L'insuffisance cardiaque du patient du troisième age à Bamako: Présentation clinique, thérapeutique et évolution / Heart failure of the elderly in Bamako: Clinical presentation, treatment and evolution

But.Décrire la présentation clinique, les modalités thérapeutiqueset l'évolution de l'insuffisance cardiaque du sujet âgé à Bamako. Méthodologie.Il s'agissait d'une étude rétrospective allant du 1ejanvier 2007 au 30 novembre 2009. Un total de 166 sujets âgés de 60 ans et plus atteints d'IC ont été recrutés parmi 1300 malades hospitalisés en cardiologie au CHU du Point G à Bamako. Résultats.La prévalence hospitalière était de 12,8%. Le sex-ratio était de 1,72 en faveur des hommes. La tranche d'âge la plus touchée était celle de 60-69 (48,2 %). Outre l'âge avancé et la ménopause (pour les femmes), les facteurs de risque cardiovasculaire (FRCV) ci-après ont été retrouvés: l'hypertension artérielle (49,4%), le tabagisme(34,3%), le diabète (9,0%), l'obésité (7,2%) et l'alcoolisme(5,4%). La dyspnée était sévère,aux stades III de la NYHAdans 11,8%des cas et IV dans 83 %des cas. Le groupe nosologique le plus important était l'insuffisance cardiaque globale (66,1%), suivi de l'insuffisance cardiaque gauche (27,1%) et l'insuffisance cardiaque droite (7,8%). La fraction d'éjection était conservée chez 59 % des patients. Les causes identifiéesétaient hypertensives (38,6%), primitives(15,7%), ischémiques(14,5%), rythmiques(9,6%) et le cœur pulmonaire chronique(7,8%). Le traitement était le plus souvent classique. Le taux delétalité hospitalière était de10, 2%. Conclusion.L'IC du sujet âgé atteintle plus souvent les hommes. L'HTA et le tabagismesont les FRCV les plusfréquents. L'IC est en règle globale ou gauche. Les principales étiologies sont l'hypertension artérielle, la cardiomyopathie primitive et la cardiopathie ischémique. Le taux de mortalité hospitalière est de 10.2%. Le suivi régulier, l'éducation et une meilleure observance thérapeutique pourraient améliorer laqualité de vie et réduire la mortalité.

Purpose. To describe the clinical presentation, therapeutic modalities and evolution of heart failure (HF) in elderly subjects in Bamako. Methodology. This was a retrospective study from January 1, 2007 to November 30, 2009. A total of 166 subjects aged 60 and over with heart failure were recruited from 1300 inpatients at the cardiology department of CHU du Point G in Bamako. Results. In-hospital prevalence was 12.8%. The sex ratio was 1.72 in favor of men. The age group most affected was 60-69 (48.2%). In addition to advanced age and menopause (for women), the following cardiovascular risk factors (CVRFs) were found: arterial hypertension (49.4%), smoking (34.3%), diabetes (9.0%), obesity (7.2%) and alcoholism (5.4%). Dyspnea was severe, NYHA stage III in 11.8% of cases and stage IV in 83%. The largest nosological group was congestive heart failure (66.1%), followed by left heart failure (27.1%) and right heart failure (7.8%). Ejection fraction was preserved in 59% of patients. The causes identified were hypertensive (38.6%), primary (15.7%), ischemic (14.5%), rhythmic (9.6%) and chronic pulmonary heart disease (7.8%). Treatment was usually conventional.The hospital case-fatality rate was 10.2%. Conclusion. HFin the elderly most often affects men. Hypertension and smoking are the most frequent CVRFs. HFis usually global or left-sided. The main etiologies are arterial hypertension, primary cardiomyopathy and ischemic heart disease. The in-hospital mortality rate is 10.2%. Regular follow-up, education and better compliance with treatment could improve quality of life and reduce mortality

Evaluation de la qualité de vie après mastectomie pour cancer du sein au CHU Gabriel Touré / Evaluation of the quality of life after mastectomy for breast cancer at the Gabriel Touré university hospital

