Synthesis of novel S- and O-disaccharide analogs of heparan sulfate for heparanase inhibition.

Heparan sulfate (HS), a glycosaminoglycan related to heparin, is a linear polysaccharide, consisting of repeating disaccharide units. This compound is involved in multiple biological processes such as inflammation, coagulation, angiogenesis and viral infections. Our work focuses on the synthesis of simple HS analogs for the study of structure-activity relationships, with the aim of modulating these biological activities. Thioglycoside analogs, in which the interglycosidic oxygen is replaced by a sulfur atom, are very interesting compounds in terms of therapeutic applications. Indeed, the thioglycosidic bond leads to an improvement of their stability and can allow the inhibition of enzymes involved in physiological and pathological processes. In our previous work, we developed a synthetic sequence which led to a non-sulfated thiodisaccharide analog of HS. In this paper, we report our results of the development of a new synthetic method allowing access to the novel sulfated S-disaccharide, as well as to their oxygenated analogues (O-disaccharide and sulfated O-disaccharide). These 4 compounds were also tested for the inhibition of heparanase, an enzyme involved in biological processes like tumor growth and inflammation. The obtained IC50 values in the micromolar range showed the impact of the interglycosidic sulfur atom and the 6-sulfate group.

Antibiotic therapy for infectious hemodialysed patients in Bamako: Pharmacokinetic analyses and first improvement suggestions.

Infection which occurs in renal kidney failure patient have to be therapeutically managed immediately and the treatment must be aggressive to be quickly efficient. In Bamako (Mali). Posology adaptation cause a problem in nephrology, especially for the most common used antibiotics to care these infections. Drug dosage is not routinely performed in Bamako. The main objective of this work is to compare anthropometric, clinical and pharmacokinetic profiles and the clinical future between infected hemodialysis patients following an antibiotic therapy in Bamako and Lyon (hospital used as a reference). To reach these objectives, a preliminary punctual study of clinical pharmacokinetic of vancomycin were set up at Bamako, following the personalization therapeutics model from Lyon. Bamako patients' samples were imported to France and dosage analysis were performed at Lyon. BestDose software was used to view and compare complete pharmacokinetic profile. It includes for the first time, in routine, the 50 ml/mn of the renal function during dialyses for 58 patients: 31 for Bamako and 21 for Lyon. The residual concentration at the beginning of the dialysis session was compared. In Bamako, patients are younger, the renal failure is more severe and arteriovenous fistula are never set up, treatments are limited in dose and in duration; the residual concentration before the dialyses are too low; as a consequence, infections are rarely quickly reduced and more especially the death linked to these infections are more important (9 in Bamako versus 1 in Lyon). Urgent corrective measures have to be proposed: propose a conciliation between therapeutic requirements formulated within Lyon protocols and the financial ability of the patient, to promote arteriovenous fistula creation as soon as possible, and develop first dose strategy (unfortunately there is often only one dose): a more aggressive dose estimated from simulation profile performed in this study.

[Mucoepidermoid carcinomas of salivary glands: prognostic significance of immunohistochemistry. A study of 49 cases]. / Carcinomes muco-épidermoïdes des glandes salivaires : valeur pronostique de l'immuno-histochimie. A propos de 49 cas.

INTRODUCTION: Mucoepidermoid carcinoma (MEC) is considered as the most common malignant salivary gland tumor. Its prognosis is dominated by the presence of high-grade forms involving life-threatening. The aim of our study was to evaluate the usefulness of immunohistochemistry to identify the most aggressive forms and allow better discrimination between low grade, intermediate grade and high grade tumors. MATERIALS AND METHODS: This was a retrospective study of 49 cases of mucoepidermoid carcinomas of salivary glands. Two immunohistochemical markers have mainly been studied: a marker of proliferation (Ki-67) and a growth factor receptor (EGFR). Additional analyzes were performed with other markers (p53, ACE, bcl2, CD 117 and her2). Statistical analysis investigated the existence of a correlation between the presence of these factors and the histopathological grade on one hand and survival of patients on the other hand. RESULTS: Regarding the results of immunohistochemical Ki-67 and EGFR, it was observed a better survival rate when the immunostaining was less than 10%. The expression of Ki-67 and EGFR was correlated with the histological grade, but did not, in our study, allow discrimination between low-grade, intermediate grade and high grade. Our results are consistent with data of the literature, including Ki-67, which appears to be a useful but not powerful marker of prognosis of MEC. Other markers studied (p53, ACE, bcl2, CD 117 and her2) showed no contributory results. CONCLUSION: The prognosis of MEC is appreciated satisfactorily following histological criteria: histological grade, surgical margins, perineural invasion or vascular emboli. The integration of immunohistochemistry in a therapeutic algorithm could be particularly useful for the challenging assessment of prognosis of intermediate grades.

Constitutive activation and accelerated maturation of peripheral blood T cells in healthy adults in Burkina Faso compared to Germany: the case of malaria?

