Staphylococcus xylosus Isolation of Conjunctival Secretions in an 8-Year-Old Child at Sikasso Hospital (Mali): About a Case

Staphylococcus xylosus is a species of bacteria belonging to the genus Staphylococcus. This genus currently includes several species and subspecies. We distinguish between 2 groups: the group of coagulase-positive staphylococci (CoPS) and coagulase-negative staphylococci (CoNS), a larger group that includes more than forty species and subspecies. Among the CoNS, Staphylococcus xylosus occupies a special place because it is frequently isolated from meats, dairy products, and agricultural environments. It is commonly used in fermentation due to its primary role in the flavor and color development of fermented products. It is a commensal bacterium of the skin of small mammals and farm animals, where it constitutes the majority of flora. In this species, there are a large number of strains, including phenotypes and genotypes. Although S. xylosus is actually a recognized non-pathogenic species, a few strains can be potentially dangerous. They can thus be responsible for mastitis and dermatitis in cattle. With the multiplicity of breeding farms, the consumption of livestock products and the increasingly frequent contact of humans with animals a few rare cases of human opportunistic infections have also been reported in the literature. These include pyelonephritis, endocarditis, urinary, lymphatic, and lymph node infections, contamination of orthopedic materials and catheters. Thereby, we report the case of a lingering and chronic infection of the lacrimal tract by Staphylococcus xylosus in an 8-year-old child in the Ophthalmology Department of Sikasso hospital in Mali.

The Epidemiology of Influenza in Children Hospitalized at the Hospital of Sikasso, Mali 2015-2019

Introduction: Influenza is an acute respiratory infectious disease, highly contagious due to influenza viruses. The objective of this work was to identify, understand the epidemiology of circulating strains and estimate disease transmission. Patients and Methods: The study was carried out in the pediatric department of the Sikasso Hospital. This was a prospective, longitudinal descriptive study over a five-year period (January 1, 2015 to December 31, 2019). She was interested in severe acute respiratory infections (SARI) for hospitalized patients in the pediatric department. Results: During the study period the prevalence of severe acute respiratory infections among hospitalized children was 21.85‰. The majority of cases were observed in 2019 with 58 cases, the sex ratio was 1.8. The age group from 0 to 1 was the most represented with 100 cases (48.30%) followed by 2 to 4 years 73 cases (35.24%) and 5 to 15 years 34 cases (16.46%). More than half of the patients lived in rural areas 129 (62.31%). Fever and cough were present in the majority of patients. No children had received influenza vaccination. In study 36 (17.39%) cases were positive for influenza A and B.

Traumatic Digestive Perforation in the Hospital of Sikasso: Epidemio-Clinical and Therapeutic Aspects

Traumatic digestive perforation is the pathological opening of the wall of a hollow organ of the digestive tract (esophagus, stomach, small intestine, large intestine, rectum, and extrahepatic bile ducts) following trauma. Injuries to the digestive viscera, especially from trauma, have been known since antiquity. Aristotle recognized that a slight blow can cause an intestinal injury. Perforation of a hollow organ of the digestive sphere results in peritonitis, which in this case is the consequence of an infection of the peritoneal cavity by spreading of the digestive contents. The aim of the work was to describe the epidemiological, clinical and therapeutic aspects of traumatic digestive perforation. Patients and method: The study was retrospective and descriptive from January 1, 2016 to December 31, 2020, in the general surgery department of the hospital of Sikasso (Mali). Patients operated for traumatic digestive perforation were included. Results: The clinical records of 42 patients were collected. Traumatic digestive perforations represented 12.3% of patients hospitalized for abdominal trauma. The average age of the patients was 26.6 years, with a sex ratio of 6:1. The most frequent etiology was road traffic accidents with 38% of patients. The average delay of consultation was 5 days. Abdominal pain was present in 38 patients, vomiting in 17 patients. On physical examination, the most frequent signs were abdominal contracture in 61.9% of patients, and disappearance of pre-hepatic dullness in 54.7% of patients. On rectal examination, the douglas was bulging and painful in 21 patients. X-ray of the abdomen without preparation showed pneumoperitoneum in 54.1% of patients. Excision, suture and peritoneal lavage were performed in 31 patients. The postoperative course was marked by parietal suppurations in 5 patients, a digestive fistula in 2 patients and 4 cases of death (9.5%). Conclusion: Traumatic digestive perforation is a frequent pathology in surgery. Road accident was the main cause. The treatment is essentially surgical.

