Projecting potential impact of COVID-19 on major cereal crops in Senegal and Burkina Faso using crop simulation models.

CONTEXT: The rapid emergence of COVID-19 could have direct and indirect impacts on food production systems and livelihoods of farmers. From the farming perspective, disruption of critical input availability, supply chains and labor, influence crop management. Disruptions to food systems can affect (a) planting area; and (b) crop yields. OBJECTIVES: To quantify the impacts of COVID-19 on major cereal crop's production and their cascading impact on national economy and related policies. METHODS: We used the calibrated crop simulation model (DSSAT suite) to project the impact of potential changes in planting area and grain yield of four major cereal crops (i.e., rice, maize, sorghum, and millet) in Senegal and Burkina Faso in terms of yield, total production, crop value and contribution to agricultural gross domestic product (GDP). Appropriate data (i.e., weather, soil, crop, and management practices) for the specific agroecological zones were used as an input in the model. RESULTS AND CONCLUSIONS: The simulated yields for 2020 were then used to estimate crop production at country scale for the matrix of different scenarios of planting area and yield change (-15, -10, -5, 0, +5, +10%). Depending on the scenario, changes in total production of four cereals combined at country levels varied from 1.47 M tons to 2.47 M tons in Senegal and 4.51 M tons to 7.52 M tons in Burkina Faso. The economic value of all four cereals under different scenarios ranged from $771 Million (M) to $1292 M in Senegal and from $1251 M to $2098 M in Burkina Faso. These estimated total crop values under different scenarios were compared with total agricultural GDP of the country (in 2019 terms which was $3995 M in Senegal and $3957 M in Burkina Faso) to assess the economic impact of the pandemic on major cereal grain production. Based on the scenarios, the impact on total agricultural GDP can change -7% to +6% in Senegal and - 8% to +9% in Burkina Faso. SIGNIFICANCE: Results obtained from this modeling exercise will be valuable to policymakers and end-to-end value chain practitioners to prepare and develop appropriate policies to cope or manage the impact of COVID-19 on food systems.

Genetic barrier to the development of resistance to rilpivirine and etravirine between HIV-1 subtypes CRF02_AG and B.

OBJECTIVES: It has been demonstrated for some drugs that the genetic barrier, defined as the number of genetic transitions and/or transversions needed to produce a resistance mutation, can differ between HIV-1 subtypes. We aimed to assess differences in the genetic barrier for the evolution of resistance to the second-generation non-nucleoside reverse transcriptase inhibitors etravirine and rilpivirine in subtypes B and CRF02_AG in antiretroviral-naive patients. METHODS: An analysis was undertaken of 25 substitutions associated with etravirine and rilpivirine resistance at 12 amino acid positions in 267 nucleotide sequences (136 HIV-1 B and 131 HIV-1 CRF02_AG subtypes) of the reverse transcriptase gene. RESULTS: The majority (7/12) of amino acid positions studied were conserved between the two HIV-1 subtypes, leading to a similar genetic barrier. Different predominant codons between the subtypes were observed in 5/12 positions (90, 98, 179, 181 and 227), with an effect on the calculated genetic barrier only at the V179D and V179F codons (2.5 versus 3.5 for V179D, and 2.5 versus 5 for V179F, respectively, for subtype B versus subtype CRF02_AG). CONCLUSIONS: The majority of amino acids involved in etravirine and rilpivirine resistance showed a high degree of conservation of the predominant codon between the B and CRF02_AG subtypes. For rilpivirine, the genetic barrier was the same between the two subtypes. Nevertheless, subtype CRF02_AG showed a higher genetic barrier to acquiring mutations V179D and V179F (mutations associated with resistance to etravirine) compared with subtype B, suggesting that it would be more difficult to produce resistance to etravirine in the CRF02_AG subtype than the B subtype.

[Determinants of low birth weight among newborns to HIV-infected mothers not eligible for antiretroviral treatment in Africa]. / Déterminants du faible poids de naissance chez des enfants nés de mères séropositives pour le VIH, non éligibles au traitement antirétroviral, en Afrique.