OBJECTIVE: It is not exactly known how frequent exposure to Plasmodium falciparum shapes the peripheral blood T-cell population in healthy West Africans. METHODS: The frequency of peripheral blood CD4(+) lymphocytes responding to Plasmodium falciparum merozoite surface protein 1 (PfMSP-1) by production of interferon-gamma (IFN-γ), interleukin-2 (IL-2) or tumor necrosis factor-alpha (TNF-α) was determined using a commercially available flow cytometric activation assay (FastImmune) in 17 healthy adults in Nouna, Burkina Faso. T-cell activation and maturation in peripheral blood of healthy adults in Burkina Faso (n=40) and Germany (n=20) were compared using immunophenotyping and three-colour flow cytometry. RESULTS: Significant numbers of PfMSP-1 -specific CD4(+) lymphocytes producing IFN-γ, IL-2 and/or TNF-α were detected in 14 healthy adults in Nouna. Cytokine profiles showed predominant production of IFN-γ and TNF-α. Compared to Germans, Burkinabé showed markedly lower proportions of CCR7+ CD45RA+ naive CD4(+) cells and slightly higher frequencies of CD95(+)CD4(+) T-cells and of CD38(+) CD8(+) T-cells. The median antibody-binding capacity of CD95(dim) CD4(+) T-cells in Burkinabé was more than twice the value observed in Germans (263 vs. 108 binding sites per cell, p<0.0001). CONCLUSIONS: We hypothesize that an IFN-γ-induced increase in the expression level of CD95 on CD4(+) lymphocytes may lower the activation threshold of resting naive CD4(+) T-cells in healthy adults living in Burkina Faso. Bystander activation of these cells deserves further study as a molecular mechanism linking strong IFN-γ responses against Plasmodium falciparum to decreased susceptibility to parasitemia observed in specific ethnic groups in West Africa.

[Radiochemotherapy for the treatment ofmuscle invasive bladder tumors in a west african radiotherapy service]. / Radiochimiotherapie pour le traitement des tumeurs de vessie infiltrant lemuscle dans un service de radiotherapie ouest africaine.

OBJECTIF: The aim of this study was to describe the results of radiochemotherapy in patients after transurethral resection of muscle invasive bladder tumors. MATERIAL AND METHODS: A retrospective study from May 2014 to May 2016 in the radiotherapy department of the Mali Hospital. Have been included, all patients with bladder cancer infiltrating the muscle. Secondary cancers of the bladder and metastatic forms have been excluded from our study. Transurethral resection of bladder was performed. Neoadjuvant chemotherapy with paclitaxel- carboplatin was administered every three weeks in all patients, then external phototherapy 6 MV at a dose of 66 Gy due to 2 Gy of 5 sessions per week 6MV photon of external beam radiotherapy at a dose of 66 Gy due to 2 Gy of 5 sessions per week associated with concomitant cisplatin at dose of 40mg / m2 / week. RESULTS: Eight patients were included in ourstudy. The average age of 53.75 ± 14.84 years. The male sex was predominant 87.5% (n = 7). The history of chronic smoking wasfound in four patients. The main carcinogenic risk factor identified in our patients was urogenital bilharzia (6 cases / 8).The histological type found was urothelial carcinomain 12.5% (n = 1) and invasive squamous cell carcinomain 87.5% (n = 7). Transurethral resection of the tumor was performed in 62.5% (n = 5). Endoscopic biopsy was performed in 37.5% (n = 3). The tumor was classified pT2N0M0 in 50% (n = 4), pT3aN0M0 in 37.5% (n = 3) and pT3bN0M0 in 12.5% (n = 1). Neoadjuvant chemotherapy with paclitaxel - carboplatin every three weeks was administered to all patients. The results of radiochemotherapy (see Table: evolution). CONCLUSION: Concomitant radiochemotherapy is a conservative curative treatment that can be proposed as a replacement for cystectomy, for non-metastatic infiltrating tumors after the most complete endoscopic resection.

OBJECTIF: Le but de cette étude était de décrire les résultats d'une radiochimiothérapie chez les patients après résection transurétrale des tumeurs de vessie infiltrant le muscle. MATÉRIEL ET MÉTHODES: Une étude rétrospective allant de mai 2014 à mai 2016 au service de radiothérapie de l'hôpital du Mali. Ont été inclus, tous les patients présentant un cancer de vessie infiltrant le muscle. Les cancers secondaires de la vessie ainsi que les formes métastatiques ont été exclus de notre étude. La résection transurétrale de vessie a été réalisée. La chimiothérapie néoadjuvante à base de paclitaxel ­ carboplatine a été administrée toutes les trois semaines. La radiothérapie externe au photon 6MV à la dose de 66 Gy en raison de 2 Gy de 5 séances par semaine associée à la chimiothérapie concomitante à base de cisplatine (CDDP) 40mg/m2/semaine a été réalisée. RÉSULTATS: Au total huit patients ont été inclus dans notre étude. L'âge moyen de 53,75±14,84 ans. Le sexe masculin était prédominant 87.5% (n=7). L'antécédent de tabagisme chronique était retrouvé chez quatre patients. Le principal facteur de risque cancérigène identifié chez nos patients était la bilharziose urogénitale (6cas/8). Le type histologique retrouvé était le carcinome urothelial dans 12.5% (n=1) et le carcinome épidermoïde infiltrant dans 87.5% (n=7). La résection transurétrale de la tumeur a été réalisée dans 62.5% (n=5). La biopsie par voie endoscopique été réalisée dans 37.5% (n=3). La tumeur été classée pT2N0M0 dans 50% (n= 4), pT3aN0M0 dans 37.5% (n=3) et pT3bN0M0 dans 12.5% (n= 1). La chimiothérapie néoadjuvante à base de paclitaxel ­ carboplatine chaque trois semaines a été administrée chez tous les malades.Les résultats de la radiochimiothérapie (cf. Tableau: évolution). CONCLUSION: La radiochimiothérapie concomitante est un traitement curatif conservateur qui peut être proposée en remplacement à la cystectomie pour les tumeurs infiltrantes non métastatiques après une résection endoscopique la plus complète possible.

