[Covid-19 And Surgical Pathologies In General Surgery Of CHU Gabriel Toure Of Bamako]. / Covid-19 Et Pathologies Chirurgicales En Chirurgie Generale Du CHU-Gabriel Toure De Bamako.

INTRODUCTION: The pure digestive form of COVID-19 is possible and initially considered rare. Our objectives were to determine the frequency of COVID-19 in patients treated in general surgery, identify the circumstances of COVID-19 discoveries in surgery, describe the post-operative complications in patients operated on COVID-1919 and describe the reorganization of post-operative COVID-19 diagnosis management. MATERIALS AND METHODS: We conducted a prospective descriptive study from March 2020 to August 2021 (18 months). All patients who have been operated on, hospitalized or consulted in the department, the Emergency Department (ERS) or other CHU-GT departments for surgical pathology with COVID-19 or infected with COVID-19 while hospitalized were included in the study. RESULTS: 23 cases collected, representing 8.91% (23/258) of COVID-19 cases identified, a frequency of 1.27/month. The age group 66-75 was the most affected, the average age was 49.13 18.75 years, the predominance was male (sex ratio of 1.3). More than 34.78% were recruited at the SAU, 16 patients (69.56%) consulted in emergency, and digestive signs of COVID-19 were: Abdominal pain 20 cases (89.96%), anorexia 19 cases (82.61%), vomiting 8 cases (34.78%) and diarrhea 3 cases (13.04%). The pulmonary signs of COVID-19 were: Cough 18 cases (78.26%), chest pain 15 cases (65.22%), and dyspnea 9 cases (39.13%). Manifestations of COVID-19 were: pulmonary 9 cases, digestive 9 cases, associated 3 cases, incidental discovery 2 cases. The diagnostic mean was Thoracic CT (100%), Test-PCR 14 cases (60.86%) with a positive PCR test in 50% of cases. Surgical pathologies were surgical emergencies in 7 cases (30.43%), cancers in 6 cases (26.09%), COVID-19 digestive event (30.43%) and other 3 cases (13.04%). More than half of patients were operated on 12 cases (52.17%). The overall mortality was 60.87% and the mortality of surgical patients was 41.67%. CONCLUSION: The infectious risk of COVID-19 during hospitalization, during or after digestive surgery is a real and potentially serious risk for the patient and caregivers.

INTRODUCTION: La forme digestive pure de la COVID-19 est possible et initialement considérée comme rare. L'objectif était d'étudier la COVID-19 en milieu chirurgical. MATÉRIELS ET MÉTHODES: L'étude était descriptive prospective de Mars 2020 à Aout 2021 (18 mois). Tous les patients qui ont été opérés, hospitalisés ou consultés dans le service, au service d'accueil des urgences (SAU) ou dans d'autres services du CHU. GT pour pathologie chirurgicale avec COVID-19 ou infecté au COVID-19 en cours d'hospitalisation étaient inclus dans l'étude. RÉSULTATS: 23 cas colligés ; représentant 8,91 % (23/258) des cas de COVID-19 recensés, une fréquence de 1,27/mois. La tranche d'âge 66-75 ans était la plus atteinte, la moyenne d'âge était de 49,13 ± 18,75ans, la prédominance était masculine (sex-ratio de 1,3). Plus de 34,78% ont été recrutés au SAU, 16 malades (69,56%) ont consultés en urgence, les signes digestifs du COVID-19étaient : Douleur abdominale 20 cas (89,96%), anorexie 19 cas (82,61%), Vomissements 8 cas (34,78%), diarrhée 3 cas (13,04%). Les signes pulmonaires du COVID-19 étaient : Toux 18 cas (78,26%), douleur thoracique 15 cas (65,22%), dyspnée 9 cas (39,13%). Les manifestations du COVID-19 étaient : pulmonaire 9 cas, digestives 9 cas, associées 3 cas, découverte fortuite 2 cas. Le moyen diagnostic a été la TDM Thoracique (100%), le Test-PCR 14 cas (60,86%) avec un test-PCR positif dans 50% des cas. Les pathologies chirurgicales étaient des urgences chirurgicales dans 7 cas (30,43%), des cancers dans 6 cas (26,09%), manifestation digestive COVID-19(30,43%), autres 3 cas (13,04%).Plus de la moitié des malades étaient opérés 12 cas (52,17%). La mortalité globale était de 60,87% et la mortalité des malades opérés était de 41,67%. CONCLUSION: Les pathologies chirurgicales et COVID-19 n'étaient pas fréquentes. La plupart des malades avaient plus de 50 ans avec une présence moyenne de comorbidité. Les signes pulmonaires étaient les plus marquants, cependant les signes digestifs étaient inaugurales dans la moitié des cas de notre étude. La TDM Thoracique associée ou non au Test-PCR oro-pharyngé permet de faire le diagnostic. Le traitement peut-être médico-chirurgical ou médical. Le risque infectieux de la COVID-19 au cours de l'hospitalisation, pendant ou après la chirurgie est réel et potentiellement grave pour le malade ainsi que les soignants.