Les thérapeutiques oncologiques entraînent des répercussions sur la qualité de vie des patientes. Cette qualité de vie constitue un élément cardinal dans le parcours de soins de malades. Nous avons initié ce travail pour évaluer la qualité de vie après mastectomie. Matériel et méthode : Nous avons réalisé une étude transversale descriptive sur une période de 5ans allant de janvier 2016 à décembre 2020 au service de chirurgie générale au CHU Gabriel Touré. Nous avons inclus tous les patients opérés pour cancer du sein avec preuve histologique et ayant subi une mastectomie et acceptant de répondre au questionnaire. Résultat : Le questionnaire QLQC3O est une échelle spécifique au cancer utilisée pour établir le score sur la qualité de vie comme beaucoup d'autres mais à la différence d'être plus simple, facile d'utilisation et plus utilisé. Nous avons enregistré 79 cas de mastectomie pour cancer du sein. La prévalence de la mastectomie était de 5,8%. L'âge médian était de 58 ans. Les patientes avaient au moins un enfant dans 92,38%. Le carcinome canalaire de type non spécifique était le type histologique le plus fréquent avec 87,33%.Les effets secondaires de la mastectomie affectent le domaine des symptômes ont constitué l'étape la plus difficile à supporter avec p value non significatif. Ces situations ont sérieusement affecté l'estime de soi. Parmi les effets secondaires affectant la qualité de vie (52 cas), les troubles digestifs (22 cas) étaient au 1er plan suivis de dyspnée (7 cas) et des difficultés financières (8 cas) qui ont abouti à la vente de biens. Conclusion : La place de la qualité de vie reste incontestable dans la stratégie thérapeutique et son évaluation améliore quant au choix thérapeutique.

Oncology therapies have repercussions on the quality of life of patients. This quality of life is a cardinal element in the care pathway of patients. We initiated this work to assess the quality of life after mastectomy. Material and method: We carried out a descriptive cross-sectional study over a period of 5 years from January 2016 to December 2020 in the General Surgery Department of the Gabriel Touré University Hospital. We included all patients who had undergone surgery for breast cancer with histological evidence and who had undergone a mastectomy and agreed to answer the questionnaire. Results: The QLQC3O questionnaire is a cancer-specific scale used to establish the quality of life score like many others, but with the difference that it is simpler, easier to use and more widely used. We have recorded 79 cases of mastectomy for breast cancer. The prevalence of mastectomy was 5.8%. The median age was 58 years. Patients had at least one child 92.38%. Non-specific ductal carcinoma was the most common histological type with 87.33%.The side effects of mastectomy affect the area of symptoms were the most difficult stage to bear with p value not significant. These situations have seriously affected self-esteem. Among the side effects affecting quality of life (52 cases), digestive disorders (22 cases) were in the first place, followed by dyspnea (7 cases) and financial difficulties (8 cases) which resulted in the sale of goods. Conclusion: The place of quality of life remains undeniable in the therapeutic strategy and its evaluation improves the therapeutic choice

Diagnosis of paediatric TB using Xpert® MTB/RIF Ultra on fresh respiratory samples.

OBJECTIVE: To evaluate the diagnostic accuracy of Xpert® MTB/RIF Ultra (Ultra) on fresh respiratory samples for the diagnosis of pulmonary TB (PTB) in children.METHODS: Between July 2017 and December 2019, children with presumed TB were prospectively enrolled at clinical sites in three African countries. Children were assessed using history, physical examination and chest X-ray. Sputum or gastric aspirate samples were analysed using Ultra and culture. The diagnostic accuracy of Ultra was calculated against culture as the reference standard.RESULTS: In total, 547children were included. The median age was 4.7 years, 77 (14.1%) were HIV infected and 77 (14.1%) had bacteriologically confirmed TB. Ultra detected an additional 20 cases in the group of children with negative culture results. The sensitivity of Ultra was 66.3% (95% CI 47-82), and the specificity was 95.4% (95% CI 89-99) when assessed against culture as the reference standard.CONCLUSION: Despite the improved performance of Ultra as compared to Xpert as was previously reported, its sensitivity remains sub-optimal for the detection of TB in children. Ultra detected additional 20 cases which otherwise could not have been detected by culture alone, suggesting that the latter is an imperfect reference standard.

Isoniazid preventive therapy in child household contacts of adults with active TB in Bamako, Mali.

BACKGROUND AND OBJECTIVE: Isoniazid preventive therapy (IPT) is known to reduce the risk of developing active TB in about 59% in children aged ⩽15 years. We assessed adherence, completion and adverse events among children who were household contacts of a newly diagnosed adult with smear-positive TB in Bamako, Mali. METHODS: Children aged <15 years living in the same house with an adult smear-positive index case were enrolled in the study in the Bamako Region after consent was obtained from the parent or legal guardian. Adherence was assessed based on the number of tablets consumed during 6 months. RESULTS: A total of 260 children aged <15 years were identified as household contacts of 207 adult patients with smear-positive TB during the study period. Among all child contacts, 130/260 (50.0%) were aged 0-4 years and were eligible for IPT; 128/130 (98.5%) were started on IPT and 83/128 (64.8%) completed with good adherence at the end of the 6 months, and without any significant adverse events. CONCLUSION: We successfully implemented IPT with good acceptance, but low completion rate. The Mali National TB Program and partners should expand this strategy to reach more children in Bamako and the whole country and create greater awareness in the population.

