyspnea. On D2, he was weaned off oxygen and resumed feeding. Conclusion: Pulmonary agenesis is a rare congenital anomaly that is frequently associated with other malformations, thus making its prognosis poor. The search for malformative abnormalities should be systematic in right pulmonary agenesis.

Para Testicular Pseudotumeurs of Calcified Gait: A Case Report from the Nianankoro Fomba Segou Hospital (Mali)

Fibrous tumors of para testicular location are extremely rare benign tumors. The diagnosis of benignity, which allows a conservative treatment, will be made intraoperatively in front of the macroscopic aspect with well enucleable nodules and confirmed by the extemporaneous anatomopathological examination. We report a case of multiple calcified paratestinal pseudotumors in a 25-year old patient with no particular history, whose benignity was proven by the histology of the operative parts. Our objective was to discuss, from this observation and a review of the literature, the diagnostic and therapeutic aspects of these tumors.

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

Profile of Newborns Hospitalized for Maternal Fetal Infection and Having a Positive CRP in the Pediatric Department of the Gabriel TouréCHU in Bamako, Mali

Objective: Early bacterial neonatal infection (INBP) or maternofetal infection (early neonatal sepsis) remains a concern of the pediatrician due to diagnostic difficulties and its increased morbidity and mortality. No study has been done in Mali on the profile of newborns admitted for INBP with positive CRP, hence the initiation of this work with the aim of studying the epidemiological, biological and bacteriological profile of newborns with a bacterial maternal-fetal infection. Method: Longitudinal study descriptive (from 27 June to 3 September 2016) which concerned all newborns aged from 0 to 72 hours of life hospitalized for confirmed early bacterial neonatal infection with a positive C-reactive protein (CRP) in the neonatal department of the CHU Gabriel Touré. INBP was defined by the presence of maternal and neonatal infectious risk factors, positivity of CRP with a germ in the blood culture. Results: During the study period we included 244 newborns for probable maternofetal infection and who benefited from the CRP assay, 43 had a positive CRP, i.e. a frequency of 17.62%. The sex ratio was 2.30. The majority had a low birth weight (<2500 g) in 69.8% of cases. Mothers were aged 18 to 35 in 93%. The majority were out of school (43.8%) and housewives in 74.4%. The main reasons for consultations were prematurity and/or low birth weight, respiratory distress and neonatal distress, i.e. 46.5%, 25.6% and 11.6% respectively. Among the 43 newborns with a positive CRP, the blood culture returned positive in 79.1% (n = 34). We deplore 2 deaths (4.7%). The main bacteria were gram-positive cocci (Staphylococcus aureus 53.01% and Streptococccus agalactiae 4.10%), gram-negative bacilli (GNB) type Enterobacteriaceae (Klebsiella pneumoniae 11.25% and E. coli at 5.70%) and non-fermentative GNBs (Pseudomonas aeruginosa 2.80% and Acinetobacter baumannii complex 2.24%). Conclusion: Maternal-fetal infection is a hospital pathology frequently encountered in the neonatal period. Its clinical presentation is dominated by respiratory distress, neurological disorders and low birth weight.

Maternal-Fetal Prognosis of Eclampsia at the Second Reference Hospital in the Urban Commune of Segou in Mali

Aim: To describe the epidemiological, therapeutic and prognostic aspects of eclampsia at the second reference hospital in the urban commune of Ségou in Mali. Patient and Methods: This was a descriptive, cross-sectional, analytical, retrospective and prospective study based on a comprehensive de-engineering. It covered a 3-year period from January 1, 2010 to December 31, 2012 and involved 176 cases. Results: The incidence of eclampsia during the study period was 2.9%. Classically, it occurred in 74.4% in young primigeste, in 73.9% in the 3rd trimester of pregnancy and 26.1% of cases during postpartum. We recorded maternal complications such as retro-placental hematoma, acute kidney failure and delivery hemorrhage. The case fatality rate was 2.3% or 4 cases of maternal death. At the fetal level, there was 29.5% prematurity, 31.8% neonatal suffering, 11.4% hypotrophy, 11.9% in utero fetal death and 7.4% early neonatal death. Conclusion: The maternal-fetal prognosis remains reserved despite the progress made in the management of eclampsia in our services.

