[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.

[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.

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.

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.

Prise en charge ortho-chirurgicale de l'inclusion d'incisive centrale maxillaire : à propos d'un cas

L'inclusion des incisives centrales maxillaires pose un problème esthétique et fonctionnel. La prise en charge ortho-chirurgicale est la thérapeutique la plus pratiquée et celle qui donne le meilleur rendu esthétique et fonctionnel. Elle nécessite cependant un bon diagnostic clinique et radiologique afin que la théra-peutique se déroule dans des conditions optimales. La désinclusion ortho-chirurgicale se fait en différentes étapes comme l'illustre le cas clinique présenté ici

[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.

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.

[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.

[Child care management in maxillofacial humanitarian mission]. / Prise en charge de l'enfant en mission humanitaire maxillofaciale.

Our practice in a humanitarian (or crisis) context differs from what we experience in daily practice. There are several reasons for this. First, the diseases encountered are sometimes unfamiliar, such as sequelae of noma, or the presentation of familiar diseases may be unusual, such as facial malformations seen at a late stage. Secondly, these missions take place in developing countries, and consequently, evaluation and anticipation of possible malnutrition should be considered, especially because facial diseases themselves may be responsible for nutritional problems. Lastly, conditions are often difficult, occurring in an unusual environment, and we sometimes have to face communication and equipment problems. The goal of our work, based on a 15-year experience (in Bamako and Mopti with the Association "Santé et Développement", and in Ouagadougou with the organization "Les enfants du noma") and the analysis of literature, is to point out these features and maybe to be helpful to others.

[Internal hemorroïd disease at the digestive endoscopy center of the Gabriel Toure University Hospital 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 internal hemorrhoid disease. This cross-sectional study was conducted at the digestive endoscopy center of the Gabriel Toure University Hospital from December 2011 to December 2012. Sixty cases of internal hemorrhoid disease were found - 36 men and 24 women and an average age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pains (58.3%) and prolapsed hemorrhoids (18.3%). The rectoscopy found isolated internal hemorrhoids in 78.4% of cases and stage I of the illness in 81.7% of cases. All patients were given medical treatment. CONCLUSION: Hemorrhoid disease is a frequent pathology in the general population mainly around the third decade of life.

Le but de ce travail était d'étudier la maladie hémorroïdaire interne. Il s'agissait d'une étude transversale déroulée au centre d'endoscopie digestive du CHU Gabriel Touré de Décembre 2011 à décembre 2012.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 hémorroï-daire est une pathologie relativement fréquente dans la population générale surtout vers la troisième décade.

[Bicortical reconstruction of a large calvarial bone defect with Hydroset® osteoconductive cement and titanium mesh. A preliminary study]. / Reconstitution bicorticale de grande taille de l'os calvarial par ciment ostéoconducteur Hydroset® associé à une grille en titane. Étude préliminaire.

INTRODUCTION: Bi-cortical calvarial bone loss is a very frequent issue for neurosurgery and craniofacial surgery. Several techniques can be used to reconstruct the skull, with variable difficulty and costs. The purpose of our study was to assess the use of Hydroset® osteoconductive cement for large size bicortical cranioplasties. MATERIALS AND METHODS: Three patients presented with extensive loss of calvarial bone bi-cortical substance (>25 cm(2)), between 2010 and 2012. The 3 patients underwent cranioplasty with Hydroset® osteoconductive cement and titanium mesh. RESULTS: The esthetic results were very satisfactory, especially for the skull dome, with a completely invisible and non-palpable cement/native skull junction. Scalp adherence to the cement was natural with maintenance of skin mobility. DISCUSSION: Bicortical calvarial bone reconstruction with Hydroset® cement is technically easy to perform, gives very good results, with an uneventful outcome, and induces lower costs.

[Non-neuromeningeal cryptococcosis in patients with AIDS in Bamako, Mali: 2 case reports]. / Cryptococcose extra-neuroméningée au cours du sida à Bamako, Mali (à propos de 2 observations).