Complex data labeling with deep learning methods: Lessons from fisheries acoustics.

Quantitative and qualitative analysis of acoustic backscattered signals from the seabed bottom to the sea surface is used worldwide for fish stocks assessment and marine ecosystem monitoring. Huge amounts of raw data are collected yet require tedious expert labeling. This paper focuses on a case study where the ground truth labels are non-obvious: echograms labeling, which is time-consuming and critical for the quality of fisheries and ecological analysis. We investigate how these tasks can benefit from supervised learning algorithms and demonstrate that convolutional neural networks trained with non-stationary datasets can be used to stress parts of a new dataset needing human expert correction. Further development of this approach paves the way toward a standardization of the labeling process in fisheries acoustics and is a good case study for non-obvious data labeling processes.

Tablet-based electroencephalography diagnostics for patients with epilepsy in the West African Republic of Guinea.

BACKGROUND AND PURPOSE: Epilepsy is most common in lower-income settings where access to electroencephalography (EEG) is generally poor. A low-cost tablet-based EEG device may be valuable, but the quality and reproducibility of the EEG output are not established. METHODS: Tablet-based EEG was deployed in a heterogeneous epilepsy cohort in the Republic of Guinea (2018-2019), consisting of a tablet wirelessly connected to a 14-electrode cap. Participants underwent EEG twice (EEG1 and EEG2), separated by a variable time interval. Recordings were scored remotely by experts in clinical neurophysiology as to data quality and clinical utility. RESULTS: There were 149 participants (41% female; median age 17.9 years; 66.6% ≤21 years of age; mean seizures per month 5.7 ± SD 15.5). The mean duration of EEG1 was 53 ± 12.3 min and that of EEG2 was 29.6 ± 12.8 min. The mean quality scores of EEG1 and EEG2 were 6.4 [range, 1 (low) to 10 (high); both medians 7.0]. A total of 44 (29.5%) participants had epileptiform discharges (EDs) at EEG1 and 25 (16.8%) had EDs at EEG2. EDs were focal/multifocal (rather than generalized) in 70.1% of EEG1 and 72.5% of EEG2 interpretations. A total of 39 (26.2%) were recommended for neuroimaging after EEG1 and 22 (14.8%) after EEG2. Of participants without EDs at EEG1 (n = 53, 55.8%), seven (13.2%) had EDs at EEG2. Of participants with detectable EDs on EEG1 (n = 23, 24.2%), 12 (52.1%) did not have EDs at EEG2. CONCLUSIONS: Tablet-based EEG had a reproducible quality level on repeat testing and was useful for the detection of EDs. The incremental yield of a second EEG in this setting was ~13%. The need for neuroimaging access was evident.

[Foreskin Cyst After Circumcision At The Hospital Of Sikasso (MALI)]. / Kyste Du Moignon Preputial Post Circoncision Traditionnelle A L'Hopital De Sikasso (MALI).

Cyst scar post circumcision of the stump of the prepuce is pathology of which we have not found any cases in the literature. The circumcision traditional is still practiced in our regions with its attendant complications, in particular, the high section, the whole or part of the gland, infections. The case we report concerns a patient 24 years of age, having a large cyst of 8cm diameter, evolving for the past 17 years. The patient has not informed his parents that when the desire to marry has become very pressing. The consultation was motivated by the psychological trauma, the discomfort and the pain caused by the infection, and the fistulisation. The treatment was surgical with bedroom suites. This observation underscores the importance of the knowledge of good surgical technique in order to minimize complications; it also sheds light on the taboo side of the pathologies the sphere uro-genitale.

Le kyste cicatriciel post circoncision du moignon du prépuce est une pathologie dont nous n'avons pas trouvé de cas dans la littérature. La circoncision traditionnelle est toujours pratiquée dans nos régions, avec son cortège de complications, notamment l'hémorragie, la section partielle ou totale du gland, les infections. Le kyste cicatriciel post circoncision traditionnelle que nous rapportons concerne un patient de 24 ans présentant un volumineux kyste de 08cm de diamètre, évoluant depuis 17ans. Le patient n'a informé ses parents que lorsque le désir de se marier est devenu très pressant. La consultation fut motivée par le traumatisme psychologique, la gêne et la douleur provoquée par l'infection et la fistulisation. Le traitement a été chirurgical avec des suites simples. Cette observation souligne l'importance de la maitrise de la bonne technique opératoire afin de minimiser les complications de la circoncision traditionnelle, elle met aussi la lumière sur le côté tabou des pathologies touchant la sphère uro-génitale.

