[Diabetes and frailty in the elderly. A prospective study of an outpatient population supported by general practitioners]. / Diabète et fragilité chez la personne âgée. Etude prospective d'une population ambulatoire prise en charge en Médecine générale.

INTRODUCTION: Elderly people with diabetes represent a large and growing part of the general practitioners patient database, but their state of frailty compared to the non-diabetic population is poorly understood. OBJECTIVE: To study the relationship between diabetes and frailty in people aged 65 and over in primary care. METHOD: Frailty syndrome was assessed by the Fried Scale and compared between populations of diabetic and non-diabetic patients; 268 patients were studied, including 129 diabetic patients. RESULTS: Frailty was found in 27.9 % of older diabetic patients. The observed mean Fried score was 1.76 in people with diabetes versus 1.39 in non-diabetics, with more frail diabetic subjects (p = 0.007). In this study, HbA1c levels showed no significant association to frailty. CONCLUSION: Larger studies in several general practice clinics should be performed on subjects over 65 years of age with or without diabetes.

INTRODUCTION: Les personnes âgées diabétiques représentent une part importante et croissante de la patientèle des médecins généralistes, mais leur état de fragilité par rapport à la population non diabétique est mal connu. Objectif : Etudier les relations entre diabète et fragilité chez la personne âgée de 65 ans et plus en médecine générale. Méthode : La fragilité a été évaluée par l'échelle de Fried et comparée entre les populations de patients diabétiques et non diabétiques; 268 patients ont été inclus dont 129 patients diabétiques. Résultats : La fragilité concernait 27,9 % des diabétiques. Le score de Fried moyen observé était de 1,76 chez les personnes diabétiques versus 1,39 chez les non-diabétiques, avec des sujets diabétiques plus fragiles (p = 0,007). Dans cette étude, le taux d'HbA1c n'est pas significativement associé à la fragilité. CONCLUSION: Des études de plus grande ampleur sur plusieurs sites ambulatoires devraient être réalisées en médecine générale chez les sujets âgés de plus de 65 ans, diabétiques ou non.

[Mortality and morbidity of tetanus in the infectious diseases department, Point G teaching hospital, in Bamako, Mali (2004-2009)]. / Morbidité et mortalité du tétanos dans le service de maladies infectieuses du CHU du Point G à Bamako, Mali (2004-2009).

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

[Strokein type 2 diabetic patients in the internal medicine department of the Teaching Hospital of Point G]. / Accident vasculaire cerebral (AVC) chez les patients diabetiques de type 2 dans le service de medecine interne du CHU du Point G.

INTRODUCTION: Diabetes is a chronic hyperglycemia which can be discovered with specific organic complications particularly affecting the eyes, kidneys, nerves, heart and vessels. Globally, the prevalence of stroke in people with diabetes is approximately 10%. OBJECTIVE: Study the epidemiological and clinical aspects of stroke in patients with type 2 diabetes. METHODOLOGY: We made a descriptive and analytical study by a retrospective survey over a period of 10 years, in the department of internal medicine at the university Hospital ofPoint G. We focused on all hospitalized patients with type 2 diabetes, in whom the diagnosis of stroke was retained. RESULTS: At the end of the study 24 patients out of 492 diabetes hospitalized in to the period met our inclusion criteria, representing a frequence of 4.9%. The mean age was 64.67 ± 13.409 years with a sex-ratio of 1.4. The reason for hospitalization was muscle weakness in 54.2% of patients. Eighty-seven point five percent (87.5%) of patients were already known to have diabetes before the weakness. Stroke was the mode of discovery of diabetes in 12.5%. Over 70% of our patients had hyperglycemia at the time of admission. Ischemic stroke was seen in 75% of patients. CONCLUSION: Stroke is a great complication of diabetes witch, can be a way discovery of type 2 diabetes.