Non-neuromeningeal cryptococcosis forms resulting from disseminated infection are rarely reported in African literature and are non-documented in Malian medical ward. We report two clinical observations. Case 1: a 26-year-old patient, carrying the HIV-1 infection, in which the clinical examination revealed skin lesions simulating molluscum contagiosum and functional impairment of the lower limbs. Radiography of the lumbar spine showed vertebral osteolysis on L4-L5. Cryptococcal research remained negative in the CSF but positive at histological examination of the skin lesions and in pathological products of lumbosacral drainage. The treatment with fluconazole and ARV led to a favorable outcome. Case 2: a 42-year-old patient, admitted for fever cough, known for his non-compliance to ARVs and in which the examination found a syndrome of pleural condensation and a painful swelling of the outer third of the right clavicle (around the acromio-clavicular joint). Paraclinical investigations concluded in osteolysis of the acromial end of the right clavicle and an image of the right lung with abundant effusion. Cryptococcal research was positive in the pleural effusion and in the product of aspiration of acromio-clavicular tumefaction, negative in CSF. It seems important to think of a cryptococcal etiology even in the absence of clinical meningeal signs in front of any cutaneous sign and any fluctuating swelling in HIV+ patient.

[Malian first observation of disseminated African histoplasmosis with predominant bone localizations in an HIV-negative child in Bamako (Mali). Review of the literature]. / Première observation malienne d'histoplasmose africaine disséminée à prédominance osseuse chez un enfant VIH négatif. Revue de la littérature.

Endemic deep fungal infections are still under recognised diseases in daily medical practice because of their rarity in sub-Saharan area. The African histoplasmosis Histoplasma capsulatum var. duboisii (H. capsulatum duboisii) is the most frequent variety described in Mali through limited studies in adult patients, since the first case described by Catanei and Kervran (1945). Our case report is a disseminated histoplasmosis in a young 6-year-old african child. He was male and rural. The infectious localisations were mucosae, skin, lymphnodes, urinary tract and bones. Evolution has been marred by an episode of worsening of symptoms despite initial clinical improvement with ketoconazole. After healing of mucocutaneous lesions, we noticed a limitation of ampliation of both wrists. The radiographic bone lesions were lysis of the right lower end of the right radius and cubitus and fragmentation of cubital epiphysis of the same arm. Lacunes were present on the fifth right finger in metatarsus and phalanx; lacune and blowing aspect of the second phalanx of the left third finger was noted. The disseminated form of African histoplasmosis may occur in HIV-negative subject. The prognosis depends on early diagnosis and administration of appropriate and well-conducted therapy.

[Surgical options in the treatment of noma]. / Options chirurgicales dans la prise en charge du noma.

In the acute phase of noma, the role of surgery is minor and the treatment consists in the realisation of local or regional flaps and sometimes the management of haemorragia. For reasons social and economic reconstruction of the loss of substance should be conducted on site. The treatment consists of surgical excision of fibrous tissue, the removal of the ankylosis and the closure of the PDS by local flaps, or free pediculated. Because of the extreme variety of loss of substance (PDS) and the multiple surgical options, a systematic and eventually, the standardization of the surgical approach in the treatment of sequelae of noma is essential.

A la phase aigue du noma, le rôle de la chirurgie est mineur et consiste en des soins locaux et occasionnellement au traitement de l'hémorragie.Pour des raisons socioculturelles et économiques, la reconstruction des pertes de substance doit se dérouler sur place. Le traitement chirurgical consiste en l'excision des tissus fibreux, la levée de l'ankylose et la fermeture des PDS par des lambeaux locaux, pédiculés ou libres.A cause de l'extrême variété des pertes de substance (PDS) et des multiples options chirurgicales, une systématisation et éventuellement, une standardisation de l'approche chirurgicale dans le traitement des séquelles de noma est indispensable.

[Epidemiological characteristics and prognosis of gastric Cancer in urban areas of Mali]. / Les caracteristiques epidemiologiques et pronostiques du cancer de l'estomac en milieu urbain au Mali.

Stomach cancer remains a public health problem. It is increasingly found in our regions, probably because of the greater availability and improvement of diagnostic facilities.The goal of this work was to study the epidemiological characteristics and prognosis of gastric cancer in the hepato-gastroenterology and general surgery wards of the Gabriel Toure university hospital. METHODS: We conduct a descriptive retrospective study on patients from June 2008 to May 2009, and the enrollment of patients lasted from June 2009 to May 2010. RESULTS: We examined the records of 68 cases of gastric cancer in 115 cases of digestive cancers a frequency of 59.1%.The mean age of patients was 56.51 ± 14.8 years with extremes of 27 and 90 years. The sex ratio was 1.6 in favor for men. The social and professional groups (housewives and farmers) were the most represented with 50 cases (73.5%). Salting, smoking, consumption of tô (cereal dough) with potash were the most found risk factors in 80.9%, 94.2% and 80.6% of cases respectively. The localization of antro-pyloric site was most represented (60.3%). Adenocarcinoma was the most common histological type (94.1%), one case of Gastrointestinal Stromal Tumor (GIST), two cases of non hodgkin malignant lymphoma were found.The curative surgery was performed in 8.9% of our patients. The overall survival rate after any surgery with two-year follow-up was 9.4%. Post curative surgery survival was 83.3% at two years follow-up. CONCLUSION: Stomach cancer is common in our context, but its management is suffering from delayed diagnosis.

