[Squamous cell carcinoma associated with use of skin-lightening cream]. / Carcinome épidermoïde associé à une dépigmentation volontaire.

BACKGROUND: Women widely use skin-lightening products for cosmetic purposes in sub-Saharan Africa despite numerous reported cutaneous and systemic complications. The occurrence of epidermoid carcinoma has long been reported, but only three cases have been published so far. We report the first case in Mali. PATIENTS AND METHODS: A 30-year old woman with no noteworthy medical history was seen at our outpatient center for cervical ulceration that had been present for the last 5 years. She had used cosmetic bleaching cream over a period of around ten years. Physical examination revealed extensive ulceration on the left side of her neck. Blood tests for viral hepatitis and human immunodeficiency virus were negative. The pathological examination of the skin biopsy confirmed the diagnosis of squamous cell carcinoma. After failure of the initial excision with early relapse, multiple surgical ablations were performed 3 months later. DISCUSSION: The high prevalence of skin-lightening cosmetic use contrasts with the rarity of epidermoid carcinoma in depigmented skin. However, a large chronic ulcer on uncovered parts of the upper body, particularly the neck, should prompt physicians to consider skin cancer. Appropriate preventive measures include the promotion of educational messages for the general population, the use of sun-protection devices, and routine skin biopsy for all women presenting chronic cervical ulceration after long-term use of skin-lightening products.

[Xerodermapigmentosum: Challenge of diagnosis in West Africa]. / Xerodermapigmentosum : Difficulte diagnostique en Afrique Occidentale.

Xeroderma pigmentosum is related to a defect of the enzymes involved in repairing the oncogenic effects of ultraviolet exposure. The condition is found all over the world, in all ethnicities and races. This rare genodermatosis is often unknown in countries lacking specialist in dermatology. This scarcity and insufficiency of qualified personnel give rise to difficulties in diagnosing this pathology, especially in West Africa where XP is wrongly diagnosed for other pathologies. Objective: To share with colleagues the problem of diagnosis of Xeroderma pigmentosum in countries with insufficient number of dermatologist and poor technical platform. Observation: 21-year-old man, with no pathological history of dermatosis was seeking for medical consultation because of cutaneous dryness and photophobia. Previous visits at several health centers failed to diagnose the condition and no noticeable improvement was seen from given treatment. Verbal questioning found the notion of consanguinity (his father and his mother are cousins, and belong to the same Dogon group). Cutaneous pigmentary disorders were absent at birth but appeared at the age of 12 years. Physical examination highlighted photophobia in addition to specific clinical and paraclinical signs allowed to diagnose Xeroderma pigmentosum varying type. Conclusion: in West Africa, the challenge of diagnosis of Xeroderma pigmentosum is undoubtedly related to a lack of qualified personnel and technical means of diagnosis, which makes its frequency underestimated.

Le Xéroderma pigmentosum (XP) est lié à un défaut des enzymes impliquées dans la réparation des effets oncogènes de l'exposition aux ultraviolets. L'affection se rencontre dans le monde entier, dans toutes les ethnies et races. Cette génodermatose rare est souvent méconnue dans les pays en manque de spécialiste en dermatologie. Cette rareté de Xeroderma pigmentosum et l'insuffisance de personnel qualifié engendrent des difficultés diagnostiques de cette pathologie surtout en Afrique Occidentale où le XP est diagnostiqué à tort pour d'autres pathologies. OBJECTIF: Partager avec les confrères la problématique de diagnostic de Xéroderma pigmentosum dans les pays en insuffisance de dermatologues et de plateau technique. OBSERVATION: il s'agissait d'un patient de 21 ans, sexe masculin, sans antécédents pathologique de dermatoses, issu d'un mariage consanguin qui a consulté pour sècheresse cutanée et photophobie après un long parcours dans beaucoup des centres de santé de la place sans diagnostic et sans amélioration notable, chez qui l'interrogatoire a retrouvé la notion de consanguinité (son père et sa mère sont des cousins, et provenaient du même clan Dogon),l'absence de troubles pigmentaires cutanées à la naissance et l'apparition des troubles pigmentaires cutanées à l'âge de 16ans. L'examen physique a objectivé la photophobie en plus des signes cliniques et paracliniques specifiques ce qui a permis de retenir le diagnostic de Xéroderma pigmentosum, forme variante. CONCLUSION: en Afrique Occidentale, la difficulté diagnostique de Xéroderma pigmentosum est sans doute en rapport avec un manque de personnel qualifié et des moyens techniques de diagnostic, ce qui rend sa fréquence sous-estimée.

[Problem Of Diabetic Foot Amputations]. / ProbléMatique Des Amputations Du Pied Diabétique.