Epidemiological and Clinical Aspects of Chronic Renal Failure in the Medical Department at the Hospital of Sikasso

Introduction: Chronic renal failure is a real public health problem because of its prevalence, the cost of its management and the high morbidity and mortality rate associated with it. The objective of this study was to determine the frequency, causes and main aggravating factors of chronic renal failure in the medical department of the hospital of Sikasso. Materials and Methods: This was a cross-sectional, retrospective, descriptive study conducted in the medical department of the Sikasso hospital from January 1, 2021 to November 30, 2022. It covered all the records of patients with chronic renal failure hospitalized in the department during this period. The MDRD formula was used to estimate the glomerular filtration rate. The KDIGO 2012 classification was used to stage CKD. Results: Of 820 patient records reviewed, we retained 197 records. The mean age of our patients was 42.25 ± 10 years. The male sex represented 114 (57.9%). The socio-economic level was considered low and precarious in 79.8% of cases. The frequency of chronic renal failure was 24%. The reason for hospitalization was mostly hyper creatinine > 185 μmol/l (92.4%). Herbal medicine was reported in 103 cases (52.3%). Medical history was hypertension 101 cases (51.3%), undocumented gastro duodenal ulcer (UGD) 14 cases (7.6%), hypertension and diabetes 11 cases (5.1%), diabetes 8 cases (4%), lower limb edema 9 cases (4.6%). Hypocalcemia was 147 cases (75.6%) with hyper phosphoremia was 153 cases (77.7%). Hemoglobin level was: <6 g/dl, 44 cases (22.3%);between 6 - 8 g/dl, 77 cases (39.1%), from 8 - 10 g/dl, 54 cases (27.4%). The etiologies of CKD were vascular nephropathy 106 cases (53.8%), interstitial nephropathy, 44 cases (22.3%), glomerular nephropathy, 33 cases (16.8%), diabetic nephropathy, 12 cases (6.1%) and polycystic kidney disease 2 (1%). CKD was classified as stage 5, 171 cases (86.8%), stage 4, 11 cases (5.6%), stage 3, 13 cases (6.6%) and stage 2, 2 cases (1%.) Dialysis was performed in 1095 (5.3%) of our patients. All these patients started dialysis with a central line. Conclusion: This study reveals the high prevalence of chronic renal failure in the department and above all the late diagnosis at very advanced stages. This imposes policies of prevention and effective management of the responsible diseases.

Postpartum Family Planning at the Timbuktu Hospital in Mali

Introduction: Postpartum family planning is the prevention of pregnancies during the 12 months following childbirth. Few studies have been devoted to postpartum family planning in Mali. Our work will contribute to reducing unmet need for family planning. Objective: To study the use of contraceptive methods in the postpartum period in the obstetrics and gynecology unit of Timbuktu hospital. Materials and Methods: This was a descriptive and analytical cross-sectional study with prospective collection of data from January 1, 2022 to December 31, 2023. All women who gave birth having chosen and benefited from a contraceptive method were included. The statistical test used was the Fisher test with a significance threshold fixed at 5%. Results: The frequency of contraception in the postpartum period was 17.03%. The average age of clients was 26.14% with extremes of 14 and 45 years. They were paupiparous at 56.4% with an inter-birth interval of less than 12 months at 12.3%. More than half of the counseling (58.5%) was done during postnatal visits. The methods chosen were implants at 48.1%, injectable progestins at 21.3%, intrauterine device at 14.7%, miro-progestin pills at 13.5%, tubal ligation at 1 .4% and condoms at 1%. The regular follow-up rate was 51.1% of cases and 25.6% had no follow-up. Conclusion: The overall rate of postpartum family planning of 17.08% remains low. Improving FP staff skills will reduce unmet needs and contribute to increasing contraceptive prevalence in Timbuktu.