INTRODUCTION: Le diabète est une hyperglycémie chronique qui peut être découvert avec des complications organiques spécifiques touchant particulièrement les yeux, les reins, les nerfs, le cœur et les vaisseaux.L'AVC en ai une de ces complications. À l'échelle mondiale, la prévalence de l'AVC chez les diabétiques est d'environ 10%. OBJECTIF: Étudier les aspects épidémiologiques et cliniques de l'accident vasculaire cérébral chez les patients diabétiques de type 2. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive et analytique sur la base d'une enquête rétrospective de 10 ans, dans le service de médecine interne du CHU du Point G. Elle a porté sur tous les patients diabétiques de type 2 hospitalisés dans le service de médecine interne, chez qui le diagnostic de l'AVC a été retenu. RÉSULTATS: Au terme del'étude 24 patients répondants à nos critères sur 492 diabétiques soit une fréquence de 4,9%. L'âge moyen était de 64,67 ± 13,409 ans avec un sex-ratio de 1,4. Le motif d'hospitalisation était un déficit moteur chez 54,2% des patients. Quatre-vingt-sept virgule cinq pourcent (87,5%) des patients étaient déjà connus diabétiques avant le déficit. L'AVC a été le mode de découverte du diabète chez 12,5%. Plus de 70% de nos patients avaient une hyperglycémieau moment à l'admission. L'AVC ischémique était observé chez 87,5% des patients. CONCLUSION: L'AVC est une complication redoutable du diabète, il peut être le mode de découverte d'un diabète de type 2.

[Stroke in type 2 diabetic patients in the internal medicine department of the Teaching Hospital of Point G]. / Accident vasculaire cerebral (avc) chez les patients diabetiques de type 2 dans le service de medecine interne du CHU du Point G.

INTRODUCTION: Diabetes is a chronic hyperglycemia which can be discovered with specific organic complications particularly affecting the eyes, kidneys, nerves, heart and vessels. Globally, the prevalence of stroke in people with diabetes is approximately 10%. OBJECTIVE: Study the epidemiological and clinical aspects of stroke in patients with type 2 diabetes. METHODOLOGY: We made a descriptive and analytical study by a retrospective survey over a period of 10 years, in the department of internal medicine at the university Hospital ofPoint G. We focused on all hospitalized patients with type 2 diabetes, in whom the diagnosis of stroke was retained. RESULTS: At the end of the study 24 patients out of 492 diabetes hospitalized in to the period met our inclusion criteria, representing a frequence of 4.9%. The mean age was 64.67 ± 13.409 years with a sex-ratio of 1.4. The reason for hospitalization was muscle weakness in 54.2% of patients. Eighty-seven point five percent (87.5%) of patients were already known to have diabetes before the weakness. Stroke was the mode of discovery of diabetes in 12.5%. Over 70% of our patients had hyperglycemia at the time of admission. Ischemic stroke was seen in 75% of patients. CONCLUSION: Stroke is a great complication of diabetes witch, can be a way discovery of type 2 diabetes.

INTRODUCTION: Le diabète est une hyperglycémie chronique qui peut être découvert avec des complications organiques spécifiques touchant particulièrement les yeux, les reins, les nerfs, le coeur et les vaisseaux.L'AVC en ai une de ces complications. À l'échelle mondiale, la prévalence de l'AVC chez les diabétiques est d'environ 10%. OBJECTIF: Étudier les aspects épidémiologiques et cliniques de l'accident vasculaire cérébral chez les patients diabétiques de type 2. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive et analytique sur la base d'une enquête rétrospective de 10 ans, dans le service de médecine interne du CHU du Point G. Elle a porté sur tous les patients diabétiques de type 2 hospitalisés dans le service de médecine interne, chez qui le diagnostic de l'AVC a été retenu. RÉSULTATS: Au terme del'étude 24 patients répondants à nos critères sur 492 diabétiques soit une fréquence de 4,9%. L'âge moyen était de 64,67 ± 13,409 ans avec un sex-ratio de 1,4. Le motif d'hospitalisation était un déficit moteur chez 54,2% des patients. Quatre-vingt-sept virgule cinq pourcent (87,5%) des patients étaient déjà connus diabétiques avant le déficit. L'AVC a été le mode de découverte du diabète chez 12,5%. Plus de 70% de nos patients avaient une hyperglycémieau moment à l'admission. L'AVC ischémique était observé chez 87,5% des patients. CONCLUSION: L'AVC est une complication redoutable du diabète, il peut être le mode de découverte d'un diabète de type 2.