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.

[Epidemiological and clinical aspects of prurigo in HIV infected patients in Fousseyni N'Daou hospital of Kayes, Mali]. / Aspects Epidemiologiques et Cliniques du Prurigo Chez les Personnes Vivant avec le VIH a L'Hopital Fousseyni N'Daou de Kayes, Mali.

INTRODUCTION: Prurigo is one of the most common dermatological conditions during HIV infection and AIDS. It appears as an immunosuppression marker associated with HIV infection. The study objective was to determine the prevalence of prurigo in people living with the human immunodeficiency virus (PLHIV) in Fousseyni N'Daou Hospital of Kayes, and to describe the socio-demographic aspects of patients and lesions associated with prurigo among PLHIV. METHODS: It was a descriptive cross-sectional study included all cases of HIV infected patients with prurigo in the Dermatology-Venomology Department of Fousseyni N'DAOU Hospital from January 1, 2015 to August 31, 2015. RESULTS: We collected 121 cases of prurigo. The hospital prevalence was 14.5% among PLHIV with 65% Female and the average age was 34.8 years old (SD: 15-81 years). The elementary lesions associated with prurigo were seropapules (40.2%), vesiculo-crusts (13%), excoriated papules (33.3%), lichenified papules (10.8%), and cicatricial lesions (2.7%). The prurigo was generalized in 68.5% of cases and localized in 31.24%. More than half of our patients had weight loss, fever, diarrhea and oral candidiasis in their medical history. Patients were infected with HIV1 in 60.03% and HIV1+ 2 in 24.3%. More than the half of our patients had a CD4 count inferior to 250 cells/mm3 at the time of prurigo diagnosis. CONCLUSION: In our study, prurigo remains a common condition in PLHIV, particularly in patients with low CD4 counts. Early detection and rapid antietroviral therapy can reduce the frequency of prurigo in PLHIV.

INTRODUCTION: Le prurigo est l'une des affections dermatologiques les plus fréquentes au cours de l'infection à VIH et du sida. Il apparait comme un marqueur de l'immunodépression associée à l'infection VIH. L'objectif était de déterminer la prévalence du prurigo chez les personnes vivant avec le virus de l'immunodéficience humaine (PVVIH) à l'hôpital Fousseyni N'Daou de Kayes (HFDK) et décrire le profil sociodémographique des patients et les lésions associées au prurigo chez les PVVIH à HFDK. PATIENTS ET MÉTHODES: Il s'agissait d'une étude transversale descriptive de tous les cas de prurigo chez les PVVIH dans le service de Dermatologie-Vénéréologie de l'hôpital Fousseyni N'DAOU durant la période du 1er janvier 2015 au 31 août 2015. RÉSULTATS: Nous avons colligé 121 cas de prurigo. La prévalence hospitalière a été de 14,5% chez les PVVIH. Le sexe féminin a représenté 65% des cas. L'âge moyen a été de 34,8 ans (extrêmes :15 ­ 81 ans). Les lésions élémentaires associées au prurigo ont été les séropapules (40,2%), vésiculo-croutes (13%), papules excoriés (33,3%), papules lichenifiés (10,8%), lésions cicatricielles (2,7%). La forme généralisée a représenté 68,5% et la forme localisée 31,24%. Plus de la moitié de nos patients avait la notion d'amaigrissement, de fièvre, de diarrhée et des candidoses buccales dans leurs antécédents. Le VIH1 a représenté 60,03% et l'association VIH1 et VIH2 a représenté 24,3% des cas. Plus de la moitié de nos patients avait un taux de CD4 inférieure à 250 cellules/mm3 au moment du diagnostic du prurigo. CONCLUSION: Dans notre étude, le prurigo reste une affection fréquente chez les PVVIH, particulièrement lorsque le taux de CD4 est bas. Un dépistage précoce et le traitement antirétroviral rapide permet de réduire la fréquence du prurigo chez les PVVIH.

Kaposi's disease in an HIV positive child, with probable contamination from his grandmother.

Kaposi's disease in children with HIV is rarely reported in everyday practice. This is a case study of cutaneous Kaposi's disease revealing HIV in a 5-year-old child with polymorphic eruption of papules and nodules on the face, trunk, back, and limbs. Histopathological examination confirmed the diagnosis of Kaposi's disease. The child's HIV serology was positive with a CD4 count of 240/mm3, normochromic and normocytic anemia, and a hemoglobin level at 8.5 g/dl. It was found that the child, after early weaning from his HIV-negative mother, had repeatedly suckled his healthy grandmother, who had no skin lesions but was HIV1 positive. Both grandmother and child were referred for treatment in their locality. The case is noteworthy for the way in which the HIV1 virus infected the child during weaning and then being suckled by his grandmother. The child already had an initial dental flare that could have injured his grandmother. Thus, in our case, there is a contamination by HIV1 virus most likely from the grandmother and contamination by the HHV8 virus, source unidentified as a technical plateau was reached.