Epidemiological and Anatomo Path Ological Aspects of Stomach Cancers at the Koutiala District Hospital

Aim: This paper aims to evaluate the epidemiological and pathological aspects of stomach cancer at Koutiala District Hospital. Methods: This was a retrospective study carried out in the General Surgery Department of the Koutiala District Hospital Health Centre. The records of patients admitted for stomach cancer in the period from August 1, 2017 to December 31, 2022 were collected. Patients who underwent surgery for stomach cancer were included in the study. Patients who had not undergone surgery were excluded. Results: We collected records from 40 patients operated on for stomach cancer. The median age was 58.4 years ± 5.7. Men were in the majority with 72.5% The sex ratio was 2.6. The incidence rate of stomach cancer in the general population in the circle was 4.9 cases per 100,000 population. Patients had a history of gastric ulcer in 90%, Helicobacter pylori infection in 47.5% and a notion of excessive salt consumption in 47.5%. The median duration of disease progression was 5 years ± 2.3. The seat was antro-pyloric in 77.5%. The cancer was ulcerative budding in 23 patients. Adenocarcinoma was the histological type in all patients. The cancer was classified as stage III in 30 cases and stage IV in 10 cases. Palliative surgical treatment was the most performed (47.5%). Postoperative morbidity was 15% and mortality was 42.5% at one year. Conclusion: Stomach cancer is common in the ward. Most patients consult at the stage of metastasis. Palliative surgery remains the most practical. Postoperative morbidity and mortality is very high.

Study of Factors Associated with Maternal Deaths at Timbuktu Hospital in Mali

Introduction: Despite progress in universal health coverage, maternal mortality remains a concern for developing countries, including Mali. The problem is not due only to a lack of health services but to a combination of factors that need to be identified to give hope to women of childbearing age. Objective: Determine the factors associated with maternal mortality in the Timbuktu region of Mali. Methodology: Retrospective, descriptive, cross-sectional and analytical study from January 1, 2018 to December 31, 2022 using a questionnaire and an interview guide to determine the factors associated with maternal mortality in the Timbuktu region of Mali. Results: A total of 112 maternal deaths were recorded between 2018 and 2022. The average age of the women who died was 26 years (standard deviation 7.6 years). The 14 – 23-year-old age group is the most affected (43.8%). 66.1% of women came from rural areas. Illiteracy (77.7%), lack of ANC (54.5%), distance of households from health facilities (76%) and insecurity (52.7%) have been identified as factors contributing to maternal mortality. Conclusion: This study reported a high prevalence of maternal mortality rates that may be associated with women’s socioeconomic conditions. Actions must be developed to integrate CPN into an advanced strategy for women living in rural areas in Mali.

Liposarcoma Retro-Peritoneal in the General Surgery Department of the Hospital of the District of the Commune IV

Retroperitoneal soft tissue sarcomas in the retroperitoneal/intra-abdominal regions represent 10% - 15% of all cases of soft tissue sarcoma. Liposarcomas, which are the most common histological type, account for 20% - 45% of retroperitoneal/intra-abdominal sarcoma cases, and 20% of liposarcomas cases are primary retroperitoneal liposarcomas. Surgical resection in case of malignancy remains the treatment of choice for liposarcomas, according to the guidelines of most major international companies. Our goal was to improve the management of retroperitoneal liposarcoma. This was a 65-year-old patient, with no medical or surgical history, who was referred to us for abdominal swelling, in whom clinical and paraclinical examination found retroperitoneal liposarcoma stage IV, and the surgical treatment consisted in making a tumor reduction. Conclusion: Retro-peritoneal liposarcoma is an undervalued malignant tumor, and the diagnosis is often late.

Lesional and Therapeutic Aspects of Tibial Plateau Fractures at the BSS University Hospital Center in Kati

Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.