[The fight against rabies in Africa: from recognition to action]. / Lutte contre la rage en Afrique: du constat à l'action.

As a follow-up to the first AfroREB (Africa Rabies Expert Bureau) meeting, held in Grand-Bassam (Côte-d'Ivoire) in March 2008, African rabies experts of the Afro-REB network met a second time to complete the evaluation of the rabies situation in Africa and define specific action plans. About forty French speaking rabies specialists from Northern, Western and Central Africa and Madagascar met in Dakar (Senegal), from March 16th to 19th, 2009. With the participation of delegates from Tunisia, who joined the AfroREB network this year, 15 French speaking African countries were represented. Experts from the Institut Pasteur in Paris, the Alliance for Rabies Control, and the Southern and Eastern African Rabies Group (SEARG, a network of rabies experts from 19 English speaking Southern and Eastern African countries) were in attendance, to participate in the discussion and share their experiences. AfroREB members documented 146 known human rabies cases in all represented countries combined for 2008, for a total population of 209.3 million, or an incidence of 0.07 cases per 100,000 people. Even admitting that the experts do not have access to all reported cases, this is far from the WHO estimation of 2 rabies deaths per 100,000 people in urban areas and 3.6 per 100,000 in rural Africa. It was unanimously agreed that the priority is to break the vicious cycle of indifference and lack of information which is the main barrier to human rabies prevention.

[Hepcidin and Plasmodium falciparum malaria in anemic school children in Mali]. / Hepcidine et infection due a Plasmodium falciparum chez un groupe d'ecoliers anémiés du Mali.

Hepcidin is a peptide produced by hepatocytes and detectable in blood and urine. Urinary hepcidin excretion appeared to be significantly increasing in humans with acute and chronic infections or inflammatory diseases. However, the effects of common tropical parasitic infections on hepcidin have not been sufficiently examined. We carried out a study in school children from Mali living in a neighborhood where Plasmodium falciparum malaria and Schistosoma haematobium infections are prevalent. Anemia (hemoglobin < 120 g/l) prevalence was very high among these children (68%); 24% had iron deficiency anemia. The prevalence of infections was also high (65% had at least one infection and 41% had C-reactive protein (CRP) levels > 10 mg/L). S. haematobium was diagnosed in 64%. We assessed first morning urine hepcidin excretion in a sub-sample of 15 children with either S. haematobium, P. falciparum malaria or none; 14 of these 15 children were included in the analyses. Children with P. falciparum malaria excreted significantly higher levels of hepcidin than those with S. haematobium (chi2 = 3.86; p = 0.05) or without any infection (chi2 = 5.95; p = 0.01). Urinary hepcidin correlated significantly with CRP (Spearman's r = 0.59; p = 0.001) and serum ferritin (Spearman's r = 0.73; p = 0.003). Our study confirms the still limited evidence of an association between human malaria and increased urinary hepcidin and points out the need for further studies to define the contribution of hepcidin to anemia associated with this disease.

[Social anthropological approach to tuberculosis in Mopti (Mali): popular representations and use of treatment]. / Approche socioanthropologique de la tuberculose à Mopti (Mali): représentations populaires et recours thérapeutiques en cas de tuberculose.