CADRE ET OBJECTIF: Le traitement préventif par isoniazide (IPT) réduit le risque de développer une TB active chez environ 59% des enfants ⩽15 ans. Nous avons évalué l'observance, l'achèvement du traitement et les évènements indésirables chez des enfants qui étaient contacts domestiques d'un adulte ayant récemment reçu un diagnostic de TB à microscopie positive à Bamako, Mali. MÉTHODES: Les enfants âgés <15 ans vivant sous le même toit qu'un cas index adulte de TB à microscopie positive ont été inclus dans l'étude dans la région de Bamako, après obtention du consentement des parents ou du tuteur légal. L'observance a été évaluée en fonction du nombre de comprimés consommés au cours d'une période de 6 mois. RÉSULTATS: Au total, 260 enfants âgés <15 ans ont été identifiés comme contacts domestiques de 207 patients adultes atteints de TB à microscopie positive pendant la période d'étude. Parmi tous les contacts pédiatriques, 130/260 (50,0%) étaient âgés de 0­4 ans et étaient éligibles à l'IPT ; 128/130 (98,5%) ont été mis sous IPT et 83/128 (64,8%) ont achevé leur traitement avec une bonne observance à la fin de la période de 6 mois, sans évènement indésirable significatif. CONCLUSION: Nous avons mis en place l'ITP avec succès. L'acceptation était bonne mais le taux d'achèvement du traitement était faible. Le programme national de lutte contre la TB du Mali et ses partenaires devraient élargir cette stratégie afin d'inclure davantage d'enfants de Bamako et du pays, et d'accroître la sensibilisation de la population.

[Prevalence of the kidney disease at the emergency department of hospital Fousseyni Daou of Kayes]. / Prevalence de la maladie renale au service des urgences de l'hopital Fousseyni Daou de Kayes.

INTRODUCTION: Kidney disease (KD) is defined as a set of functional, morphological and histological kidney abnormalities. It is a truly global public health problem. Its prevalence is estimated to be 50 times that of end-stage renal disease (ESRD). In Kayes, there is no data on the prevalence of kidney disease, hence the interest of this study. OBJECTIVES: to determine the prevalence of renal disease, its main causes and the main factors of aggravation of this pathology in the emergency department at hospital Fousseyni DAOU of Kayes. METHODOLOGY: Retrospective cross-sectional study carried out from January 1, 2014 to February 1, 2015. We included all hospitalized patients in whom a renal damage marker (elevation of plasma creatinine, urinary sediment abnormality, ultrasound, histology and significant proteinuria) has been found. RESULTS: the prevalence of kidney disease was 9.9% (109/1099). Eighty-nine met the inclusion criteria. The study population was composed of 47 women (52.8%) and 42 men (47.2%), with a sex ratio of 0.89 in favor of women. The average age was 40.09 years with a predominance of patients in the age group [40-59]. The main reasons for consultation were hypercreatininaemia (48.3%), edematous syndrome (16.9%), low back pain (10.1%). High blood pressure (55.1%) and lower extremity edema (46.1%) were the medical history frequently found in our study. The kidney disease found was in order of growth: chronic renal failure (51%); acute renal failure (28%); proteinuria (16%), hematuria (3%), morphological abnormality of the kidneys (2%). Tubulointerstitial nephropathy represented 64% of acute renal failure with P = 0.000306. Vascular nephropathy constituted 46.7% of chronic renal failure with P = 0.000251. No cases of glomerular nephropathy were found in patients over 60 years of age.The most common causes were represented by nephrotoxic drugs injuries; infectious; high blood pressure and diabetes. The most observed aggravating factors are herbal medicine, urinary tract infections, renal hypoperfusion and unbalanced hypertension. CONCLUSION: kidney disease is not uncommon in the emergency room at Hospital Fousseyni Daou of Kayes. The most common causes are nephrotoxic drugs, hypertension and diabetes.

