ECG and Echocardiographic Findings of Female Hypertension (fHTN) in the Cardiology Department of the University Hospital Gabriel Touré (UH-GT)

Introduction: In our setting there is a lack of publications on female hypertension in general population motivating this study to look for electro- and echocardiographic findings of female hypertension. Methods: We performed a cross-sectional study during 6 months in the cardiology department of the UH-GT including 324 female patients aged 18 and more seen in the outpatient unit and by whom the diagnosis of hypertension was set. All patients consented to be study participants after receiving clearly information about the study and that care giving will not be affected by their eventual refusal. Data collection has been done with all needed confidentiality rules. A survey formular was used to collect data in order to record them in an Access database. Analysis was done using IBM SPSS software. Quantitative data are presented as mean with standard deviation and qualitative as proportion. Level of significance for statistic test was set at 5%. Results: During the study time 324 among 524 hypertensive patients visited our outpatient unit giving a prevalence of fHTN of 61.8%. The means for age, body mass index (BMI) in female hypertensive patients were respectively 52 ± 14.461 years and 27.35 ± 06.585 Kg/m2. Main ECG findings were left ventricular hypertrophy (LVH) and sinus tachycardia with respectively 93.6% and 46.4% followed by isolated ventricular extrasystole with 33.7%. Echocardiography findings included LVH, relative wall thickness (RWT) and reduced ejection fraction (EF) in respectively 41.05%, 37.35% and 21.91%. The left ventricular mass (LV) mass and geometry were abnormal in 44.4% and 37.3%. Remodeling as geometry modification (18.2%) and mitral flow Type 2 (90.4%) have been the most abnormal findings. Conclusion: Hypertension induced modifications mainly LVH in ECG and Echocardiography in female patients less than encountered among male hypertensive patients.

Evaluation of the Practice of Immediate Care for Newborns in the Obstetric Gynecology Department of the Gabriel Touré University Hospital of Bamako, Mali

The care provided in the neonatal period by caregivers in health facilities and by parents in the community is essential for the survival of the newborn. Our work aimed to assess the practice of essential care for newborns at the maternity hospital during the first six hours of life. Methodology: It was a cross-sectional study, which took place over a period of six months and fifteen days (from April 27 to November 12, 2020). We evaluated the practice of immediate care given to newborns over 32 weeks of amenorrhea by the health personnel involved against the recommendations of the World Health Organization (WHO) on essential newborn care (ENC). Results: Our study involved 422 live newborns, which represented 22% of all live births. The sex ratio was 1.2. The gestational age of newborns was 37 to 41Week of Amenorrhea (WA) in 69.2%. The majority of births were performed by doctors specializing in gynecology and obstetrics, or 66.4% of cases. Midwives provided care in 51.7% of cases. Out of 422 newborns, 408 were immediately dried, 96.7% of the time. Less than half (44.1% of newborns) had benefited from the late cord clamping. Eye care was administered to the vast majority of newborns (94.3% of cases). The breastfeeding technique was verified in only 2.8% of cases. Only 1.7% (7 newborns) were monitored during the first six hours of immediate postpartum. In the immediate post-partum period, 18 newborns had problems that required treatment. NNS were correctly administered in 39 newborns (9.2%). Conclusion: Our study shows inadequacies in the practice of essential care for newborns within our maternity. Thus, many newborns can be saved through the practice of essential newborn care (NHS) at different levels of the health pyramid.

Complications of Sinusitis: About 9 Cases in the Ear Nose &Throat (ENT) Department of the University Hospital Gabriel Touréin Bamako