[Health care-associated infections in teaching hospital Gabriel TOURE]. / Les infections associées aux soins dans le service de chirurgie generale du CHU Gabriel TOURE.

OBJECTIVES: To study health care-associated infections (HCAI) in teaching hospital Gabriel TOURE. METHODOLOGY: This was a prospective study of 6 months (from April to September 2016) which included patients admitted to the General Surgery Department, operated or not, except those who had undergone a necrosectomy. The criteria used for the diagnosis of the infection were those of the CDC of Atlanta. RESULTS: A total of 200 patients were included in the study. Twenty one patients developed IAS that is a frequency of 10.5%. There were 11 men and 10 women with a mean age of 37.7 years with a standard deviation of 17.6 years. Surgical site infection was the most common HCAI (77.3%) followed by urinary tract infection (13.6%) and burn infection (9.1%). The influencing factors were those related to the patients (nutritional status p = 0.004, anemia RR = 3.1 IC p = 0.003 and diabetes), those related to the surgical intervention (the duration of the intervention ≥ 2H, p = 0,0001, the Altemeier class 3 and 4, RR = 4.24, IC p = 0.005, the number of interveners in the blocks ≥7, p = 0.000, the NNISS score 1 and 2 p = 0.0009), invasive procedures (bladder catheter ≥ 4 days p = 0.0000). Escherichia coli was the most isolated microorganism (31.2%) followed by Klebsiella pneumonia and A baumannii (18.7%). The treatment was local (twice-daily dressing with antiseptics), surgical (necrosectomy 16% and re-intervention 10%) and general (adapted to the antibiogram). The consequences of HCAI were an extension of total hospital stay (greater than 7 days) with p = 0.0000, morbidity 3% and mortality 5%. CONCLUSION: HCAI remains a concern in our country and globally. They prolong the hospital stay. The implementation of a prevention, control and surveillance program will improve the quality of care by significantly reducing HCAI.

Une infection est dite associée aux soins (IAS) si elle survient au cours ou au décours d'une prise en charge. L'OBJECTIF ÉTAIT: d'étudier les infections associées aux soins en chirurgie générale du CHU Gabriel Touré. MÉTHODOLOGIE: Il s'agissait d'une étude prospective de 6mois (d'avril à septembre 2016) intéressant les malades hospitalisés dans le service de chirurgie générale opérés ou non, sauf ceux ayant subi une nécrosectomie. Les critères utilisés pour le diagnostic de l'infection ont été ceux du CDC d'Atlanta. RÉSULTATS: Au total 200 malades ont été inclus dans l'étude. Vingt un patients ont développé des IAS soit une fréquence de 10,5%. Il s'agissait de 11 hommes et 10 femmes ayant un âge moyen de 37,7 ans avec un écart type de 17,6 ans. L'infection du site opératoire a été la plus fréquente des IAS (77,3%) suivie par l'infection urinaire (13,6%) et l'infection des brûlures (9,1%). Les facteurs influençant ont été ceux liés aux malades (état nutritionnel p=0,004 ; anémie RR=3,1 IC p=0,003 et diabète), ceux liés à l'intervention chirurgicale (la durée de l'intervention sup ≥2H p=0,0001 ; la classe d'Altemeier 3 et 4 ; RR=4,24 ; IC p=0,005 ; le nombre d'intervenants au blocs ≥7 ; p=0,000 ; le score de NNISS 1et 2 p=0,0009), les actes invasifs (sondage vésical ≥ 4 jours p=0,0000). Escherichia coli a été le germe le plus isolé parmi les micro-organismes (31,2%) suivi de Klebsiella pneumonia et A baumannii (18,7%). Le Traitement a été local (pansement biquotidien avec des antiseptiques), chirurgical (nécrosectomie 16% et ré-intervention 10%) et général (adapté à l'antibiogramme). Les conséquences des IAS ont été le prolongement de la durée totale d'hospitalisation (supérieur à 7 jours) avec p= 0,0000, la morbidité 3% et la mortalité 5%. CONCLUSION: Les IAS demeurent préoccupantes dans notre pays comme à l'échelle mondiale. Elles prolongent le séjour hospitalier. La mise en œuvre d'un programme de prévention, de contrôle et de surveillance permettra d'améliorer la qualité des soins en réduisant considérablement les IAS.

Stroke burden in Guinea: Results from the Conakry Ignace Deen Hospital stroke registry.