INTRODUCTION: La maladie rénale (MR) définie comme l'ensemble des anomalies rénales fonctionnelle, morphologique et histologique. Elle est un véritable problème mondial de santé publique. Sa prévalence serait 50 fois celle de l'insuffisance rénale terminale (IRT). A Kayes, il n'existe pas de donnée sur la prévalence de la maladie rénale, d'où l'intérêt de cette étude. OBJECTIFS: déterminer la prévalence de la maladie rénale, ses principales causes et les principaux facteurs d'aggravation de cette pathologie dans le service des urgences de l'hôpital Fousseyni DAOU de Kayes. MÉTHODOLOGIE: Etude transversale rétrospective réalisée du 1er janvier 2014 au 1er février 2015. Etaient inclus, tous les patients hospitalisés chez qui au moins un marqueur d'atteinte rénale (élévation de la créatinine plasmatique, anomalie du sédiment urinaire, anomalie échographique ou histologique et une protéinurie significative) a été retrouvé. Les paramètres analysés étaient socio-épidémiologiques, cliniques et para-cliniques. Nous avons exclu tous les patients dont les dossiers médicaux étaient inexploitables. RÉSULTATS: la prévalence de la maladie rénale était de 9,9% (109/1099). Quatre-vingtneuf répondaient aux critères d'inclusion. La population d'étude était composée de 47 femmes (52,8%) et de 42 hommes (47,2%), avec un sex-ratio de 0,89 en faveur des femmes. La moyenne d'âge était de 40,09 ans avec une prédominance des patients de la tranche d'âge [40-59]. Les principaux motifs de consultation étaient hypercréatininémie (48,3%), syndrome œdémateux (16,9%), douleur lombaire (10,1%). L'hypertension artérielle (55,1%) et œdème des membres inférieurs (46,1%) étaient les antécédents pathologiques fréquemment retrouvées dans notre étude. La maladie rénale retrouvée était par ordre de croissance : insuffisance rénale chronique (51%) ; insuffisance rénale aigue (28%) ; protéinurie (16%), hématurie (3%), anomalie morphologique des reins (2%). La néphropathie tubulo-interstitielle représentait 64% des insuffisances rénales aiguës avec P= 0,000306. La néphropathie vasculaire constituait 46,7% des insuffisances rénales chroniques avec P= 0,000251. Aucun cas de néphropathie glomérulaire n'a été retrouvé chez les patients de plus de 60 ans.Les causes les plus fréquentes étaient représentées par les causes toxiques (médicaments néphrotoxiques) ; infectieuses ; l'hypertension artérielle et le diabète. Les facteurs d'aggravations les plus observés sont la phytothérapie, l'infection urinaire, l'hypoperfusion rénale et l'HTA non équilibrée. CONCLUSION: la maladie rénale n'est pas rare aux urgences de l'hôpital Fousseyni Daou de Kayes. Les causes les plus fréquemment rencontrées sont les médicaments néphrotoxiques, l'HTA et le diabète.

[Drug-resistant tuberculosis with rifampicin in children co-infected with HIV in Bamako]. / Tuberculose resistante a la rifampicine chez un enfant co-infectepar le VIH a Bamako, Mali.

Drug-resistant tuberculosis, especially in children, is a major public health challenge. We report a case with rifampicin resistance diagnosed in an HIV co-infected in Bamako. The history of the disease suggests possible father-to-child transmission. After confirmation, MDR-TB treatment was initiated. Global improvement and normalization of biological parameters and X-Ray was obtained. The identification of this case highlights the need to improve diagnosticand treatment algorithms for rapid confirmation and better management.

La tuberculose pharmaco-résistante surtout de l'enfant représente un défi majeur de santé publique. Nous rapportons un cas avec résistance à la rifampicine chez un enfant séropositif au VIHà Bamako. L'histoire de la maladie suggère une possible transmission du père à l'enfant. Après la confirmation, l'enfant a été mis sous traitement de TB-MR. Une amélioration de son état général et une normalisation des paramètres biologiques et radiologiques a été observée. L'identification de ce patient met en évidence la nécessité d'améliorer les algorithmes de diagnostic et de traitement pour une confirmation rapide et une meilleure prise en charge.

[Contribution of the University Clinical Research Center's laboratoryin the diagnosis of SARS-CoV-2 in Mali]. / Contribution du laboratoire du Centre Universitaire de Recherche Clinique (UCRC) au diagnostic de SRAS-CoV-2 au Mali.

