Assessment of the impact of pregnancy and malaria infection on the variation of neutrophil levels in women from San, Mali.

BACKGROUND: In patients with severe neutropenia, infections can rapidly become serious and life-threatening. It is essential to understand whether pregnancy induces changes in neutrophil levels thereby posing an increased threat to the health of gravidae. METHODOLOGY: This cross-sectional study was conducted in San Health District (Mali) and involved pregnant women infected or not by malaria parasites and non-pregnant healthy volunteers. Subjects were categorized as having neutropenia, normal neutrophil levels, and neutrophilia regarding their neutrophil levels. A logistic regression analysis was performed to determine factors associated with neutrophil level variation in pregnant women. RESULTS: Whether or not the pregnant women were infected with malaria, 98 of the 202 cases (48.5%) showed neutrophilia. Surprisingly, 67 of the 71 cases of neutropenia (94.4%) observed in this study concerned healthy people who were not pregnant. The mean percentage of neutrophil levels was significantly (p < 0.001) lower (49.9%) in the first trimester compared to the second trimester of pregnancy (62.0%). A logistic regression model showed that compared to early pregnancy, the second (OR = 12.9, 95% CI 2.2-248.1, p = 0.018) and the third trimesters (OR = 13.7, 95% CI 2.3-257.5, p = 0.016) were strongly associated with the increase of neutrophil levels. CONCLUSIONS: Pregnancy can induce the production of mature neutrophils that are continually released into circulation. Neutrophil levels were lower during the first trimester of the pregnancy compared to the second and third trimesters, but not affected by the presence or absence of malaria infection.

A Case of Rosai-Dorfman Disease Successfully Treated by Corticotherapy.

Rosai-Dorfman disease (RDD) is a benign histiocytic proliferation that results in nodal and extranodal involvements. It is a rare disease, with fewer than 1,000 cases reported in the literature, which explains its lack of knowledge by physicians and the lack of codified therapeutic strategies. We report the case of an 8-year-old girl who presented a rapidly progressive cervical lymph node mass; the diagnosis of RDD was made based on histology and immunohistochemistry. The patient was treated with oral corticosteroids at a dose of 1 mg/kg/d with a favorable outcome and no recurrence after one year of follow-up. This observation illustrates the clinical presentation and diagnosis of this rare clinicopathological entity. The prognosis and treatment options are also discussed.

Homozygous Sickle Cell Disease after Age of 40: Follow-Up of a Cohort of 209 Patients in Senegal, West Africa.

Objectives: The aim of this study was to describe the morbidity and mortality of homozygous sickle cell disease after the age of 40. Methods: This was a cohort study of 209 patients followed from 1994 to 2022. All hemoglobin electrophoresis-confirmed SS sickle cell patients over 40 years were included. A descriptive study of epidemiological, diagnostic, therapeutic, and evolutionary data was used to assess morbidity and mortality. Results: Sex ratio (M/F) was 0.6. Median age was 47 (41-75). According to morbidity, 95.1% had less than 3 vaso-occlusive crises/year. Acute anemia was the most frequent complication (52.63%). Chronic complications were noted in 32.5%. At diagnosis, mean hemoglobin was 8.1 g/dl ± 1.9, HbS was 86.5 ± 10, and HbF was 9.4 ± 7.6. Number of patients transfused was 66%. We noted that 8.1% of patients died, 29.2% were lost to follow-up, and 62.7% were still being followed up. The risk factors identified for death were geographical origin, comorbidity, high HbS, low HbF, and thrombocytosis. Conclusion: This study shows that homozygous SCD is increasingly becoming an adult disease and that it can be carried into old age in Africa. Advanced age over 40 is marked by an upsurge in chronic complications, making it essential to set up a screening program and to organize multidisciplinary follow-up.

Efficacy and safety of pyronaridine-artesunate (PYRAMAX) for the treatment of P. falciparum uncomplicated malaria in African pregnant women (PYRAPREG): study protocol for a phase 3, non-inferiority, randomised open-label clinical trial.