Objective: This study aims to analyze clinical, paraclinical and therapeutic aspects of sinusitis complications in the Otorhinolaryngology department at the teaching hospital of Gabriel Toure in Bamako. Materials and methods: This descriptive and longitudinal study was conducted on 12 months from March 2012 to February 2013 in 9 cases of sinusitis complications in the department of Otorhinolaryngology at the University Hospital Gabriel Toure in Bamako. Results: The average age of patients was 22.7 years;a median of 19 years within 6 men and 3 women with almost 12.9 days of care seeking duration. The factors of risky were the use of nonsteroid anti-inflammatory drugs NSAID (4 cases), maxillofacial trauma (1 case) and HIV (1 case). Facial pain was the major symptom, such as frontal oedema, rhinorrhea with pus shedding and nasal obstruction. Computer tomography was used for complications specification. Frontal sinusitis was the most encountered with subperiosteal abscess (44.4%). Streptococcus pneumoniae was identified in 3 cases. Medical treatment associated to surgery was conducted on 7 patients. Two cases of death have been registered. Conclusion: The complicated sinusitis is an emergency and dangerous disease requiring specific care by a multidisciplinary staff. Much of complications are commonly encountered despite the antibiotic era.

Chest Trauma at the Emergency Department of the Gabriel TouréUniversity Hospital Bamako, Mali

In Mali, chest injuries remain a real public health problem and are associated with heavy morbidity and mortality. Faced with a resurgence of urban civil violence and the explosion of road accidents, we decided to conduct this study in order to describe the epidemiological, clinical and therapeutic aspects of thoracic trauma in the emergency department. Method and Material: This is a descriptive prospective study over a period of one year in the emergency department of the CHU Gabriel Touré. Including all patients admitted for thoracic trauma. Analysis and Entry: Data were entered and analyzed on SPSS software version 20.0. The test was significant for a p value < 0.05. Results: We recorded 21,090 appeals in our structure among which 1284 patients were suspected of thoracic trauma. The diagnosis of thoracic trauma was retained in 119 (0.56%) patients. All patients were transported to the emergency room without prehospital medicalization. Clinical presentation was dominated by dyspnea in 54.6% of patients, however pain was the almost constant symptom in conscious victims. Various traumatic mechanisms had caused these lesions of the thorax, of which road traffic accidents represented half of the causes, followed by urban civil violence in 28.6% of patients. Landslides and falls from a great height were responsible for 19.5% of chest injuries. Open chest trauma was the type of lesion found in a third of the cases. This type of injury was exclusively due to blows and injuries during the brawls. Standard chest radiography was performed as the first intention in 60% of patients compared to 10.9% for the pleuropulmonary ultrasound. Thirteen patients required ventilatory assistance after orotracheal intubation. The average length of stay was 65.23 hours. During the period of our study, the overall mortality was 1.85% in the emergency departments with a lethality specific to chest trauma of 15%. Conclusion: Urban violence with its share of ballistic wounds determined the severity of this condition.

Hypertension in Clinical Practice: Control Rate in Short Term and Associated Factors in the Cardiology Department of the University Hospital Gabriel Touré(UH-GT) in Bamako (Mali)

Introduction: Hypertension (HTN) is for many decades a worldwide major risk factor for cardiovascular disease.However, hypertension control rates are globally low in the world. Studies on observance have been published in Mali but there is to our knowledge no published data about HTN control rate. We therefore conducted this study to assess the control rate in short term after 3 months management and to look for factors associated with HTN control. Materials and Methods: This study designed as prospective was conducted in the cardiology department of the University Hospital Gabriel Touré (UH-GT) from March 24 to September 24, 2017. All outpatients aged 18 years and more who came for visit and with hypertension as diagnose were involved. All patients have consented to participate in the study. Sociodemographic and data on physical examination including measures for BP, height, weight, waist circumference (WC) and direct costs as reported by the patients were recorded. Patients were asked about medication discontinuation and if yes why and then they were informed about the need to take regularly medication. The concept of chronic disease was explained to them. A formulary served to collect data that were inserted into a Microsoft Access database and analyzed using SPSS version 18. After describing of sociodemographics and continuous variables, crosstabs and finally a logistic regression was performed to look for blood pressure control predictors. Results: There was no statistical difference in sociodemographics between older and newly diagnosed patients. At 3 months globally 40.90% (31.1 for old Patients and 09.8% for newPatients) of the sample were controlled (Figure 1). For old patients, hypertension control rate at inclusion was 12.78% and reached 49.44% at 3 months (Figure 2). After logistic regression only HTN duration was significant predictor with Odd-ratio of 0.365 [0.213 - 0.624] 95% CI and p-value patients as reference). During the study period therapeutic regimen remained unchanged in 73.1% (44.4 for old Patients and 28.7 for newPatients. Calcium channel blocker (CCB), diuretics (DIU) and ACE-inhibitors (ACE-I) were the most prescribed drugs without statistical difference between patients with and without blood pressure under control. Conclusion: Short term hypertension control rate is low and patient follow-up must incorporate information at each visit as well as information through others channels for preventing hypertension. The duration of hypertension was found to be predictor for hypertension control.

