[Epidemiological And Clinical Aspects Of Obesity In The Medicine And Endocrinology Service Of Mali Hospital]. / Aspects Epidemiologique Et Clinique De L'Obesite Dans Le Service De Medecine Et D'Endocrinologie De L'Hopital Du Mali.

INTRODUCTION: Lifestyle changes have played an important role in increasing the prevalence of obesity. The objectives were to describe the epidemiological, clinical and progressive aspects of obesity in patients of the Mali hospital. PATIENTS AND METHOD: this is a descriptive study with retrospective collection of data from the medical records of patients hospitalized in the Medicine and Endocrinology department. Our patients benefited from weight gain, height, waist measurement and hip measurement with calculation of the body mass index. RESULTS: the study concerned 90 obese patients out of 1515 hospitalized (5.94% of frequency). The mean age was 42 ± 5 with extremes 10 and 74. The sex ratio was 0.38. Obesity was mixed: 75.4% of men, 60% of woman; Android in 36% of men, 18% of women and the only child aged 10 had morbid obesity. The reason for hospitalization was complications of obesity in 13.30%. The psychological reactions collected were: anxiety 54.40%, indifference 40% and shame 5.60%. There were 68.90% complications including 37.80% cardio metabolic (hypertension associated in 51.10%). The lipid assessment carried out showed hyper LDLdemia: 70%; HDL hypoemia: 67.80%, hyper triglyceridaemia: 66.70%. Our patients received dietary and dietary advice. No drug or surgical treatment has been initiated despite the indication. We recorded 3.30% of deaths. CONCLUSION: The epidemiological and clinical description, diagnosis and evaluation of the repercussions of obesity are easy in our daily practice. However, care remains insufficient due to the inadequacy of the technical platform, the lack of financial means and the prejudices of our patients (ignorance of obesity as a disease).

INTRODUCTION: Le changement du mode de vie a joué un rôle important dans l'augmentation de la prévalence de l'obésité. Les objectifs étaient de décrire les aspects épidémiologiques, cliniques et évolutifs de l'obésité chez les patients de l'hôpital du Mali. PATIENTS ET MÉTHODE: il s'agit d'une étude descriptive avec recueil rétrospectif des données à partir des dossiers médicaux des patients hospitalisés dans le service de Médecine et d'Endocrinologie. Nos patients ont bénéficié d'une prise de poids, de la taille, du tour de taille et du tour de hanche avec calcul de l'indice de masse corporelle. RÉSULTATS: l'étude a concerné 90 patients obèses sur 1515 hospitalisés (5.94% de fréquence). L'âge moyen était 42 ans ± 5 avec des extrêmes 10 et 74 ans. Le sex - ratio était de 0,38. L'obésité était de type mixte : 75.4% des hommes, 60% de femme ; androïde chez 36% des hommes, 18% de femme et la seule enfant âgée de 10 ans avait une obésité morbide. Le motif d'hospitalisation était les complications de l'obésité dans 13,30 %. Les réactions psychologiques recueillies étaient : l'inquiétude 54.40%, l'indifférence 40% et la honte 5.60%. Il y avait 68.90% de complications dont 37.80% cardio métaboliques (HTA associée dans 51.10%). Le bilan lipidique réalisé montrait une hyper LDLdémie : 70% ; une hypo HDLdémie : 67.80%, une hyper triglycéridémie : 66.70%. Nos patients ont reçu des conseils hygiéno-diététiques. Aucun traitement médicamenteux, ni chirurgical n'as été instauré malgré l'indication. Nous avons enregistré 3.30% de décès. CONCLUSION: La description épidémio-clinique, le diagnostic et l'évaluation du retentissement de l'obésité sont faciles dans notre pratique quotidienne. Cependant la prise en charge reste insuffisante du fait de l'insuffisance du plateau technique, le manque de moyen financier et les préjugés de nos patients (méconnaissance de l'obésité comme une maladie).