INTRODUCTION: Malaria infection during pregnancy increases the risk of low birth weight and infant mortality and should be prevented and treated. Artemisinin-based combination treatments are generally well tolerated, safe and effective; the most used being artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DP). Pyronaridine-artesunate (PA) is a new artemisinin-based combination. The main objective of this study is to determine the efficacy and safety of PA versus AL or DP when administered to pregnant women with confirmed Plasmodium falciparum infection in the second or third trimester. The primary hypothesis is the pairwise non-inferiority of PA as compared with either AL or DP. METHODS AND ANALYSIS: A phase 3, non-inferiority, randomised, open-label clinical trial to determine the safety and efficacy of AL, DP and PA in pregnant women with malaria in five sub-Saharan, malaria-endemic countries (Burkina Faso, Democratic Republic of the Congo, Mali, Mozambique and the Gambia). A total of 1875 pregnant women will be randomised to one of the treatment arms. Women will be actively monitored until Day 63 post-treatment, at delivery and 4-6 weeks after delivery, and infants' health will be checked on their first birthday. The primary endpoint is the PCR-adjusted rate of adequate clinical and parasitological response at Day 42 in the per-protocol population. ETHICS AND DISSEMINATION: This protocol has been approved by the Ethics Committee for Health Research in Burkina Faso, the National Health Ethics Committee in the Democratic Republic of Congo, the Ethics Committee of the Faculty of Medicine and Odontostomatology/Faculty of Pharmacy in Mali, the Gambia Government/MRCG Joint Ethics Committee and the National Bioethics Committee for Health in Mozambique. Written informed consent will be obtained from each individual prior to her participation in the study. The results will be published in peer-reviewed open access journals and presented at (inter)national conferences and meetings. TRIAL REGISTRATION NUMBER: PACTR202011812241529.

A Review of Low-Cost Ultrasound Compatible Phantoms.

Ultrasound-compatible phantoms are used to develop novel US-based systems and train simulated medical interventions. The price difference between lab-made and commercially available ultrasound-compatible phantoms lead to the publication of many papers categorized as low-cost in the literature. The aim of this review was to improve the phantom selection process by summarizing the pertinent literature. We compiled papers on US-compatible spine, prostate, vascular, breast, kidney, and li ver phantoms. We reviewed papers for cost and accessibility, providing an overview of the materials, construction time, shelf life, needle insertion limits, and manufacturing and evaluation methods. This information was summarized by anatomy. The clinical application associated with each phantom was also reported for those interested in a particular intervention. Techniques and common practices for building low-cost phantoms were provided. Overall, this article aims to summarize a breadth of ultrasound-compatible phantom research to enable informed phantom methods selection.

Detection of Mycobacterium angelicum in Human Urinary Tract, French Polynesia.

We definitively characterized Mycobacterium angelicum, an aquatic zoonotic opportunistic pathogen of the M. szulgai complex, using a polyphasic approach that included whole-genome sequencing. The sequence was obtained on the island of Tahiti, French Polynesia, from a urine specimen collected from a patient experiencing a urinary tract infection.

Assessment of lung injury severity using ultrasound in critically ill COVID-19 patients in resource limited settings.

BACKGROUND: Lung ultrasound is a non-invasive tool available at the bedside for the assessment of critically ill patients. The objective of this study was to evaluate the usefulness of lung ultrasound in assessing the severity of SARS-CoV-2 infection in critically-ill patients in a low-income setting. METHODS: We conducted a 12-month observational study in a university hospital intensive care unit (ICU) in Mali, on patients admitted for COVID-19 as diagnosed by a positive polymerase chain reaction for SARS-CoV-2 and/or typical lung computed tomography scan findings. RESULTS: The inclusion criteria was met by 156 patients with a median age of 59 years. Almost all patients (96%) had respiratory failure at admission and many needed respiratory support (121/156, 78%). The feasibility of lung ultrasound was very good, with 1802/1872 (96%) quadrants assessed. The reproducibility was good with an intra-class correlation coefficient of elementary patterns of 0.74 (95% CI 0.65, 0.82) and a coefficient of repeatability of lung ultrasound score < 3 for an overall score of 24. Confluent B lines were the most common lesions found in patients (155/156). The overall mean ultrasound score was 23 ± 5.4, and was significantly correlated with oxygen saturation (Pearson correlation coefficient of - 0.38, p < 0.001). More than half of the patients died (86/156, 55.1%). The factors associated with mortality, as shown by multivariable analysis, were: the patients' age; number of organ failures; therapeutic anticoagulation, and lung ultrasound score. CONCLUSION: Lung ultrasound was feasible and contributed to characterize lung injury in critically-ill COVID-19 patients in a low income setting. Lung ultrasound score was associated with oxygenation impairment and mortality.