In Mali, there were 4508 new cases of tuberculosis in 2003, and 5222 in 2006. Tuberculosis (TB) is thus an important public health problem, decreasing the physical, financial and social capital of individuals, their families and society. Because responses to TB have not yet applied a sufficiently integrated approach that can improve patients' access to quality care, this FORESA project advocates a patient-centered approach. Before any intervention, FORESA thus sought to analyse the situation of TB in Mali and responses to it. The study aims to analyse the discourse about and popular representations of TB (its forms, its signs), the situations in which people are exposed to it or transmit it, and popular practices related to its prevention and the experience of having it. This qualitative, descriptive and analytical study includes a literature review, in-depth interviews with opinion leaders, community health workers and TB patients, focus groups, and the observations of practices. The interviews were recorded, transcribed, and analysed. Subjects provided informed consent to participation. This study showed that: * the terms for TB in local languages (Bambara, Dogon and Fulfuldé) include white cough, big cough, and long cough; * These communities differentiate between 2 main forms of cough (simple and wet); * TB is perceived as a transmissible disease, a disease of contact with a contaminated body or objects; * TB is seen as a serious, contagious, hereditary, shameful disease that may result from the transgression of social norms; * The prevention of TB consists of avoiding people who have the disease or transmitting factors; * Therapeutic remedies, in order, are self-medication, the use of traditional healers, and finally visits to health centres; * The population wants more information about TB and be involved in the fight against it. This study shows the many points of convergence about TB nosology, etiology and therapy between the Mopti population and other groups in Mali (including the Mande, Senoufo and Soso), between the population of Mali and some ethnic groups in Burkina Faso (such as the Dioula, Bobo, Tiéfo Vigué), and between the population of Mali and, Burkina Faso and others in Africa (Gambia, Nigeria, South Africa, etc.). There is also a difference between popular knowledge about TB and biomedical knowledge. The population does not know that TB is transmitted mainly, even exclusively, by nasal droplets or that patients are no longer contagious after two weeks of treatment. The widespread dissemination of this information may have a positive effect, reducing stigmatization and improving access to treatment. Mali must strengthen the skills of all participants in the fight against tuberculosis, to strengthen their framework and to monitor and evaluate their activities.

[Status Of Markers Of Oxidative Stress At The Internal Medicine And Endocrinology Department Of The Mali Hospital]. / Statut Des Marqueurs Du Stress Oxydatif Au Service De Medecine Interne Et D'Endocrinologie De L'Hopital Du Mali.

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.

[Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report]. / Cryptococcose neuroméningée chez des patients VIH négatif au CHU du Point G de Bamako (Mali): à propos de trois observations cliniques.

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.

A public health approach for leprosy detection based on a very short term-training of primary health care workers in basic dermatology.

INTRODUCTION: In countries where leprosy control is integrated to general heath services, health workers, at primary health care level, often manage a large number of patients with skin diseases including leprosy. The distinction of leprosy from others skin diseases requires more skill and attention. Basic dermatological knowledge will help these staff to provide a better quality of care. A few years ago, a short term training programme focussed on leprosy and some common skin diseases was set up in Mali through a pilot project. This study will evaluate the impact of this training on the detection of leprosy at primary health care level. METHODS: health care workers from two health districts were invited to participate in the training. Trainee was submitted to an anonymous written test before training, immediately after and 12-18 months post-training using a standardized scoring system. The suspected or referred leprosy cases before and after training were compared. Data were recorded and analysed with the software Epi info version 6.04. RESULTS: Overall, 495 HCW attended the three anonymous written tests (before training, just after and 12-18 months later). The proportion of participants who gave correct answers before training, just after were respectively: 33 and 57% for correct diagnosis, 5 and 39% for test of sensation and 28 and 47% for referral. Eight patients suspected of leprosy were referred for further examination; in these, five cases of leprosy were detected. DISCUSSION: The training showed a huge improvement in the skill of the participants in managing leprosy patients. This study addresses how leprosy control can be improved by involving primary health care staff and by the implementation of only a single day's training on basic dermatology. CONCLUSION: The role of the dermatologist in this post-elimination era of leprosy needs to be reconsidered and adapted to the increasing need to take multiple programmes, inclusive of dermatology and leprosy, into primary health care services and those interested in leprosy control should fund these programmes.