BACKGROUND: Low birth weight (LBW) increases the risk of infant death, but little is known about its rate and determinants among babies born to HIV-infected mothers in sub-Saharan Africa. METHODS: This study was conducted in South Africa, Burkina Faso, Uganda and Zambia, during the recruitment process of the PROMISE-PEP (ANRS 12174) clinical trial. The study sample included 1196 subjects screened between August 2009 and December 2011, respectively 254 in South Africa, 221 in Burkina Faso, 197 in Uganda and 524 in Zambia, all ineligible for antiretroviral therapy. Data were collected during ANRS12174 clinical trial antenatal and postnatal screening visits, and during an inclusion visit for completion of an electronic case report form (eCRF). RESULTS: The mean (±SD) age of mothers was 27±5years and their mean CD4 count was 576±195cells/µL. Most mothers lived in a couple (78.7%), had no employment (72.3%) and had a good level of education (74% had gone to school). Male newborns predominated (51.7%). The mean birth weight was 3043g±435g, and 7.8% ([95%CI: 6.3%-9.3%]) of newborns weighed less than 2500g. In univariate analyses, being married or cohabiting, body mass index, WHO HIV disease stage II, female newborn and low gestational age were associated with risk of LBW. In multivariate regression model, low gestational age (aOR=3.74, P<0.0001) and female newborn (aOR=1.63, P=0.04) were significantly associated with LBW. CONCLUSION: The risk factors for LBW found in HIV-infected women ineligible for antiretroviral therapy were the same as in the general population. There was no evidence of additional risk factors associated with HIV infection.

Increased susceptibility of Pseudomonas aeruginosa to macrolides and ketolides in eukaryotic cell culture media and biological fluids due to decreased expression of oprM and increased outer-membrane permeability.

BACKGROUND: Macrolides show high minimum inhibitory concentrations (MICs) against Pseudomonas aeruginosa when tested in recommended media (cation-adjusted Muller-Hinton broth [CA-MHB]). Nevertheless, azithromycin is successfully used in cystic fibrosis patients, supposedly because of "nonantibiotic effects." METHODS: CA-MHB and Roswell Park Memorial Institute (RPMI) 1640 medium (used for growing eukaryotic cells) were compared for measuring azithromycin MICs (with or without Phe-Arg-ß-naphthylamide [PAßN], an efflux inhibitor), [(14)C]-clarithromycin accumulation, azithromycin-induced protein synthesis inhibition, oprM (encoding the outer-membrane protein coupled with MexAB and MexXY efflux systems) expression, outer-membrane permeability (tested with 1-N-phenylnaphthylamine and nitrocefin), and synergy (determined by checkerboard assay) between azithromycin and outer-membrane disrupting agents. Key experiments were repeated with CA-MHB supplemented with serum, mouse bronchoalveolar lavage fluid, other macrolides, and other gram-negative bacteria. RESULTS: Azithromycin MICs were ≥128 mg/L in CA-MHB, compared with 1-16 mg/L in RPMI 1640 medium, CA-MHB supplemented with serum, or bronchoalveolar lavage fluid (repeated for RPMI 1640 medium with clarithromycin, other macrolides, and other gram-negative bacteria). [(14)C]-clarithromycin accumulation was 2.2-fold higher in RPMI 1640 medium, compared with CA-MHB. Inhibition of >95% of protein synthesis was obtained with azithromycin at 16 mg/L in RPMI 1640 medium, compared with >512 mg/L in CA-MHB. Strains not expressing oprM showed an MIC of 4 mg/L in CA-MHB. PAßN decreased MICs in CA-MHB but not in RPMI 1640 medium. Real-time polymerase chain reaction showed downregulation of oprM by azithromycin in RPMI 1640 medium. Outer-membrane permeability was 3-4.5 times higher in RPMI 1640 medium or bronchoalveolar lavage fluid, compared with CA-MHB. Azithromycin combined with outer-membrane disrupting agents were synergistic in CA-MHB but indifferent in RPMI 1640 medium. CONCLUSIONS: Macrolides show antimicrobial activity against P. aeruginosa in eukaryotic media through increased uptake and reduced efflux. These data may help explain the clinical efficacy of macrolides against pseudomonal infections.