Gold Panning-Related Chronic Cutaneous Ulcers in Guinea, West Africa.

Chronic cutaneous ulcers caused potentially by several pathogens are of increasing concern in endemic tropical countries, including Guinea in West Africa, in rural populations exposed to aquatic environments during recreational, domestic, or agricultural activities. By plotting 1,011 cases of chronic cutaneous ulcers classified under the name Buruli ulcer in 24 of 33 Guinea health districts (72%) between 2018 and 2020 against the gold map and gold-panning map of Guinea, we revealed a significant spatial association between chronic cutaneous ulcer foci and gold-panning foci (P < 0.05), but not with nongold-panning foci (P = 0.12) in Guinea. Gold panning should be listed as an additional economic activity exposing populations to chronic cutaneous ulcers. Further research may aim to clarify whether any geological and biologic factors underlie such an association, besides the possibility that the unprotected skin of gold panners may be exposed to opportunistic, pathogen-contaminated environments in gold-panning areas.

Evaluating the Effectiveness of a Novel Systematic Screening Approach for Tuberculosis among Individuals Suspected or Recovered from COVID-19: Experiences from Niger and Guinea.

Evidence suggests that the COVID-19 pandemic negatively impacts tuberculosis (TB) activities. As TB and COVID-19 have similar symptoms, we assessed the effectiveness of integrated TB/COVID-19 screening in Guinea and Niger. From May to December 2020, TB screening was offered to symptomatic patients after a negative COVID-19 PCR test or after recovery from COVID-19 in Guinea. From December 2020 to March 2021, all presumptive COVID-19 patients with respiratory symptoms were tested simultaneously for COVID-19 and TB in Niger. We assessed the TB detection yield and used micro-costing to estimate the costs associated with both screening algorithms. A total of 863 individuals (758 in Guinea, and 105 in Niger), who were mostly male (60%) and with a median age of 34 (IQR: 26-45), were screened for TB. Reported symptoms were cough ≥2 weeks (49%), fever (45%), and weight loss (30%). Overall, 61 patients (7%) tested positive for COVID-19 (13 in Guinea, 48 in Niger) and 43 (4.9%) were diagnosed with TB disease (35 or 4.6% in Guinea, and 8 or 7.6% in Niger). The cost per person initiating TB treatment was USD $367 in Guinea and $566 in Niger. Overall, the yield of both approaches was high, and the cost was modest. Optimizing integrated COVID-19/TB screening may support maintaining TB detection during the ongoing pandemic.

Dataset of coal bio-gasification and coalbed methane stimulation by single well nutrition injection in Qinshui anthracite coalbed methane wells.

In-situ coal bio-gasification can be defined as one of the coal bio-mining methodology that fully utilizes the methanogenic bacteria in coal to review the current findings, namely anaerobic digestion of organic components. The following experiment has been done in regards, one vertical well and one multi-branch horizontal well were used as experiment wells and two vertical wells were used as control wells, the pilot test was carried out with single well nutrition injection method. By applying the above mentioned method, the concentration of Cl- ion and number altered in Methanogen spp. were used to trace nutrition diffusion. Furthermore, technical implementation results analysis has been made with the observation of CH4 production changes and coal bed biome evolution. Gas production rates in each well were monitored by using the FLLQ gas roots flow mete. The concentration of CH4 and CO2 were evaluated by using the Agilent 7890A gas chromatograph, on the other hand, concentrations of Cl- were determined by the application of ICS-1100 ion chromatography system. The F420 fluorescence method was adopted to test for the presence of methanogenic bacteria. In the interim of the completion stage, the study stated that the bacterial diversity of underground water of Z-7H well has a high pass sequence with the experimental period of 814 days. Gas production data in Z-159 and Z-7H wells showed the gasification of coal lasted 635 and 799 days, yielded 74817 m3 and 251754 m3 coalbed methane, respectively. Furthermore, experimental data presented that one time nutrition injection in anthracite coalbed methane wells achieved an average of 717 days of continuous gas production among all experimental wells. The above fore-said study dedicated the significance of native bacterial fermentation, as it proven the fact that anthracite can be applied to accomplish coal bio-gasification and coalbed methane production stimulation in-situ.

