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Whether early chronic kidney disease (CKD) is associated with fracture in middle-aged adults is unclear. In a cross-sectional analysis of the CARTaGENE survey, we observed that early CKD was not associated with increased fracture, did not modify the association between calcaneal QUS and fracture, but modified the association between clinical, pharmacological parameters and fracture. INTRODUCTION: The association between advanced CKD and increased fracture risk is well described. However, whether early CKD is associated with increased fractures, especially in middle-aged adults, is unclear. We aimed to assess if early CKD is associated with increased fracture status and whether early CKD status modifies the association between calcaneal quantitative ultrasound parameters, clinical, pharmacological parameters, and fractures. METHODS: Cross-sectional analysis of CARTaGENE, a population-based survey of 40- to 69-year-old individuals. Individuals with CKD (stage 2, estimated glomerular filtration rate [eGFR] 60-89 ml/min/1.73 m2; stage 3, eGFR 30-59) were compared to non-CKD individuals (eGFR > 90). Fracture status (excluding face, toe, hand, and patella) was identified through a questionnaire at baseline. Calcaneal quantitative ultrasound (QUS) was measured in each participant. RESULTS: A total of 17,608 individuals (656 CKD stage 3; 8227 stage 2; 8725 non-CKD) were included. CKD stage 2 and 3 individuals (mean eGFR 78 and 53 ml/min/1.73 m2) were older and had more diabetes, cardiovascular disease, and hypertension. Fracture status prevalence was 14.9% in CKD stage 3, 10.8% in CKD stage 2, and 9.0% in non-CKD individuals. Fracture status prevalence was similar between CKD and non-CKD individuals when stratified by age or after adjustment for demographic and clinical parameters. QUS stiffness index was associated with fracture status in both CKD stage 3 (standardized odds ratio [sOR] = 1.525 [1.200 to 1.939] per 1 SD decrease), stage 2 (sOR = 1.415 [1.310 to 1.530]), and non-CKD individuals (sOR = 1.477 [1.361 to 1.602]). The associations between blood pressure, antihypertensive, and fracture status followed a U-shape throughout the progression of CKD. CONCLUSIONS: CKD stage 3 was not associated with an increase in fracture status. QUS parameters were similarly associated with fracture status in patients with and without CKD.
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Fraturas por Osteoporose/etiologia , Insuficiência Renal Crônica/complicações , Adulto , Distribuição por Idade , Idoso , Calcâneo/diagnóstico por imagem , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/epidemiologia , Prevalência , Quebeque/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Índice de Gravidade de Doença , UltrassonografiaRESUMO
We performed a case-control study on 130 age- and sex-matched hemodialysis patients. In multivariate analysis, we observed that FGF23 levels were associated with fracture incidence and that soluble α-klotho levels were associated with the aortic-brachial arterial stiffness ratio. INTRODUCTION: New bone markers such as sclerostin, Dickkopf-related protein 1 (DKK1), fibroblast growth factor-23 (FGF23), and α-klotho have been identified as potential key players in bone and vascular abnormalities of chronic kidney disease. Therefore, we aimed to assess whether these markers are associated with fractures, bone metabolism, and vascular stiffness in dialysis patients. METHODS: In a prospective hemodialysis cohort, where plasma samples and vascular assessment were performed at baseline, we matched patients who experienced a fracture during follow-up with sex- and age-matched non-fractured patients on a 1:4 ratio. Sclerostin, DKK1, α-klotho, FGF23, and markers of bone formation (alkaline phosphatase and procollagen type 1-N terminal propeptide [P1NP]) and bone resorption (tartrate-resistant acid phosphatase 5b [TRAP5b]) were measured in baseline plasma samples. Aortic-brachial pulse wave velocity ratio, a blood pressure independent measure of arterial stiffness, was used to assess vascular stiffness at baseline. RESULTS: We included 130 hemodialysis patients (26 fractured, 104 non-fractured) with a median follow-up of 42 months and a median age of 72 years. In multivariate Cox regression models, high FGF23 levels were associated with increased fracture incidence (adjusted HR = 2.97; 95% CI 1.18, 7.43). α-Klotho levels were associated with bone formation but not resorption markers. In both univariate and multivariable adjusted models, α-klotho levels were inversely associated with the aortic-brachial pulse wave velocity ratio (ß = - 0.070; 95% CI - 0.133, - 0.006). CONCLUSIONS: These results suggest a role for FGF23/klotho axis on bone and vascular metabolism in dialysis populations.
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Fatores de Crescimento de Fibroblastos/sangue , Glucuronidase/sangue , Falência Renal Crônica/complicações , Fraturas por Osteoporose/etiologia , Rigidez Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Artéria Braquial/fisiopatologia , Estudos de Casos e Controles , Feminino , Fator de Crescimento de Fibroblastos 23 , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Proteínas Klotho , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/sangue , Fraturas por Osteoporose/fisiopatologia , Análise de Onda de Pulso , Diálise Renal , Fatores de RiscoRESUMO
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive hematologic malignancy, that most commonly manifests as cutaneous lesions. A 19-year-old Malian female was admitted to the Unit of Medicine of Hopital du Mali with anemia, fever, weakness, and weight loss. On physical examination she was wasted, pale, febrile (37.4°C), and had inguinal and axillary lymphadenopathies. The complete blood count found pancytopenia with Hemoglobin level of 4.8 g/dL, Leucocytes count of 1900/µL (neutrophil: 300/µL), and platelets count of 56 000/µL. The ultrasonographic examination found hepatomegaly and splenomegaly. The bone marrow biopsy and flow cytometer analysis were in keeping with a diagnosis of BPDCN. The patient, unfortunately, was lost four months later after her hospital admission due to late diagnosis by septicemia. The early diagnosis and availability of specific drugs for acute leukemia could improve the clinical outcome of patients with BPDCN in Mali.