[Prevalence of infantile haemangiomas on black skin]. / Prevalence des hemangiomes infantiles sur peau noire au Mali.

INTRODUCTION: Hemangiomas are regenerative benign vascular tumors of the child, which may be of interest to all organs, most often located on the skin. The aim of our study is to determine the prevalence of haemangiomas on black skin. It is a descriptive cross-sectional study that took place from November 2015 to August 2016 at CNAM, in the department of dermatology-leprology- Venereology of Mali. RESULTS: Of 14,810 patients seen in consultation, we received 17 cases of hemangioma, ie 0,11%. The average age was 5 months with extremes of 1 month and 60 months. Tuberous angiomas represent 82,35% of clinical forms, subcutaneous angiomas 11,76% and mixed angiomas 5,89%. In 4/17 of our patients there was an infectious complication, following an ulceration on the first day of the consultation. The average lesion size was 3,25cm with extreme 0.5cm and 8cm. The number of lesions per patient was 1 in 16 patients and 2 in 1 patient. In 10/17 patients the lesions were localized at the cephalic level, 3/17 at the trunk level, and 4/17 at the perineum. CONCLUSION: Infantile hemangioma is a poorly reported condition on black skin. The demands for care are motivated either by the character showing lesions or by ulcerative complications. Sensitization of populations and ongoing training of health workers are needed to detect hemangiomas.

INTRODUCTION: Les hémangiomes sont des tumeurs vasculaires bénignes régressives de l'enfant, qui peuvent intéresser tous les organes, le plus souvent localisés sur la peau. Le but de notre étude est de déterminer la prévalence des hémangiomes sur peau noire. C'est une étude transversale descriptive qui s'est déroulée de novembre 2015 à Août 2016 au CNAM, dans le service de dermatologie-léprologie- Vénéréologie du Mali. RÉSULTATS: Sur 14 810 patients vus en consultation, nous avons reçu 17 cas d'hémangiome soit 0,11%. La moyenne d'âge était de 5 mois avec des extrêmes de 1mois et 60 mois. Les angiomes tubéreux représentent 82,35% des formes cliniques, les angiomes sous-cutanés 11,76% et les angiomes mixtes 5,89%. Chez 4/17 de nos patients existait une complication infectieuse, suite à une ulcération le premier jour de la consultation. La taille moyenne des lésions était de 3,25cm avec des extrêmes 0,5cm et 8cm. Le nombre de lésions par patient était de 1 pour 16 patients et 2 pour 1 patient. Chez 10/17 des patients les lésions étaient localisées au niveau céphalique, 3/17 au niveau du tronc, et 4/17 au niveau du périnée. CONCLUSION: L'hémangiome infantile est une affection peu rapportée sur peau noire. Les demandes de soins sont motivées soit par le caractère affichant des lésions ou par les complications ulcéreuses. Une sensibilisation des populations et une formation continue des agents de santé sont nécessaires pour détecter les hémangiomes.

[Orthostatic low blood pressure in patient suffering from hypertension, in external cardiology consultation]. / L'Hypotension orthostatique chez l'hypertendu en consultation externe de cardiologie.

This work was aimed to describe the epidemiological, clinical, biological and electrical aspects of orthostatic low blood pressure (LBP) within patients with high blood pressure (HBP) in the cardiology department of the Kati University Hospital. This was a prospective cross-sectional study conducted between June 1st, 2012 and May 31st, 2013. It included all the patients with HBP regularly assessed for at least a month, following their treatment and having no other treatments which can induce a orthostatic LBP. RESULTS: With a total of 300 subjects with high blood pressure, 42 subjects presented an orthostatic LBP with or without suggestive clinical demonstrations, among which 16 men and 26 women, with an average age of 55 year. In the HBP population, the orthostatic LBP had a 14% frequency (42/300), the sex ratio was 0.61. Most of the patients were 55 years old or more. The HBP was not controlled in 66.7% of cases. Twelve percent of the patients with orthostatic LBP were diabetics. The number of antihypertensive drug used did not appear to influence the appearance of an orthostatic LBP. Monotherapy was associated with an orthostatic LBP in 47.6% of cases and this monotherapy used the calcic inhibitors in 62% of the cases. Orthostatic low blood pressure is frequent within patient with HBP undergoing treatment. It must be systematically looked for, especially in the uncontrolled HBP, among older subjects, the diabetics, and those with a personal history of neurological disease.