A geographical approach to identify sleeping sickness risk factors in a mangrove ecosystem.

OBJECTIVES: To provide a better understanding of sleeping sickness transmission and spread in mangrove areas to optimize its control. METHODS: In the Forecariah mangrove area, Guinea, 19 sleeping sickness cases and 19 matched controls were followed up in their living areas (at home, in fields and at water points). All occupational sites and pathways were mapped and then placed in their environmental context. RESULTS: The sleeping sickness cases displayed a significantly broader and more diverse spatial occupation than the controls. They covered double the daily walking distances of controls and had on average two more occupational sites, most of which were located in mangrove forests. Activities with a higher transmission risk (rice culture, attendance of pirogue jetties) were identified as well as high-risk areas and pathways. CONCLUSIONS: An entomological control strategy targeting transmission risk areas is proposed. Its implementation in a control programme would reduce by 86% the efforts needed for a classical vector control programme throughout the area. Medical surveys set up at specific locations, such as pirogue jetties and high-risk paths, should also enable better targeting of the population at highest risk.

[Implementation of in vitro culture of Mycobacterium ulcerans from clinical samples versus detection of acid-fast bachilli and bacterial genome in Abidjan, Côte d'Ivoire]. / Mise en place de la culture in vitro de Mycobacterium ulcerans à partir d'éhantillons cliniques versus recherche de BAARet détection du génome bactérien à Abidjan, Côte d'Ivoire

Mycobacterium ulcerans infections are a public health problem in Céte d'Ivoire. The etiological diagnosis of this disease made by culture remains a big concern due to the slowness and difficulties encountered. This detection by culture of M. ulcerans represents a big interest as it allows obtaining the circulating strains for research. The purpose of this study was to determine on a routine basis in a poorly equipped laboratory, in vitro culture of M. ulcerans from exudates of skin ulcerations and from biopsy of patients with suspected Buruli ulcer. A particular attention was paid to the conditioning of the sample forwarded to the laboratory and inoculation in Lowenstein-Jensen medium supplemented with glycerol. The results of the three methods for the analysis showed 26.7, 57.4 and 17.8% positive rate respectively in the microscopy examination by nested PCR and by culture. In all the analysis, the positive rate from biopsy is higher than that obtained from exudates. The overall contamination rate by invasion of the three tubes of culture by fungi is 15.8 with 14.3 and 19.4% respectively,from exudates and biopsies. All positive samples in Ziehl-Neelsen staining and in culture were also positive by nested PCR. The nested PCR confirmed the positive strains found in culture, which were responsible for skin ulcerations. After culture, only one strain was nPCR negative. This strain was identified as Mycobacterium Gordonae. Our culture conditions showed that M. ulcerans was not the only strain identified and that other strains were present in the culture. We can conclude that the culture of M. ulcerans, in spite of the growth difficulties of the bacterium can be performed in laboratory in developing countries despite the lack of reagent and consumables. The implementation of this culture is the only way to determine sensitivity tests in vitro and in vivo in order to treat patients with Buruli ulcer.

[Prevalence Of Periodontal Recessions In The Odontology Department Of The Bamako Hospital Infirmery (Ihb)]. / Prevalence Des Recessions Parodontales Dans Le Service D'Odontologie De L'Infirmerie Hopital De Bamako (Ihb).

Periodontal or gingival recession is the term used to characterize the apical displacement of the marginal gingiva on the surface of the root beyond the enamel junction. THE OBJECTIVE: of this study was to determine the prevalence of periodontal recession in the Dentistry Department of the Bamako Hospital Infirmary. METHOD: This study was carried out in the dentistry department of the Bamako Hospital Infirmary over a 3-month period from January 15 to April 15, 2020. The inclusion criteria concerned patients who came for consultation in the department. A survey sheet comprising socio-demographic and clinical variables was developed for this purpose. RESULTS: The prevalence of periodontal recession was 23.64%. Men were the most represented with 63.9%. Oral hygiene was fair with 42.62%, 36% of periodontal recessions were shallow and narrow. Miller's Class I and Class II recession types were the most represented with 41%. The incisors were the most affected with a rate of 29.64%. At the community level, adequate awareness and education in maintaining oral hygiene should prove successful in the long term.