Sub-Saharan Africa has extremely high stroke prevalence and case fatality. Most Sub-Saharan African regions are uncharted in terms of stroke characteristics, epidemiology, and burden. We report here the results from the first stroke registry in Guinea.

[Surgical treatment of chronic subdural hematoma in Guinea: Analysis of 22 cases at the Kipe hospital of Conakry]. / Traitement chirurgical des hématomes sous-duraux chroniques en Guinée : étude de 22 cas à l'hôpital Kipe de Conakry.

OBJECTIVE: We report the results of surgical treatment of chronic subdural hematoma in the Kipe Hospital in Conakry, Guinea, for the period July 2012 to November 2015. MATERIAL AND METHOD: Clinical, radiological and therapeutic data from 22 cases were collected retrospectively and analyzed, with a mean follow-up of 61.6 days. Univariate analysis screened for factors for neurological outcome on the Markwalder Grading Scale (MGS; 0=normal to 4=coma). RESULTS: Male-female sex ratio was 2.6:1. Mean age at diagnosis was 71.09±8 years, with peak incidence of CSDH in the 60-79 age group. Traumatic brain injury was identified as causal in 40.9% of cases. Burrhole trepanation was used in 86.36% of cases, under local anesthesia in 76%, and with postoperative drainage in all cases. No recurrences were recorded. At follow-up, mean postoperative MGS was 0.59 (up from 3.08 preoperatively); 54.54% of patients had normal neurological examination (grade 0). Age 60-79 years, time to diagnosis>12 weeks and preoperative MGS≥3 had significant negative impact on outcome (respective P-values: 0.03, 0.001, 0.001). CONCLUSION: Our data were similar to those of the literature, but with longer time to diagnosis and poorer initial clinical status, with negative impact on clinical progression.

[Breast Cancer: Immunohistochemistry And Prognosis At Gabriel Touré Teaching Hospital In Bamako-Mali]. / Cancer Du Sein : Immunohistochimie Et Pronosticau Chu Gabriel Toure De Bamako-Mali.

Breast cancer is the second cancer of women in Mali. Immunohistochemistry is poorly performed in our African countries. OBJECTIVES: To describe the immunohistochemical aspect and determine the prognosis of breast cancer. METHODOLOGY: This is a retrospective descriptive study (March 2006-July 2016) in the General Surgery Department of Gabriel Toure University Hospital in Bamako, Mali. Immunohistochemistry was performed in all patients through a collaboration of our German partners. RESULTS: We collected 98 patients (95 women and 3 men) with an average age of 40.04 ± 13.07 years. Twenty-two patients (22.44%) had a personal history of benign breast disease. In 16 patients (16.33%), we found a family breast cancer. The most common histological types were intra ductal carcinoma with 84 (85.72%) and invasive lobular carcinoma in 9 cases (9.18%). Immunohistochemistry found a predominance of triple negative with forty nine patients (50%) followed by Luminal A subtype with 26 cases (26.23%). According to the TNM classification, 44 patients (44.90%) were received at stage III. The median survival was 60 months in the group of patients who received hormone therapy versus 28 months for the group without hormone therapy (p = 0.007). CONCLUSION: Immunohistochemistry is essential for the adequate management of breast cancer. Its realization has allowed us to improve the prognosis of hormone-dependent cancers.

Le sein est le deuxième siège du cancer chez la femme au Mali. Les examens immunohistochimiques sont peu réalisés dans nos pays africains. OBJECTIFS: Décrire l'aspect immunohistochimique et déterminer le pronostic du cancer du sein. MÉTHODOLOGIE: C'est une étude descriptive à collecte rétrospective (mars 2006-juillet 2016) dans le service de chirurgie générale du CHU Gabriel TOURE de Bamako au Mali. L'examen immunoihistochimique a été réalisé chez tous les malades grâce à la collaboration de nos partenaires allemands. RÉSULTATS: Nous avons colligé 98 malades (95 femmes et 3 hommes) avec un âge moyen de 40,04 ± 13,07 ans. Vingt-deux malades (22,44 %) avaient un antécédent personnel de pathologie bénigne du sein. Chez 16 malades (16,33 %), il y avait une notion familiale de cancer du sein. La prise d'œtroprogestatifs a été évoquée chez 28 femmes (28,57%). Les types histologiques les plus fréquents étaient le carcinome canalaire infiltrant avec 84 (85,72%) et le carcinome lobulaire infiltrant dans 9 cas (9,18%). L'immunohistochimie a permis de trouver une prédominance du triple négatif avec quarante neuf malades (50%) suivi du sous type Luminal A avec 26 cas (26,23%).Selon la classification TNM, 44 patients (44,90 %) ont été reçus au stade III. La médiane de survie a été de 60 mois dans le groupe des patients ayant bénéficié d'une hormonothérapie versus 28 mois pour le groupe sans hormonothérapie (p=0.007). CONCLUSION: l'immunohistochimie est essentielle pour la prise en charge adéquate des cancers du sein. Sa réalisation nous a permis d'améliorer le pronostic des cancers hormono dépendant.