Invasive <i>Haemophilus influenzae</i>Type b (Hib) Infections in Children in the Pediatric Department of the University Hospital Gabriel Touré(UH-GT)

Introduction: According to Mali’s National Immunization Center, the Haemophilus influenzae b (Hib) vaccine coverage rate was 90% in 2015. Our work aimed to study invasive bacterial infections due to Haemophilus influenzae type b in children aged 0 - 15 years hospitalized in the pediatrics department of the UH-GT. Method: We carried out a retrospective descriptive study from January 2017 to December 2018 (i.e. 2 years) among children aged 0 - 15 years and hospitalized for Haemophilus influenzae type b infection confirmed by culture (blood culture, Cerebro-spinal Fluid, and pleural and skin fluid). Results: Thirty-three cases of Hib infections were collected giving a frequency of 0.2% and the age group 3 months to 3 years was the most affected (72.73%). Children who received no vaccine accounted for 21.21%. The Cerebro-spinal Fluid culture and other samples (pleural and skin) identified the bacterium in 100% of cases, against 72.72% in the blood culture Meningitis was the most frequent pathology (78.79%) and the lethality was high (21.21%). Conclusion: Despite the introduction of the Hib vaccine in the routine immunization program in Mali, Hib infections remain with a high lethality linked to meningitis.

Etiological Aspects of the Dilatation of the Upper Urinary Tract at University Hospital of Gabriel Toure

Introduction: The dilatation of the upper urinary tract, signs in the vast majority of cases the presence of a ureteral obstacle. The etiologies are diverse. Mali is a country where urinary schistosomiasis is endemic. Repeated infestation may result in long-term ureteropelastic dilatation secondary to stenotic sequelae. The objective is to study the causes of dilatations of the upper urinary tract. Materials and Methods: This is a prospective study of 12 months, from October 2010 to September 2011, performed in the urology department of Gabriel Toure University Hospital in Bamako. The parameters studied were: age, sex, reason for consultation, medical history, urinary analysis, etiological diagnosis, management, evaluation of renal failure. Result: In 12 months, we collected 50 cases of dilatations of the upper urinary tract representing 0.66% of all consultations. The average age of our patients was 35 years old. The sex ratio was 2.13 in favor of men. A history of urinary schistosomiasis was found in 25 patients or 50%. Low back pain was the most common reason for consultation, 76%. The renal and bladder ultrasonography performed in all 50 patients in our series found bilateral dilatation in 68% of patients and unilateral dilation in 32% of cases. Urinary tract infection with Escherichia coli was found in 53% of cases. Ureterovesical reimplantation was performed in 40% of cases. Conclusion: The dilatation of the upper urinary tract, consequence of an anatomical or functional obstruction, constitutes a rather frequent pathology and constituted 10% of the surgical acts of our service. Etiologies are diverse: congenital and acquired. Open surgery gives good results, but the introduction of innovative minimally invasive surgical technique is necessary.