Statut des marqueurs du stress oxydatif au service de médecine interne et d'endocrinologie de l'hôpital du Mali

Introduction : Le stress oxydant est un déséquilibre entre les défenses antioxydantes endogènes etla 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

Evaluation de l'outil de sélection des candidats au don pour améliorer la qualité des produits dérivés de sang à l'Hôpital du Mali

Introduction : La sécurité transfusionnelle constitue un défi majeur dans les pays en développement. La sélection médicale est un élément essentiel dans la stratégie visant à réduire la transmission d'agents infectieux Mali. Dans ce travail nous avons évalué l'outil utilisé pour le screening pré-don dans l'unité de banque de sang de l'hôpital du Mali. Matériel et Méthodes : Il s'agissait d'une étude prospective du 30 mars 2016 au 14 février 2017 incluant tous les candidats au don de sang. Après la sélection médicale, une qualification biologique a été réalisée au niveau du Centre National de Transfusion Sanguine notamment pour les 4 infections transmissibles obligatoires de l'OMS (VHB, VHC, VIH et Syphilis). Résultats : Au total, 726 candidats au don ont été inclus. La moyenne d'âge était de 30,72 ± 8,8 ans, compris entre 17 et 60 ans. Le sex-ratio H/F était : 8,48. Il s'agissait dans 83,5% des cas d'un don de compensation, 67% étaient à leur premier don. La sélection médicale a permis d'écarter 108 candidats pour des raisons diverses. Sur les 618 candidats retenus, 79 soit 12,8% des PSL n'étaient pas qualifiés pour la distribution pour VIH (0,3%), VHB (10,7%), VHC (1,8%), syphilis (0,3%) et co-infection VHB+VHC (0,3%). Conclusion : Cette étude nous a permis d'identifier quelques insuffisances de l'outil. Nous concluons que cet outil utilisé pour la sélection médicale doit être amélioré

Hyperthyroïdies à l'hôpital du Mali

Introduction : L'hyperthyroïdie est une pathologie fréquemment rencontrée dans notre pratique clinique. Elle est la conséquence d'une hyperproduction des hormones thyroïdiennes. Patients et méthodes : Il s'agissait d'une étude descriptive, rétrospective et prospective de 3 ans et 3 mois ayant inclus 523 patients présentant des signes cliniques et biologiques d'hyperthyroïdie. Les données ont été recueillies à partir des dossiers médicaux des patients.Résultats : La fréquence hospitalière de l'hyperthyroïdie était de 9,5%. L'âge moyen de nos patients était de 40,27 ± 15,77 ans. Il y avait 461 femmes (88,1%) et 62 hommes (11,9%) soit un sex-ratio de 0,13. Le goitre (36,3%) et les palpitations (13,2%) dominaient les motifs de consultations. Les signes cardiovasculaires étaient au premier plan avec les palpitations (61%) et la tachycardie (51,8%). La maladie de Basedow (56,4%) était l'étiologie la plus rencontrée et fréquemment observée avant l'âge de 40 ans. Les goitres multinodulaires toxiques et les adénomes toxiques étaient l'apanage des sujets de plus de 40 ans (p < 0,001). Les antithyroïdiens de synthèse étaient utilisés chez tous nos patients exceptés ceux présentant une thyroïdite qui ont reçu un antiinflammatoire stéroïdien ou non-stéroïdien. Seul neuf de nos patients (1,7%) ont subi une thyroïdectomie.Conclusion : L'hyperthyroïdie est une pathologie avec une symptomatologie cardiovasculaire bruyante. Les causes périphériques sont de loin les plus fréquentes. Ainsi, le dosage de la TSH (Thyroid Stimulating Hormone) seule suffit au diagnostic

[Clitoral reconstruction after female genital mutilation at CHU Yalgado of Ouagadougou, Burkina Faso. About 68 patients operated]. / Reconstruction clitoridienne après mutilation génitale féminine au CHU Yalgado de Ouagadougou, Burkina Faso. À propos de 68 patientes opérées.

OBJECTIVE: The objective of this survey was to assess the results of a new clitoral transposition technique in the obstetrics and gynecology department of CHUYO. MATERIALS AND METHOD: A cohort of 68 women victims of genital mutilation has received clitoral reconstruction by a new technique of transposition of the clitoris. They were operated and followed for 12 months in CHUYO gynecology ward in Ouagadougou. We evaluated the management of pain, anatomical aspect, functional and occurrence of complications. RESULTS: Anatomically have no new increase was within a neoclitoris, and a very satisfactory ratio of 100 % of women with clitoral massif visible in the 12th month assessment. Functionally, before clitoral reconstruction half of the women had mild pain or discomfort during sexual intercourse. However, clitoral reconstruction after the 6th month and 12th month this pain or mild discomfort were 3.18 % and 0 % respectively. In addition, we noted a sensitive neoclitoris in all women, after one year. Very few postoperative complications were observed in this series compared to previous series. CONCLUSION: These results are of interest in this new clitoral transposition technique in favor of women victims of genital mutilation.

[Assessment of the availability and use of antivenom in the district of Bamako, Mali, West Africa]. / Évaluation de la disponibilité et l'utilisation du sérum antivenimeux dans le district de Bamako, Mali, Afrique de l'Ouest.