[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.

[Osteo-Articular Complications Of Hemoglobinosis S And C In Children Of Pediatric Age At The University Hospital Of Bobo-Dioulasso]. / Les Complications Osteo-Articulaires Des Hemoglobinoses S Et C Chez Les Enfants En Age Pediatrique Au Centre Hospitalier Universitaire De Bobo-Dioulasso.

INTRODUCTION: Sickle cell disease is the most common hemoglobinopathy in the world. Serious in its major form (SS), it exposes the sickle cell subject to osteoarticular complications that can be early and disabling. OBJECTIVE: The objective of this study was to contribute to a better understanding of the osteoarticular complications of hemoglobinopathy S and C in pediatric settings. MATERIAL AND METHOD: It was a retrospective cross-sectional study, conducted over a period of 3 years, from January 1, 2017 to December 31, 2019. Were included, children aged 0 to 15 years with hemoglobin S or C confirmed by electrophoresis and having an osteo-articular complication. RESULTS: The analysis focused on 42 cases including 24 boys and 18 girls. The median age was 7.5 years. Functional impotence and fever were the main clinical signs observed. Osteomyelitis was the majority diagnosis (59.6%). Hemoglobin electrophoresis found 33.3% SS hemoglobin and 21.4% SC hemoglobin. Staphylococcus aureus was the main germ isolated from the samples. Radiological lesions were multifaceted and dominated by the periosteal reaction. Management based mainly on orthopedic treatment allowed a favorable evolution in 69% of cases. The average length of hospitalization was 23.78 days. CONCLUSION: Osteoarticular complications of hemoglobinopathies S and C are not exceptional. Of chronic and sometimes disabling course, their management requires a preventive approach of primary and secondary type of sickle cell disease.

INTRODUCTION: La drépanocytose est l'hémoglobinopathie la plus fréquente dans le monde. Grave dans sa forme majeure (SS), elle expose le sujet drépanocytaire à des complications ostéo-articulaires qui peuvent être précoces et invalidantes. OBJECTIF: L'objectif de cette étude était de contribuer à une meilleure connaissance des complications ostéo-articulaires des hémoglobinoses S et C en milieu pédiatrique. MATÉRIEL ET MÉTHODE: Il s'est agi d'une étude transversale, descriptive et rétrospective, conduite sur une période de 3 ans, allant du 1er janvier 2017 au 31 décembre 2019. Ont été inclus, les enfants âgés de 0 à 15 ans porteurs d'une hémoglobine Sou C confirmée par l'électrophorèse et ayant une complication ostéo-articulaire. RÉSULTATS: L'analyse a porté sur 42 cas dont 24 garçons et 18 filles. L'âge moyen était de 7,5 ans. L'impotence fonctionnelle et la fièvre étaient les principaux signes cliniques observés. L'ostéomyélite était le diagnostic majoritaire (59,6%). L'électrophorèse de l'hémoglobine retrouvait 33,3% de phénotypes SS et 21,4% phénotypes SC. Le staphylocoque doré a été le principal germe isolé dans les prélèvements. Les lésions radiologiques étaient multiformes et dominées par la réaction périostée. La prise en charge basée principalement sur le traitement orthopédique a permis une évolution favorable dans 69% des cas. La durée moyenne d'hospitalisation était de 23,78 jours. CONCLUSION: Les complications ostéo-articulaires des hémoglobinoses S et C ne sont pas exceptionnelles. D'évolution chronique et parfois invalidante, leur prise en charge passe par une approche préventive de type primaire et secondaire de la drépanocytose.