Deafness: Epidemiological, Clinical and Therapeutic Aspects in 15 Year Olds and over at the University Hospital Center Gabriel Toure of Bamako

Objective: To study the epidemiological, clinical and therapeutic aspects of hearing loss in 15-year-olds and over at the CHU GT of Bamako. Materials and Method: This is a longitudinal prospective study carried out in the ENT department of the University hospital Gabriel Toure in Bamako over 13 months (from September 2018 to September 2019). We carried out an exhaustive sampling of all the patients who consulted in the department for hearing loss and whose deafness was confirmed at pure tone audiometry with age greater than or equal to 15 years. The exclusion criteria were all patients under the age of 15 as well as a hearing loss related to earwax or foreign bodies and refusals to participate in the study. Results: Two hundred and thirty (230) patients were collected during the study. Dominated by the male sex with a sex ratio of 1.5 or 3 men for 2 women, with an average age of 38.16 ± 19 years with extremes ranging from 15 to 86 years. Among our patients, 37.40% had unilateral deafness, progressive installation evolving more than 12 weeks with a rate of cases had headaches 41% and had a history of chronic otitis media (CMO) 27%. There were a few cases of mixed type deafness, 30% had mild deafness, 22% moderate deafness and 40% severe deafness, according to the BIAP classification. Among our patients, 22.16% had conductive hearing loss, and those with sensorineural hearing loss accounted for 15.24%. Conclusion: Pure tone audiometry remains essential in the diagnosis of deafness. It not only makes it possible to confirm or invalidate the deafness, but also to define the type of deafness and especially to classify the deafness according to the degree of the average hearing loss established by the BIAP.

Prognostic Factors for Acute Heart Failure (AHF) in the Cardiology Intensive Care Unit (ICU) of the University Hospital Point G (UH Pt G)

Background and Aim: The absence of data in our context motivates this study aiming to determine the frequency of AHF at the ICU, assess the in-hospital evolution of the disease and to find out poor prognosis.Material and Methods: It was an observational and descriptive study covering the time from January 1, 2014 to March 30, 2017 involving all inpatient records in ICU. From January 2014 to December 2017, collected data included those on socio-demographic, history of diseases and physical examination, and some labor dataincluding Pro BNP, serum creatinine, blood ionogram,?cardiac enzymes and blood count. Also data electrocardiography, echocardiography and in-hospital evolution were collected. Statistical Analysis:Statistical analysis was performed using SPSS (IBM Inc) version 18. Results: AHF occured in 47.36% with a mean age of 58.74 ± 18.407 and extremes of 17 and 90 years, women representing 53.1% (sex ratio Male:Female = 0.88). Hypertension and diabetes were the predominant cardiovascular risk factors with respectively 67.4% and 18.4%. At admission?44%, 37.7% and 17.9% of patients were respectively hypertensive,?normotensive and hypotensive. The clinical expression was mainly global heart failure with 42.6% followed by left heart failure and right heart failure with respectively 37% and 20.4%. The coronary syndromes (all forms) was the first cause of ICA with 34% of cases followed by pulmonary embolism and hypertension with respectively 25.3% and 24.1%. Mean hospital stay was 5.61 ± 3.527 days (1 to 25 days). Complications were recorded in 18.5% of patients with cardiogenic shock in half of all cases. In multi-variate analysis, only hypotension at admission was shown to be the independent factor of poor prognosis with p = 0.016 and OR = 4.453 (1.322 - 14.996). Conclusion: As a common manifestation heart failure can be rapidly fatal in presence of collapsus or hypotension at admission. These factors should be accurately managed to reduce mortality, which remains high in our context.

Pyogenic liver abscess in children: Diagnosis and treatment at the teaching hospital Gabriel Touré, Bamako, Mali

Purpose: To determine diagnostic and therapeutic problems of pyogenic liver abscess in our hospital. Method and material: We conducted a retrospective study from January 2006 to December 2010 of all children aged from 0 - 15 years admitted and treated for pyogenic liver abscesses. Amoebic liver abscesses and other hepatobiliary disorders were not considered. Results: Pyogenic abscesses accounted for 50 cases. The mean age of patients at presentation was 2.4 ± 0.78 years (range from 6 months to 15 years). Sex ratio was 2.8 for boys. Abdominal pain was the primary reason for consultation in 27 cases (54%). Fever has been noted in 42 patients (84%) and the patient general state was altered in 13 patients (26%). Escherishia coli was the most frequent bacteria found at pus. The pus was sterile in 25 cases (50%). The ultrasonographic percutaneous drainage was performed in 33 patients (66%), open surgery in 6 (12%) and antibiotics alone in 11 others (22%). The short outcomes were simple in 36 patients (72%) while pain and fever persisted in 12 others (24%). Two patients (4%) died from sepsis soon after the operating room. Improving the frequency of early diagnosis will depend on education of clinicians about the need for clinical suspicion aided by ultrasound.