INTRODUCTION: The rapid diagnostic capacities of laboratories in Mali have been an essential element in the response to COVID-19. The University Clinical Research center (UCRC) diagnosed the first cases of Mali COVID-19. OBJECTIVE: The objective was to describe the contribution of the UCRC in the diagnosis of Covid-19 and to clinically and epidemiologically characterize the patients tested in the UCRC laboratory. MATERIALS AND METHODS: A cross-sectional study was conducted during eight months of intense activity. The samples were sent from the National Institute of Public Health (INSP) to the UCRC. RESULTS: The UCRC tested 12,406 contacts and suspected samples and confirmed the diagnosis in 1091 patients, or 9%. The most common symptoms were cough (48.78%), headache (34.14%), fatigue / weakness (34.14%), while (33.33%) of the patients were asymptomatic. The sample positivity rate among new cases decreased from May to September 2020, despite almost 230% of the number of samples tested. CONCLUSION: The laboratory played a major role in the response and there may be a low transmission of the virus in the Malian community.

INTRODUCTION: Les capacités de diagnostic rapide des laboratoires au Mali ont été un élément essentiel dans la riposte contre la COVID-19. Le Centre Universitaire de Recherche Clinique (UCRC)a diagnostiqué les premiers cas du Mali. OBJECTIF: Etait de décrire l'apport de l'UCRC dans le diagnostic de la Covid-19 et de caractériser cliniquement et épidémiologiquement les patients testés au laboratoire de l'UCRC. MATÉRIELS ET MÉTHODES: Une étude transversale a été conduite pendant huit mois d'activité intense. Les échantillons ont été envoyés de l'Institut National de Santé Publique (INSP) à l'UCRC. RÉSULTATS: L'UCRC a testé 12 406 échantillons contacts et suspects et a confirmé le diagnostic chez 1091 patients soit 9%. Les symptômes les plus rencontrés ont été la toux (48,78%), les maux de tête (34,14%), la fatigue/faiblesse (34,14%), tandis que (33,33%) des patients étaient asymptomatiques. Le taux de positivité des échantillons a diminué entre mai et août et avec une légère diminution en septembre 2020,avec près de 230% du nombre d'échantillons testés. CONCLUSION: Le laboratoire a joué un grand rôle dans la riposte et il y'aurait une faible transmission du virus dans la communauté Malienne.

Fluorescein diacetate and rapid molecular testing for the early identification of rifampicin resistance in Mali.

BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB.METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RR-TB.RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7-3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M (P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%.CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.

Performance of Mali's biosafety level 3 laboratory in the external quality assessment in preparedness of laboratory accreditation and support to clinical trials.

Background: The external quality assessment (EQA) or external quality control is an evaluation conducted by a certified external organization to inquire about the quality of the results provided by a laboratory. The primary role of EQA is to verify the accuracy of laboratory results. This is essential in research because research data should be published in international peer-reviewed journals, and laboratory results must be repeatable. In 2007, the University Clinical Research Center (UCRC's) biosafety level 3 (BSL-3) laboratory joined the EQA program with the College of American Pathologists in acid-fast staining and culture and identification of mycobacteria as per laboratory accreditation preparedness. Thus, after 11 years of participation, the goal of our study was to evaluate the performance of our laboratory during the different interlaboratory surveys. Methods: We conducted a descriptive retrospective study to evaluate the results of UCRC mycobacteriology laboratory from surveys conducted during 2007 and 2017. Results: Of the 22 evaluations, the laboratory had satisfactory (100% of concordance results) in 18 (81.8%) and good (80% of concordance results) in 4 (18.2%). Overall, the laboratory was above the commended/accepted limits of 75%. Conclusion: So far, UCRC's BSL-3 performed well during the first 11 years of survey participation, and efforts should be deployed to maintain this high quality in the preparedness for laboratory accreditation and support to clinical trials.

Diabetes Mellitus among new tuberculosis patients in Bamako, Mali.

INTRODUCTION: Diabetes Mellitus (DM) increases worldwide, mostly in low- and middle-income countries. In Mali, the prevalence in the adult population is estimated at 1.8%, but tuberculosis (TB) patients are not systematically screened. The goal of our study was to determine the prevalence of DM among newly diagnosed TB patients. METHODS: We conducted a cross sectional study and a pilot prospective cohort study in four health centers in Bamako. All patients underwent fasting capillary-blood glucose (FCBG) test at Day 0, and repeated after one-week of TB treatment. Venous FBG test was performed for discrepancies between the two FCBG results. Thereafter, FCBG was performed for pilot study at month-2 (M2) and M5 of TB treatment. RESULTS: Two hundred and one patients were enrolled in this study. Impaired fasting blood glucose was identified in 17 (8.5%), of whom 11 (5.5%) had DM (VFBG >7 mmol/L). Among patients with DM, seven (63.6%) had successful TB treatment outcome, versus 142 (74.7%) of those without DM (p = 0.64), and (OR: 1.69, 95%CI 0.47-6.02). CONCLUSION: The prevalence of DM among TB patients in Bamako exceeds that of the general population and screening at TB diagnosis suffices to identify those with DM. Systematic screening of both diseases will allow better treatment.