La récession parodontale ou gingivale est le terme utilisé pour caractériser le déplacement apical de la gencive marginale à la surface de la racine au-delà de la jonction amelocementaire. L'OBJECTIF: de cette étude était de déterminer la prévalence de la récession parodontale dans le service d'Odontologie de l'Infirmerie Hôpital de Bamako. MÉTHODE: Cette étude a été réalisée dans le service d'odontologie de l'Infirmerie Hôpital de Bamako sur une période de 3 mois du 15 janvier au 15 Avril 2020. Les critères d'inclusion concernaient les patients venus en consultation dans le service. Une fiche d'enquête comportant les variables sociodémographiques et les variables cliniques a été élaborée à cet effet. RÉSULTAT: La prévalence de la récession parodontale était de 23,64%. Les hommes étaient les plus représentés avec 63,9%. L'hygiène bucco-dentaire était passable dans 42,62% des cas et 36% des récessions parodontales étaient peu profondes et étroites. Les types de récession de classe I et II de Miller étaient les plus représentés avec 41%. Les incisives étaient les plus touchées avec un taux de 29,64%. Au niveau communautaire une sensibilisation et une éducation adéquate en matière de maintien de l'hygiène buccale s'avère bénéfique à long terme.

[Surgical site infections at surgery service B of Point "G" hospital]. / Infections du site operatoire en chirurgie « B ¼ CHU du Point G.

BACKGROUND: Surgical site infections (SSI) complicate most operations in developing countries. A variety of germs is responsible for it. The purpose of this study was to determine the incidence of surgical site infections and the bacteriological profile. PATIENTS AND METHODS: We conducted a prospective study for descriptive purposes. The included patients were treated between August 2016 and July 2017 in the Surgery B department of the University Hospital Center Point G. The study population consisted of all patients operated on and hospitalized for at least 72 hours. Patients who had an infection of the operative site were retained. The incidence of ISOs, the different bacterial strains and their susceptibility to antibiotics were studied. Data was analyzed on SPSS 12.0. RESULTS: The incidence of surgical site infections was 4.7%. The median age of the patients was 29.5 ± 4.34, the sex ratio was 1.66. The average time to onset of infections was 7.33 days. Of the samples taken, 4 bacterial strains were identified: Escherichia coli, Staphylococcus aureus, Acinobacter baumanii and Enterobacter spp. Isolated strains of Escherichia coli and Staphylococcus aureus were sensitive to Cefotaxim, Amikacin, Nitrofurantoin, but resistant to Ceftriaxon, Amoxicillin + Clavulanic acid. The species of Acinobacter baumanii and Enterococcus spp. Were sensitive to Colistin, but resistant to Ceftriaxone, Amoxicillin + clavulanic acid. CONCLUSION: Escherichia coli and Staphylococcus aureus are the main germs of the generally antibiotic-resistant ISOs commonly used in the service.

INTRODUCTION: Les infections du site opératoire (ISO) compliquent la plupart des opérations dans les pays en développement. Une diversité de germes en est responsable. Le but de cette étude était de déterminer l'incidence des infections du site opératoire et leur profil bactériologique. PATIENTS ET MÉTHODES: Nous avons réalisé une étude prospective à visée descriptive. Les patients inclus étaient pris en charge entre Aout 2016 et Juillet 2017 dans le service de chirurgie B du centre hospitalier universitaire du Point G. La population d'étude était constituée de tous les patients opérés et hospitalisés pendant au moins 72 heures. Les patients ayant présenté une infection du site opératoire étaient retenus. L'incidence des ISO, les différentes souches bactériennes et leur sensibilité aux antibiotiques ont été étudiées. Les données ont été analysées sur SPSS 12.0. RÉSULTATS: L'incidence des infections du site opératoire était de 4,7%. L'âge médian des patients était de 29,5 ans ±4,34, le sex ratio de 1,66. Le délai moyen d'apparition des infections était de 7,33 jours. Sur les prélèvements réalisés, 4 souches bactériennes étaient identifiées : Escherichia coli, Staphylococcus aureus, Acinobacter baumanii et Enterobacter spp. Les souches d'Escherichia coli et de Staphylococcus aureus isolées étaient sensibles au Cefotaxime, à Amikacine, à Nitrofurantoïne, mais résistantes à Ceftriaxone, à Amoxicilline+Acide clavulanique. Les espèces d'Acinobacter baumanii et d'Entérocoque spp étaient sensibles à Colistine, mais résistantes à Ceftriaxone, à Amoxicilline+Acide clavulanique. CONCLUSION: Escherichia coli et Staphylococcus aureus sont les principaux germes des ISO généralement résistants aux antibiotiques couramment utilisés dans le service.

[Diagnosis and treatment of acute surgical abdomen in Koutiala]. / Abdomens aigus chirurgicaux a Koutiala : Diagnostic et traitement.

PURPOSE: To describe the epidemiological, clinical and therapeutic aspects of acute surgical abdomens at the Koutiala Reference Health Center. PATIENTS AND METHOD: This was a prospective and descriptive study from August 1, 2017 to May 31, 2018. It included all patients operated on for acute abdomen in the General Surgery Department of the Koutiala Reference Health Center. The study did not include the nonoperated surgical acute abdomens, the non-surgical acute abdomens. Clavien-Dindo classification was used to evaluate complications. RESULTS: One hundred patients were registered. Acute surgical abdomens accounted for 8.4% of consultations (n = 1190), 27.7% of surgical procedures (n = 361) and 70% of surgical emergencies (n = 142). The average age was 34.4 years ± 18.5. Men were in the majority with 70%. The mean duration of change in symptomatology was 4.8 days ± 5.4. Patients consulted for abdominal pain (100%), fever (60%), vomiting (88%) and discontinuation of materials and gases (32%). The physical examination noted abdominal distension (53%), abdominal contracture (36%), abdominal defense (56%) and pain in the cul de sac of Douglas (95%). X-rays of the abdomen without preparation and abdominopelvic ultrasonography contributed to the diagnosis in 46% of cases and 18% of cases, respectively. Acute appendicitis (35%) was the most common etiology followed by acute peritonitis (31%) and acute intestinal obstruction (15%). We performed an appendectomy in 45 patients (45%), resection anastomosis (15%) and excision-suture (13%). The average duration of hospitalization was 4.7 days. The morbidity was 12%. According to the Clavien-Dindo classification, 9 patients were grade III and 3 grade V. The mortality was 3%. CONCLUSION: Acute surgical abdomens are the most common emergencies in our practice. The diagnosis is clinical and para-clinical most often. Morbidity and mortality remain elevated. The outcome of treatment depends on early management and mastery of abdominal surgery techniques.