Management of Arterial Hypotension Induced by Spinal Anesthesia during Cesarean Section at the Parakou University Hospital in Benin in 2020: Ephedrine versus Noradrenaline

Background: Spinal anesthesia (SA) is a preferred anesthetic technique for childbirth through caesarean section. It causes a sympathetic block responsible for low blood pressure which can be prevented or treated with vasopressors. Aim: This research aims to compare the effect of Noradrenaline with that of Ephedrine in the management of arterial hypotension caused by SA during Caesarean act. Study method: It was a cross-sectional study with two comparative settings which took place at the Teaching hospital of Parakou from April 15th to August 15th 2020. It included all parturients who underwent a caesarian act and received spinal anesthesia. To prevent hypotension two groups were formed. The first group parturient received Noradrenaline (10 γ) as prophylactic and the second group received Ephedrine (10 mg) before anesthesia. The main evaluation criteria were the time before the hypotension occurs and, the secondary endpoint was the number of hypotension episode. The two groups were compared using the usual statistical tests. The study received the approval of the Local Ethical committee of University of Parakou. Results: Two hundred and four parturients were compiled with 102 in each group. The mean age was 28.37 ± 6.15 years with extremes of 16 and 45 years. The main indications for Caesarean section were respectively iterative Caesarean section (46.57%) for scheduled Caesarean section and acute fetal distress (15.69%) for emergency Caesarean section. The incidence of hypotension was 38.24%. The mean delay of occurrence of hypotension was significantly longer in adrenaline group (19.90 min) than ephedrine group (12.53 min) with P = 0.001. According to the secondary endpoint the number of episodes of hypotension, number of tachycardia, and the total doses of each vasopressor were significantly lower in adrenaline group than in the ephedrine group. Conclusion: The use of Noradrenaline according to the established protocol demonstrated its efficiency compared with Ephedrine in the management of hypotension after spinal anesthesia.

Podiatric Risk Assessment in Diabetic Patients at University Hospital Center of Point G

Introduction: Diabetes, a chronic pathology, is the source of many acute and chronic complications whose treatment requires many daily constraints that can have a serious impact on the quality of life of the patient and his family. The diabetic foot is a real public health problem which is still dominated by a very high lower limb amputation rate even in countries with high socioeconomic status. The diabetic foot classically results from the association of three entangled mechanisms which are neuropathy, arteriopathy and infection. Objectives: To determine the frequency of arterial disease, neuropathy, and other aggravating factors that influence the podiatry risk, and to proceed with the gradation of the podiatry risk. Methodology: This was a cross-sectional study concerning the period from July 1 to October 31, 2017, covering all diabetic patients received in consultation and hospitalization in the Internal Medicine Department of the G-University Hospital Center. Results: Our study included 50 patients (35 women for 15 men) out of 95 diabetic patients receiving a frequency of 52.6%, with a sex ratio of 0.42. The average age of our patients was 54.38 ± 13.98 years. Overweight/obesity found in 44% of patients. The average Body Mass Index (BMI) of our patients was 27.16 kg/m2. Patients with diabetes less than 5 years old represented 56% with an average duration of 5.39 ± 5.34 years. The mode of discovery of diabetes was polyuria-polydipsia syndrome in 56% of cases. Type 2 diabetes represented 74% of patients. Among the patients who had performed the HbA1C test, 80.77% were not well balanced. The antecedent of macrosomia in women accounted for 77.1%. Patients who did not know foot hygiene recommendations accounted for 82%. Among the identified podiatry risk factors, diabetic neuropathy accounted for 73.8%, and arterial disease was 32.3%. Grade 1 patients in our study accounted for 52% (gradation of foot risk). Conclusion: The diabetic foot is a major public health problem because of its frequency, its direct and indirect cost, and its consequences on the life of diabetic subjects.