A monoallelic variant in EYA1 is associated with Branchio-Otic syndrome in a Malian family.

BACKGROUND: Branchio-otic syndrome (BO) is one of the most common types of syndromic hearing impairment (HI) with an incidence of 1/40,000 globally. It is an autosomal dominant disorder typically characterized by the coexistence of branchial cysts or fistulae, malformations of the external, middle, and inner ears with preauricular pits or tags and a variable degree of HI. Most cases of BO have been reported in populations of European ancestry. To date, only few cases have been reported in people from African descent. METHODS: After a careful clinical examination, a pure tone audiometry was performed. DNA was extracted from peripheral blood and whole exome, and Sanger sequencing were performed for genetic analysis. RESULTS: Eight individuals from a large non-consanguineous Malian family, with autosomal dominant inheritance were enrolled. The ages at diagnosis ranged from 8 to 54 years. A high phenotypic variability was noted among the affected individuals. Four patients presented with a post-lingual and mixed type of HI, one individual had conductive HI while three had normal hearing but presented other BO features namely branchial fistulae and preauricular sinus. Serum creatinine level and renal ultrasonography were normal in three affected individuals who performed them. Genetic testing identified a monoallelic pathogenic variant in EYA1 (c.1286A > G; p.Asp429Gly) segregating with BO syndrome in the family. CONCLUSION: This is the first genetically confirmed case of BO syndrome caused by EYA1 variant in the sub-Saharan African population, expanding the genetic spectrum of the condition.

Dataset of response characteristics of H2-producing bacteria consortium to ß-lactams, aminoglycosides, macrolides, quinolones antibiotics.

Antibiotics on H2 producing bacteria shall be considered as being one of the critical elements in biological H2 production utilizing livestock manure as raw resources. Despite the fact that the manure stands a significance role in bio-fermentation, the possibility of antibiotics being contained in excreta shall not be eliminated. Findings of whether the above saying might threaten the safety of bio-H2 production needs to be further studied. The experiment subjects include: six single and three combined antibiotics were tested and analyzed by the application of the gradient experiment method. Along with the H2 production rate, CHO content, pH and OD600 were used to analyze the effects of various antibiotics introduction on the hydrolysis, fermentation and H2 production. To a further extent, four typical representative samples were selected for biodiversity analysis from the single antibiotic experiment groups. Amounting more than 6000 pieces of data were obtained in a series of experiments. Data suggested that remarkable measure of antibiotics have various degrees of H2 production inhibition, while some antibiotics, Penicillin G, Streptomycin Sulfate, and their compound antibiotics, could promote the growth of Ethanoligenens sp. and improve H2 yield in the contrary. Correspondent to the transition of key metabolic intermediates and end products, the mechanism of each antibiotic type and dose on H2 production were summarized as follows: the main inhibitory mechanisms were: (1) board-spectrum inhibition, (2) partial inhibition, (3) H2 consumption enhancement; and the enhancement mechanisms were: (1) enhance the growth of H2-producing bacteria, (2) enhanced starch hydrolysis, (3) inhibitory H2 consumption or release of acid inhibition. Meanwhile, data analysis found that the effect of antibiotics on H2 producing was not only related to type, but also to dosage. Even one kind of antibiotic may have completely opposite effects on H2-producing bacteria under different dosage conditions. Inhibition of H2 yield was highest with Levofloxacin at 6.15 mg/L, gas production was reduced by 88.77%; and enhancement of H2 yield was highest with Penicillin G at 7.20 mg/L, the gas production increased by 72.90%.

The response regularity of biohydrogen production by anthracite H2-producing bacteria consortium to six conventional veterinary antibiotics.