[Internal Hemorroïd Disease In Digestive Endoscopy Center Of Chu Gabriel Toure Of Bamako]. / La Maladie HemorroïDaire Interne Au Centre D'Endoscopie Digestive Du Chu Gabriel Toure De Bamako.

the goal of this study was to investigate the internal hemorroid disease in our endoscopic center. METHOD: This transversal study went from December 2011 to December 2012. RESULTS: Sixty cases of internal hemorroid desease were enroled with36 men and 24 women and a middle age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pain (58.3%) and hemorrhoid prolapsed (18.3%). The anal and rectum scopy found only internal hemorrhoid in 78.4% of cases and the grade I was about 81.7% of cases. All patients were beneficied of medical treatement. CONCLUSION: hemorrhoid disease is a frequent pathology in general population mainly around third decade.

le but de ce travail était d'étudier la maladie hémorroïdaire interne. MÉTHODE: Il s'agissait d'une étude transversale déroulée au centre d'endoscopie digestive du CHU Gabriel Touré de Décembre 2011 à décembre 2012. RÉSULTATS: Nous avons colligé 60 cas de maladie hémorroïdaire interne dont 36 hommes et 24 femmes avec un âge moyen de 47 ±14,4 ans. Le tableau clinique était dominé par le saignement (66,7 %), la constipation (58,4 %), la douleur anale (58,3%) et le prolapsus hémorroïdaire (18,3%). L'anorectoscopie réalisée objectivait des hémorroïdes internes isolées dans 78,4% des cas et le stade I de la maladie était observé dans 81,7% des cas. Tous les patients ont bénéficié d'un traitement médical. CONCLUSION: La maladie hémorroïdaire est une pathologie relativement fréquente dans la population générale surtout vers la troisième décade.

[Neuromeningeal cryptococcosis in Mali]. / La cryptococcose neuro-méningée au Mali.

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.

[Repair of palatal fistulae in cleft patients]. / Fermeture des fistules palatines séquellaires de fentes.

OBJECTIVES: Treatment of oronasal fistulae in cleft patients remains a surgical challenge because of its high failure rate. The authors report the results of an aggressive surgical technique using the total elevation of palatal mucoperiosteum, even for small fistulae. METHODS: This approach was used on twelve consecutive patients, from five to 33 years of age, presenting with a Pittsburgh classification type IV palatal fistulae. The surgical procedure was total elevation of the hard palate mucoperiosteum starting from the dental sulcus combined with sealed double layer sutures. Clinical and photographical control was made at least 6 months after to detect a possible relapse. RESULTS: The success rate was 100%. No relapsing fistula was observed with follow-up ranging from 6 to 36 months. DISCUSSION: This technique allows wide exposure and safe closure of the nasal layer. It is simple and leaves no raw bone surface exposed and no additional scar. The authors think it can be used in all type IV fistulae less than 1cm wide. Several other surgical techniques have been described to close palatal fistulae: local turnover flaps, pedicled flaps from adjacent oral tissue, tongue flaps, tissue expansion, and even free flaps. Obturator prostheses have also been used. The technique we report, even if more aggressive, seems to be more reliable with fewer relapse and sequelae.

Case report: a rare case of NOMA (cancrum oris) in a Malian woman.

Noma or cancrum oris is a multi-bacterial and opportunistic infection that destroys soft tissue, as well as muscle and bone, and can be fatal. We present a rare case of Noma in a 32-year-old Malian woman, from whom we isolated an Escherichia coli extended-spectrum beta-lactamase.

High level of primary drug resistance in Mali.