Satisfaction of Patients Operated on and Hospitalized in the Surgery Department of the Referral Health Center of Commune I in the District of Bamako (Resource-Limited Health District)

Introduction: Evaluating the quality of care offered is a reliable indicator of the effectiveness of a health system. Developing countries are still lagging behind in implementing these principles. This work aims to evaluate the satisfaction of patients operated on and hospitalized in the surgery department at the municipality’s reference health center over a period of 6 months (June 2020 to December 2020). Materials and Methods: This is a quantitative, qualitative, transversal and evaluative study over a period of 6 months based on a self-administered questionnaire to patients who underwent surgery and were hospitalized in the surgery department of the reference health center of commune I upon leaving their hospitalization. The questions are structured around welcome, respect and privacy, care, accommodation conditions as well as overall satisfaction. Results: The survey included 260 patients, 60.8% of whom were male. The 31 - 40 year old age group was in the majority and the majority had completed primary education (42.3%). Married patients were the majority, i.e. 60.4% of cases. Patients were not insured in 66.5% of cases. Almost all of the patients surveyed found that the welcome, care, waiting time, respect and privacy were satisfactory. On the other hand, patients found the rooms and beds uncomfortable. Conclusion: The satisfaction survey reveals worrying data regarding the comfort of patients who must challenge caregivers in healthcare structures. Decision-makers should find useful information there to improve the quality of care.

Perioperative Materno-Fetal Morbimortality Related to the Caesarean in the Hospital Setting in Mali

Introduction: During childbirth by Caesarean, several types of anesthesia can be used. The Caesarean, the most practiced surgical delivery technique in obstetrics, has a risk for complications for both the pregnant women and newborns. Objective: To evaluate the importance of the complications due to Caesarean in the Teaching hospital Gabriel Toure. Patient and Methods: We conducted a cross sectional survey in the departments of intensive care unit and gyneco-obstetric from January to August 2017 in the University hospital Gabriel Touré of Bamako. Our study population was pregnant women who gave birth to children by Caesarean. We included all cases of preventive and emergent Caesarean under loco-regional or general anesthesia. Data were compiled from the obstetrical files of the patients, the anesthetic consultation registry and the databasis of the department of gyneco-obstetric. The test of khi2 of Pearson was used for the comparison of our results with a value of p < 0.05 considered as statistically significant. The consent of the patients or parents was gotten. The survey didn’t include a potentially dangerous act. Results: During the study period, 1875 childbirths have been recorded of which 633 were by Caesarean (33.7%). We collected and analyzed 524 files of Caesarean. The mortality rate was 1.5% in pregnant women and 15% in newborns. The average age was 26.6 ± 6.9 ans. Pregnant women were referrals in 59.4% of the cases. The most frequent motive of referrals was high blood pressure and pregnancy in 66.6%. The Caesarean was indicated in most of the cases on previously operated uterus in 22% and eclampsia was present in 14%. The maternal mortality had occurred in a context of hemorrhage in 50% of the cases. The factors of maternal morbi-mortality were the mode of admission, iterative Caesarean, t surgeon, context of the Caesarean, realization of the anesthetic consultation and the technic of anesthesia (p = 0.05). The factors of fetal mortality were the realization of endo-tracheal intubation, technic of anesthesia, realization of the anesthesia consultation, context of the Caesarean, iterative Caesarean and the mode of admission (p ≤ 0.05). Conclusion: The caesarean is associated with a high risk of maternal complications and a very important fetal mortality. The anesthesia consultation in the follow-up of pregnancy would reduce this high mortality.