OBJECTIF: Ce travail visait à décrire les aspects épidémiologiques, cliniques, biologiques et électriques de l'hypotension orthostatique chez l'hypertendu dans le service de cardiologie du CHU de Kati. PATIENTS ET MÉTHODES: L'étude était transversale et prospective allant du 1er Juin 2012 au 31 Mai 2013 dans le service de cardiologie du CHU de Kati. Il s'agissait de l'ensemble des patients hypertendus régulièrement suivis depuis un mois et plus, bien observant et n'ayant pas d'autres traitements pouvant favorisés l'hypotension orthostatique. RÉSULTATS: Au total 42 sujets présentant une hypotension orthostatique avec ou sans manifestations cliniques évocatrices ont étés inclus, dont 16 hommes et 26 femmes, en moyenne âgés de 55 ans. Dans la population d'hypertendus, l'hypotension orthostatique avait une fréquence de 14% (42/300), le sex ratio était de 0,61. Les patients âgés de plus de 55 ans étaient plus nombreux. L'hypertension artérielle n'était pas contrôlée dans 66,7%. 11,9% des patients hypotendus orthostatiques étaient diabétiques. Le nombre d'antihypertenseur utilisé ne paraissait pas influencer l'apparition d'une hypotension orthostatique. La monothérapie était associée à une hypotension orthostatique dans 47,6% et cette monothérapie utilisait les inhibiteurs calciques dans 62% des cas. CONCLUSION: L'hypotension orthostatique est fréquente chez les hypertendus traités. Elle doit être recherchée systématiquement, en particulier dans l'HTA non contrôlée, chez les sujets âgés, les diabétiques, et chez ceux ayant un antécédent neurologique.

[Epidemiological aspects of poliomyelitis in Mali (author's transl)]. / Les aspects epidémiologiques de la poliomyélite au Mali.

1800 cases of poliomyelitis has been observed in Mali during 8 years from 1968 to 1975. Children, and specially infants from 6 months to 2 years are specially concerned with a sex-ratio giving a higher frequency in boys though this difference goes decreasing with age. The dry season and the hotter one are the two periods of great morbidity. The three types (I, II, III) have the same importance. Oral immunization at the age of 3 or 4 months must be extended.

[Mali children antipoliomyelitic immunity before and after two oral immunizations against poliomyelitis (author's transl)]. / L'immunité antipoliomyélitique des enfants au Mali avant et après deux vaccinations orales contre la poliomyélite.

In tropical areas transport and storage of living antipoliomyelitic vaccine are difficult and consequently it is considered as hazardous to get a correct immunity with this vaccine. Still, good results have been obtained in Mali children with Sabin vaccine. A previous virological survey has shown that 31 p. 100 of children below 3 years carry enterovirus which are, for 30 p. 100 of them, wild poliovirus. In a serological survey conducted during the same period, near 50 p. 100 of the children in that age group were seronegative for the 3 types of virus and 90 p. 100 of the children between 4 to 7 had neutralizing antibodies against type I, 88 p. 100 against type II and 67 p. 100 against type III. By doubling or trebling the immunizing dose at the first vaccination, the following results have been observed after the second vaccination: 86 p. 100 of the immunized children under 3 years had neutralizing antipoliomyelitic antibodies (titre 1/10) against type I and II and 64 p. 100 against type III, whereas, in the elder group (from 4 to 7) the conversion rate is 100 p. 100 for types I and II and 96 p. 100 for type III.

[Human immunodeficiency virus (HIV) infection in Mali]. / L'infection par le virus de l'immunodéficience humaine (VIH) au Mali.

This review summarises epidemiological and clinical data of HIV infection who was recognized in Mali since 1985. The most important rate of seropositivity for HIV is observed in the prostitutes group (40%). The estimated seroprevalence for adult population is between 1% and 5%. 46 cases for AIDS are reported in both sexes. The mean age is 35 years. Main signs are weight loss (91%), fever (80%), diarrhea (70%) and lymphadenopathy (50%). Three among the five cases of Kaposi's sarcoma are aggressive. 19.5% of AIDS have antibodies to HIV1, 41.3% to HIV2 and 39.1% to HIV1 and HIV2. Death rate is more than 50%. These data are compared with other countries of Africa.

Diphtheria immunity in Mali (mothers and their neonates and children under two years of age.