BACKGROUND: As access to antiretroviral drugs increases in developing countries, it will become increasingly important to monitor the emergence of resistance and to define the molecular pathways involved to identify optimal therapeutic regimens. METHODS: We performed genotypic resistance testing on plasma obtained from 101 HIV-infected treatment-naïve individuals from Mali. Genotyping was carried out using the Virco protocols and HXB2 was used as the reference strain. RESULTS: CRF02_AG was the most common subtype, present in 71.3% of our patient population. Other subtypes included B, C, G, CRF06_CPX, CRF09_CPX, CRF01_AE, A2/CRF16_A2D, A1 and CRF13_CPX. A total of 9.9% [95% confidence interval (CI) 6.9-12.9%] of patients had at least one resistance mutation. The prevalences of mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 5% (95% CI 0.7-9.2%), 6% (95% CI 1.3-10.6%) and 0%, respectively. The most frequent mutations were T215A/Y for NRTIs and K103N/T for NNRTIs. One patient harboured three NRTI resistance mutations and one NNRTI mutation. This is the first reported case of multi-drug-resistant viral transmission in Mali. Polymorphisms at protease codons 10I/V and 33F potentially associated with resistance were observed in 18.8% and 1% of patients, respectively. Several polymorphisms in the C-terminal domain of reverse transcriptase were observed: A371V (in 63.4% of patients), G335D (76.2%), E399D (10.9%) and G333E (1%). CONCLUSION: Primary resistance was seen in 9.9% of subjects, which is higher than previously reported in Mali. Taking into consideration other polymorphisms in protease such as L10I/V and 33F, primary resistance could reach 28.7% (95% CI 19.9-37.5%). Our study reflects the need to monitor the evolution of resistance on a regular basis and trends of transmitted resistance.

[Representation of illness in Mandingo society]. / La représentation de la maladie dans la société mandingue.

The Mandingo people are a 10-million strong ethnic group spread over several countries in West Africa but sharing a common culture. In Mandingo society that is permeated by a notion of sacredness, illness is represented in a much different way from contemporary European society. Because health is integrated into the social and religious structure, illness is associated with interpretations and preventive rules of conduct. For Western medical teams working in Mandingo communities, knowledge of these cultural implications is essential to establishing a good relationship with patients and to ensuring quality of care.

The effect of combined tobramycin-clarithromycin on Mycobacterium tuberculosis isolates.

This study investigated the susceptibility of 25 Mycobacterium tuberculosis clinical isolates to tobramycin (TBM) and clarithromycin (CLM). The effect of the drugs administered together was examined for possible synergistic effect. The median minimum inhibitory concentration (MIC) for both drugs was 8 mug/ml. In 36% of the isolates, a decrease of the CLM MIC by a single or two-fold dilution was observed when a sub-inhibitory concentration of TBM was added. The results suggest that both drugs should be investigated further as potential adjuncts to the treatment of resistant tuberculosis, in particular through new drug delivery systems such as the dry powder inhaler allowing high lung deposition.

[Benign cartilaginous tumors of the jaws]. / Tumeurs cartilagineuses bénignes des mâchoires.

Benign cartilaginous tumors are a rare entity in jaw bones. The histogenesis is still discussed but an embryological hypothesis is suggested. Chondroma, osteochondroma, chondroblastoma and chondromyxoid fibroma are the main benign maxillary cartilaginous tumors.

[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.

[Prevalence Of Tooth Decay In Children From Age 3 To 14 At The Department Of Odontology Of Militairy Hopital Of Bamako (IHB) In Mali]. / Prevalence De La Carie Dentaire Chez Les Enfants De 3 A 14 Ans Dans Le Service D'Odontologie De L'Infirmerie Hopital Militaire De Bamako (IHB) Au Mali.

This was a cross-sectional, descriptive study lasting 8 months from 20 January to 20 September 2013, carried out in the Department of Dentistry of the Bamako IHB Military Hospital. Thus, out of 263 children surveyed, 178 cases of tooth decay were recorded, ie 67.68%. Females accounted for 97 cases or 54.49% with a sex ratio of 1.2; the 3- to 6-year age group accounted for 72 cases, or 40.45%. School children accounted for 85.39% of cases. The children who brushed represent 168 cases or 94.38%. Those who brushed once were the most represented with 145 cases or 86.30%. Almost all patients had consulted for swelling and pain. The group of lower right and left lower temporal molars were the most represented with respectively 24.71% and 28.09%. Temporary teeth were 103 (71.0%) were mainly the most affected. Stage 3 caries known as pulp according to the classification of early childhood caries represented 145 cases, ie 81.46%. The lower jaw represented 142 cases, ie 77.76%. Oral health plays an important role in children to maintain oral functions. It is necessary for eating, developing speech and a positive self-image. It is therefore time to focus on education campaigns, information for behavioral change in oral hygiene and the use of anti-caries adjuvants in children.