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Medula Óssea/patologia , Células Dendríticas/patologia , Leucemia Mieloide Aguda/patologia , Biópsia , Evolução Fatal , Feminino , Humanos , Leucemia Mieloide Aguda/diagnóstico , Mali , Adulto JovemRESUMO
Treatment with alpha interferon in hepatitis C triggers a thyroid autoimmunity in a variable percentage of cases (2-8%). This complication raises some questions about its screening, the possibility to continue anti-viral therapy and thyroid treatment. Alpha interferon has an immunomodulatory effect on the thyroid, but also an inhibitory effect on thyroid hormone synthesis. This explains the occurrence of cases of thyroid dysfunction, which often remain undetected because of their latency. Factors predicting thyroid dysfunction with interferon use are: female sex, history of thyroid disease and previous autoimmunity. Several clinical aspects are encountered including hypothyroidism (the most frequent depending on the series) and hyperthyroidism related to Graves' disease. For their detection, a cooperation between general practionners, gastroenterologists and endocrinologists is mandatory thyroid function tests are requested before, during and after treatment,with alpha interferon. Therapeutic aspects of thyroid disorders range from simple monitoring to symptomatic treatment, such as thyroxine prescription in the presence of hypothyroidism. Antithyroid drugs radioactive iodine or thyroid surgery are used in cases of severe or persistent Graves' disease induced by alpha interferon.
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Hipertireoidismo/induzido quimicamente , Interferon-alfa/efeitos adversos , Adulto , Hepatite C/tratamento farmacológico , Humanos , Hipertireoidismo/patologia , Interferon-alfa/administração & dosagem , MasculinoRESUMO
To identify patients with autoimmune diseases who are at high risk of developing vascular cell dysfunction, early biomarkers must be identified. This study was designed to detect and characterize circulating autoantibodies to VE-cadherin (AAVEs) in patients with early-stage autoimmune diseases. An enzyme-linked immunosorbent assay (ELISA) was developed to capture autoantibodies, using a recombinant human VE-cadherin fragment covering the extracellular domains as a target antigen. AAVEs specificity for the target antigen was confirmed by western blotting. Basal AAVEs levels were determined for healthy donors (n=75). Sera from patients (n=100) with various autoimmune diseases, including rheumatoid arthritis (n=23), systemic lupus erythematosus (SLE, n=31), systemic sclerosis (n=30), and Behçet's disease (BD, n=16) were also tested. Levels of AAVEs were significantly higher in rheumatoid arthritis (P<0.0001), SLE (P<0.05), and BD (P<0.05) populations than in healthy subjects. Purified immunoglobulin G (IgG) from a BD patient with exceptionally high AAVEs levels recognized the EC1-4 fragment in western blots. Further characterization of the epitopes recognized by AAVEs showed that BD patients had antibodies specific for the EC3 and EC4 domains, whereas SLE patients preferentially recognized the EC1 fragment. This suggests that distinct epitopes of human VE-cadherin might be recognized in different immune diseases. Purified IgG from BD patients was found to induce endothelial cell retraction, redistribution of VE-cadherin, and cause the formation of numerous intercellular gaps. Altogether, these data demonstrate a potential pathogenic effect of AAVEs isolated from patients with dysimmune disease. This is the first description of AAVEs in humans. Because regions EC1 and EC3-4 have been shown to be involved in homophilic VE-cadherin interactions, AAVEs produced in the course of dysimmune diseases might be specific biomarkers for endothelial injury, which is part of the early pathogenicity of these diseases.
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Antígenos CD/imunologia , Autoanticorpos/sangue , Doenças Autoimunes/imunologia , Caderinas/imunologia , Antígenos CD/química , Artrite Reumatoide/imunologia , Autoantígenos/química , Síndrome de Behçet/imunologia , Caderinas/química , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Epitopos/química , Células Endoteliais da Veia Umbilical Humana , Humanos , Imunoglobulina G/sangue , Lúpus Eritematoso Sistêmico/imunologia , Fragmentos de Peptídeos/química , Fragmentos de Peptídeos/imunologia , Escleroderma Sistêmico/imunologiaRESUMO
OBJECTIVE: to report the epidemiological, clinical, paraclinical and therapeutic characteristics of the first COVID 19 patients in intensive care. PATIENTS AND METHOD: retrospective descriptive and analyticalstudy over 4 months, covering all adult patients tested positive for SARS-Cov-2 and admitted to intensive care. RESULTS: 49 patients, 35 men and 14 women (2% of cases) were admitted to intensive care. The median age was 64 years [26 - 92]. Hypertension (16; 32.6%), and diabetes (11; 22.4%) were the mostcommoncomorbidities. The most common symptoms on admission were cough (38; 80.9%), shortness of breath (35; 74.5%), and fever (33; 70.2%). The median time to onset of symptoms was 11 days. Non-invasive ventilation (NIV) was used in 21 patients (42.9%). Fourteen (28.6%) wereintubated and put onassisted ventilation. The mean hospital stay was 7.77 ± 7.30 days. We recorded 20 (40.8%) deaths. Factors associated with death were high blood pressure, onset of shock, and on mechanical ventilation. CONCLUSION: Covid-19 remains a public healthproblemwith high morbidity and mortality. The morbidity and mortalityfactorsare: comorbidities and the severity of the clinicalpicture.