The aim of this study is to describe the difficulties related to problems of supply and use of antivenom serum (SAV) in the district of Bamako. A retrospective study over a span of five years (January 1998-December 2002) and an interview with the staff of various facilities were conducted. The study included 2 wholesalers of pharmaceuticals, 20 private pharmacies, and 2 hospital pharmacies as they were involved in antivenom trades. A market-driving ability survey of driving practice was conducted in 37 community health centers (CHCs) and 4 dispensaries because they performed antivenom treatments during the study period. A total of 3,318 doses of antivenom were bought, including 84.4% by the People Pharmacy of Mali (PPM), a public organization, and 15.6% by Laborex, a private company. These were out of stock in 1999. Three kinds of SAV were ordered: the polyvalent IPSER Africa (1,200 vials or 36.2%), FAV Africa (318 vials or 9.6%), and Sii anti-snake venom polyvalent serum (1,800 vials or 54.2%). Orders from PPM involved IPSER Africa (Pasteur Mérieux Serum & Vaccines) and Sii anti-snake venom polyvalent serum (Serum Institute of India), and those from Laborex involved IPSER Africa and FAVAfrica (Aventis Pasteur). Onehalf of private pharmacies (54.3%) had made at least one order of SAV. The PPM lost 50% of 2,000 vials of SAV in 1996 due to the expiration of vials that were bought. Private pharmacies lost 3.6% of stocks due to expiration. Prices varied depending on the type of service and the point of sale. Costs of vials were 19,440-35,000 CFA francs (29.6-53.4 euros) for Sii antivenom and 50,200-63,000 CFA francs (76.5-96.1 euros) for FAV Africa antivenom. In CHCs, 59.5% of prescribers were unaware of the indications and methods of proper administration of the SAV, 32.3% ignored the existence of SAV, and 30.9% were skeptical about its effectiveness in treatment of envenomation by snakebite.

[Epidemiological, clinical and therapeutics aspects of snakebites in the Gabriel-Touré and Kati national hospitals of Mali: a ten-year retrospective study]. / Aspects épidémiologiques, cliniques et thérapeutiques des morsures de serpent dans les hôpitaux nationaux Gabriel-Touré et de Kati du Mali: étude rétrospective sur dix ans.

A retrospective study has been performed on snakebites from January 1993 to December 2002 in the national hospitals Gabriel-Touré, in Bamako, and Kati. It aimed to establish a synthesis of epidemiological, clinical, and therapeutic aspects from snakebites. Eight hundred thirty-two snakebites were recorded during this period. Men were mostly represented: 72 versus 28% of women. The average age was 28 ± 18 years. Farmers were most affected (28%). Most bites occurred between 16 and 20 hours, during the fieldwork and pasture in 44% cases. Lower limbs (73.8%) were more involved than hands (25.8%). Although the type of snake has not been determined, the clinical picture was that of viper syndrome, the severity of which was assessed by the grade of bleeding, edema, renal involvement (15.8%), and neurological disorders (13.3%). Antivenom was administered to 40.6% of patients whose case fatality rate was 2.8%, whereas it was 8.1% in its absence. The case fatality rate associated with serum therapy varied according to the antivenin, 1.5% with the antivenoms manufactured in Europe and 4% with those manufactured in Asia. Five parturients had a favorable outcome with antivenom. The initial management was carried out by traditional healers in 49.7% of cases. The annual case fatality rate decreased gradually from 12% in 1995 to 3% in 2002. The incidence of snakebite is greatly underestimated in hospitals because of inadequate records.

[Costs of operation of an urban reinforced community health post (Senegal)]. / Analyse des coûts de fonctionnement d'un Poste de Santé renforcé en milieu urbain (sénégal).

INTRODUCTION: In Senegal, the public funding in community health post is low. Resources are mainly obtained from the sale of services. The aim of this study is to analyse the operating cost of a community health post and to propose a relevant tariffing that would assure sustainable activities. METHODS: We used the method of complete costs. It comes out from our study that the total cost is 20 870 920F. RESULTS: Wages represent 70% of total expenses, operating costs represent 27% and 4% are investment. The public funding represents a value of 12 257 325F (60% of the total) in which 88% correspond to expenses induced by civil servant wages. The health committee participates for 33% and the other participants (7%). CONCLUSION: At the end of our study, a sustainable and social tariffing, was proposed.