[An action research network to improve the quality of tuberculosis care in West Africa]. / Améliorer la qualité des soins aux patients tuberculeux par la recherche-action en réseau. Une expérience en Afrique de l'Ouest.

BACKGROUND: Improvement in management systems for tuberculosis (TB) care is urgently needed in West Africa. In 2003, an experimental action research network began there, involving care providers, health system managers, and TB programme managers. Each project in all 6 countries used a "patient-centered" approach to improve tuberculosis case management. METHODS: The research teams included care providers, district medical officers, anthropologists and TB programme managers. Each research team conducted its project for a one-year period and then assessed its results. The specific problems identified were low TB detection rates (Burkina Faso, Côte d'Ivoire and Niger) and poor compliance among patients receiving treatment, including their ensuing loss to follow-up (Benin, Mali and Senegal). Investigators concluded that these weaknesses were due to the lack of access to care (geographical, financial and cultural), the complexity of the care system and the low quality of care. Solutions for all 6 countries aimed at improving access to high-quality care. RESULTS: One year after the experiment began, results varied from one country to another. In general, all participants understood the need to collaborate beyond national health systems because the problems from all 6 countries were quite similar. The research process led to better sharing of work between care providers and sometimes between care providers and TB patients. It provided participants with new concepts and a constant opportunity to implement them. These repeated meetings, however, keep care providers away from their offices. CONCLUSION: The research would have improved case management and care more effectively had the teams taken into account the psychological and sociological need of TB patients. A new regional dynamic has begun and must be pursued to help improve health care systems.

Digital health and the need to develop centers of expertise in sub-Saharan Africa : two examples in Mali and Cameroon.

It is generally agreed today that digital technology provides a lever for improving access to health care, care processes, and public health planning and activities such as education and prevention. Its use in countries that have reached a given level of development has taken place in a somewhat fragmented manner that raises important interoperability problems and sometimes makes synergy impossible between the different projects of digital health. This may be linked to several factors, principally the lack of a global vision of digital health, and inadequate methodological knowledge that prevents the development and implementation of this vision. The countries of Africa should be able to profit from these errors from the beginnings of digital health, by moving toward systemic approaches, known standards, and tools appropriate to the realities on the ground. The aim of this work is to present the methodological approaches as well as the principal results of two relatively new centers of expertise in Mali and Cameroon intended to cultivate this vision of digital governance in the domain of health and to train professionals to implement the projects. Both centers were created due to initiatives of organizations of civil society. The center in Mali developed toward an economic interest group and then to collaboration with healthcare and university organizations. The same process is underway at the Cameroon center. The principal results from these centers can be enumerated under different aspects linked to research, development, training, and implementation of digital health tools. They have produced dozens of scientific publications, doctoral dissertations, theses, and papers focused especially on subjects such as the medicoeconomic evaluation tools of e-health and health information technology systems. In light of these results, we can conclude that these two centers of expertise have well and truly been established. Their role may be decisive in the local training of participants, the culture of good governance of digital health projects, the development of operational strategies, and the implementation of projects.

The delegation of tasks in the era of e-health to support community interventions in maternal and child health: lessons learned from the PACT-Denbaya project.

The PACT-Denbaya project (Program for community access to telemedicine for families) aimed to help improve the health of mothers and child in rural communities through the delegation of obstetric-gynecologic and pediatric tasks, supported by teleconsultations. This operational research took place in 6 community health centers in the Dioïla health district in Mali. Our method was based of the delegation of tasks, supported by teleconsultations. Experts in pediatrics and obstetrics/gynecology provided a week-long training program to general practitioners and midwives, in the management of the most common problems in the field and in the use of the "Bogou" teleconsultation and "Dudal" tele-education platforms to ensure exchanges and follow-up. Overall, 17 healthcare providers, that is, general practitioners, nurse-obstetricians, and midwives participated in sessions to strengthen gynecology-obstetric and pediatric capacity in the field. The evaluation of knowledge and of the indicators compared with the baseline of 8359 pregnancies and 1991 documented deliveries and of user satisfaction showed that this type of service resulted in decreased maternal and child mortality. In view of these results, we can deduce that the delegation of tasks, when it is supported by telehealth, encounters no resistance from the specialists and contributes to the significant improvement of maternal and infant health in remote areas. A long-term impact study is necessary to reinforce these results.