OBJECTIF: rapporter les caractéristiques épidémiologiques, cliniques, paracliniques et thérapeutiques des premiers patients COVID 19 en réanimation. PATIENTS ET MÉTHODE: étude rétrospective descriptive et analytique sur 4 mois, portant sur l'ensemble des patients adultes testés positif au SARS-Cov-2 et admis en réanimation. RÉSULTATS: 49 patients, 35 hommes et 14 femmes (2% des cas) étaient admis en réanimation. L'âge médian était de 64 ans [26 92]. L'HTA (16 ; 32,6%), et le diabète (11 ; 22,4%) étaient les comorbidités les plus fréquentes. Les symptômes les plus fréquents à l'admission étaient la toux (38 ; 80,9%), l'essoufflement (35 ; 74,5%), et la fièvre (33 ; 70,2%). Le délai médian d'apparition des symptômes était de 11 jours. La ventilation non invasive (VNI) a été utilisée chez 21 patients (42,9%). Quatorze (28,6%) ont été intubés et mise sous ventilation assistée. La durée moyenne d'hospitalisation était de 7,77 ± 7,30 jours. Nous avons enregistré 20 (40,8%) décès. Les facteurs associés au décès étaient l'hypertension artérielle, la survenue d'un état de choc, la mise sous ventilation assistée. CONCLUSION: la Covid-19 reste un problème de santé publique avec une morbi mortalité élevée. Les facteurs de morbi-mortalité sont : les comorbidités et la sévérité du tableau clinique.
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Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.
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Meningite Criptocócica/diagnóstico , Meningite Criptocócica/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Progressão da Doença , Feminino , Soropositividade para HIV/complicações , Soropositividade para HIV/diagnóstico , Soropositividade para HIV/epidemiologia , Humanos , Masculino , Mali/epidemiologia , Meningite Criptocócica/sangue , Meningite Criptocócica/etiologia , Técnicas Microbiológicas , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto JovemRESUMO
In March 2021, in the framework of a partnership between the Geneva University Hospitals (HUG), the Santé Diabète Organization and the Ministry of Health of Mali, a 4-day workshop training course was organized with the objective of strengthening the skills of caregivers in Therapeutic Patient Education (TPE) for children and young people with type 1 diabetes. To ensure interprofessionalism, physician-nurse pairs already working together in health structures in 7 regions of Mali participated in the training. Beyond complementarity between health professionals, the aim was to cope with the realities of the Malian health system. All activities were co-chaired by physician-nurse pairs, specialized in diabetes and in TPE. A total of 30 professionals took part in the training, which consisted of 2 days of classroom training and 2 days of hands-on training with type 1 diabetic children and their families. To build the caregivers capacity in TPE, we chose innovative approaches with activities allowing the immediate application of skills learned with various pedagogical tools. The beneficiaries are not only the professionals, but also the children, teenagers and their families, including the trainers.
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Diabetes Mellitus Tipo 1 , Adolescente , Cuidadores , Criança , Diabetes Mellitus Tipo 1/terapia , Escolaridade , Humanos , Aprendizagem , MaliRESUMO
INTRODUCTION: Sars Cov 2 infection is a complex viral infectious lung disease that can be complicated by damage to other organs. CASE REPORT: This is a type 2 diabetic patient, overweight and hypertensive, who consults in an emergency for a meningeal syndrome in a context of fever and cough, in whom laboratory and para-clinical investigations have concluded diagnosis of severe Sars cov2 pneumonia complicated by meningeal syndrome. Resuscitation under antibiotic therapy and immunosuppressant treatment associated with risk factor treatments led to a cure without serious complications. CONCLUSION: Sars Cov 2 pneumonia complicated by meningism is serious, early management combining antibiotic therapy and immunosuppressive treatment improves the prognosis.
INTRODUCTION: L'infection à Sars Cov2 est une pneumopathie infectieuse virale complexe qui peut se compliquer d'atteinte d'autres organes. OBSERVATION DE CAS: Il s'agit d'une patiente diabétique de type 2, en surpoids et hypertendue, qui consulte aux urgences pour un syndrome méningé dans un contexte de fièvre et de toux, chez qui les explorations biologiques et para cliniques ont conclu au diagnostic de pneumopathie sévère à Sars cov2 compliquée de méningite. La prise en charge en réanimation sous antibiothérapie et traitement d'immuno-suppresseur associées aux traitements des facteurs de risques ont conduit à une guérison sans complication grave observée. CONCLUSION: La pneumopathie à Sars Cov2 compliquée de méningisme est grave, la prise en charge précoce associant l'antibiothérapie et le traitement d'immunosuppresseur améliore le pronostic.