Lipomatosis of interdigital nerves: Unusual localization.

Lipomatosis of the nerve (LN) is a rare benign tumor that is characterized by proliferating fibrous fatty tissue surrounding and infiltrating the peripheral nerves. While there are numerous case reports of LN affecting the median nerve and its branches, there are few reports, to the authors' knowledge, of their occurrence in the foot and ankle. A rare case of LN involving the second and third interdigital nerve in a 41-year-old man, which was successfully treated with surgical excision, is reported.

Impact of poorly controlled epilepsy in the Republic of Guinea.

PURPOSE: To characterize people with epilepsy (PWE) presenting to a free neurology consultation and antiepileptic drug (AED) service in the Republic of Guinea. METHODS: Guinea is a low-income country in West Africa that recently experienced an Ebola Virus Disease epidemic. Community-dwelling PWE were seen at a public referral hospital in Conakry, the capital city. During two visits in 2017, an African-U.S. team performed structured interviews and electroencephalograms and provided AEDs. RESULTS: Of 257 participants (143 children, 122 female), 25% had untreated epilepsy and 72% met our criteria for poorly controlled epilepsy. 59% had >100 lifetime seizures, and 58% reported a history consistent with status epilepticus. 38 school-aged children were not in school and 26 adults were unemployed. 115 were not currently taking an AED, including 50 participants who had previously taken an AED and stopped. Commonly cited reasons for AED discontinuation were perceived side effects, unaffordability, and unavailability of AEDs. Traditional medicine use was more frequent among children versus adults (92/143 vs. 60/114, p = 0.048). 57 participants had head injuries, 29 had burns, and 18 had fractures. In a multivariable regression analysis, >100 lifetime seizure count was strongly associated with seizure-related injury (p < 0.001). Burns were more likely to occur among females (p = 0.02). CONCLUSIONS: There is an urgent need to improve the standard of care for PWE in Guinea. Several missed opportunities were identified, including low use of AEDs and high use of traditional medicines, particularly in children. Targeted programs should be developed to prevent unintentional injury and improve seizure control.

Chronic anterior shoulder instability with significant Hill-Sachs lesion: Arthroscopic Bankart with remplissage versus open Latarjet procedure.

BACKGROUND: The objective of this study was to compare short-term shoulder stability after arthroscopic Bankart repair with remplissage versus the open Latarjet procedure in patients who had chronic anterior shoulder instability with a significant Hill-Sachs lesion. HYPOTHESIS: The dislocation recurrence rate is higher after Bankart repair with remplissage than after open Latarjet. PATIENTS AND METHODS: An observational non-randomised retrospective cohort study was conducted at two surgical centres in patients treated for chronic anterior shoulder instability with a significant Hill-Sachs defect between January 2009 and July 2014. The study compared 43 patients managed by arthroscopic Bankart repair and remplissage and 43 patients managed with open Latarjet. The two groups were matched on age at surgery and on follow-up duration. All patients were evaluated by independent observers based on a questionnaire including recurrences, range of motion, and functional outcomes (Shoulder Subjective Value [SSV], Walch-Duplay score, and Rowe score). RESULTS: Mean follow-up was 47.3 months (range, 24-67 months). The recurrence rate at last follow-up was not significantly different between the two groups (9.3% versus 11.2%; P=0.67). The Bankart group had significantly greater loss of external rotation and a significantly higher proportion of patients with residual pain (21% versus 9%, P=0.023). The SSV, Walch-Duplay score, and Rowe score values were similar between groups. DISCUSSION: In patients who had chronic anterior shoulder instability with a significant Hill-Sachs lesion, arthroscopic Bankart repair with remplissage and open Latarjet were reliable and safe procedures associated with low and similar recurrence rates. However, loss of external rotation and residual pain were significantly more common with the combined Bankart-remplissage procedure. LEVEL OF EVIDENCE: III; comparative retrospective study.

[Bilio-Digestives Derivative In The Palliative Surgery Of Pancreatic Head Cancer At The CHU Gabriel TOURE]. / Derivations Bilio-Digestives Dans La Chirurgie Palliative Du Cancer De La Tete Du Pancreas Au CHU Gabriel TOURE.