[Knowledge and behaviours concerning HIV/AIDS infection among sex workers in Ziguinchor (Senegal)]. / Connaissances et pratiques concernant l'infection a VIH/SIDA chez les travailleuses du sexe a Ziguinchor (Senegal).

INTRODUCTION: The Human Immunodeficiency virus (HIV) and the Acquired Immunodeficiency Syndrome (AIDS) which it causes constitute one of the major concerns of these two last decades. In Senegal, 77000 people live today with the HIV. In 2002, 28.5% of sex workers in Ziguinchor were infected with HIV. Professional sex work is considered as a main determinant of HIV/AIDS propagation. The objective of this study is to assess knowledge, a ttitudes and behaviours concerning HIV/AIDS within this target group in order to formulate recommendations to improve ongoing activities in information, education and communication. METHOD: The study was cross-sectional, descriptive and analytic. It was set up at the Ziguinchor sexual transmitted diseases (STD) center. Between April 16th and May 2nd in 2003, 68 sex workers who visited the center were interviewed. Data was entered and analyzed with Epi Info 6.04d software. RESULTS: The level of knowledge of sex workers in Ziguinchor was satisfactory: 94% gave at least one mode of contamination, 98.5% knew one means of prevention and 81% gave at least one symptom of the disease. However 35.3% of them did not require the wearing of condom, either because of trust in their partners, because of ignorance of the risk, or because of the proposition of special prices. CONCLUSION: Among sex workers followed at STD center of Ziguinchor, the observed attitudes and behaviors don't match the knowledge level. Information campaigns, that focus on at-risk behaviours, as well as the orientation of research towards specific means for women to prevent infection, such as microbicides, would be critical tools for better fighting against the HIV/AIDS epidemic.

[Envenomation accidents caused by snakebites in the surgical emergency unit of Gabriel-Touré Hospital, Bamako, Mali (1998-1999)]. / Les accidents d'envenimation par morsure de serpent dans le service des urgences chirurgicales de l'hôpital Gabriel-Touré, Bamako, Mali (1998-1999).

This study aimed at assessing envenomations caused by snakebite in the Gabriel Touré hospital between January 1998 and December 1999. We included in total 112 victims of snakebites proved by the identification of the snake, the fangs traces and envenomation signs. The bites concerned 34 women (30.36%) versus 78 men (69.64%) from the Bamako district, while 66.7% were from a rural environment. The farmers were the most affected category (35.1%). The bite concerned the lower limb in 83.3% of the cases. Snakes such as Echis ocellatus, Bitis arietans, Naja nigricollis and N. katiensis caused the envenomations. The viperine syndrome dominated the clinical picture; its severity depended on the bleeding stage and the delay of administration of the antivenom serum (AVS) after the envenomation: 19 hours for Echis sp. and 2 hours for Naja sp. This study shows that the envenomation accidents caused by snakes are frequent with a lethality rate of 9.8%.

Geographic variation in viral load among hepatitis B carriers with differing risks of hepatocellular carcinoma.

The risk of hepatocellular carcinoma (HCC) varies significantly among hepatitis B virus (HBV) carriers from different geographic regions. We compared serological markers of HBV infection in adult male carriers from Haimen City, China and Senegal, West Africa, where the prevalence of chronic infection is similar. HCC mortality among HBV carriers is much higher in Haimen City than it is in Senegal (age-standardized rate, 878 versus 68 per l0(5) person-years). A dramatic difference was observed when HBV DNA levels in serum were assessed among carriers by Southern blot. In the Senegalese group (n = 289), 14.5% were HBV DNA positive by Southern blot in their 20s, and this percentage declined in each subsequent decade of age to 3.3, 2.9, and 0% thereafter. In the Chinese group (n = 285), a higher prevalence of HBV DNA positivity and a less consistent reduction were seen; 29.4% were positive in their 20s, and 30.2, 23.6, and 20.6%, respectively, were positive in each subsequent decade of age. Among 102 male Asian-American HBV carriers, the prevalence of HBV DNA positivity was intermediate between the Chinese and Senegalese populations (36.8, 10.7, 3.0, and 4.6% in each subsequent decade of age). Viral titers were similar among those who were HBV DNA positive in all three populations [median value, 10(7) virions/ml (range, 10(6)-10(9) virions/ml)]. The presence of HBV DNA in serum was positively associated with serum glutathione S-transferase, a marker of liver damage. These findings suggest that the more prolonged maintenance of productive virus infection in the Chinese carriers compared with the Senegalese carriers may explain their higher risk of HCC. This profound difference in the natural history of chronic infection may be due to earlier age of infection in China or to as yet unknown environmental or genetic factors.