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Absent SRY gonadal dysgenesis (negative) is the set of clinical and biological manifestations linked to the lack of development of the testes in humans. Authors report the first case of gonadal dysgenesis SRY-negative 46, XX male with gynecomastia documented in Mali. CASE OBSERVATION: This is a 15 years old boy of a deaf-mute brother, no family consanguinity. He was referred to the hospital because of severe bilateral gynecomastia. Hypergonado-tropic hypogonadism condition was investigated by hormonal laboratory assessment and the result of cytogenetic analysis carried out in France revealed a karyotype SRY-negative 46, XX isch Yp11, 3. The patient received psychological assistance and substitutive treatment based on testosterone. Reconstructive surgery was also conducted to correct urogenital malformations. CONCLUSION: Diagnosis of 46, XX male syndrome is rare and need cytogenetic analysis. In Mali, cost and availability of this technique make diagnosis difficult and care inadequate for patients.
La dysgénésie gonadique à SRY absent (négatif) est l'ensemble des manifestations clinico-biologiques liées à l'absence de développement des testicules chez l'homme. Les auteurs rapportent le premier cas de dysgénésie gonadique type 46, XX male à SRY Négative avec gynécomastie documenté au Mali. OBSERVATION: Il s'agissait d'un jeune garçon de 15 ans, avec antécédents d'un frère sourd-muet, sans consanguinité familiale, qui a consulté pour gynécomastie bilatérale marquée. Devant l'hypogonadisme hypergonadotrope objectivé sur le bilan hormonal, une étude cytogénétique réalisée en France a montré un caryotype à 46, XX isch Yp 11,3 à SRY Négative. La prise en charge repose sur une assistance psychologique, le traitement substitutif en testostérone et la chirurgie réparatrice des malformations uro-génitales. CONCLUSION: Le diagnostic du syndrome 46, XX mâle est rare et le diagnostic est cytogénétique. Le coût et l'accessibilité de cette technique au Mali rendent le diagnostic difficile et la prise en charge inefficiente.
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INTRODUCTION: Lifestyle changes have played an important role in increasing the prevalence of obesity. The objectives were to describe the epidemiological, clinical and progressive aspects of obesity in patients of the Mali hospital. PATIENTS AND METHOD: this is a descriptive study with retrospective collection of data from the medical records of patients hospitalized in the Medicine and Endocrinology department. Our patients benefited from weight gain, height, waist measurement and hip measurement with calculation of the body mass index. RESULTS: the study concerned 90 obese patients out of 1515 hospitalized (5.94% of frequency). The mean age was 42 ± 5 with extremes 10 and 74. The sex ratio was 0.38. Obesity was mixed: 75.4% of men, 60% of woman; Android in 36% of men, 18% of women and the only child aged 10 had morbid obesity. The reason for hospitalization was complications of obesity in 13.30%. The psychological reactions collected were: anxiety 54.40%, indifference 40% and shame 5.60%. There were 68.90% complications including 37.80% cardio metabolic (hypertension associated in 51.10%). The lipid assessment carried out showed hyper LDLdemia: 70%; HDL hypoemia: 67.80%, hyper triglyceridaemia: 66.70%. Our patients received dietary and dietary advice. No drug or surgical treatment has been initiated despite the indication. We recorded 3.30% of deaths. CONCLUSION: The epidemiological and clinical description, diagnosis and evaluation of the repercussions of obesity are easy in our daily practice. However, care remains insufficient due to the inadequacy of the technical platform, the lack of financial means and the prejudices of our patients (ignorance of obesity as a disease).
INTRODUCTION: Le changement du mode de vie a joué un rôle important dans l'augmentation de la prévalence de l'obésité. Les objectifs étaient de décrire les aspects épidémiologiques, cliniques et évolutifs de l'obésité chez les patients de l'hôpital du Mali. PATIENTS ET MÉTHODE: il s'agit d'une étude descriptive avec recueil rétrospectif des données à partir des dossiers médicaux des patients hospitalisés dans le service de Médecine et d'Endocrinologie. Nos patients ont bénéficié d'une prise de poids, de la taille, du tour de taille et du tour de hanche avec calcul de l'indice de masse corporelle. RÉSULTATS: l'étude a concerné 90 patients obèses sur 1515 hospitalisés (5.94% de fréquence). L'âge moyen était 42 ans ± 5 avec des extrêmes 10 et 74 ans. Le sex - ratio était de 0,38. L'obésité était de type mixte : 75.4% des hommes, 60% de femme ; androïde chez 36% des hommes, 18% de femme et la seule enfant âgée de 10 ans avait une obésité morbide. Le motif d'hospitalisation était les complications de l'obésité dans 13,30 %. Les réactions psychologiques recueillies étaient : l'inquiétude 54.40%, l'indifférence 40% et la honte 5.60%. Il y avait 68.90% de complications dont 37.80% cardio métaboliques (HTA associée dans 51.10%). Le bilan lipidique réalisé montrait une hyper LDLdémie : 70% ; une hypo HDLdémie : 67.80%, une hyper triglycéridémie : 66.70%. Nos patients ont reçu des conseils hygiéno-diététiques. Aucun traitement médicamenteux, ni chirurgical n'as été instauré malgré l'indication. Nous avons enregistré 3.30% de décès. CONCLUSION: La description épidémio-clinique, le diagnostic et l'évaluation du retentissement de l'obésité sont faciles dans notre pratique quotidienne. Cependant la prise en charge reste insuffisante du fait de l'insuffisance du plateau technique, le manque de moyen financier et les préjugés de nos patients (méconnaissance de l'obésité comme une maladie).