Pronostic des accidents thromboemboliques et hémorragiques sous AVK dans le service de cardiologie du CHU mère-enfant « Le Luxembourg »

But. Décrire la prise en charge des accidents thromboemboliques, hémorragiques sous AVK et décrire leur pronostic à court terme dans le service de cardiologie du CHU Mère-Enfant « le Luxembourg ». Matériels et méthodes. Il s'agit d'une étude transversale effectuée sur les patients hospitalisés ou suivis en ambulatoire, sous AVK et présentant une complication hémorragique ou thromboembolique, dans la période allant du 1er octobre 2017 au 30 juillet 2018, dans le service de cardiologie du CHUME. Les données ont été recueillies à l'aide des fiches d'enquête, au chevet des malades hospitalisés et au cours des visites de contrôle. Résultats. L'étude a porté sur 27 patients. Le risque thromboembolique a été important dans 78 % des cas, avec un risque hémorragique faible dans tous les cas. La fluindione a été la molécule la plus utilisée, avec un taux de 67 % et l'INR a été instable dans 89 % des cas. Quarante-un pourcent (41 %) des accidents hémorragiques et 60 % des accidents thromboemboliques ont été constatés au cours de la troisième semaine du traitement anticoagulant. Des accidents hémorragiques ont été notés dans 81 % des cas et leur prise en charge a été assurée par la vitamine K1, dans 63 % des cas. Il a été noté des embolies cérébrales dans 80 % des cas et leur prise en charge a été intégralement assurée par l'HBPM. Finalement, l'évolution des accidents sous traitement a été favorable dans 70 % des cas. Conclusion. Il a été donc constaté que les accidents hémorragiques et thromboemboliques sont survenus le plus souvent au cours de la troisième semaine du traitement anticoagulant et dans des proportions importantes. La prise en charge des accidents hémorragiques ; par la vitamine K, et des accidents emboliques ; par les HBPM, a permis d'obtenir généralement une évolution favorable

Clinical characteristics of non-tuberculous mycobacterial pulmonary infections in Bamako, Mali.

The global spread of non-tuberculous mycobacteria (NTM) may be due to HIV/AIDS and other environmental factors. The symptoms of NTM and tuberculosis (TB) disease are indistinguishable, but their treatments are different. Lack of research on the epidemiology of NTM infections has led to underestimation of its prevalence within TB endemic countries. This study was designed to determine the prevalence and clinical characteristics of pulmonary NTM in Bamako. A cross-sectional study which include 439 suspected cases of pulmonary TB. From 2006 to 2013 a total of 332 (76%) were confirmed to have sputum culture positive for mycobacteria. The prevalence of NTM infection was 9.3% of our study population and 12.3% of culture positive patients. The seroprevalence of HIV in NTM group was 17.1%. Patients who weighed <55 kg and had TB symptoms other than cough were also significantly more likely to have disease due to NTM as compared to those with TB disease who were significantly more likely to have cough and weigh more than 55 kg (OR 0.05 (CI 0.02-0.13) and OR 0.32 (CI 0.11-0.93) respectively). NTM disease burden in Bamako was substantial and diagnostic algorithms for pulmonary disease in TB endemic countries should consider the impact of NTM.

[Multidrug-resistant tuberculosis (MDR-TB) in a black African carceral area: Experience of Mali]. / Tuberculose multi-résistante (TB-MR) en milieu carcéral noir africain : expérience du Mali.

INTRODUCTION: Prison constitutes a risk factor for the emergence of multi-drug resistance of tuberculosis (MDR-TB). The aim of this work was to study MDR-TB in a black African carceral center. MATERIAL AND METHODS: Prospective study from January to December 2016 at the central house of arrest for men, Bamako. The study population was composed of tuberculous detainee. The suspicion of MDR-TB was done in any tuberculosis case remained positive in the second month of first-line treatment or in contact with an MDR-TB case. RESULT: Among 1622 detainee, 21 cases of pulmonary tuberculosis were notified (1.29%), with an annual incidence of 13 cases/1000 detainee, they were 16 cases of SP-PTB (microscopy smear positive tuberculosis) and five cases of microscopy smear negative tuberculosis. The mean age was 28±7 years, extremes of 18 and 46 years. A negative association was found between the notion of smoking and occupation in the occurrence of tuberculosis (OR=0.036, [95% CI: 0.03-0.04], P=0.03. Among the 21 tuberculosis cases notified, one confirmed case of MDR-TB was detected (4.7%). In the first semester of 2016 cohort, we notified a cure rate of 87.5% (7/8 SP-PTB cases), and the confirmed MDR-TB case on treatment (21-month regimen), evolution enameled of pulmonary and hearing sequelae at seven months treatment. CONCLUSION: It was the first case of MDR-TB detected in a prison in Mali. Late diagnosis, evolution is enameled of sequelae and side effects.

