Pleurisy in Hemodialysis Patients: Epidemiological and Etiological Aspects at Donka National Hemodialysis Center

Introduction: Pleural effusion being a frequent complication in hemodialysis patients, its etiologies are diverse and the diagnosis is easy, based on clinical and radiological proofs. The main objective of this study was to describe the epidemiological and etiological profiles of pleurisy in hemodialysis patients at the National Hemodialysis Center of Donka National Hospital. Patients and methods: it was a retrospective, descriptive and analytical study that extended over a period of three years from January 1, 2017 to December 31, 2019. It concerned, among hemodialysis patients in the center during the study period, all those who had a confirmed pleurisy on chest x-ray. The variables were epidemiological (based on frequency, sex and age), clinical (based on history of the disease, physical examination looking for a reduction or elimination of vesicular murmur) and paraclinical (mainly radiological). Results: Among 286 patients undergoing hemodialysis in our center, pleural effusion was diagnosed in 35 or 12.24%. The average age of our patients was 52.22 years with ranges of 18 and 78 years. The sex ratio M/F was 2.5. Bilateral pleurisy was found in 51.43% of patients;unilateral right in 40% of cases and unilateral left in 8.57%. We observed 68.57% citrus yellow fluid and 31.43% sero haematic fluid. The bacteriology of the pleural fluid was positive in 62.86% against 37.14% negative. Tumor, tuberculosis and non-specific bacterial etiologies have been encountered. Conclusion: Pleurisy is therefore a frequent complication in hemodialysis patients at Donka National Hemodialysis Center. Etiological research is a major step for better management of these patients. Improving the technical platform of the laboratories should be an important contribution to this stage.

Prognosis of Pregnancy and Childbirth in Heart Operated Patients: Experience in a 3 Referral Hospital in Mali, Case of the Gabriel University Hospital in Bamako

Introduction: In sub-Saharan Africa and Mali, young women who have had heart surgery want to become pregnant. The occurrence of pregnancy in these women who have had heart surgery is becoming more and more frequent in our country because of the persistence of acute rheumatoid arthritis (RAA) and especially the increasingly easy access to heart surgery. General Objective: To study the evolution of pregnancy and the prognosis of childbirth in women who have undergone heart surgery. Methodology: This was a retrospective and descriptive study that took place over a period of five (5) years in the gynecology-obstetrics department of University Teaching Hospital (UTH) Gabriel Touré and the cardiology department of UTH Luxembourg. Was included in the study any pregnant woman admitted to the gynecology-obstetrics department of UTH Gabriel Touré and having a history of heart surgery. The variables studied were the socio-demographic characteristics, the type of heart disease, the management, the evolution of the pregnancy and the prognosis. Data was typed on word processor, Excel and analyzed on Epi info and SPSS. The Chi square or Fisher exact test (for the number < to 5) and the relative risk (RR) with confidence interval (CI) to 95% were calculated. P was considered as significant if <0.05. Results: Of the 13,388 pregnant women admitted to the gynecology/obstetrics department of UTH Gabriel Touré, 20 pregnant women had a history of heart surgery (1.49‰). The average age was 26 years old. The main cardiac pathology was valvular heart disease supported in 80.00% by the placement of a prosthesis. During pregnancy follow-up, 55% of pregnant women were on Anti-Vitamin K (AVK). In 95.00% of cases, heart disease was asymptomatic. We reported a case (5.00%) of iterative cardiac decompensation, in which cardiac ultrasound found a very arrhythmic heart, grade III mitral leak, and massive aortic leak. We did not find any case of prosthetic thrombosis. The abortion rate was 5.00%. The caesarean section rate was 31.60% and the instrumental extraction rate (forceps) was 23.10%. Newborns had a normal birth weight (68.40%), and were hypotrophic (15.80%) and premature (15.80%). In pregnant women on AVK, we reported 2 cases of fetal deaths in utero (10.00%). Conclusion: Surgical treatment of operable heart disease is a real prophylaxis for gravidocardiac accidents. Pregnancy can be well tolerated in patients who underwent heart surgery with artificial heart valves.

Splenectomy in the Surgery Department “A” at the University Hospital Point G Bamako

We conducted a retrospective study that included patients with erythrocyte and hemolytic pathology justifying a splenectomy and patients presenting splenic trauma for which hemostasis splenectomy is required. We performed 27 total splenectomy in which 26 are by laparotomy (92.86%) and 1 by laparoscopy (3.57%). A partial splenectomy was performed by laparoscopy. The morbidity was marked by 2 cases of infectious syndrome and 1 case severe anemia. The mortality was 7.14% (n = 2). Splenectomy is part of the therapeutic arsenal for benign or malignant hematological disorders that constitute the main indication for elective splenectomy. Splenectomy was one of the most common operations in abdominal surgery. During the past decade, an increased rate of late complications, specially septic and thromboembolic complications are well documented. The risk is related to the indication of splenectomy, and is less than 1% in adults without immunodeficiency. However, these overwhelming postsplenectomy infections are associated with a high mortality rate. The best treatment of these infections is preventive measures which are based on vaccination and education of asplenic patients.