[Vulvar complications of urogenital schistosomiasis: study of 8 cases in Ségou, Mali]. / Complications vulvaires de la schistosomose uro-génitale: étude de 8 cas à Ségou, Mali.

We present a retrospective study of eight cases of vulvar bilharziasis who attended our institution for dermatological visit from 1998 to 2001. The mean age was 11 years old (range: 7 to 13). The clinical examination found wart like or ulcerated nodules, papules and/or diffuse infiltration. All the lesions were located on the left side of the vulvae (labium) and/or the groin. S. haematobium was the only causative agent identified in all specimens. The exclusive left side location of the lesions reported here has never been mentioned in the previous studies. The physiopathology of this finding is possibly linked to factors similar to those explaining the Cockett syndrome. Further examinations, including ultrasonography of the pelvis in larger series, are needed to learn more about the mechanism of this clinical entity.

Definition of an algorithm for the management of common skin diseases at primary health care level in sub-Saharan Africa.

In order to help primary health care (PHC) workers in developing countries in the care of common skin diseases, an algorithm for the management of pyoderma, scabies, superficial mycoses, contact dermatitis and referral of early leprosy cases (based on the identification of diseases through the presence of objective key signs, and on treatments by generic drugs) was elaborated. One thousand patients were seen by trained dermatologists, who established diagnoses and treatments; in addition, there was systematic recording of each key sign, according to the successive algorithm steps. We compared the diagnostics and treatments obtained for several combinations of diagnostic signs, with those of the dermatologists. Sensitivity, specificity, positive predictive value and negative predictive value of defined combinations were high for pyoderma, scabies and superficial mycoses. Values were less exact for dermatitis and leprosy, but were considered sufficient for the level of health care targeted. The apportionment of treatments between the algorithm and the dermatological approaches was considered appropriate in more than 80% of cases; mismanagement was possible in 7% of cases, with few predictable harmful consequences. The algorithm was found satisfactory for the management of the dermatological priorities according to the standards required at the PHC level.

High prevalence of non-leprotic hypochromic patches among children in a rural area of Mali, West Africa.

The identification of one or several hypochromic patches (HP) on the skin is a key stage in the diagnosis of leprosy on dark skin. However, HP are often caused by other disorder than leprosy. A study to determine the prevalence and causes of HP among children was carried out in a rural area of Mali in November 2001. All children under 15 years of age in two villages in an endemic area were screened by two dermatologists. Among the 1729 children seen, HP were identified in 71 patients, with a prevalence of 4.1%. The most common cause of HP was tinea versicolor, which was present in 39.4% of children with HP, followed by pityriasis alba in 31%, naevus achromicus in 24% and vitiligo in 5.6%. No case of leprosy was detected. Our study raises several points with practical consequences for the detection of leprosy cases: the high prevalence of non-leprous HP compared to leprosy, the reliability of the clinical diagnosis of leprosy, and the role of general health care workers in the detection of leprosy cases. Helping those who should be involved in that detection in distinguishing true cases from other hypochromic disorders appears to be a priority.

[Gastrointestinal manifestations of AIDS in adults in Mali]. / Manifestations digestives du sida chez l'adulte au Mali.