Performance of microscopic observation drug susceptibility for the rapid diagnosis of tuberculosis and detection of drug resistance in Bamako, Mali.

OBJECTIVES: In Mali early detection and treatment of multidrug-resistant tuberculosis (MDR-TB) are still challenging due to the cost, time and/or complexity associated with regular tests. Microscopic Observation Drug Susceptibility (MODS) is a low-cost assay validated by WHO in 2010. It is a liquid-culture-based assay to detect the 'cording' characteristic of Mycobacterium tuberculosis complex and to assess susceptibility to both isoniazid and rifampicin defining multidrug-resistant tuberculosis (MDR-TB). In this study we aimed to evaluate the performance of MODS as diagnostic tool compared with a validated method-Mycobacteria Growth Indicator Tube/Antimicrobial Susceptibility Testing/Streptomycin, Isoniazid, Rifampicin and Ethambutol (MGIT/AST/SIRE). METHODS AND RESULTS: Between January 2010 and October 2015 we included 98 patients with suspected TB in an observational cohort study. The sensitivity and specificity of MODS assay for detecting TB were respectively 94.12% and 85.71% compared with the reference MGIT/7H11 culture, with a Cohen κ coefficient of 0.78 (95% CI 0.517-1.043). The median time to culture positivity for MODS assay and MGIT (plus interquartile range, IQR) was respectively 8 days (IQR 5-11) and 6 days (IQR 5-6). In detecting patients with MDR-TB, the sensitivity and specificity of MODS assay were respectively 100% and 95.92%. The positive predictive value and negative predictive value were, respectively, 66.7% and 100%. The median turnaround times for obtaining MDR-TB results using MODS assay and MGIT/AST/SIRE was respectively 9 days and 35 days. Hence, the MODS assay rapidly identifies MDR-TB in Mali compared with the MGIT/AST/SIRE. CONCLUSION: As an easy, simple, fast and affordable method, the MODS assay could significantly improve the management of TB.

Establishing Reference Ranges of Hematological Parameters from Malian Healthy Adults.

INTRODUCTION: Measurement of immuno-hematological parameters has been historically helpful in the diagnosis and treatment monitoring of many infectious diseases and cancers. However, these parameters have not yet been established in many developing countries where patient care strongly relies on such low-cost tests. This study describes the immuno-hematological parameter ranges for Malian healthy adults. METHODS: A cross sectional study was conducted from August 2004 to May 2013. We included 213 healthy volunteers (173 male and 40 female), aged between 18-59 years. Median, 2.5 and 97.5 percentile ranges for each immuno-hematological parameter are presented. RESULTS: In our study population, the hematological parameters' ranges were mostly different to the universal established ranges. We found in our population a Median white blood cell (WBC) count of 5200 cells/µL [3237.5-11900], Red Blood Cell (RBC) count of 4.94 10^6 [3.56-6.17], hemoglobin (Hb) of 14.2 g/dL [12.2-17.38], platelet count (Plt) of 275 10^3/µL [145.4-614.4], lymphocytes 2050/µL [1200-3800], neutrophils 2200/µL [1040-6220]; monocytes 200/µL [100-660]; eosinophils 131/µL [0-1026]; CD4 902 cells/µL [444-1669] and CD8 485 cells/µL [0-1272]. We found significant gender differences in RBC, Hb level and MPV. However, RBC and Hb were higher in males median values compared to females (median values) (p<0.001), whereas the Mean platelet volume lower values (MPV) in males than females (P<0.047). The hemoglobin level for some West African countries (Mali, Burkina Faso, Togo, and Nigeria) ranged from 13.5 to 15.1 g/dL for males and 12 to 13 g/dL for females. However in East and Southern Africa, the values were anywhere from 14.1 to 16.1 for males and 11.2 to 14.4 for females. CONCLUSION: Our data may help physicians to better define hematological abnormalities in patients. They may also be used to define new "normal hematological values" in Malian population or in the whole West African population.

Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014.

BACKGROUND: Although Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the "blank" countries without systematic data. METHODS: Between 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance. RESULTS: A total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs. CONCLUSION: The drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment.

Tuberculosis specific responses following therapy for TB: Impact of HIV co-infection.

Characterizing perturbations in the immune response to tuberculosis in HIV can develop insights into the pathogenesis of coinfection. HIV+ TB+ and TB monoinfected (TB+) subjects recruited from clinics in Bamako prior to initiation of TB treatment were evaluated at time-points following initiation of therapy. Flow cytometry assessed CD4+/CD8+ T cell subsets and activation markers CD38/HLA-DR. Antigen specific responses to TB proteins were assessed by intracellular cytokine detection and proliferation. HIV+ TB+ subjects had significantly higher markers of immune activation in the CD4+ and CD8+ T cells compared to TB+ subjects. HIV+ TB+ had lower numbers of TB-specific CD4+ T cells at baseline. Plasma IFNγ levels were similar between HIV+ TB+ and TB+ subjects. No differences were observed in in-vitro proliferative capacity to TB antigens between HIV+ TB+ and TB+ subjects. Subjects with HIV+ TB+ coinfection demonstrate in vivo expansion of TB-specific CD4+ T cells. Immunodeficiency associated with CD4+ T cell depletion may be less significant compared to immunosuppression associated with HIV viremia or untreated TB infection.

Virology. Mutation rate and genotype variation of Ebola virus from Mali case sequences.

The occurrence of Ebola virus (EBOV) in West Africa during 2013-2015 is unprecedented. Early reports suggested that in this outbreak EBOV is mutating twice as fast as previously observed, which indicates the potential for changes in transmissibility and virulence and could render current molecular diagnostics and countermeasures ineffective. We have determined additional full-length sequences from two clusters of imported EBOV infections into Mali, and we show that the nucleotide substitution rate (9.6 × 10(-4) substitutions per site per year) is consistent with rates observed in Central African outbreaks. In addition, overall variation among all genotypes observed remains low. Thus, our data indicate that EBOV is not undergoing rapid evolution in humans during the current outbreak. This finding has important implications for outbreak response and public health decisions and should alleviate several previously raised concerns.

Analysis of cell identity, morphology, apoptosis and mitotic activity in a primary neural cell culture system in Drosophila.

In Drosophila, most neurogenetic research is carried out in vivo. Mammalian research demonstrates that primary cell culture techniques provide a powerful model to address cell autonomous and non-autonomous processes outside their endogenous environment. We developed a cell culture system in Drosophila using wildtype and genetically manipulated primary neural tissue for long-term observations. We assessed the molecular identity of distinct neural cell types by immunolabeling and genetically expressed fluorescent cell markers. We monitored mitotic activity of cell cultures derived from wildtype and tumorous larval brains. Our system provides a powerful approach to unveil developmental processes in the nervous system and to complement studies in vivo.

Molecular strain typing of Mycobacterium tuberculosis complex in Bamako, Mali.

OBJECTIVE: To identify strains of Mycobacterium tuberculosis complex (MTC) circulating in Bamako and to examine the relationship between the strains and their drug susceptibility profiles. METHODS: Between 2006 and 2010, we conducted a cross-sectional study using spoligotyping to identify strains of MTC recovered from 126 tuberculosis (TB) patients under treatment in Bamako, Mali. RESULT: Three members of the MTC were isolated: M. tuberculosis (71.4%), M. africanum (27.8%) and M. bovis (0.8%). Of these, three strains were found to be the most prevalent: M. tuberculosis T1 (MTB T1; 38.9%), M. africanum F2 (MAF2; 26.2%) and M. tuberculosis Latin American and Mediterranean 10 (MTB LAM 10; 10.3%). MAF2 and MTB LAM 10 strains have a lower risk of multidrug resistance (MDR) than MTB T1 (respectively OR 0.1, 95%CI 0.03-0.4 and OR 0.1, 95%CI 0.01-0.8). Age ≥ 32 years (OR 1.4, 95%CI 0.4-3.9), negative human immunodeficiency virus status (OR 0.4, 95%CI 0.1-2.5) and male sex (OR 4, 95%CI 0.9-16.5) were not associated with MDR. The prevalence of MDR among treatment and retreatment failure patients was respectively 25% and 81.8% compared to new patients (2.9%). CONCLUSION: This study indicates a low level of primary drug resistance in Bamako, affirms the importance of using correct drug regimens, and suggests that the MTB T1 strain may be associated with the development of resistance.