Contribution of Stress Testing to the Management of Ischemic Heart Disease in Mali

Introduction: Exercise stress testing (on a treadmill or ergometer bicycle) is an important test in cardiology for diagnosing myocardial ischemia. This test in Mali is still in its beginning compared to other countries in the sub-region. The lack of data in Mali prompted this study, which aimed to evaluate the indications of this activity and its diagnostic contribution to cardiology in Mali. Materials and Methods: This was a retrospective, descriptive study. The study was conducted at the “TOUCAM” medical clinic in Kati based on the analysis of stress test reports between January 2016 and August 2022. Result: During the study period, we documented 73 patients who underwent exercise testing on a bicycle ergometer for suspected coronary heart disease. The mean age of our patients was 47.5 ± 13.8 years (14 and 79 years). Males accounted for the majority (78.1%). The sex ratio is 3.5. More than half of our patients were overweight or obese (77.1%). Hypertension and diabetes affected 52.1% and 25.8% of patients, respectively. 20.8% of patients had coronary artery disease. renin-angiotensin-aldosterone system blockers (56.8%) and beta-blockers (51.3%). The main indications were chest pain (63.0%) and ischemia detection (15.1%). A modified STEEP protocol was used. The majority of our patients (71.2%) achieved at least 85% of their maximum theoretical heart rate. The main reason for the termination of the study was fatigue (57.3%). The average duration was 11.3 ± 4.2 minutes. 24.7% thought the stress tests were positive and 17.8% thought they were controversial. Conclusion: This study demonstrates the importance of stress testing in the diagnosis and treatment of ischemic heart disease, especially in settings where we have very limited access to coronary angiography.

Management of Acute Myeloblastic Leukaemia (AML) Treated with Intensive Chemotherapy: Experience in a Single Centre

Introduction: Acute myeloblastic leukaemia (AML) is a haematological malignancy with a poor prognosis, despite significant therapeutic progress. This study presents the results of AML management in Mali according to GFAOP recommendations. Methodology: This was a retrospective, cross-sectional study. It included patients aged 0 - 15 years treated in the paediatric oncology unit for AML and followed up between January 2016 and December 2020. Results: During the study period, 85 cases of acute leukaemia were diagnosed in the paediatric oncology unit (including 51 cases of ALL), of which 34 cases of AML were included in this study. The majority were boys (59%). The mean age was 8 years, with extremes of 18 months and 15 years. The mean time to diagnosis was 68 days. In 79% of cases, patients were referred by 1st or 2nd level hospitals. Anaemia was observed in 91% of cases, an infectious syndrome in 68%, haemorrhage in 56% and a tumour syndrome in 85%. The haemogram showed hyperleukocytosis in 15% of cases, thrombocytosis in 22% and severe anaemia in 73%. Death occurred in 85% of cases, most often in the context of sepsis or haemorrhage. Conclusion: AML is probably underestimated in Mali and diagnosis delayed, which may be explained by patient-related factors (lack of knowledge, financial constraints) and a cumbersome referral system. These results suggest the need to implement an appropriate diagnostic and therapeutic strategy, with strong involvement of the political authorities.

Evaluation of the Resuscitation of the Newborn in the Birth Room of the Maternity Ward of the Gynecology-Obstetrics Department of Reference Health Center (RHC) of the District V of Bamako, Mali

Birth is the transition from fetal life to ectopic life. This transition is usually smooth. Only 10% of newborns will need birth assistance. Successful resuscitation is linked to the skills of the health worker. It is to assess their skills that this work was undertaken with the objective of evaluating the practice of neonatal resuscitation in the delivery room of the RHC maternity hospital in District V of Bamako. Methodology: This was a descriptive cross-sectional study over a four-month period. We included in the study all live newborns who had a gestational age greater than or equal to 32 weeks and who had an Apgar score at the first minute of less than 7. At each birth, we observe the health agent responsible for the care of the newborn by observing the preparation of resuscitation and compliance with the neonatal resuscitation algorithm. We have excluded all newborns who met our inclusion criteria, were reanimated outside of our collection time and had visible or diagnosed anomalies or malformations in the prenatal period, and those whose parents refused to give their consent to participate in the study. Data were collected from the survey sheet and analyzed with the Statistical Package for Social Sciences (SPSS) software version 25. Results: We observed a 24.66% frequency of neonatal resuscitation. Pregnancies were too close in 15% (less than one year). Caesarean section delivery represented 34% of the sample. They were at term in 93% of cases. All newborns were well dried (98.5%), with wet linen change only at 49.5%. Apgar was less than 3 in 7.5% of newborns at first. The resuscitation needs were for the absence of a scream in 78.5% of cases and or heart rate Conclusion: The study evaluated neonatal resuscitation practices at a maternity hospital in Bamako, Mali. It found a 24.66% resuscitation rate, with a 95.5% success rate despite technical limitations. Most steps were correctly applied, though some improvements are needed in areas like preventing hypothermia and equipment preparation.