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INTRODUCTION: Hyperprolactinemia, which is a supra-physiological secretion of prolactin, is the most common anterior pituitary disorder encountered in clinical practice. Its incidence and prevalence are poorly defined in Africa and the rest of the world. The objectives were to study the clinical, paraclinical, etiological and therapeutic aspects of hyperprolactinemia at the Mali hospital. METHODOLOGY: This was a 5-year cross-sectional study. Data collection was retrospective (July 2011 to October 2015) and prospective (December 2015 to July 2016). RESULTS: We collected 37 cases of hyperprolactinemia. The sex ratio was 0.85. The average age was 37.32 years with extremes ranging from 15 to 74 years. The clinical picture was dominated in women by amenorrhea (80%), galactorrhea (70%), headache (55%), hypofertility (50%), visual disorders (25%) and in men by decreased libido (64.7%), gynecomastia (47.1%), headache (47.1%), visual disorders (41.2%) and erection disorders (29.4%). Basal prolactinemia was greater than 100ng/ml in 45.9% of patients. Cerebral CT had objectified: 11 cases of macroadenomas and 5 cases of pituitary microadenomas. The main causes of hyperprolactinemia were: prolactin pituitary adenoma (43.24%); hypothyroidism (5.40%) and estrogen-progestin use in 5.40%. For treatment, 64.9% of patients were placed on cabergoline; 27% on bromocriptine and 8.10% on simple clinical and biological monitoring. CONCLUSION: Hyperprolactinemia is a condition that exists in our health care facilities. Clinicians should consider this in the face of galactorrhea amenorrhea or decreased libido. It is also necessary to improve the technical platform for better care.
INTRODUCTION: L'hyperprolactinémie, qui est une sécrétion supra physiologique de prolactine est en clinique le désordre hypophysaire antérieur le plus fréquemment rencontré. Son incidence et sa prévalence sont peu définies, en Afrique et dans le reste du Monde. Les objectifs étaient d'étudier les aspects cliniques, paracliniques, étiologiques et thérapeutiques de l'hyperprolactinémie à l'hôpital du Mali. MÉTHODOLOGIE: Il s'agissait d'une étude transversale de 5 ans. La collecte des données a été rétrospective (juillet 2011 à octobre 2015) et prospective (décembre 2015 à juillet 2016). RÉSULTATS: Nous avons colligés 37 cas d'hyperprolactinémie. Le sex ratio était de 0,85. L'âge moyen était 37,32 ans avec des extrêmes allant de 15 à 74 ans. Le tableau clinique était dominé chez les femmes par l'aménorrhée (80%), la galactorrhée (70%), les céphalées (55%), l'hypofertilité (50%), les troubles visuels (25%) et chez les hommes par la baisse de la libido (64,7%), la gynécomastie (47,1%), les céphalées (47,1%), les troubles visuels (41,2%) et les troubles de l'érection (29,4%). La prolactinémie basale était supérieure à 100ng/ml chez 45,9% des patients. La tomodensitométrie cérébrale avait objectivé : 11 cas de macroadénomes et 5 cas de microadénomes hypophysaires. Les principales causes de l'hyperprolactinémie étaient : l'adénome hypophysaire à prolactine (43,24%) ; l'hypothyroïdie (5,40%) et la prise d'oestroprogestatifs chez 5,40%. Pour le traitement, 64,9% des patients étaient mis sous cabergoline ; 27% sous bromocriptine et 8,10% sous simple surveillance clinique et biologique. CONCLUSION: L'hyperprolactinémie est une pathologie qui existe dans nos structures de santé. Les cliniciens doivent y penser devant une aménorrhée galactorrhée ou une baisse de la libido. Il est aussi nécessaire d'améliorer le plateau technique pour une meilleure prise en charge.
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INTRODUCTION: Dysthyroidism (hyperthyroidism or hypothyroidism) in children and adolescents is much rarer than in adults. The purpose of our study was to study the epidemiological, clinical, paraclinical, etiological and etiological aspects and to specify the therapeutic and evolutionary modalities of this condition. METHOD: This was a five-year descriptive, retrospective and prospective study of children and adolescents under 18 years of age with dysthyroidism. RESULTS: We collected 90 children and adolescents with dysthyroidism (hyperthyroidism 77.8% (n=70) and hypothyroidism 22.2% (n=20). For hyperthyroidism (n=70): the average age was 13.07 years and the sex ratio was 0.16. The family history of dysthyroidism was found in 24.3% (n=17). Clinical manifestations were dominated by tachycardia 88.57% (n=62), weight loss 87.14% (n=61), vibrating pulse 87.14% (n=61) and palpitation 81.42% (n=57). Bilateral exophthalmos was present in 70% of patients (n=49) with palpebral retraction in 51.42% (n=56). Goitre was present in 54 patients (77.1%). It was diffuse in 62.9% (n=44) and nodular in 12.9% (n=9). Basedow's disease represented the first etiology with 84.3% (n=59), followed by toxic multinodular goitre12, 9% (n=9). Sixty-eight patients (97.1%) received medical treatment with synthetic antithyroid drugs. Clinical remission was achieved in 64.3% (n=45) and 54.3% of patients were in biological euthyroidism at 6 months follow-up. For hypothyroidism (n=20): the average age was 10.70 years and the sex ratio was 0.53. Six family cases of hypothyroidism and three cases of family goitre were found. The clinical picture was dominated by signs of hypo metabolism at hypersomnia type 95% (n=19) and anorexia 75% (n=15). The skin was dry in 60% (n=12). A staturo-weight delay in 65% (n=13), behavioural disorders in 55% (n=11), weight gain in 40% (n=8) and puberty delay in 10% (n=2). Goitre was nodular in 25% (n=5) with cervical adenopathy present in 15% (n=3). Hashimoto's thyroiditis accounted for 45% (n=9) of etiologies followed by iodine deficiency disorders in 15% (n=3) and iatrogenic causes (2 cases of thyroidectomy). All patients were started on hormone replacement therapy for life. Five patients with large multinodular goiter received total thyroidectomy in addition to medical treatment. Euthyroidism was observed in 55% (n=11) of patients at 6 months follow-up. CONCLUSION: Dysthyroidism in children and adolescents exists in our health facilities. Its management is deficient because of the technical and financial platform. Our public health decision-makers must help implement a screening strategy to facilitate faster diagnosis and treatment.