Il s'agissait d'une étude transversale, descriptive d'une durée de 8 mois allant du 20 Janvier au 20 Septembre 2013 réalisée dans le service d'Odontologie de l'Infirmerie Hôpital Militaire de Bamako IHB. Ainsi, Sur 263 enfants enquêtés 178 cas de carie dentaire ont été recensés soit une prévalence de67,68 %. Le sexe féminin a représenté 97 cas soit 54,49 % avec un sexe ratio de 1,2. La tranche d'âge de 3 à 6 ans a représenté 72 cas soit 40,45 %.Les enfants scolarisés ont représenté 85,39 % des cas. Les enfants qui se brossaient représentent 168 cas soit 94,38 %. Ceux qui se brossaient une fois ont été les plus représentés avec 145 cas soit 86,30%. La quasi-totalité des patients avaient consulté pour tuméfaction et douleur.Le groupe des molaires temporaires inferieures droite et gauche ont été les plus représentées avec respectivement 24,71% et 28,09 %.Les dents temporaires soient 103 (71,0%) ont été principalement les plus affectées. La carie du stade 3 dite pulpaire selon la classification de la carie de la petite enfance a représenté 145 cas soit 81,46 %. Le maxillaire inferieur a représenté 142 cas soit 77,76%.La santé bucco-dentaire joue un rôle important chez les enfants pour maintenir les fonctions orales. Elle est nécessaire pour manger, développer la parole et une auto-image positive. Il est donc temps de mettre l'accent sur les campagnes d'éducation, information pour un changement de comportement face à l'hygiène bucco-dentaire et à l'utilisation des adjuvants anti carieux chez les enfants.

[Hyperthyroidism in children. Experience in internal medicine in Mali]. / Hyperthyroïdie chez l'enfant. Expérience d'un service de médecine interne au Mali.

INTRODUCTION: Thyroid pathology is frequent in Mali, which is an endemic zone for goiter. But this pathology rarely occurs in children. The purpose of our study was to characterize this illness among children in Mali. METHODS: We report on patients aged less than 15-year old who presented with clinical signs and symptoms with hyperthyroidism at the medicine service at Hospital de Point G from January 1999 and December 2005 to determine the characteristics of hyperthyroidism. RESULTS: The frequency was 9.6 per thousand (38/3972), with an average age of 12.5+/-3.34-year. The sex ratio was 3 girls/1 boys. The most common symptoms were tachycardia (n=30, 78.9%), palpitations (n=15, 34.4%). 31 patients (81.5%) presented with exophthalmoses, 93.5% being bilateral. Weight loss was present in 31.5% (n=12). Goiter was present in 37 patients (97.4%). The goiter was diffuse in 27 patients (73%) and nodular in 10 (27.%). The presence of goiter caused signs of compression in the neck in half of the cases: dyspnea and dysphonia were the most common consequences. TSH less than 0.05 microUI/1 was used to confirm the diagnosis. Graves's disease was the most common cause (n=32, 84.2%), followed by toxic adenoma (n=4, 10.5%). Other causes included toxic multinodular goiter and thyroiditis. Etiologies were independent of sex and age: (p=0.95). All patients were started on medical therapy upon diagnosis. 7 patients (18.4%) were lost to follow-up during the 6 months of treatment. Remission was obtained in 26 patients (83.9%), and relapse occurred in 5 patients (16.1%). CONCLUSION: The frequency of hyperthyroidism in children in Mali is a problem in a goiter endemic zone like Mali. Poor general health in children and signs and symptoms of neck compression are markers of progressive disease.