BUT: Décrire les aspects épidémiologiques, cliniques et thérapeutiques des abdomens aigus chirurgicaux au Centre de Santé de Référence de Koutiala. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective et descriptive allant du 1er Aout 2017 au 31 Mai 2018. Elle a porté sur tous les patients opérés pour abdomen aigu dans le service de chirurgie générale du centre de santé de référence de Koutiala. N'ont pas été retenus dans notre étude les abdomens aigus chirurgicaux non opérés, les abdomens aigus non chirurgicaux. La classification de Clavien-Dindo a été utilisée pour évaluer les complications. RÉSULTATS: Cent patients ont été enregistrés. Les abdomens aigus chirurgicaux ont représenté 8,4% des consultations (n=1190), 27,7% des interventions chirurgicales (n=361) et 70% des urgences chirurgicales (n=142). L'âge moyen était de 34,4 ans±18,5. Les hommes étaient majoritaires avec 70%. La durée moyenne d'évolution de la symptomatologie était de 4,8 jours±5,4. Les patients ont consulté pour douleur abdominale (100%), la fièvre (60%), les vomissements (88%) et l'arrêt des matières et des gaz (32%). L'examen physique a noté la distension abdominale (53%), la contracture abdominale(36%), la défense abdominale (56%) et la douleur au cul de sac de Douglas (95%). La radiographie de l'abdomen sans préparation et l'échographie abdominopelvienne ont contribué respectivement au diagnostic dans 46% des cas et 18% des cas. Les appendicites aigues(35%) étaient les étiologies les plus fréquentes suivies des péritonites aigues (31%) et les occlusions intestinales aigues (15%). Nous avons réalisé une appendicectomie chez 45 patients (45%), la résection anastomose (15%) et l'excision-suture (13%). La durée moyenne d'hospitalisation était de 4,7 jours. La morbidité était de 12%. Selon la classification de Clavien-Dindo, 9 patients étaient de grade III et 3 de grade V. La mortalité était de 3%. CONCLUSION: Les abdomens aigus chirurgicaux sont des urgences les plus fréquentes dans notre pratique. Le diagnostic est clinique et para clinique le plus souvent. La morbi-mortalité reste élever. Le résultat du traitement dépend de la prise en charge précoce et la maitrise des techniques de chirurgie abdominale.

[Non-traumatic digestive perforation in Koutiala: epidemiological and therapeutic aspects]. / Perforation digestive non traumatique a Koutiala : aspects epidemio-cliniques et therapeutiques.

PURPOSE: the aim of this study was to evaluate the clinical and therapeutic aspects of non-traumatic digestive perforations at the Koutiala Reference Health Center. PATIENTS AND METHODS: This was a prospective and descriptive study from August 1, 2017 to December 31, 2018. Patients admitted and operated on for non-traumatic digestive perforation were included. The parameters studied were age, sex, frequency, clinical aspects, etiologies, treatment and operative follow-up. RESULT: Sixty-one patients were registered. Non-traumatic digestive perforations accounted for 78.2% of cases of acute peritonitis (n = 78). Men were in the majority with 73.8%. The average age was 34.5 years old. The symptomatology was represented by abdominal pain in all patients, vomiting in 56 patients and fever in 42 patients. The mean duration of evolution of the symptomatology was 5.5 days. On physical examination, the most common signs were abdominal contracture with 81.9%, disappearance of prehepatic maturation (52.4%) and pain in rectal examination (95.1%). Radiological pneumoperitoneum was found in 39 patients. The serodiagnosis of Widal was positive in 15 cases. The etiologies were dominated by perforation of infectious origin with 77.0% (46). The perforation was ileal in 28 patients, appendicular in 18 patients and gastroduodenal in 11 patients. Excision-suturing of the perforation was done in 30 patients, resection anastomosis in 8 patients and appendectomy in 18 patients. Morbidity and mortality were respectively 14.7% and 6.5%. CONCLUSION: Non-traumatic digestive perforations are the first cause of peritonitis in our department. The ileal seat is the most common and is most often secondary to typhoid fever. Morbidity and mortality remain high and this result is a reflection of late diagnosis which is the main factor of severity of digestive perforations.