INTRODUCTION: La dysthyroïdie (hyperthyroïdie ou hypothyroïdie) chez l'enfant et l'adolescent est beaucoup plus rare que chez l'adulte. Notre étude avait pour but d'étudier les aspects épidémiologiques, cliniques, paracliniques, étiologiques et de préciser les modalités thérapeutiques et évolutives de cette affection. MÉTHODE: Il s'agissait d'une étude descriptive, rétrospective et prospective de cinq ans portant sur les enfants et adolescents âgés de moins de 18 ans présentant une dysthyroïdie. RÉSULTATS: Nous avons colligé 90 enfants et adolescents présentant une dysthyroïdie (hyperthyroïdie 77,8% (n=70) et hypothyroïdie 22,2% (n=20).Pour l'hyperthyroïdie (n=70) : l'âge moyen était de 13,07 ans et le sex ratio de 0,16. L'antécédent familial de dysthyroïdie était retrouvé dans 24,3% (n=17). Les manifestations cliniques étaient dominées par la tachycardie 88,57% (n=62), l'amaigrissement 87,14% (n=61), le pouls vibrant 87,14% (n=61) et la palpitation 81,42% (n=57).L'exophtalmie bilatérale était présente chez 70% des patients (n=49) avec rétraction palpébrale dans 51,42% (n=56). Le goitre était présent chez 54 patients (77,1%). Il était diffus dans 62,9% (n=44) et nodulaire dans 12,9% (n=9). La maladie de Basedow représentait la première étiologie avec 84,3% (n=59), suivie du goitre multinodulaire toxique12, 9% (n=9). Soixante-huit patients (97,1%) ont bénéficié d'un traitement médical par antithyroïdien de synthèse. La rémission clinique était obtenue chez 64,3% (n=45) et 54,3% des patients étaient en euthyroïdie biologique au bout 6 mois de suivi. Pour l'hypothyroïdie (n=20) : l'âge moyen était de 10,70 ans et le sex ratio à 0,53. Six cas familiaux d'hypothyroïdie et trois cas de goitre familial étaient retrouvés. Le tableau clinique était dominé par les signes d'hypo métabolisme à type d'hypersomnie 95% (n=19) et d'anorexie 75% (n=15). La peau était sèche dans 60% (n=12). Un retard staturo-pondéral dans 65% (n=13), les troubles du comportement dans 55% (n=11), la prise pondérale chez 40% (n=8) et le retard pubertaire chez 10% (n=2). Le goitre était nodulaire chez 25% (n=5) avec présence d'adénopathies cervicales dans 15% (n=3). La thyroïdite d'Hashimoto représentait 45% (n=9) des étiologies suivies des troubles dus à la carence iodée dans 15% (n=3) et des causes iatrogéniques (2 cas de thyroïdectomie). Tous les patients ont été mis sous traitement hormonal substitutif à vie. Cinq patients ayant un volumineux goitre multinodulaire ont bénéficié en plus du traitement médical une thyroïdectomie totale. L'euthyroïdie était observée chez 55% (n=11) des patients au bout 6 mois de suivi. CONCLUSION: La dysthyroïdie chez les enfants et les adolescents existe dans nos structures de santé. Sa prise en charge est déficiente à cause du plateau technique et financier. Nos décideurs en santé publique doivent aider à la mise en place d'une stratégie de dépistage pour faciliter le diagnostic et le traitement plus rapide.
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GOAL: To study the diabetes sweetened in farming environment in the sanitary district of Selingue (CS Ref of Selingue). MATERIALS AND METHODS: It was about a descriptive survey done from January 01 to June 30, 2016 with a prospective compilation of data in the center of health of reference of Selingue (CS Ref of Selingue). All our patients benefitted from a complete clinical exam with research of factor of risk and reverberation of the diabetes.The statistical test used was Chi-square 2 with a threshold of significance p ≤ 0.05. RESULTS: Among the 1 525 patients collected, 84 were diabetic is a hospitable frequency of 5, 51% and the average age of 51, 43 years ±12, 25.The sex ratio was 1, 33. Diabetes type 2 was in 98% of cases. We did not record specific diabetes or gestational diabetes. A sedentary lifestyle was found in 70, 23% of the cases followed by Dyslipidemia with 42.85% of the cases. 1.2% of our patients presented an AOMI, a fifth of our patients have suffered from erectile dysfunction, 2/3 had a diabetic neuropathy and 4% had a wound. (P: 0.048) neuropathy and nephropathy (p: 0.016) diabetic were correlated with blood sugar imbalance. CONCLUSION: the gravity, the inaccessibility and the cost raised of the follow-up balances in Selingue limit the hold in charge of the diabetes in this sanitary district.