OBJECTIVES: Our objective was to determine the frequency of bilio-digestive bypass in palliative surgery in pancreatic head cancers, to determine the clinical and para-clinical aspects and to analyze the results of the treatment. METHODS: This was a-15 year retrospective study from 1999 to 2014 including any patient with confirmed pancreatic cancer in the anatomo-pathology treated by palliative surgery in the department. RESULTS: In 15 years, we operated152 cases of cancer of the head of the pancreas. The bilio-digestive derivation was performed in 78 patients, or 51.32%. The average age was 58.61 years ± 11.22 years with the extremes of 34 and 79 years old, the sex ratio was 1.44. The disease duration was 4.88 months on average with a standard deviation of 4.28 months and extremes of 1 and 24 months. Courvoisier-Terrier's disease was observed in 76 cases with lesions of the cases. The average pancreatic tumor size was 62.98 mm, and standard deviation = 8.68 with the extremes of45 and 121 mm. We performed a choledoco-duodenal anastomosis and a gastro-entero-anastomosis (GEA) in 85.90% of cases (n = 67), a choledocojejunal anastomosis and a GEA in 7 cases and a choledoco-duodenal anastomosis without GEA in 4 cases. The morbidity and the mortality rates were15.4% and 6.41%, respectively. At six (6) months postsurgery, a complete disappearance the majority of the functional signs was observed. CONCLUSION: Pancreatic cancer is a slowly developing tumor. Therefore its diagnosis is late; the derivation makes it possible to improve the quality of life of the patients.

OBJECTIFS: Nos objectifs étaient de déterminer la fréquence des dérivations bilio-digestives dans la chirurgie palliative dans les cancers de la tête du pancréas, de déterminer les aspects cliniques et para cliniques et d'analyser les résultats du traitement. MÉTHODE: Il s'agissait d'une étude rétrospective sur 15 ans allant de 1999 à 2014 incluant tout patient présentant un cancer du pancréas confirmé à l'anatomo-pathologie traité par la chirurgie palliative dans le service. RÉSULTATS: En 15 ans, 152 cas de cancer de la tête du pancréas ont été opérés dans le service. La dérivation bilio-digestive a été réalisée chez 78 patients soit 51,32%. L'âge moyen était de 58,61 ans±11,22 ans et des extrêmes de 34 et 79 ans, le sex-ratio était de 1,44. La durée d'évolution de la maladie a été en moyenne de 4,88 mois avec un écart-type de 4,28 mois et des extrêmes de 1 et 24 mois. La loi de Courvoisier-Terrier était observée dans 76 cas avec des lésions de grattage dans 96,15% (n=75) des cas. La taille moyenne de la tumeur pancréatique était 62,98 mm et écart-type=8,68 avec des extrêmes de 45 et 121 mm. Nous avons réalisé une anastomose cholédoco-duodénale et une gastro-entéro-anastomose (GEA) dans 85,90% des cas (n=67), une anastomose cholédoco-jéjunale et une GEA dans 7 cas et une anastomose cholédoco-duodénale sans GEA dans 4 cas. La morbidité était de15, 4% ; et la mortalité de 6,41%.A 6 mois une disparition complète de la majorité des signes fonctionnels a été observée. CONCLUSION: Le cancer du pancréas est une tumeur à évolution lente, par conséquent son diagnostic est tardif. La dérivation permet d'améliorer la qualité de vie des patients.

[Appendiceal Duplication In A Patient Operated For Chilled Appendix Breastplate At Gao Regional Hospital]. / Duplication Appendiculaire Chez Une Patiente Operee Pour Plastron Appendiculaire Refroidi A L'Hopital Regional De Gao, A Propos D'Un Cas.

Appendiceal duplication is the very rare malformation. It was first described by Picoli in 1892. It is a condition that is most often seen in the first years of life, sometimes some forms may remain asymptomatic and only occur in adulthood. We report the case of appendiceal duplication in a patient operated for chilled appendix breastplate at Gao Regional Hospital. CONCLUSION: appendiceal duplication is a rare abnormal abnormality of intraoperative discovery in general. Each surgeon must think about it during an appendectomy.

La duplication appendiculaire est une malformation très rare. Elle a été décrite pour la première fois par Picoli en 1892. C'est une affection qui se manifeste le plus souvent dans les premières années de vie, parfois certaines formes peuvent rester asymptomatiques et ne s'expriment qu'à l'âge adulte. Nous rapportons le cas de duplication appendiculaire chez une patiente opérée pour plastron appendiculaire refroidi à l'hôpital régional de Gao. CONCLUSION: la duplication appendiculaire est une anomalie malformative rare de découverte per opératoire en général. Chaque chirurgien doit y penser au cours d'une appendicectomie.

Anemia Offers Stronger Protection Than Sickle Cell Trait Against the Erythrocytic Stage of Falciparum Malaria and This Protection Is Reversed by Iron Supplementation.