The impact of antibiotics on H2-producing bacteria must be considered in the industrialization of biological H2 production using livestock manure as raw resources. However, whether antibiotics that may be contained in excreta will threaten the safety of biohydrogen production needs to be researched. This study explored the impact characteristics and mechanism of six single antibiotics and three groups of compound antibiotics on H2 production. Experiments confirmed that most antibiotics have different degrees of H2 production inhibition, while some antibiotics, which like Penicillin G, Streptomycin Sulfate, and their compound antibiotics, could promote the growth of Ethanoligenens sp. and improve H2 yield on the contrary. Comprehensive analysis shows that the main inhibitory mechanisms were: (1) board-spectrum inhibition, (2) partial inhibition, (3) H2 consumption enhancement; and the enhancement mechanisms were: (1) enhance the growth of H2-producing bacteria, (2) enhanced starch hydrolysis, (3) inhibitory H2 consumption or release of acid inhibition. Meanwhile, experiment found that the effect of antibiotics on H2 producing was not only related to type, but also to dosage. Even one kind of antibiotic may have completely opposite effects on H2-producing bacteria under different dosage conditions. Inhibition of H2 yield was highest with Levofloxacin at 6.15 mg/L, gas production was reduced by 88.77%; and enhancement of H2 yield was highest with Penicillin G at 7.20 mg/L, the gas production increased by 72.90%. In the selection of raw material, the type and content of antibiotics demand a detailed investigation and analysis to ensure that the sustainability of H2 yield.

GJB1 variants in Charcot-Marie-Tooth disease X-linked type 1 in Mali.

X-linked Charcot-Marie-Tooth type 1 (CMTX1) disease is one of the most common subtypes of inherited neuropathies and is caused by mutations in the GJB1 gene. To date, more than 400 mutations have been reported in GJB1 worldwide but none in sub-Saharan Africa (SSA). We aimed to clinically characterize patients with CMTX1 and identify the genetic defects. All patients were examined thoroughly, and Nerve Conduction Studies (NCS) were done. EEG and pure tone audiometry (PTA) were also done in select individuals having additional symptoms. DNA was extracted for CMT gene panel testing (50 genes + mtDNA and PMP22 duplication), and putative variants were screened in available relatives. The predominant starting symptom was tingling, and the chief complaint was gait difficulty. Neurological examination found a distal muscle weakness and atrophy, and sensory loss, skeletal deformities, decreased or absent reflexes and steppage gait. The inheritance pattern was consistent with dominant X-linked. NCS showed no response in most of the tested nerves in lower limbs, and normal or reduced amplitudes in upper limbs. A severe sensorineural hearing impairment and a focal epileptic seizure were observed in one patient each. A high intra and inter-familial clinical variability was observed. Genetic testing found three pathogenic missense variants in GJB1, one in each of the families (Val91Met, Arg15Trp, and Phe235Cys). This is the first report of genetically confirmed cases of CMTX1 in SSA, and confirms its clinical and genetic heterogeneity.

Differential Incidence of Malaria in Neighboring Villages in a High-Transmission Setting of Southern Mali.

Throughout a phase IIIb/IV efficacy study of repeated treatment with four artemisinin-based combination therapies, significant heterogeneity was found in the number of clinical episodes experienced by individuals during the 2-year follow-up. Several factors, including host, parasite, and environmental factors, may contribute to the differential malaria incidence. We aimed to identify risk factors of malaria incidence in the context of a longitudinal study of the efficacy of different artemisinin-based combination therapy regimens in Bougoula-Hameau, a high-transmission setting in Mali. Risk factors including age, residence, and treatment regimen were compared among individuals experiencing eight or more clinical episodes of malaria ("high-incidence group") and individuals experiencing up to three clinical episodes ("low-incidence group"). Consistent with the known association between age and malaria risk in high-transmission settings, individuals in the high incidence group were significantly younger than individuals in the low-risk group (mean age, 7.0 years versus 10.6 years, respectively; t-test, P < 0.0001). Compared with individuals receiving artemether-lumefantrine, those receiving artesunate-amodiaquine had greater odds of being in the high-incidence group (odds ratio [OR], 2.24; 95% CI, 1.03 - 4.83, P = 0.041), while individuals receiving dihydroartemisinin-piperaquine had a lower odds of being in high incidence group (OR: 0.30, 95% CI, 0.11-0.85; P = 0.024). Individuals residing in the forested areas of Sokourani and Karamogobougou had significantly greater odds of being in the high-incidence group compared with individuals residing in the semi-urban area of Bougoula-Hameau 1 (Karamogobougou: OR, 3.68; 95% CI, 1.46-9.31; P = 0.0059; Sokourani: OR, 11.46; 95% CI, 4.49-29.2; P < 0.0001). This study highlights the importance of fine-mapping malaria risks even at sub-district levels for targeted and customized interventions.

Transfusion Practice, Post-Transfusion Complications and Risk Factors in Sickle Cell Disease in Senegal, West Africa.