BUT: Etudier le diabète sucré en milieu rural dans le district sanitaire de Sélingué (CS Réf Sélingué). MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude descriptive effectuée du 01 janvier au 30 juin 2016 avec un recueil prospectif des données au Centre de Santé de Référence de Sélingué (CS Réf de Sélingué). Tous nos patients ont bénéficié d'un examen clinique complet avec recherche de facteurs de risque et de retentissement du diabète. Le test statistique utilisé était le Khi 2 avec un seuil de significativité p ≤ 0,05. RÉSULTATS: Parmi les 1 525 dossiers de patients colligés, 84 était diabétiques soit une fréquence hospitalière de 5,51 % et l'âge moyen de 51,43 ans ± 12,25. Le sex ratio était de 1, 33. Le diabète était de type 2 dans 98% des cas. La sédentarité était retrouvée dans 70,23 % des cas suivie de la dyslipidémie avec 42,85 % des cas. 1,2 % de nos patients ont présenté une AOMI, un cinquième de nos patients ont souffert d'une dysfonction érectile, 2/3 avaient une neuropathie diabétique et 4 % avait une plaie. La neuropathie (p: 0,048) et la néphropathie (p: 0,016) diabétique étaient corrélées au déséquilibre glycémique. CONCLUSION: La gravité, l'inaccessibilité et le coût élevé des bilans de suivi à Sélingué limitent la prise en charge du diabète dans ce district sanitaire.
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The authors are reporting here a documented case of hyperparathyroidism leading to hypercalcemia diagnosed spontaneously. A 75-year old female patient with has been treated since 3-4 years with metformin and ramipiril fortype 2 diabetes and high blood pressure, respectively. She was seen in our endocrinology outpatient visit for tingling in the arms associated with cervical pain with increasing intensity over the last six months. The patient's mother was diabetic and her father had high blood pressure. The diagnostic of primary hyperparathyroidism, resulting from a diffuse hyperplasia of the parathyroid gland, was retained after medical, biological, chirurgical and anatomo-pathological investigations. The blood level of PTH1-84 was 916.60pg/ml Normal value=15-68.3pg/ml. CONCLUSION: Diffuse poly-arthralgia in the neck and the lower limbs may not always be due to arthrosis in elderlies. Further investigation such as the dosage of blood level of calcium and PTH are required.
Les auteurs rapportent un premier cas d'hyperparathyroïdie primaire de découverte fortuite documentée au Mali et responsable d'hypercalcémie. Il s'agissait d'une patiente âgée de 75 ans, diabétique de type 2 depuis trois ans traitée par metformine et hypertendue depuis 4ans traitée par ramipril ; venue en consultation externe en endocrinologie pour fourmillement brachial et douleur cervicale diffuse augmentant progressivement d'intensité depuis 6 mois. Aux antécédents familiaux de diabète chez la mère et hypertension artérielle chez le père. Apres les investigations médicaux, biologiques, chirurgicaux anatomopathologiques le diagnostic retenu fut une hyperparathyroïdie primaire (PTH1-84= 916,60pg/ml (N=15-68, 3pg/ml) causée par hyperplasie diffuse de la glande parathyroïde. CONCLUSION: La présence de poly arthralgie diffuse cervicale et des membres inférieurs peut ne pas être seulement due à une arthrose chez le sujet âgé. Cela mérite une investigation plus approfondie telle que le dosage de la calcémie et de la PTH.
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Oxidative stress represents an imbalance between the endogenous antioxidant defenses and the production of pro-oxidant molecules. The present study describes oxidative stress markers (oxidant and antioxidant) metabolic disturbances in diabetic and non-diabetic patients at the Internal Medicine and Endocrinology ward of hospital of Mali. MATERIALS AND METHODS: We conducted a descriptive case / control study involving 30 diabetic and 30 non-diabetic patients. Studied markers were Glutathione erythrocyte peroxidase (GPX), intra erythrocyte Superoxide dismutase (SOD), plasmatic uric acid, direct and total bilirubins, albumin and markers for diagnosis and monitoring of diabetes. RESULTS: Non-diabetic patients (9%) had higher glutathione peroxidase levels compared diabetics (3%) (p = 0.005). An increase in superoxide dismutase was observed in 73.3% of diabetics versus 40% of nondiabetics (p = 0). The albumin, uric acid and bilirubin levels were identical in both populations. Glycated hemoglobin was significantly correlated with microangiopathies (p = 0.0058) and macro angiopathies( p=0,0007) in diabetics. CONCLUSION: The study showed an increase in antioxidant defenses in diabetics by the elevation of superoxide dismutase and a relative normalization of glutathione peroxidase.
INTRODUCTION: Le stress oxydant est un déséquilibre entre les défenses antioxydantes endogènes et la production de molécules pro-oxydantes. L'objectif principal était d'étudier les différents marqueurs du stress oxydatif (oxydant et antioxydant) chez les sujets diabétiques et non diabétiques au niveau du service de médecine interne et d'endocrinologie de l'hôpital du Mali à Bamako. MATÉRIELS ET MÉTHODES: l'étude était transversale avec comparaison entre 30 sujets diabétiques et 30 sujets non diabétiques. Les marqueurs étudiés : Glutathion peroxydase érythrocytaire (GPX), la Superoxyde dismutase (SOD) intra érythrocytaire, l'acide urique plasmatique, Les bilirubines directes et totales, l'albumine ainsi que quelque marqueur de diagnostic et de suivi du diabète. RÉSULTATS: Trois pour cent de nos diabétiques avaient un taux de glutathion peroxydase élevé contre 9% des non diabétiques (p =0,005) ; augmentation de la Superoxyde dismutase des diabétiques 73,3% contre 40% des non diabétiques (p =0). Taux d'albumine, acide urique et la bilirubine identiques dans les deux populations ; hémoglobine glyquée était corrélée significativement aux complications dégénératives micro angiopathies (p=0,0058) et macro angiopathies (p=0,00017) chez les diabétiques. CONCLUSION: l'étude a montré une augmentation des défenses antioxydantes chez les trente diabétiques par l'élévation de la Superoxyde dismutase et normalisation relative du glutathion peroxydase.