Interest of Beta-2-Microglobilin Plasma Assay in Iterative Haemodialysis in the Nephrology and Haemodialysis Department of University Teaching Hospital of Point G, Bamako, Mali

Beta-2-microglobulin (B2M) is a low molecular weight polypeptide (11,800 Da) that exists in a free form and a form bound to cell membranes (light chains of HLA class I molecules). Their dosage is used in the exploration and monitoring of renal function in haemodialysis patients, hence the interest of this study, the objective of which is to study the different players involved in the increase of beta-2-microglobulin. Materials and Methods: This was a prospective and descriptive study from January 1st, 2017 to August 31, 2017 (08 months). All patients with chronic hemodialysis for 3 years or more were included. We analyzed sociodemographic, clinical and paraclinical data. Results: We collected 50 patients. The mean age was 50 ± 4.6 years with extremes of 30 and 82 years. The female sex predominated (52%). Chronic end-stage renal failure was hypertensive (86%), diabetic (4%). All patients benefited from intermittent hemodialysis for 8 hours per week using a low permeability membrane (cuprophane). The average duration of hemodialysis was 68 ± 6.4 months with extremes of 36 and 204 months. Twenty percent (20%) and four percent (4%) of chronic dialysis patients had joint pain and sensory deficit. Phalen’s sign was positive in 2% (1 case), Tinel’s sign in 2% (1 case) and carpal tunnel syndrome in 2% (1 case). The mean serum beta-2-microglobulin level was 58.34 ng/l with extremes of 16.99 and 112.24 ng/l. There was a correlation between hypertensive nephropathies and beta-2-microglobulin levels above 50 ng/l (P < 0.001). The mortality rate was 6%. Conclusion: Our study has objectified factors such as inadequate dialysis (8 hours/week), use of low permeability membrane in the increase of beta-2-microglobulin. The increase in serum beta-2-microglobulin levels in our patients is evidence of poor purification of medium molecules. Its reduction can be established by improving the quality of dialysis, in particular by using a high-permeability membrane.

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.

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.

Treatment of Pelvic Limb Fractures in a Hospital of 2e Reference in Mali

Introduction: A fracture is a solution in the continuity of a bone. Pelvic limb fractures may involve one or more of the bones. They constitute a real public health problem, which requires the identification of the factors inherent to this phenomenon for better prevention, but also for quality management of fractures and sequelae. Objectives: Were to describe the epidemiological, clinical and therapeutic profile of pelvic limb fractures in Timbuktu Hospital. Patients and Method: We conducted a prospective, descriptive study in the Surgery Department of Timbuktu Hospital, covering a period of one year from January 1 to December 31, 2017. We collected 39 patients who presented with fractures of the pelvic limbs, who were hospitalized and monitored throughout our study. Results: We obtained a hospital frequency of 2.86% limb fractures. Among the 39 patients included in our study, the male sex was predominant in 69.2% of cases, the average age of our patients was 20.5 years. Pupils and students were in the majority in 48.7% of cases. Road traffic accidents were the most common cause of fracture with 59.0% of cases. The tibia was the most affected segment in 38.5% of cases. Surgical treatment was predominant in 64.0% of cases. We obtained very good results in 94.87% of cases. Conclusion: Limb fractures remain frequent due to road traffic accidents. Osteosynthesis treatment provides a good result with fewer complications.

Maternal-Fetal Prognosis of Delivery in the Presentation of the Seat at the Kayes Hospital (Mali)