Venous Thromboembolic Disease in a Regional Hospital in Mali

Introduction: Venous thromboembolism (VTE) is a nosological group which mainly includes deep vein thrombosis (DVT) and pulmonary embolism (PE), it is frequently associated with high morbidity and mortality. We initiated this study with the aim of studying VTE in a cardiological hospital environment in a regional hospital in Mali. Methodology: This was a descriptive study with prospective recruitment over 1 year from June 20, 2019 to June 20, 2020, covering patients hospitalized and followed in consultation in the cardiology department of the Ségou regional hospital in Mali. Results: We collected 31 cases of VTE out of 366 patients, representing a frequency of 8.47%. The sex ratio was 0.88. VTE risk factors were dominated by immobilization (29.03%), pregnancy and postpartum (16.12%), heart failure (16.12%). The reason for consultation was dyspnea (93.54%) followed by chest pain (83.87%). On admission the clinical manifestations were tachycardia (74.19%), tachypnea (90.32%), muffled heart sounds (70.96%), global heart failure syndrome (51.6%). According to VTE probability scores;51.61% of patients had an intermediate clinical probability according to the simplified Wells score for PE and 54.84% had an intermediate clinical probability for the simplified Geneva score for DVT. D-Dimers were only performed in 12 patients (38.70%) and were elevated in all. A chest CT angiogram showed PE in 90% of patients (n = 28/31). Venous Doppler ultrasound of the lower limbs showed venous thrombosis in 3 patients. Conclusion: Venous thromboembolism, although underdiagnosed, is common in our health structures. Prevention, particularly heparinoprophylaxis and early recovery in a hospital environment, remains the effective means of combating this condition.

Congenital Heart Disease: Epidemiological and Echocardiography Aspects in the Cardiology Department of Tombouctou Hospital, Mali

Congenital heart diseases are abnormalities of heart that occur during intrauterine life. Our work aimed to study the epidemiological and echocardiographic aspects of congenital heart disease with Cardiology Department of the Tombouctou hospital. This was a descriptive cross-sectional study from November 2018 to December 31, 2019 on Doppler echocardiography reports from patients admitted to the Cardiology department. The probes used were 3.5 and 5 MHz on an Esaote Mylab40 device. The inclusion criteria concerned patients of both sexes under the age of 16, hospitalized or followed in the cardiology department for cardiac symptoms and having benefited from a cardiac Doppler ultrasound. Results: During the study period, 370 echocardiographic examinations were performed and revealed 20 cases of congenital heart disease with a prevalence of 5.45%. The female sex was the majority 13/7 cases which makes a sex ratio of 0.54. Heart murmurs were the main reason for requesting cardiac Doppler ultrasound with the 13 out of 20 cases of congenital heart disease (65%). Interventricular communication was represented by 15 cases (75%). Congenital heart disease is a reality in Africa. Its frequency and reported series are underestimated due to the inaccessibility of Doppler echocardiography.

Epidemiological and Clinical Profile of Patients Undergoing Primary Nephrological Consultation at the Fousseyni DAOU Hospital in Kayes, Mali

Introduction: The first nephrological consultation is often late, even in developed countries. This delay is related to the insidious nature of renal disease, the lack of qualified personnel and structures for the management of these conditions and the context of chronic insecurity in our country. In Kayes, there is no data related to the first consultations of patients with the nephrologist, hence the interest of this study, which aimed to describe the epidemiological and clinical characteristics of patients undergoing a first nephrological consultation in Kayes hospital. Materials and methods: This was a retrospective, descriptive study conducted from January 1 to December 31, 2020 at the nephrology unit of the Fousseyni DAOU hospital in Kayes. All patients received for nephrological consultation for whom a medical record was made were included. The following data were collected and analyzed: the specialty of the medical referent, the reason for consultation, sociodemographic characteristics and the renal assessment of patients. Patients who consulted for non-nephrological pathologies and those who had no medical record were not included. Results: We collected the records of 346 patients, composed of 180 (52%) women and 166 (48%) men, i.e. a sex ratio of 0.92. The age group [20 - 40 years] was the most represented, 107 cases or 30.9%, with a mean age of 48.84 ± 21.33 years and extremes of 1 and 90 years. Housewives were the most consulted population, 149 cases (41.33%). Patients consulted more between the months of January and February, 116 cases (33.5%), this period was followed by the months of October-December, July-September and April-June with respectively 94 cases (27.2%), 76 cases (22.0%) and 60 cases (17.3%). The patients were referred by the general practitioner in 59.5% (209 cases), specialist doctor, 26.0% (90 cases). The patients came mainly from hospital practitioners, 172 cases (49.7%), private clinic and practice 81 cases (23.4%), community health center (CSCOM), 69 cases (19.9%). The main reasons for consultation were hypercreatinemia 205 cases (59.2%), low back pain 46 cases (13.3%) and edematous syndrome 16 cases (4.6%). The mean blood pressure was 140/80 mmHg with extremes of 70 and 240 mmHg for systolic and 40 and 160 mmHg for diastolic. Mean creatinine was 660.53 μmol/l ± 821.311 with extremes of 46 and 5447 μmol/l. Patients transferred from the emergency department had a creatinine level above 700 μmol/l in 41.1% (39) of cases (p = 0.003 Person’s Chi-square = 8643 ddl = 1). Among the 316 patients who had a blood count, anemia was found in 221 (69.9%) and the mean hemoglobin level was 9.61 g/dl ± 3.11 with extremes of 1.70 g/dl and 19.56 g/dl. The diagnostic hypotheses evoked were acute renal failure (124 cases, i.e. 38.5%), chronic renal failure (81 cases, i.e. 23.7%). Conclusion: Primary nephrological consultation is more solicited by general practitioners. The consultations, often in the emergency room, were motivated by significant hypercreatinemia. Awareness of the nursing staff, the patients and the political authorities are necessary to encourage nephrological consultations at an early stage of the renal disease.