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INTRODUCTION: The diabetic foot wound is a real public health problem, 10% of the reasons for hospitalization. The risk of amputation is 10 to 30 times higher in diabetics than the general population. OBJECTIVE: To study the problem of amputations of the diabetic foot. METHOD: This was a descriptive and cross-sectional study that took place in the Department of Medicine and Endocrinology of the Mali Hospital from July 1st, 2016 to June 30th, 2017. RESULTS: Twenty-five (25) diabetic patients were enrolled in our study. The sex ratio was 0.66. At admission, 100% of our patients had arterial disease, 96% neuropathy, and mixed foot in 80%. Poor glycemic control in 64% of patients; osteitis in 52% of cases; 92% of the patients had a 100% amputation risk according to the University of Texas classification. Nearly half or 46% of patients had amputations in the leg. We recorded 1 death case that is 4%. CONCLUSION: The problem of amputation of diabetic feet is a function of the poor equilibrium and progressive neurological and vascular complications of diabetes.
INTRODUCTION: La plaie du pied diabétique constitue un réel problème de santé publique, 10% des motifs d'hospitalisation. Le risque d'amputation est de 10 à 30 fois plus élevé chez les diabétiques que la population générale. OBJECTIF: Etudier la problématique des amputations du pied diabétique. MÉTHODE: II s'agissait d'une étude descriptive et transversale qui s'est déroulée dans le service de médecine et d'endocrinologie de l'hôpital du Mali du 1er Juillet 2016 au 30 Juin 2017. RÉSULTATS: Vingt-cinq (25) patients diabétiques ont été recrutés dans notre étude. Le sex ratio était de 0,66. A l'admission, 100% de nos patients avaient une artériopathie, 96% une neuropathie, et un pied mixte dans 80%. Un mauvais équilibre glycémique chez 64% des patients ; l'ostéite dans 52% des cas; 92% des patients avaient un risque d'amputation à 100% selon la classification de l'université du Texas. Près de la moitié soit 46% des patients ont été amputé au niveau de la jambe. Nous avons enregistré 1 cas de décès soit 4%. CONCLUSION: La problématique de l'amputation des pieds diabétiques est fonction du mauvais équilibre et des complications évolutives neurologiques et vasculaires du diabète.
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We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.
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Soronegatividade para HIV , Meningite Criptocócica/diagnóstico , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Ceftriaxona/uso terapêutico , Cryptococcus neoformans/isolamento & purificação , Evolução Fatal , Fluconazol/uso terapêutico , Humanos , Masculino , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Several years ago, infectious diseases such as tuberculosis, HIV/AIDS, and malaria were the principal health menace on an international scale. But, today, noncommunicable diseases (NCD), such as diabetes and cardiovascular diseases, are a health emergency in both high- and low-income countries. The NGO Santé Diabète (Diabetes Health) has now been developing actions for diabetes prevention and management in Africa for 15 years. The strategies they have developed combine advocacy, support for the Ministry of Health for the implementation of plans to fight NCDs, staff training, and the establishment of a structure for prevention and management. In Mali, these activities, begun a decade ago, now manage 15,000 patients with diabetes.
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Diabetes Mellitus/terapia , Promoção da Saúde/organização & administração , Organizações , África , Países em Desenvolvimento , HumanosRESUMO
The authors are reporting here for the first time a documented case of androgen-secreting luteal cyst responsible for primary sterility in Mali. A 26-year married woman with a history of familial hyper androgenia of diabetes and high blood pressure who consulted for hyper androgen syndrome and primary infertility. Hirsutism with the presence of hairs on her chin, upper lips, thorax, forearms, arms, and her legs under waxing which made a Ferriman and Galloway scoreof10. A pelvic ultrasound coupled with a laparoscopy allowed us to retain the diagnosis of luteal cyst. CONCLUSION: Hyper androgenicity in women is rare and the luteal cystis one of its multiple etiologies.
Les auteurs rapportent le premier cas de kyste lutéal androgéno-sécrétant responsable d'une stérilité primaire documenté au Mali. Il s'agissait d'une femme mariée de 26ans, avec des antécédents d'hyper androgénie familiale de diabète et hypertension artérielle qui a consulté pour syndrome d'hyper androgénie et stérilité primaire. Hirsute avec la présence de poils au niveau du menton, des lèvres supérieurs, du thorax, des avant-bras, des bras, des jambes sous épilation ce qui faisait un score de Ferriman et Galloway à 10. Une échographie pelvienne couplée à une coelioscopie nous a permis de retenir le diagnostic de kyste lutéal. CONCLUSION: L'hyper androgénie chez la femme est rare et d'étiologie multiple parmi lesquelles le kyste lutéal.