BUT: Evaluer les aspects cliniques et thérapeutiques des perforations digestives non traumatiques au Centre de Santé de Référence de Koutiala. PATIENTS ET MÉTHODES: Il s'agissait d'une étude prospective et descriptive allant du 1erAoût 2017 au 31 décembre 2018. Les patients admis et opérés pour perforation digestive non traumatique étaient inclus. Les paramètres étudiés étaient l'âge, le sexe, la fréquence, les aspects cliniques, les étiologies, le traitement et les suites opératoires. RÉSULTAT: Soixante-un patients ont été enregistrés. Les perforations digestives non traumatiques ont représenté78,2% de causes de péritonite aigue (n=78). Les hommes étaient majoritaires avec 73,8%.L'âge moyen était de 34,5 ans. La symptomatologie était représentée par la douleur abdominale chez tous les patients, les vomissements chez 56 patients etla fièvre chez 42 patients. La durée moyenne d'évolution de la symptomatologie était de 5,5 jours. A l'examen physique, les signes les plus fréquents étaient la contracture abdominale avec 81,9%, la disparition de la matité pré hépatique (52,4%) et la douleur au toucher rectal (95,1%). Un pneumopéritoine radiologique a été trouvé chez 39 patients. Le sérodiagnostic de Widal était positif dans 15 cas. Les étiologies étaient dominées par la perforation d'origine infectieuseavec77,0% (46). La perforation était iléal chez 28 patients, appendiculaire chez 18 patients et gastroduodénale chez 11 patients. L'excision-suture de la perforation a été faite chez 30 patients, la résection anastomose chez 8 patients et l'appendicectomiechez18 patients. La morbidité et la mortalité ont été respectivement de 14,7%de 6,5%. CONCLUSION: Les perforations digestives non traumatiques sont la première cause de péritonite dans notre service. Le siège iléal est le plus fréquent et qui est secondaire le plus souvent à la fièvre typhoïde. La morbi-mortalité reste élever et ce résultat est le reflet du diagnostic tardif qui constitue le principal facteur de gravité des perforations digestives.

[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.

[Contribution Of The Cytology In The Diagnosis And Evaluation Of The Pronostic Of Metastatic Ascites]. / Contribution De La Cytologie Au Diagnostic Et A L'Evaluation Du Pronostic Des Ascites Metastatiques Au Mali.

INTRODUCTION: Metastatsic tumoral ascites are characterised by the presence of cancerous cells in peritoneal fluid. They are frequent at an advanced stage of cancer. The goal of our work was to study cytology's contribution in the diagnosis of metastatic ascites at the teaching hospital of Point G. MATERIAL AND METHODS: It was a 3 years retrospective and prospective study, from January 2013 to December 2015. The study included every ascitic samples containing malignant cells at the teaching hospital of Point G. We looked for clinical informations in the patient's fold to find the primary cancer site, the histological diagnosis and the folllowup. RESULTS: We collected data from 213 patients with ascite. Among them, 61 where malignant (28.6 %). Sixty-six percent (66%) of our patients were women. The most represented range age was from 46 to 60 years with a mean of 57.7 years. Housewives were the most frequent among our patients with a rate of 50.8%. Ovarian cancer was the first site with metastatic ascite (26%). It was followed by liver and stomach with respectively 20% and 18%. Ascite was the first clinical manifestation in 36% patients with cancer. It was isolated in 78%. After 6 months, the mortality rate was 76.6%. CONCLUSION: The cytology of ascite liquid is an imortant test for the diagnostic of metastatic ascites.

INTRODUCTION: Les ascites métastatiques cancéreuses sont caractérisées par la présence de cellules cancéreuses métastatiques dans le liquide péritonéal. Elles sont fréquentes à un stade avancé des cancers. Il s'agissait de déterminer la contribution de la cytologie au diagnostic et à l'évaluation du pronostic des ascites métastatiques dans le service d'Anatomie et Cytologie Pathologiques du CHU du Point G. MATÉRIEL ET MÉTHODE: Notre étude s'est étendue de Janvier 2013 à Décembre 2015; soit une période de 3 ans. Elle était rétrospective et prospective incluant tous les patients dont l'étude cytologique des liquides d'ascitea mis en évidence des cellules malignes. Le dossier médical des patients a été exploité pour la recherche du site primitif et du diagnostic histologique éventuel et le suivi. RÉSULTATS: Sur 213 examens cytologiques de liquide d'ascite; 61 étaient malins, soit un taux de 28,64%. La tranche d'âge la plus répresentée était de 46 à 60 ans avec un âge moyen de 53,7 ± 14,7 ans. Le sexe féminin était dominant avec un taux de 66%. La profession la plus fréquente était les ménagères soit un taux de 50,82%. Le siège primitif le plus fréquent était l'ovaire (26%). Il était suivi par le foie et l'estomac avec respectivement 20% et 18%. L'ascite a été le signe révélateur du cancer dans 36% des cas. Elle était isolée dans 78%. Après 6 mois de suivi, le taux de mortalité était 75,6%. CONCLUSION: L'examen cytologique constitue un examen paraclinique dans le diagnoticdes ascites metastatiques cancéreuses.

[Acute Complications Of Snakebite Envenomation In Department Resuscitation Of CHU-Mother Child "Luxembourg" Of Bamako]. / Complications Aigues De L'Envenimation Par Morsures De Serpent Au Service De Reanimation Du Chu Mere Enfant "Le Luxembourg" De Bamako.