Objective: The purpose of this study was to assess the risk factors associated with seat presentation and to determine the maternal-fetal prognosis of delivery in the presentation of the seat. Materials and methods: This was a descriptive, cross-sectional and analytical case-control study with prospective data collection, from January 1, 2018 to December 31, 2019, a 12-month period at Kayes Hospital, Mali. Results: During our study period we recorded 3820 deliveries, including 120 breos;a frequency of 3.14% of all deliveries. The 20 - 35 age group was the most represented in cases 61.7%. Of the cases 66.7% (n-80) were out of school, we note 75.8% (n-182) of out-of-school controls. Primiparaes were the majority among cases 39.2% (n-47), as were 39.1% of the controls (n-118). The cases had a history of caesarean section at 15% (n-18);13, 3% (n-32). The most common mode of presentation was the 70% decomplete seat. It was mainly the anterior left sacro iliac variety (85.8%). The low pathway was preferred during these deliveries to 70% against 30% of caesarean section of which 28.3% of cases were carried out in an emergency. Several factors such as delivery pathway, mode of presentation, length of expulsion and obstetric manoeuvres used influenced fetal prognosis. Fetal complications were dominated by acute fetal suffering (15.8%), followed by dislocation of the shoulder (0.8%). The most common morbid maternal complications were soft part tears (15 cases or 12.5%) and parietal suppuration (1 case or 0.8%). We did not record any maternal deaths. Conclusion: Our results confirm that childbirth is a risky delivery, and must require careful selection of eligible cases and rigorous management of labour with trained teams. In these circumstances, it seems totally abusive to advocate as a single mode of delivery caesarean section in all presentations of the chair in the primigestes.

Morbidity and Mortality of Newborns in a Context of Limited Resources in Tombouctou, Mali

Introduction: Worldwide, 2.3 million children died in the first 20 days after birth in 2022, according to the WHO. In Mali, according to the sixth Demographic and Health Survey, the neonatal mortality rate was estimated at 33% live births in 2018. The Timbuktu region had the highest neonatal mortality rate in the country with 44%. The objective of this work was to study the causes of neonatal morbidity and mortality and related factors in the paediatrics department of Timbuktu hospital. Materials and method: This was a descriptive, cross-sectional study conducted from 1 January to 31 December 2023 in the neonatology unit of the paediatrics department of Timbuktu hospital, including all newborns admitted to hospital. Results: Our study took place over 12 months, during which 618 admissions were made to the paediatric ward, including 244 newborns, i.e. 39.48%. The majority of newborns (86.5%) were admitted in the first week of life. The mean age was 3 days, with a sex ratio of 1.1 for males. Weight under 2500 g was 54.1% for an average weight of 2372 g. The main mode of admission was transfer from the hospital maternity unit (62%). The main reasons for admission were acute foetal distress (27.9%) and prematurity (26.2%). The average age of the mothers was 24, with extremes of 15 and 49. The mothers were housewives (87.3%), uneducated and primiparous (59% and 36.5% respectively);only 40.2% had made more than 3 antenatal care visits. Newborns born by vaginal delivery accounted for 80.7% and those born by caesarean section for 19.3%. The risk of infection was present in 52.5% of cases. The three leading causes of hospitalisation were birth asphyxia (40.2%), neonatal infection (32.4%) and prematurity (25%). The mortality rate was 21.7%. The main causes of death were prematurity (39.6%), birth asphyxia (32.1%) and neonatal infection (24.5%). Conclusion: Neonatal morbidity and mortality remain a concern in Timbuktu. Despite the unfavourable security situation, morbidity and mortality indicators are close to those in some hospitals in Mali. The correct application of Essential Newborn Care and antenatal care remains a major challenge for the hospital and the Timbuktu region.