CONTEXT AND OBJECTIVES: Blood transfusions (BT) remain a mainstay of therapy for patients with sickle cell disease (SCD) but pose significant clinical challenges. We aim to assess infectious markers, red cell alloimmunization, and iron overload secondary to BT in SCD patients. MATERIALS AND METHODS: This case-control study included 253 SCD (153 SCD-transfused and 100 SCD non-transfused). We evaluated the transfusion practice (modalities, indications), post-transfusion complications (infections, alloimmunization, iron overload), and risk factors of these complications (socio-demographic, clinical, biological). RESULTS: Median age was 28.5 years (5 - 59). The sex ratio was 0.86. Homozygous SCD was the most common (95.3%). Simple BT was performed in 92.8% and transfusion exchange in 18.9%. Transfusion indications were dominated by acute anemia (57.06%) and vaso-occlusive crisis (VOCs) (14%). Red blood cell concentrates (RBCSs) were administered to 93.46%. The median RBCs received per patient was 10 (2 - 48). The prevalence of VHC in SCD-transfused was 1.33% and 2% for VHB. Anti-HIV antibodies were not found. Red cell alloimmunization frequency was 16%. The most common alloantibodies were anti-rhesus (34.19%) and anti-Kell (23.67%). Iron overload was detected in 7.84%. The number of RBCs transfused was the only risk factor for alloimmunization (p = 0.03) and iron overload (p = 0.023). BT frequency was not related to infectious transmission. CONCLUSION: BT therapy is still a risk for SCD polytransfused patients despite advances in blood safety. Although infectious transmission has rare, the risk of alloimmunization and iron overload is high in these patients.

[Upper Airway Obstruction in a Type 4 Laryngeal Palmar in Infant]. / Obstruction des Voies Aeriennes Superieures dans une Palmure Laryngee de Type 4 Chez le Nourrisson.

INTRODUCTION: Congenital malformations of the larynx in children are often manifested by laryngeal noise (stridor), dyspnea, dysphonia and sometimes swallowing disorders. Laryngomalacia is the most common anomaly, but it is necessary to know how to look for laryngeal paralysis, congenital subglottic stenosis, sometimes a subglottic angioma or a laryngeal diastema. Endoscopy is the master examination for confirming the diagnosis and guiding the management, which may be medical and/or surgical depending on the case [1]. OBJECTIVE: Aim: The aim of our work is to study the diagnostic and therapeutic particularities of a congenital malformation in an infant in a context of insufficient materials. OBSERVATION: We report an observation of an infant aged 06 months, who was referred to us from pediatrics for chronic dyspnea with dysphonia dating back to birth without other congenital anomalies after multiple treatments without improvement based on nebulization, corticoids and antibiotics. Nasofibroscopy revealed a laryngeal web-like larynx connecting the two vocal cords on its anterior two-thirds leaving a small respiratory tract (Figure 1). The diagnosis of laryngeal palmaris was retained. Management consisted of resection during panendoscopy. Nasofibroscopy at regular intervals of up to twelve months were performed without particularity. CONCLUSION: Dyspnea in infants can be frequent and have many causes. Only a thorough clinical and paraclinical examination can help to diagnose laryngeal palmaris. They are confusing to all laryngeal malformations. The prognosis can be serious if management is not carried out as soon as possible.

INTRODUCTION: Les malformations congénitales du larynx de l'enfant se manifestent souvent par un bruit laryngé (stridor), une dyspnée, une dysphonie et parfois des troubles de la déglutition. La laryngomalacie est l'anomalie la plus fréquente, mais il faut savoir rechercher notamment une paralysie laryngée, une sténose sous-glottique congénitale, parfois un angiome sous-glottique ou un diastème laryngé. L'endoscopie est le maître-examen pour confirmer le diagnostic et orienter la prise en charge qui peut être médicale et/ou chirurgicale suivant les cas [1]. OBJECTIF: Le but de notre travail est d'étudier les particularités diagnostiques et thérapeutiques d'une malformation congénitale chez un nourrisson dans un contexte de matériel insuffisant. OBSERVATION: Nous rapportons une observation d'un nourrisson âgé de 06 mois, qui nous a été référé de la pédiatrie pour dyspnée chronique avecdysphonie remontant à la naissance sans autres anomalies congénitales après de multiples traitements sans amélioration à base de nébulisation, corticoïdes et antibiotiques.La nasofibroscopie mettait en évidence un larynx d'aspect de palmure laryngée reliant les deux cordes vocales sur ses deux tiers antérieurs laissant une petite filière respiratoire (Figure 1). Le diagnostic de palmure laryngée a été retenu. La prise en charge a consisté en une résectionlors de la panendoscopie. Des nasofibroscopiesà intervalle régulier jusqu'à douze mois furent réalisées sans particularité. CONCLUSION: Lesdyspnées chez le nourrisson peuvent êtrefréquentes et avoir beaucoup de cause. Seul un examen clinique et paraclinique poussé peut aider à diagnostiquer la palmure laryngée. Ils prêtent à confusion a toutes les malformations laryngées.Le pronostic peut être grave si la prise en charge n'est pas effectué dans les meilleurs délais.