Envenomation by snakebite remains a public health problem in Africa. The purpose of our work was to study the acute complications of snakebite envenomation and the risk factors for its complications. METHOD: This was a retrospective and prospective study over a period of 07 years, which was performed in the department of anesthesia resuscitation and emergencies of CHU-Mother Child "Luxembourg" of Bamako. RESULTS: During this period, 76 cases of Ophidian envenomation were recorded. The average age of the patients was 34 ± 12 years old. . The family of vipers (Echis and Bitis) was the most incriminated 84,61% of the cases. Hemorrhagic complications were observed in 78.94% of patients, other complications (cardiovascular, neurological, dermatological, ophthalmological ...) were observed in 21.05% of patients. The main risk factor for complication observed was the delay in management (> 6 hours delay) in 100% of patients. The absence of serotherapy and or the initial resort to traditional treatment have been complicating risk factors. Almost all victims of Elapidae bites, 89.9% (5/6 cases) died. Serotherapy was performed urgently in 97.4% of cases. The morbidity in our study was 10.52% with a 7.8% mortality. CONCLUSION: in our context, the management of envenomations by snake bite remains dependent on a multitude of complications. The prognosis is conditioned by the early administration of symptomatic treatment and a specific antidote.

L'envenimation par morsure de serpent reste un problème de santé publique en Afrique. Notre travail avait pour objectif d'étudier les complications aigues de l'envenimation par morsure de serpent, ainsi que les facteurs de risque de ses complications. MÉTHODE: Il s'agissait d'une étude rétrospective et prospective sur une période de 07 ans, qui a été réalisée dans le département d'anesthésie réanimation et des urgences du CHU-Mère enfant le « Luxembourg ¼ de Bamako. RÉSULTATS: Durant cette période, 76 cas d'envenimations ophidiennes ont été enregistrés. L'âge moyen des patients était de 34±12 ans. . La famille des vipéridés (Echis et Bitis) était la plus incriminée 84,61% des cas. Les complications hémorragiques ont été observées chez 78,94% des patients, d'autres complications (cardiovasculaire, neurologique, dermatologique, ophtalmologique...) ont été observées chez 21,05% des patients. Le principal facteur de risque de survenu de complication observé, était le retard de prise en charge (délai> 6heures) Chez 100% des patients. L'absence de la sérothérapie et ou le recours initial à un traitement traditionnel ont été des facteurs de risques de complication. La presque totalité des victimes par morsures d'Elapidés soit 89,9% (5/6 cas) sont décédées. La sérothérapie a été effectuée en urgence chez 97,4% des cas. La morbidité dans notre étude a été de 10,52% avec une mortalité à 7,8%. CONCLUSION: dans notre contexte, la prise en charge des envenimations par morsure de serpent reste tributaire d'une multitude de complications. Le pronostic est conditionné par l'administration précoce d'un traitement symptomatique et d'un antidote spécifique.

Status epilepticus in black African patients with hypertensive encephalopathy: a rare entity that must not be underrated.

The severity of a blood pressure spike is more closely associated with serious organ dysfunction, which can be life-threatening in the short term, than with the blood pressure level itself. A hypertensive emergency is defined as the presence of high blood pressure associated with acute organ dysfunction. The specific nature of high blood pressure in black patients may cause more frequent hypertensive emergencies. In this retrospective case study, we report our experience and highlight the specific prognosis for black African patients. We examined three patients, aged 27, 47, and 59 years, admitted to intensive care for a hypertensive emergency with neurological distress, and all in status epilepticus. Average blood pressure was 171 mm HG. Treatment included intubation, ventilation, and induction of a barbiturate coma, plus antihypertensive treatment. The outcome was favorable, with an average stay of 5 days. The frequency of hypertensive emergencies varies according to age, ethnic origin, and period studied. Black patients often suffer from more severe forms of high blood pressure, arising at an earlier age. Hypertensive encephalopathy can occur in patients with or without chronic hypertension. Without treatment, the encephalopathy induces a coma that can quickly become fatal. Its spontaneous course is catastrophic (10-20% survival at one year), but more favorable with adequate treatment (60-80% survival at five years).

Sleeping sickness in West Africa (1906-2006): changes in spatial repartition and lessons from the past.

OBJECTIVE: To review the geography and history of sleeping sickness (Human African trypanosomiasis; HAT) over the past 100 years in West Africa, to identify priority areas for sleeping sickness surveillance and areas where HAT no longer seems active. METHOD: History and geography of HAT were summarized based on a review of old reports and recent publications and on recent results obtained from medical surveys conducted in West Africa up to 2006. RESULTS/CONCLUSIONS: Active HAT foci seem to have moved from the North to the South. Endemic HAT presently appears to be limited to areas where annual rainfall exceeds 1200 mm, although the reasons for this remain unknown. There has also been a shift towards the south of the isohyets and of the northern distribution limit of tsetse. Currently, the most severely affected countries are Guinea and Ivory Coast, whereas the northern countries seem less affected. However, many parts of West Africa still lack information on HAT and remain to be investigated. Of particular interest are the consequences of the recent political crisis in Ivory Coast and the resulting massive population movements, given the possible consequences on HAT in neighbouring countries.

ST2859 serogroup A meningococcal meningitis outbreak in Nouna Health District, Burkina Faso: a prospective study.