Aseptic Pseudoarthrosis of the Humeral Diaphysis. Epidemiological Features—Therapeutic Assessment

Objective: The aim of this work was to assess the epidemiological factors of the pseudoarthroses of diaphyseal humeral fractures in order to prevent them and also to assess the results of their treatment by screwed plate associated with an auto-graft. Material and method: This was a retrospective series of 36 aseptic pseudoarthroses of the humeral diaphysis treated by screwed plate, associated or not with a bone autograft between January 1997 and December 2016 at the Treichville University Hospital. The criteria of inclusion refer to the existence of an aseptic pseudoarthrosis of the humeral diaphysis treated by screwed plate. The approach was antero-external. Two thirds of pseudoarthroses were between the middle 1/3. 23 atrophic pseudoarthroses (65%) and 13 hypertrophic pseudoarthroses. Functional results were assessed using the Steward and Hundley criteria. Results: Mortality was zero, and postoperative complications were dominated by 4 hematomas and 2 transient iatrogenic paresthesias of the radial nerve. The sequelae were minor and the consolidation was acquired in 97.25% of patients. Conclusion: The treatment of aseptic pseudoarthroses of the humerus by screwed plate associated with an auto-graft is a reliable technique, inexpensive with a satisfactory functional outcome.

Perforations of Gastro-Duodenal Ulcers in the Surgery Department “A” at the University Hospital Point G Bamako

The purpose of this study was to investigate the clinical and therapeutic aspects of peritonitis by perforation of gastric and duodenal ulcer. This was a retrospective and descriptive study over 8 years (2010-2018) which allowed to collect 54 cases of peptic ulcer. Included in the study were all patients with confirmed gastroduodenal perforation on histology or laparotomy. We collected 54 cases of peptic ulcer perforated s. The age group of 30 - 49 years was the majority. The male sex was dominant with 90.7% of cases;the clinical picture was dominated by abdominal contracture associated with pain in 74.07% of cases. X-ray of the abdomen without preparation (AWP) revealed in 87.03% of cases of pneumoperitoneum. The perforation was in 68.52% of cases on the gastric antrum and in 31.48% on the duodenum. The surgical procedure used was the bank of excision, and a suture reinforcement epiploic in 68.52% of cases, a simple suture made in 31.48% of cases, the disease was marked by a fistula (1.90%) and mortality was 5.55% of cases. The gastroduodenal ulcer perforation is potentially serious and responsible peritonitis whose surgical treatment involves the peritoneal toilet and sutures the puncture.

The Lithiasis of Choledoque: Epidemiological Aspects, Clinics and Therapeutiques in the Surgery Department “A” at the University Hospital Point G

Considered as rare in Africa lithiasis of the main bile duct (MBD) is a potentially serious pathology, diagnosis is facilitated by imaging tests (ultra-sound, CT, MRI cholangiopancreatography). Its surgical management is improved by laparoscopy coupled with interventional endoscopy. However, laparotomy remains the only way in Mali. This was a 14-years retrospective and descriptive study (2010-2014). All patients with BPV lithiasis were included. We studied the field, antecedents, clinical, biological, radiological, therapeutic and outcome aspects. 40 cases of stones in the main bile duct were collected during the study period. The hospital frequency was 2.8 cases per year, the clinical signs dominated by the Charcot triad (pain, fever, jaundice) found in 40 cases (100%). The average age was 60 years, female represented 70% of cases. Ultrasonography was the most requested review in 40 cases (100%). The procedure performed was cholecystectomy associated with choledochotomy with calculation extraction in all patients (100% of cases). One case of biliary fistula and one case of wall abscess were observed. The mortality was 5% and the simple suited in 90% of the cases. The lithiasis of the main bile duct is an infrequent pathology in Mali and potentially serious. This diagnosis is assisted in our context by ultrasound and CT. Laparotomy remains the only route of entry in Mali.

Prevalence and Prognosis of Relapse of Nephroblastoma at the Pediatric Oncology Unit of Bamako

The nephroblastoma is the third pediatric cancer in Mali, this study aimed to describe the prevalence and prognosis of nephroblastoma relapses. Methods: It was a descriptive retrospective study over a 10-year period from January 2005 to March 2015. We collected children aged 0 to 15 years followed for relapse of nephroblastoma in the pediatric oncology unit of university hospital center (UHC) Gabriel Toure. Results: The frequency of relapse of nephroblastoma was 7.4% (19 cases) whose mean age was 42 months with a sex ratio of 1.3. The relapse occurred before the end of the postoperative course in 16% of cases (3 patients). It was local recurrence in 52% of cases (10 patients), pulmonary 16% (3 patients), and hepatic 11% (2 patients). According to the SIOP classification, 47% of patients were diagnosed in stage III (9 patients) and 21% (4 patients) in stage IV. The tumor was high risk in 37%. Palliative chemotherapy was performed in 63% of the patients (12 patients) and the remaining seven were put on a high risk diet. The overall survival at 5 years was 21% or 4 patients. Conclusion: Our results showed all the difficulties in the management of nephroblastoma relapses in our context.

Etiology of Pediatric Jaundice: Observation in the Pediatric Ward of the Gabriel Toure University Hospital

Objective: Pediatric jaundice is caused by various conditions. Although some data is available on this issue, data from Mali is insufficient. The present retrospective observational study was an attempt to determine the etiology of pediatric jaundice in the pediatric department of Gabriel Touré teaching hospital in Bamako, Mali. Methods: We reviewed all pediatric patients with jaundice who were hospitalized and treated in this department during January 1 to December 31, 2016 (n = 168). Result: Pediatric jaundice patients accounted for 1.88% of the hospitalized patients, with median age of 6 years and male/female ratio being 1.6. Infectious, cholestatic, and hemolytic jaundice accounted for 75%, 11% and 10%, respectively. Malaria and sickle cell disease accounted for 67% and 9%, respectively. Hepatomegaly and splenomegaly were observed in 49 (29%) and 23 (13.7%) patients, respectively. Of 168, 9 patients died. Conclusion: Infectious jaundice, especially jaundice due to malaria, was the most frequent. However, variety of etiologies was observed, of which the practitioners should be aware. The observation presented here may become fundamental data in health-policy making in this area.