[Serological markers of viral hepatitis B and C in children with sickle cell disease monitored in the Pediatrics Department at the University Hospital of Bobo-Dioulasso (Burkina Faso)]. / Étude des marqueurs sérologiques des hépatites virales B et C chez les drépanocytaires suivis en pédiatrie au CHU de Bobo-Dioulasso (Burkina Faso).

Viral hepatitis B and C are universal public health problems. Burkina Faso is a high endemic area for hepatitis B. Patients with sickle cell disease are at risk. The aim of this study was to investigate and quantify the serological markers of viral hepatitis B and C among pediatric patients with sickle cell disease. This was a descriptive cross-sectional study, which took place from July to November 2014 at the Department of Pediatrics, University Hospital of Bobo- Dioulasso. The study included 44 SS and 26 SC sickle cell patients. General data (age, gender) and medical information (vaccinations, medical history including transfusion) were collected. Blood samples were taken for research and titration of serological markers of hepatitis viruses B and C with a commercial Elisa test on the ARCHITECT i1000® automat of Abbott Laboratories. The mean age of the patients was 7.98 years. Seventeen patients (13 SS and SC 4) had already been transfused at least once. The transfusion rate was significantly higher among the SS patients than among SC (29.5% and 15.3% respectively) patients. No patient with HBs Ag was been found. In two patients, the anti-HBc Ab was found alone. In 33% of cases, no markers of hepatitis B were found. Less than 20% of children fully vaccinated (N = 45) had a protective level of anti-HBs Ab (greater than 10 IU/l). The prevalence of anti-VHC Ab was 2.8%. No case of HBV-HCV co-infection was found. The prevention of infection is an important part of the management of sickle cell patients. Immunization against hepatitis B should be systematic. The results of this study assume that blood safety was good.

Tetanus associated with road accidents in the infectious diseases department of Point G University Hospital, Bamako, Mali.

The aim of this study was to describe the epidemiological, clinical, and prognostic aspects of tetanus associated with road accidents and to make recommendations. This observational study collected retrospective clinical data over a 9-year period about adults admitted for trismus and/or generalized or localized paroxysm after a road accident. The study included 25 patients, accounting for 22.12 % of all tetanus cases. Men were massively overrepresented (sex-ratio M/F: 24/1). The median age was 34 ± 8 years. In all, vaccination status was unknown for 4 patients and known to be negative for 21. Immunoprophylaxis was nonexistent in all cases. The generalized clinical form was dominant (96 %). Severity reached level III for 12 % of patients. The points of entry included open leg fractures (4 cases), head wounds (2), mucocutaneous wounds (14), and muscle contusions (5). The mean time to referral for tetanus was 8 ± 7 days, and the median hospital stay 9.08 ± 11 days. Patients were mostly residents of urban (56 %) and suburban areas (28 %) [P = 0.04]. Two cases were complicated by severe malaria. The mortality rate was 60 %, and 52 % of the deaths occurred within the first 72 hours after hospitalization. It is essential to promote serum therapy and tetanus immunization for patients after road accidents. Increasing the awareness of traditional healers of these treatments deserves consideration.

[Evolution of severe pediatric malaria in Togo between 2000 and 2002]. / Evolution du paludisme grave de l'enfant au Togo de 2000 à 2002.

The aim of this study was to analyse the clinical and evolutive aspects of severe malaria in hospitalised children in 2000, 2001, and 2002 in Togo. The study included 361 children in the pediatrics department of Lomé-Tokoin University hospital. All them received a 10% dextrose infusion, then an infusion of quinine or intramuscular artemether. Malaria accounted for 4.37% of all hospitalizations. Children aged 1 to 5 years were more affected (69.53%). The most frequent clinical forms were anaemia (55.7%) followed by cerebral manifestations. The frequency of hemoglobinuria increased (17.2%) as well as renal failure (3%) compared to previous years. Thirty-five children died (9.7%). Most of them presented with anaemia, neurological manifestations, or respiratory distress. Neurological sequels were present in 2.2% of patients.