An analysis of diphtheria antibodies (indirect haemagglutination technique) in 85 paired sera of Malian mothers and their newborns (cord blood) showed that all mothers had protective antibody levels (greater than 0.1 I.U./ml). 81 per cent of the neonates demonstrated protective immunity towards diphtheria. Since in Mali respiratory diphtheria is rare, is may be assumed that a silent immunization by skin sores, contaminated with diphtheria germs takes place. This assumption is supported by an analysis of 30 unimmunized 6 to 24 months old babies from whom 10 had protective and 16 low levels of diphtheria antibodies in their sera. By inclusion of 13 further children of the same age group (possibly previously immunized, since they had demonstrable antibodies against tetanus) we found a geometric mean diphtheria antibody titer for all 43 children of 0,08 I.U./ml.

A serological study of the age distribution of endemic treponematoses in children from Mali, Africa.

Using the Treponema Pallidum Haemagglutination Assay (TPHA) for the demonstration of treponema-specific antibodies, 444 children in age groups between 5 months and 10 years from different parts of Mali (Africa) were investigated for endemic treponematoses. The rate of seroreactivity (1,85%) in the age groups under four years (n = 270) indicates a low incidence of treponemal infections. From these observations it can be concluded that treponemal infections in infants are not caused by suckling of the babies on infectious nipples of their mothers. The high rate of TPHA-reactive children (17,8%) in the age groups between 5 and 10 years (n = 174) can be explained by the assumption of nonvenereal transmission of the disease. Furthermore, 101 mothers from Bamako and their newborn babies, were investigated serologically. In 17 mothers (17%) the TPHA was reactive. Treponema-specific antibodies were transmitted to the children in all cases and with nearly identical antibody titres.

Influenza and corona-virus antibodies in the newborns and their mothers in Mali (1980).

In February 1980 blood samples from 91 women and their newborn babies (cord blood) from Mali have been analysed for influenza and corona OC 43 HI antibodies. The titers of influenza HI antibodies were higher in blood samples collected from the mothers at delivery than in their newborns. Considering the GMT values and percentage of persons with protective titers (greater than or equal to 1:40) we may assume that influenza A (H3N2) viruses had been highly active in Mali. Influenza A (H1N1) and B activity may be considered as minor. The prevalence of OC 43 coronaviruses HI antibodies was higher in the cord blood of the newborn babies (95%) than in the blood samples of their mothers (75%).

[Edwardsiella tarda and Plesiomonas shigelloides. Their role as diarrhea agents and their epidemiology]. / Edwarsiella tarda et Plesiomonas shigelloides. Leur rôle comme agents de diarrhées et leur épidémiologie.

During a bacteriological investigation of infectious diarrhoea among the population of Mopti, a town situated on the river Niger in Mali, a high prevalence of Edwardsiella tarda and Plesiomonas shigelloides in diarrhoeic stools was demonstrated. Suspecting that the human infection originated from river fish, the prevalence of both bacterial species was studied in Zairese freshwater fish. E. tarda and P. shigelloides were isolated from nearly 60% of the examined fish. It is concluded that these organisms are part of the commensal intestinal flora of tropical freshwater fish and that the latter constitute a reservoir of human infection.

Study of HLA antigens in a population of Mali (West Africa).

Eighty-two healthy individuals have been typed for HLA-A, B, C, antigens, and 49 of them also for HLA DR alleles. They were a sample representative of 11 of the 14 Malian ethnic groups living in the area of Bamako (Mali). Phenotypic frequencies have been compared to those of other Negroid and Caucasoid reference populations. As expected, in Negroids the increased frequency of HLA A23, A28, A30, and ATh was confirmed in the present series. Additionally, a significantly increased frequency of HLA B5 (B51 and Bw52) was noted--already observed in some but not all Negroid populations. Conversely, a decreased frequency--compared with that usually found in Negroid population--was observed for the alleles Bw42, Bw58, Cw6, and DRw6. Our results underline the originality of the Malian population among Western Africans.

Glucose-6-phosphate dehydrogenase and hemoglobin variants in Kel Kummer Tuareg and related groups. Indirect evidence for alpha-thalassemia trait.

A field study of glucose-6-phosphate dehydrogenase (G6PD) and hemoglobin polymorphisms was performed in 327 subjects belonging to the Kel Kummer, a highly inbred Tuareg tribe of North-East Mali, and to the contact populations. In the Kel Kummer group 11% of the investigated subjects carried the nondeficient G6PD A+ variant. No other G6PD variant was found. Hemoglobin D Ouled-Rabah was found in 21% of the subjects of this group. The presence of an alpha-thalassemic trait was also inferred from indirect evidence. The contact groups (Inedän, Iklan, Kel es Suq and Dausahaq) exhibited different polymorphisms at the G6PD and globin loci, substantiating their belonging to different ethnic stock.