BACKGROUND: Iron deficiency causes long-term adverse consequences for children and is the most common nutritional deficiency worldwide. Observational studies suggest that iron deficiency anemia protects against Plasmodium falciparum malaria and several intervention trials have indicated that iron supplementation increases malaria risk through unknown mechanism(s). This poses a major challenge for health policy. We investigated how anemia inhibits blood stage malaria infection and how iron supplementation abrogates this protection. METHODS: This observational cohort study occurred in a malaria-endemic region where sickle-cell trait is also common. We studied fresh RBCs from anemic children (135 children; age 6-24months; hemoglobin <11g/dl) participating in an iron supplementation trial (ISRCTN registry, number ISRCTN07210906) in which they received iron (12mg/day) as part of a micronutrient powder for 84days. Children donated RBCs at baseline, Day 49, and Day 84 for use in flow cytometry-based in vitro growth and invasion assays with P. falciparum laboratory and field strains. In vitro parasite growth in subject RBCs was the primary endpoint. FINDINGS: Anemia substantially reduced the invasion and growth of both laboratory and field strains of P. falciparum in vitro (~10% growth reduction per standard deviation shift in hemoglobin). The population level impact against erythrocytic stage malaria was 15.9% from anemia compared to 3.5% for sickle-cell trait. Parasite growth was 2.4 fold higher after 49days of iron supplementation relative to baseline (p<0.001), paralleling increases in erythropoiesis. INTERPRETATION: These results confirm and quantify a plausible mechanism by which anemia protects African children against falciparum malaria, an effect that is substantially greater than the protection offered by sickle-cell trait. Iron supplementation completely reversed the observed protection and hence should be accompanied by malaria prophylaxis. Lower hemoglobin levels typically seen in populations of African descent may reflect past genetic selection by malaria. FUNDING: National Institute of Child Health and Development, Bill and Melinda Gates Foundation, UK Medical Research Council (MRC) and Department for International Development (DFID) under the MRC/DFID Concordat.

Parameter and state estimation in a Neisseria meningitidis model: A study case of Niger.

Neisseria meningitidis (Nm) is a major cause of bacterial meningitidis outbreaks in Africa and the Middle East. The availability of yearly reported meningitis cases in the African meningitis belt offers the opportunity to analyze the transmission dynamics and the impact of control strategies. In this paper, we propose a method for the estimation of state variables that are not accessible to measurements and an unknown parameter in a Nm model. We suppose that the yearly number of Nm induced mortality and the total population are known inputs, which can be obtained from data, and the yearly number of new Nm cases is the model output. We also suppose that the Nm transmission rate is an unknown parameter. We first show how the recruitment rate into the population can be estimated using real data of the total population and Nm induced mortality. Then, we use an auxiliary system called observer whose solutions converge exponentially to those of the original model. This observer does not use the unknown infection transmission rate but only uses the known inputs and the model output. This allows us to estimate unmeasured state variables such as the number of carriers that play an important role in the transmission of the infection and the total number of infected individuals within a human community. Finally, we also provide a simple method to estimate the unknown Nm transmission rate. In order to validate the estimation results, numerical simulations are conducted using real data of Niger.

[Histologic kidney lesions during pure nephrotic syndrome in adults in Conakry]. / Lesions histologiques renales au cours du syndrome nephrotique pur de l'adulte a Conakry.

INTRODUCTION: Nephrotic syndrome represents a significant part of chronic kidney disease in Black Africa. Our work aimed to determine the frequency and type of kidney lesions in an adult carrying pure nephrotic syndrome. PATIENTS AND METHODS: We conducted a prospective and descriptive study (2003-2004), 40 patients were recruited on the basis of the presence of a pure nephrotic syndrome. Proteinuria was plentiful, selective to albumin greater than 3 g/24h, not accompanied by hematuria, or high blood pressure, or kidney failure. Cases of bacterial, parasitic and viral infections (hepatitis B, C, HIV) were excluded. By following contra-indications of renal biopsy, samples were taken under local anesthesia by means of percutaneous lumbar and fixed in two tubes, one containing "Michel's medium" and the other 12% Formalin. These techniques and readings were carried out in the pathological anatomy Laboratories of Nantes (France) and Conakry (Guinea). RESULTS: There were 24 men and 16 women with an average age of 26.2 ± 8 years [range: 20-51]. Clinical symptoms were dominated by weight gain characterized by edema. Proteinuria was between 3-3.5 g/24h in 16 (40%); between 3.6-5 g in 2 cases (5%) and greater than 5 g/24h in 22 cases (55%). The number of glomeruli was on average 11 ± 9 [range: 3-36]; glomerular permeability was on average 10.4 ± 10. Renal impairment was glomerular in 22 cases, tubulointerstitial in 12 cases and vascular in 6 cases. Immunofixation was positive in 30/40 cases for IgA IgG IgM; in 26 cases for C1q C3; in 4 cases for C1q C3 C4; and finally for fibrin in 28 cases. Histological renal lesions were FSGS (40%), MDC (35%), MGN (5%), MPGN (5%) and undetermined (15%). CONCLUSION: A regular practice of renal anatomopathological examination "on the spot" will lead us to carefully assess the causes of kidney failure associated with nephrotic syndrome.

