Association of haemolysis markers, blood viscosity and microcirculation function with organ damage in sickle cell disease in sub-Saharan Africa (the BIOCADRE study).

Sickle cell anaemia (SCA) is a monogenic disease with a highly variable clinical course. We aimed to investigate associations between microvascular function, haemolysis markers, blood viscosity and various types of SCA-related organ damage in a multicentric sub-Saharan African cohort of patients with SCA. In a cross-sectional study, we selected seven groups of adult patients with SS phenotype in Dakar and Bamako based on the following complications: leg ulcer, priapism, osteonecrosis, retinopathy, high tricuspid regurgitant jet velocity (TRV), macro-albuminuria or none. Clinical assessment, echocardiography, peripheral arterial tonometry, laboratory tests and blood viscosity measurement were performed. We explored statistical associations between the biological parameters and the six studied complications. Among 235 patients, 58 had high TRV, 46 osteonecrosis, 43 priapism, 33 leg ulcers, 31 retinopathy and 22 macroalbuminuria, whereas 36 had none of these complications. Multiple correspondence analysis revealed no cluster of complications. Lactate dehydrogenase levels were associated with high TRV, and blood viscosity was associated with retinopathy and the absence of macroalbuminuria. Despite extensive phenotyping of patients, no specific pattern of SCA-related complications was identified. New biomarkers are needed to predict SCA clinical expression to adapt patient management, especially in Africa, where healthcare resources are scarce.

[Platelet count in the steady state phase and clinical severity of sickle cell disease in a reference centre for sickle cell disease in Mali]. / Taux des plaquettes sanguines en phase intercritique et expressivité clinique de la drépanocytose dans un centre de référence de la drépanocytose au Mali.

Risk factors associated with complications occurring in sickle cell disease are not fully elucidated. The purpose of this study was to evaluate the existence of an association between the clinical severity of sickle cell disease and platelet count in the steady state phase in patients with sickle cell disease followed up at the Center for Research and Control of Sickle Cell Disease in Bamako, Mali. We conducted a retrospective review of 40 medical records of patients aged 5 to 42 years with sickle cell disease at the Center for Research and Control of Sickle Cell Disease in Bamako, Mali. Clinical severity of sickle cell disease was assessed according to the criteria of VOC and/or hospitalizations < 2 or ≥ 2 per year. Data entry was carried out using the Excel 2013 version. The statistical tests used were the Chi2, Student and Mac Nemar tests. Of the 40 patients, 82.5% had haemolytic phenotype and 17.5% hyperviscous phenotype; complications of sickle cell disease were more frequent in the haemolytic phenotype group (p < 0.05). There was a significant association between mean platelet count ≥ 450 G/L in the steady state phase and the annual number of CVOs ≥ 2 (p = 0.002). This study shows that mean platelet count ≥ 450 G/L in sickle cell patients in the steady state phase could be a risk factor for the frequent occurrence of CVO. It underlines the importance of conducting prospective studies focusing on both hyperplateletosis and platelet activation markers in larger sample sizes, as well as therapeutic trials involving platelet activation inhibitors, such as Crizanlizumab, a humanised anti-P-selectin monoclonal antibodies.

Preliminary study of the fungal ecology at the haematology and medical-oncology ward in Bamako, Mali.

Data on fungal epidemiology in sub-Saharan African countries are scarce. This exploratory study aimed to characterize the fungal flora at the Onco-Haematology ward of the National Teaching Hospital of Point G in Bamako, Mali. A cross-sectional survey was conducted in the dry and in the rainy seasons. Nasal swab and sputum samples were collected from the hospitalized patients while airborne fungal spores were collected using electrostatic dust-fall collectors. Fungi were identified by their morphological characteristics and MALDI-TOF mass spectrometry. Candida albicans was the most frequent yeast species colonizing patients; Aspergillus species were isolated in 86 % of the patients and were the main airborne environmental contaminants. Overall, airborne fungal contamination rates increased from 33.8 % in the dry to 66.2 % in the rainy season (p < 0.001). The most frequent Aspergillus species were Aspergillus niger (36.6 %) and Aspergillus flavus (32.92 %). In contrast, Aspergillus fumigatus (5.43 %) was relatively rare. This high level of fungal exposure raises concern regarding the management of at-risk patients in this Onco-Haematology ward and stresses the need for strengthening the mycological diagnostic capacities to accompany the implementation of adapted fungal infection prevention and management policies.

[Epidemiological and Clinical features of colorectal cancer at the hematology and oncology ward of Point G in Bamako, Mali, from 2005 to 2011: 113 cases]. / Particularites epidemiologiques et cliniques du cancer colorectal dans le service d'hematologie oncologie medicale du Point G de Bamako au Mali de 2005 a 2011: 113 cas.

AIMS: Epidemiological, clinical and biological characteristics of colorectal cancer vary across continents probably because of different risk factors that are not yet fully listed in countries with limited resources. This study describes the epidemiological and clinical features of colorectal cancer at a University hospital in Bamako, Mali. PATIENTS AND METHODS: A retrospective study that concerned the period from 2005 to 2011 was carried out. It included records of patients with colorectal cancer histologically documented in the service. Were analyzed epidemiological, clinical and biological data stored in files. RESULTS: One hundred-thirteen (113) cases of colorectal cancer were diagnosed representing 15% of all cancers documented over the 7 years. The number of cases increased year by year. The cases of colorectal cancer are not uncommon in young patients (23% under 30 years of age, 60% under 50). The male is significantly more represented in this population of colorectal carriers with a sex ratio M / F = 2. The time between first the symptom and care is long and the diagnosis is made in 85% of cases at a metastatic stage. Localization of the cancer is more frequent in the colon (56%) than in the rectum (44%). Cancer is an adenocarcinoma in 97% of cases. CONCLUSION: These epidemiological and clinical features invite practitioners to reconsider the concept of rarity of colorectal cancer in Africa and vigilance in front of a digestive disorder, even the patient is young, they also emphasize the need to conduct prospective studies to identify specific risk factors and develop appropriate strategies for the prevention and treatment of colorectal cancer in Mali.