Incidences and Risk Factors for Surgical Site Infections in Koutiala, Mali

Purpose: This paper aims to assess the incidences and risk factors for surgical site (ISO) infections in the general surgery department of the Koutiala District Hospital. Patients and Methods: This was a prospective and descriptive study from August 1, 2017 to October 31, 2020 involving all patients who underwent laparotomy in the general surgery department of the Koutiala District Hospital. Patients who were not operated on and who did not have a laparotomy were not included. Age, sex, frequency, patient history, National Nosocomial Infections Surveillance (NNIS) index, time to occur, bacteriological test results and course of infection were analyzed. Results: Fifty patients were registered. The average age was 34.2 ± 21.2 years old. Eleven patients were 60 years old or older. The hospital incidence rate was 4.3% and the community incidence rate was 6.1 cases per 100,000 population. The concept of smoking was noted in 15 patients. Patients were operated on in emergency 84% of cases. Peritonitis was the most common initial lesion with 32% of cases. Our patients had an NNIS index greater than 0 in 84% of cases. The time to develop infection from the surgical site was less than 3 days in 8 patients (16% of cases). Depending on the depth of the infection, it was superficial (cutaneous) in 39 patients (78%) and deep (subcutaneous and organic) in 11 patients (22%). Escherichia coli was the most common germ with 72% followed by staphylococcus aureus at 24%. We noted 22% morbidity. The median length of hospitalization was 9 ± 2.2 days. Conclusion: ISO is common in our service. Prevention and mastery require knowledge of risk factors.

Prevalence of Refractive Errors among School Children Aged 5 to 15 Years Old at CHU-IOTA

Introduction: Undetected refractive errors constitute a health problem among school children who cannot take advantage of educational opportunities. The authors studied the prevalence of refractive errors in school children aged 5 to 15 at CHU-IOTA. Patients and Method: This is a prospective, descriptive cross-sectional study carried out in the ophthalmic-pediatrics department of CHU-IOTA, from October to November 2023. Results: We received 340 school children aged 5 to 15, among whom 111 presented ametropia, i.e. a prevalence of 32.65%. The average age was 11.42 ± 2.75 years and a sex ratio of 0.59. The average visual acuity was 4/10 (range 1/10 and 10/10). We found refractive defects: astigmatism 73.87%, hyperopia 23.87% of cases and myopia 2.25%. The decline in distance visual acuity was the most common functional sign. Ocular abnormalities associated with ametropia were dominated by allergic conjunctivitis (26.13%) and papillary excavation (6.31%) in astigmatics;allergic conjunctivitis (9.01%) and papillary excavation (7.20%) in hyperopic patients;turbid vitreous (0.90%), myopic choroidosis (0.45%) and allergic conjunctivitis (0.45%) in myopes. Conclusion: Refractive errors constitute a reality and a major public health problem among school children.

Prevalence of Ocular Trauma at the Reference Health Center (CSREF) of Kati

Introduction: The authors wanted to study the prevalence of ocular trauma in the ophthalmology unit of the CSREF of Kati. Patients and method: This is a retrospective study, covering the period from January to December 2015, carried out in the ophthalmology unit of the CSREF in Kati. Results: The sample consisted of 568 patients, or 6.82% of ophthalmological consultations. Children aged 0 to 14 years accounted for 154 (27.11%) of the trauma cases. Bruises constitute the main circumstance (58.1%) of eye trauma, followed by domestic accidents (15.6%). Closed globe ocular trauma was the main type of trauma (61.6%), followed by ocular adnexal trauma (30.1%) and open globe trauma (8.3%) in which the penetrating wound was the lesion, the least common (2.6%) but the most serious. Medical treatment was the most used therapeutic modality in 82.4% of cases, followed by surgery with 17.6% of cases. The evolution of the lesions after treatment was favorable in 85.6% of cases and unfavorable in 14.4% of cases. Complications were observed in 5.8% of cases and sequelae in 8.6% of cases. Conclusion: Ocular trauma constitutes an important reason for ophthalmological consultation at the CSREF of Kati. The severity of some of these lesions requires frequent recourse to surgery. The complexity of the treatment should encourage us to favor preventive measures.

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.

Congenital Gangrene in a Premature Newborn: A Case Report

Introduction: Congenital limb gangrene is a rare pathology. In the majority of cases, no cause is identified and its treatment is not codified. Observation: 29-week premature newborn, female from poorly followed twin pregnancy. Clinical examination at admission found an unstable neonate, the presence of necrosis of the left hand and forearm well limited, with absent humeral pulse and absence of hand movement. Surgical treatment was scheduled for amputation of the limb after the agreement of the parents whose postoperative follow-ups were simple. Conclusion: Congenital gangrene remains a rare entity in neonatology.