INTRODUCTION: Le syndrome néphrotique représente une part importante d'insuffisance rénale chronique en Afrique noire. Notre travail avait pour but de déterminer la fréquence et le type de lésions histologiques rénales chez un adulte porteur d'un syndrome néphrotique pur. PATIENTS ET MÉTHODES: Au cours d'une étude prospective et descriptive (2003­2004), 40 patients ont été sélectionnés sur la base de la présence d'un syndrome néphrotique pur. La protéinurie était abondante, sélective à l'albumine, supérieure à 3 g/24h, non accompagnée d'hématurie, ni d'hypertension artérielle, ni d'insuffisance rénale. Les cas d'infections bactériennes, parasitaires et virales (hépatites B, C, HIV) ont été volontiers exclus. En respectant les contre indications de la biopsie rénale, les prélèvements ont été effectués sous anesthésie locale, par voie lombaire percutanée, puis fixés dans deux tubes dont un contenait du « liquide de Michel ¼ et l'autre du Formol à 12%. Les techniques et lectures ont été effectuées aux Laboratoires d'anatomie pathologique de Conakry (Guinée) et de Nantes (France). RESULTATS: Il s'agissait de 24 hommes et de 16 femmes âgés en moyenne de 26,2 ± 8 ans [20­51]. La symptomatologie clinique était dominée par une prise de poids marquée par les œdèmes. La protéinurie était comprise entre 3­3,5 g/24h dans 16 cas (40%); entre 3,6­5 g dans 2 cas (5%) et supérieure à 5 g/24h dans 22 cas (55%). Le nombre de glomérules était en moyenne de 11 ± 9 [3­36]; la perméabilité des glomérules était en moyenne de 10,4 ± 10. L'atteinte rénale était glomérulaire dans 22 cas, tubulo-interstitielle dans 12 cas et vasculaire dans 6 cas. L' immunofixation a été positive dans 30 cas /40 pour les IgA IgG IgM; dans 26 cas pour C1q C3; dans 4 cas pour C1q C3 C4; et en fin pour la fibrine dans 28 cas. Les lésions histologiques rénales étaient une HSF (40%), une LGM (35%), une GEM (5%), une GNMP (5%) et indéterminée (15%). CONCLUSION: Une pratique régulière de l'examen anatomo-pathologique rénal «sur place" nous amènerait à apprécier judicieusement les causes d'insuffisance rénale en rapport avec un syndrome néphrotique.

[Subcutaneous fat necrosis after moderate therapeutic hypothermia in two newborns of African origin]. / Cytostéatonécrose après hypothermie thérapeutique contrôlée chez deux nouveau-nés d'origine africaine.

Moderate therapeutic hypothermia (MTH) significantly reduces the risk of death or long-term neurodevelopmental disability. Subcutaneous fat necrosis (SCFN) is a rare particular form of panniculitis in full-term newborns. It can occur in preterm infants with predisposing risk factors (birth asphyxia, gestational diabetes, etc.). A few cases of SCFN after MTH have been described. We report two original cases of SCFN after MTH in newborns of African origin. Ethnic origin has not yet been reported in the literature as a risk factor. We describe here the possibility of a new risk factor of SCFN. Dermatologists and pediatricians should be aware of this complication and recognize it early because of the risk of hypercalcemia, even late after skin remission.

[Donohue syndrome or leprechaunism]. / Le syndrome de Donohue ou lepréchaunisme : à propos d'un cas.

Donohue syndrome or leprechaunism is a severe congenital insulin-resistance syndrome. It is characterized by intra-uterine and neonatal growth retardation, typical dysmorphic features, and metabolic abnormalities with hyperinsulinism and hyperandrogenism. Problems in energy metabolism and loss of glucose homeostasis are responsible for early death in the first year of life. We describe a case with a novel homozygote mutation in the insulin receptor gene. This patient had hypertrophic cardiomyopathy with heart failure and bronchial compression leading to clinical deterioration over 5 days and subsequently death. A treatment with recombinant IGF-1 was tried without efficacy.