Le cancer de l'estomac reste un problème de santé publique.Il est de plus en plus constaté dans nos régions, du fait probablement de la disponibilité plus importante des moyens diagnostiques.Le but de ce travail était d'étudier les caractéristiques épidémiologiques et pronostiques du cancer de l'estomac dans les services d'hépato-gastroentérologie et de Chirurgie générale du CHU Gabriel Touré.Il s'agissait d'une étude rétrospective descriptive ayant porté sur les malades colligés de juin 2008 à mai 2009 et l'étude des dossiers de ces malades a duré de juin 2009 à mai 2010. Nous avons consulté les dossiers de 68 cas de cancers de l'estomac sur 115 cas de cancers digestifs soit une fréquence de 59,1%. L'âge moyen des patients était de 56,51±14,8 ans avec des extrêmes de 27 et 90 ans .Le sexratio était de 1,6 en faveur des hommes. Les couches socioprofessionnelles (ménagères et cultivateurs) étaient les plus représentées avec 50 cas soit 73,5%. La salaison, le fumage, la consommation de tô (pâte de céréales) avec potasse ont été les facteurs de risque les plus retrouvés dans respectivement 80,9%;94,2% et 80,6% des cas. Le siège antro-pylorique a été plus représenté (60,3%). L'adénocarcinome a été le type histologique le plus fréquent (94,1%), un cas de tumeur stromale, deux cas de lymphome malin non hogdkinien ont été retrouvés. La chirurgie à visée curative a été réalisée chez 8,9% de nos patients. Le taux de survie globale après toute chirurgie confondue à deux ans de suivi a été de 9,4%. La survie post chirurgie curative a été de 83,3% à deux ans de suivi. CONCLUSION: Le cancer de l'estomac est fréquent dans notre contexte mais sa prise en charge souffre du retard diagnostique.

[Epidemiological, clinical and evolving HIV-positive patients referred to the University Hospital of Point G, Bamako, Mali]. / Profil épidémioclinique et évolutif de patients VIH positif, référés au CHU du Point G, Bamako, Mali.

We conduct a longitudinal descriptive study in the department of infectious diseases to CHU of Point G during 18 months. It concerned adult patients referred from another care center. All the patients underwent systematic clinical examination and complementary exploration. Our sample was 352 HIV+ patients, with a mean age of 37.8 ± 9.8 years and a sex ratio (M/F)=0.94 shared among patients receiving ARV treatment (ART-s) and not (n-ART). Delay of reference was 5 ± 4.4 days. All patients benefited from clinical and paraclinical examinations. In both groups patients were mostly from level II. On admission, 132 cases were ART-s (38%). The main reasons for consultation were mainly fever [87.9%, p <0.05] and vomiting [17.4%, p =0.005] in the ART-s. Cough (p=0.9), and diarrhoea (p=0.5] were most noted in the n-TARV no statistically significant (no SS). Other reference reasons were similar in the 2 groups: headache (p=0.4), dyspnea (p=0.1). Selected diagnoses were dominated by tuberculosis (p=0.6) for n-ART no SS. Nontuberculosis infectious pneumonia (p=0.8) and cerebral toxoplasmosis (p=0.8) were comparable in the two groups. Severe systemic bacterial infections occurred more noted in the n-TARV (p=0.7). Malaria has been the main non-AIDS defining disease in the n-ART [-p=0.07] no SS. Patients were seen to late stage a corollary of a more collapsed of immunity in n-ART group [93.3%, p <0.05]. The fatality rate was similar in both groups (43.2%). Pathological factors were mainly tuberculosis (p=0.3) no SS. The factors involved significantly in TARV-s were non-tuberculosis bacterial pneumonia (p=0.001). The hospital mortality of HIV and AIDS is still important. Despite free ARVs and the large number of support center, the delay in diagnosis is a key as well as the lack of monitoring of patients factor.

[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.

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.