[Hemangioma of the tongue: Experience in Mali]. / Prise en charge d'un hemangiome de la langue : Experience au Mali.

PURPOSE: To study the diagnostic and therapeutic aspects of hemangioma of the tongue. OBSERVATION: A 65 year old man admitted to ENT for a swelling of the tongue that appeared two years ago and progressively increased in volume leading to permanent protrusion. The swelling took up the entire anterior third of the tongue. It had a reddish appearance. On palpation, it was a rounded, firm, well-limited, slightly sensitive mass, measuring 5 cm in diameter. The rest of the ENT examination was unremarkable. Lingual CT scan revealed a very limited mass with hyperechogenic content that did not increase in size after injection of the contrast agent. Surgical excision was performed and the postoperative follow-up was simple. Histology concluded that there was a hemangioma of the tongue. CONCLUSION: Hemangioma of the tongue is a rare pathology. It must be considered in front of any lingual mass in adults. Its positive diagnosis is clinical and histological.

BUT: Etudier les aspects diagnostiques et thérapeutiques de l'hémangiome de la langue. OBSERVATION: Un homme de 65 ans admis en ORL pour une tuméfaction de la langue apparue depuis deux ans ayant progressivement augmenté de volume entrainant sa protrusion permanente. La tuméfaction prenait toute le tiers antérieur de la langue. Elle était d'aspect rougeâtre. A la palpation, il s'agissait d'une masse arrondie, ferme, bien limitée, légèrement sensible, mesurant 5 cm de grand diamètre. Le reste de l'examen ORL était sans particularité. La TDM linguale a objectivé une masse bien limitée à contenu hyperechogène ne se rehaussant pas après injection du produit de contraste. L'exérèse chirurgicale a été effectuée et les suites opératoires ont été simples. L'histologie a conclu à un hémangiome de la langue. CONCLUSION: L'hémangiome de la langue est une pathologie rare. Il faut y penser devant toute masse linguale chez l'adulte. Son diagnostic positif est clinique et histologique.

Etiologies of Childhood Hearing Impairment in Schools for the Deaf in Mali.

Objectives: To identify the etiologies of hearing impairment (HI) in schools for students who are deaf and to use a systematic review to summarize reports on the etiologies and clinical and genetic features of HI in Mali. Methods: We included individuals with HI that started before the age of 15 years old. Patients were carefully evaluated under standard practices, and pure-tone audiometry was performed where possible. We then searched for articles published on HI in the Malian population from the databases' inception to March 30, 2020. Results: A total of 117 individuals from two schools for the deaf were included, and a male predominance (sex ratio 1.3; 65/52) was noted. HI was pre-lingual in 82.2% (n = 117), and the median age at diagnosis was 12 years old. The etiologies were environmental in 59.4% (70/117), with meningitis being the leading cause (40%, 20/70), followed by cases with genetic suspicion (29.3%, 21/117). In 11.3% (8/117) of patients, no etiology was identified. Among cases with genetic suspicion, three were syndromic, including two cases of Waardenburg syndrome, while 15 individuals had non-syndromic HI. An autosomal recessive inheritance pattern was observed in 83.3% of families (15/18), and consanguinity was reported in 55.5% (10/18) of putative genetic cases. Conclusion: This study concludes that environmental factors are the leading causes of HI in Mali. However, genetic causes should be investigated, particularly in the context of a population with a high consanguinity rate.