BUT: Les caractéristiques épidémiologiques, cliniques et biologiques du cancer colorectal sont variables selon les continents, probablement à cause de facteurs de risque différents et non encore complètement répertoriés dans les pays à faibles moyens. Cette étude décrit les particularités épidémiologiques et cliniques du cancer colorectal dans un service hospitalier de référence spécialisé de Bamako au Mali. PATIENTS ET MÉTHODES: L'étude rétrospective a concerné la période de 2005 à 2011. Elle a inclus les dossiers des patients atteints de cancer colorectal documenté histologiquement. Ont été analysés, les données épidémiologiques, cliniques et biologiques enregistrées dans les dossiers. RÉSULTATS: Cent-treize (113) cas de cancer colorectal ont été colligés et représentaient 15% de l'ensemble des cancers diagnostiqués sur 7 ans. Ces cas étaient en augmentation d'année en année et s'observaient chez une population souvent jeune (23% avant 30 ans, 60% avant 50 ans). Le sexe masculin était significativement plus représenté, soit 2 hommes pour une femme. Le délai entre le premier symptôme et la prise en charge du malade était long avec dans 85% des cas, un diagnostic porté à un stade métastatique. La localisation était plus souvent colique (56%) que rectale (44%). Le cancer était un adénocarcinome dans 97% des cas. CONCLUSION: Ces particularités épidémiologiques et cliniques invitent à reconsidérer le concept de rareté du cancer colorectal en Afrique et à la vigilance de la part des praticiens devant un trouble digestif même chez un sujet jeune, ils soulignent aussi la nécessité de conduire des études prospectives pour identifier des facteurs de risque particuliers et élaborer les stratégies les mieux adaptées pour la prévention et la prise en charge du cancer colorectal au Mali.

High incidence of triple-negative tumors in sub-saharan Africa: a prospective study of breast cancer characteristics and risk factors in Malian women seen in a Bamako university hospital.

OBJECTIVE: Few studies have been conducted on breast cancer in Sub-Saharan Africa and their results have been suspected to be impaired by artefacts. This prospective study was designed to determine tumor and patient characteristics in Mali with control of each methodological step. These data are necessary to define breast cancer treatment guidelines in this country. METHODS: Clinical and tumor characteristics and known risk factors were obtained in a consecutive series of 114 patients. Each technical step for the determination of tumor characteristics [histology, TNM, grade, estrogen (ER) and progesterone receptors (PR), HER2, and Ki67] was controlled. RESULTS: Patients had a mean age of 46 years. Most tumors were invasive ductal carcinomas (94%), T3-T4 (90%) with positive nodes (91%), grade III (78%), and ER (61%) and PR (72%) negative. HER2 was overexpressed in 18% of cases. The triple-negative subgroup represented 46%, displaying a particularly aggressive pattern (90% grade III; 88% Ki67 >20%). CONCLUSION: This study demonstrates the high incidence of aggressive triple-negative tumors in Mali. Apart from a higher prevalence of premenopausal women, no significant difference in risk factors was observed between triple-negative tumors and other tumors. The hormonal therapy systematically prescribed therefore needs to be revised in light of this study.

[The malignant hemopathies in children: epidemiologic aspects in the Haematology and Medical Oncology Ward of Point G Hospital, Bamako, Mali (1996-2003)]. / Les hemopathies malignes de l'enfant: aspects epidemiologiques dans Le Service D'Hematologie Oncologie Medicale de L'Hopital Du Point G, Bamako, Mali (1996-2003).

Data from developed countries place the malignant hemopathies among the most frequent cancers in children. The epidemiologic and prognostic aspects of these diseases are not well known in developing countries notably in Africa sub-Saharan countries because of lack of registry and clinical collaborative studies. Nevertheless, the good progress in the management of paediatric diseases that were a big concerns in former times authorize to think that in future, these countries will be engaged in programs to fit malignant diseases as major health problems in children. A good knowledge of epidemiologic aspects of these diseases must be therefore an important concern. This study describes epidemiologic and prognosis particularities of malignant hemopathies in children diagnosed in a last referral hospital ward, Bamako, Mali (West Africa) during height years. Fifty-nine cases of malignant hemopathies were diagnosed by January 1996 to December 2003 in 19 females and 40 males. Data were analysed retrospectively with SPSS 11.0. These children were aged from 4 to 15 years and the modal class of age was 6-10 years. The mean recruitment of cases per year was 7.37. Lymphomas were more frequent (70%) particularly the Burkitt lymphoma. The Hodgkin's lymphoma was not observed under 5 years of age but represents 24% of cases over this age and was more frequent in male. This study emphasizes the need to put in place strategies for a better understanding of epidemiological aspects of malignant hemopathies in children and for developing policies to improve management and prevention of cases in Mali.