We analysed cerebrospinal fluid samples from suspected meningitis cases in Nouna Health District, Burkina Faso, during the meningitis seasons of 2004-2006. Serogroup A ST2859 meningococci belonging to the ST5 clonal complex of subgroup III meningococci were the predominant causative agent. ST2859 bacteria were associated with focal outbreaks in the north of the district. While >10% of the population of an outbreak village carried ST2859, the population in the south of the district was predominantly colonised by serogroup Y ST4375 meningococci, which were associated with only sporadic cases of meningitis. Colonisation with the less virulent Y meningococci may interfere with the spread of the ST2859 to the south of the district, but there are concerns that this serogroup A clone may cause a third wave of subgroup III meningococcal disease in the African Meningitis Belt.

[Degenerating neurocysticercosis cysts: differential diagnosis with cerebral metastasis]. / Neurocysticercose cérébrale au stade de dégénérescence : diagnostic différentiel des métastases cérébrales.

INTRODUCTION: Neurocysticercosis is the most common parasitic disease of the central nervous system. It has a worldwide distribution. CASE REPORT: We report the case of a 70-year-old woman from Guadeloupe presenting gait abnormalities, impaired ideation, right hemiparesis in a context of weight loss, and fatigue. Blood analyses were normal with neither inflammatory syndrome nor blood hypereosinophilia. Brain computed tomography and magnetic resonance imaging showed hydrocephaly in relation with Sylvius' aqueduc stenosis, and diffuse contrast-enhancing lesions suggesting metastases. Because of clinical symptoms, the patient underwent ventriculostomy; the cerebral spinal fluid examination was normal. Then a frontal biopsy was performed. Histological examination was compatible with neurocysticercosis and confirmed by serology. The patient was successfully treated with albendazole and steroids. CONCLUSION: Neurocysticercosis must be considered as a differential diagnosis of cerebral metastasis, especially in patients from endemic countries.

[Histological and molecular classification of gliomas]. / Classification histologique et moléculaire des gliomes.

Gliomas are the most frequent tumors of the central nervous system. The WHO classification, based on the presumed cell origin, distinguishes astrocytic, oligodendrocytic and mixed gliomas. A grading system is based on the presence of the following criteria: increased cellular density, nuclear atypias, mitosis, vascular proliferation and necrosis. The main histological subtype of grade I gliomas are pilocytic astrocytomas, which are benign. Diffuse astrocytomas, oligodendrogliomas and oligoastrocytomas are low-grade (II) or high-grade (III and IV) tumors. Glioblastomas correspond to grade IV astrocytomas. C. Daumas-Duport et al. have proposed another classification based on histology and imaging data, which distinguishes oligodendrogliomas and mixed gliomas of grade A (without endothelial proliferation and/or contrast enhancement), oligodendrogliomas and mixed gliomas of grade B (with endothelial proliferation or contrast enhancement), glioblastomas and glioneuronal malignant tumors. Both classifications lack reproducibility. Many studies have searched for a molecular classification. Recurrent abnormalities in gliomas have been found. They encompassed recurrent chromosomal alterations, such as lost of chromosome 10, gain of chromosome 7, deletion of chromosome 1p and 19q, but also activation of the Akt pathway (amplification of EGFR), dysregulation of the cell cycle (deletion of p16, p53). These studies have enabled the description of two molecular subtypes for glioblastomas. De novo glioblastomas, which occur in young patients without of a prior history of brain tumor and harbor frequent amplification of EGFR, deletion of p16 and mutation of PTEN while mutation of p53 is infrequent. Secondary glioblastomas occur in the context of a preexisting low-grade glioma and are characterized by more frequent mutation of p53. On the other side, combined complete deletion of 1p and 19q as the result of the translocation t(1;19)(q10;p10) is highly specific of oligodendrogliomas. However, histological and molecular classifications do not always correspond as many alterations are shared by high-grade tumors, whatever their histological type. Besides, few molecular alterations have a prognostic value. Among them combined 1p19q loss is associated with a better prognosis and response to treatment for oligodendrogliomas. Another promising marker is MGMT, a DNA repairing enzyme. If inactivated (by methylation of the promoter of the gene) a better sensitivity is observed with nitrosoure agents. However, some concerns exist for the method of detection of this abnormality. Quality control for molecular techniques is also required before using them for therapeutic strategy. In the future, studies of gene expression profiles by cDNA-microarray as well as works in the field of neural progenitor cells will probably provide new insights in gliomagenesis.

[Staphylococcus aureus isolated from a case of lymph node botryomycosis]. / Une botryomycose ganglionnaire àStaphylococcus aureus.

Botryomycosis is an uncommon chronic bacterial infection, which usually involves the skin and the subcutaneous tissues. Visceral involvement often occurs in immunodepressed patients. We describe the case of a 4-year-old boy who presented a right inguinal inflammatory mass associated with pruritic papules without fever. Blood analyses showed a substantial inflammatory syndrome and blood hypereosinophilia. Histological examination of the right inguinal lymph node showed granulomatous adenitis with a Splendore-Hoeppli phenomenon surrounding Gram-positive bacteria, corresponding to Staphylococcus aureus after biopsy culture. The diagnosis of S. aureus lymph node botryomycosis was made and the child was successfully treated with a double dose of oxacillin over 3 weeks.