Our main objective consists in evaluating the frequency of digestive signs and digestive opportunistic infections in AIDS patients with diarrhea. The prospective study occurred from January 1997 to July 1998 in Bamako hospitals. The patients underwent a clinical examination, blood and stools tests, and sometimes upper digestive endoscopy. Among 434 cases of AIDS, 426 patients (98%) had at least one digestive sign. The main digestive signs were diarrhea (80.1%), abdominal pains (62.2%), vomiting (47.2%) and dysphagea (36.6%). Isospora belli and Cryptosporidium parvum have been pointed up in respectively 9% and 16.3% of examined specimen. Echerichia coli was found in 8.6% of stool cultures and in 2.9% in the case of Salmonella Arizonae. Twenty cases of Kaposi's sarcoma were diagnosed and mycosis was found in 71.9% of patients. In conclusion, digestive change is a constant phenomenon in AIDS patients. Patients survival could be improved by early management, improvement of diagnosis and provisioning of medicines.

[Prevalence of pulmonary tuberculosis and HIV infection in the district of Diré in Mali]. / Prévalences de la tuberculose pulmonaire et de l'infection par le VIH dans le cercle de Diré au Mali.

In 1990, a study was made in the district of Diré, North Mali in West Africa, to determine the prevalence of pulmonary tuberculosis and HIV infections in general population. From 1,814 subjects tested, 1.1% (n = 20) have active pulmonary tuberculosis and 0.2% (n = 4) were seropositive with HIV1 or HIV1 + 2. No relation was made between the two diseases.

[Frequency, risk factors and prognostic value of anemia associated with HIV/AIDS in the adult in Mali]. / Fréquence, facteurs de risque et valeur pronostique de l'anémie associée au VIH/SIDA chez l'adulte au Mali.

Anaemia is a common complication of the HIV infection. To understand the mechanism of HIV associated anaemia and to suggest a consequent therapeutic approach in adults in Mali, we undertook a prospective case/control study in two services of reference with essentially adults recruitment in Bamako. We studied the frequency, the risk factors and the prognosis value of this complication in 133 patients with HIV infection matched to 133 others non HIV infected. The average age of our patients was 36.08 +/- 8.80 years (age range: 19 to 66 years). The frequency of anaemia was significantly higher in patients with HIV infection compared to the controls (78.9% vs. 51.9%; OR = 2.46; 95% CI [1.56-3.92]). Anaemia was more frequent in women than in men (p = 0.00003). A significant association between anaemia and thrombopenia or lymphopenia was observed only in patients with HIV infection. The severity of anemia was positively associated with the HIV2 infection and the progression of the HIV disease. Mortality was more frequently associated to the anaemia (p < 10(-5)) in patients infected by HIV. These findings suggest that bone marrow depression leading to a decreased red blood cells production is the main mechanism of HIV associated anaemia in adult in Mali. Therefore, without evidence of a best cost-effectiveness ratio of a human recombinant erythropoietin treatment in the context of countries with a low income, the therapy of this haematological complication must be an emergency focusing on red blood cells transfusions.

[Portal vein: echographic anatomy]. / Veine porte: anatomie échographique.

The principal descriptions of the portal vein are mainly on the results of the dissections of the corpses. The aim of the work was to determine the usual sizes of the portal vein on the alive subject by echography. From the same machine, 3 ultrasonographers studied the anatomy of the portal vein of the volunteers according to a standardized methodology. The study was about 60 old people from 11 to 82 years old, whom 31 were males (51.7%) and 29 females (48.3%). The transverse diameter of the portal vein, originally varied between 8 and 10 mms un 57.9% of cases. The average was 9.05 mms +/- 2.82 and the extremes varied from 5 to 16 mm. The transverse diameter of the portal vein, at the end varied between 8 and 10 mms. The average was 9.16 mms +/- 2.58 and the extremes varied between 6 and 16 mms. In 29.8% of cases, the length of the portal vein was between 61 and 70 mms and in 8.8% between 81 and 100 mms. The average was 58.0 +/- 22.3 mms. Before its entry into the liver, the portal vein is divided into 3 branches in 2 cases (3.3%). The study showed a significant change of the length of the portal vein according the age and sex.