Subcutaneous Emphysema Associated with Pneumomediastinum and Complicated Pneumopericardium in a 14-Month-Old Infant

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.

ECG and Echocardiographic Findings of Athletes in Bamako—A Study among 227 Footballers

Background: A cardiovascular assessment is rarely performed among athletes despite more and more frequently reported fatal events. Most of these accidents are of cardiovascular origin. Moreover, data on ECG or Echocardiography are rare in our context justifying our study to assess electrical and echocardiographic pattern among high-level footballer in Bamako. Methods: It was a cross-sectional study conducted in Bamako from April 2015 to?March 2016 among high-level footballers aged 14 to 35 years old without distinction of sex with at least 10 hours weekly training since one year. The ECG and echocardiographies were recorded respectively with a 12-lead CONTEC and an ATL 5000 echocardiographic machine. Each ECG record was analyzed by a cardiologist in accordance with the Seattle 2013 criteria and those pathological reviewed by a second cardiologist according to the same criteria and definitively classified as normal (physiological) or abnormal ECG (requiring complementary explorations). A third cardiologist was associated in case of discordance of the first results. The collected data were inserted in a Microsoft Excel sheet and analyzed with SPSS version 20. Chi Square and Fisher statistical tests were used to compare our results. The significance level was set at 0.05. Results: We collected data of 227 top footballers with male sex represented in 90.3% giving a sex ratio of 3.04. Means for age, weight, height, body mass index (BMI) were respectively 22 years, 69.90 kg, 177.21 cm and 22.21 kg/m2. Sinus bradycardia was found in a proportion of 45.8% more represented in the age group of 30 and more years (p = 0.275). First-degree atrioventricular block (AVB) was present in 19.4%. Short PR was found in 0.4% of the sample. Left ventricular hypertrophy (LVG) according to the Sokolow index was found in 70.5% (96.9% males and 3.1% females) with p Conclusion: Many electrical and echocardiographic signs of cardiac adaptation were found in our sample and must lead to a closer follow-up of these trained footballers to avoid or prevent dramatic cardiovascular events.

Urinary Tract Infections Identified in the Preoperative and Their Sensitivities to Antibiotics

Introduction: Urinary tract infection is a public health problem. Patients who have to undergo urology surgery are exposed to infectious complications if there is an untreated urinary tract infection. The objective of our study is to identify all the germs responsible for urinary tract infections discovered in the preoperative assessment of hospitalized patients with their susceptibility and antibiotic resistance profiles. Patients and Methods: This is a retrospective and descriptive study of 124 cases of cytobacteriological examination of urine collected over 2 years from January 1st, 2016 to December 31st, 2017, performed in the urology department of the University Hospital of Bocar S. Sall of Kati. The parameters studied were: age, sex, reason for admission, the diagnosis chosen, the result of the cytobacteriological examination of urine and the antibiogram. Results: We collected 124 cases of cytobacteriological examination of urine during this period. The average age of our patients was 58 years old with extremes ranging from 3 years to 84 years. The sex ratio was 6 in favor of men. 86 patients, or 69%, were admitted for micturition disorders. In 53.2%, the diagnosis was BPH followed by urolithiasis 22.6%. Cytobacteriological examination of urine identified 55 cases of urinary infection, 44%. In 34 cases or 60%, the germ responsible was an E. coli. Two germs were sensitive only to one antibiotic. Conclusion: This study made it possible to have an idea about the antibiotic susceptibility of germs involved in urinary tract infections. Awareness-raising for the proper use of antibiotics needs to be strengthened to minimize the risk of increasing antibiotic resistance.