Parathyroidectomy in Chronic Haemodialysis in the Nephrology and Haemodialysis Department at the University Hospital Center of Point G in Bamako, Mali

Introduction: Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. Objective: To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. Results: We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis time). There were no cases of complications or mortality. Conclusion: Parathyroidectomy is an effective treatment to curb hypersecretion of parathyroid hormone. Despite this satisfactory result, the management of phosphocalcic abnormalities in renal failure remains an ongoing concern.

Reversible Semi-Fragile Watermarking Technique for Integrity Control of Relational Database

Reversible watermarking schemes for relational database are usually classified into two groups: robust schemes and fragile schemes. The main limitation of existing reversible fragile methods is that they cannot differentiate between legal and malicious modifications. In this paper, we introduce a novel lossless semi-fragile scheme based on prediction-error expansion for content protection of relational database. In the proposed method, all attributes in a database relation are first classified according to their sensitivity to legitimate updates. Then, the watermark is embedded by expanding the prediction error of the two least significant digits of securely selected attributes. At watermark extraction, the proposed method has the ability to fully restore the original data while detecting and localizing tampering. The applicability of our method is demonstrated theoretically and experimentally.

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.

Isolation of Six Phosphate Dissolving Rhizosphere Bacteria （Bacillus subtilis） and Their Effects on the Growth, Phosphorus Nutrition and Yield of Maize （Zea mays L.） in Mali

The disadvantages of the long term application of Tilemsi natural phosphate （TNP） on maize （Zea mays L.） production has come out because of its low P availability. Some functional soil microbes, such as phosphate dissolving bacteria, have great potential in improvement of P solubility from TNP and P uptake by plants. The present study aimed to isolate and characterize typical phosphate dissolving bacterial strains （Bacillus subtilis） from Malian soils, and investigate their role in P uptake by maize grown in soils amended with TNP. The experimental design was a split plot with three main plots of fertilizers sources, i.e., natural phosphate, commercial fertilizer and without fertilizer, and with seven sub-plots of six microorganisms plus the control. The field experiment results have shown that the maize inoculated with the phosphate dissolving bacteria was improved in seed germination, plant growth, plant production （increase yield by 42%）, grain and aerial dry biomass （P） content of 34% and 64%, respectively. They have also shown that the locally available TNP can be used by the Malians farmers in maize culture and have comparable production to the one obtained with the costly imported commercial phosphate fertilizer, like the complex cereal. The project has provided information for the combined use of the Mali TNP and phosphate dissolving bacteria Bacillus subtilis subsp, subtilis （T）： DSM 10 in improvement of maize production in the country.

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.