Socio-cultural representation of epilepsy at the teaching hospital of point G, Mali.

Background: Epilepsy is a significant public health concern with psychosocial impacts, including fear, stigma, and misconceptions. These factors contribute to human rights violations and discrimination. The objective of this study was to describe the sociocultural representation of epilepsy in Mali. Materials and methods: This cross-sectional descriptive study was carried out from April 2015 to November 2016 at the University Hospital of Point G. Patients with epilepsy were identified prospectively, and a questionnaire was administered to each patient and their parents. Results: A total of 104 patients were enrolled with an average age of 35 years, ranging from 15 to 89 years. Males were slightly predominant, accounting for 53.85%, resulting in a sex ratio (M/F) of 1.17. In terms of occupation, workers comprised 68.27% of participants. Patients residing in urban areas represented 61.54%, and the most level of education was secondary (40.38%). The majority of patients (57.69%) and their relatives (69.23%) thought that epilepsy was caused by mystical causes. Stigma was reported by 66.35% of our patients. Conclusion: The sociocultural perception of epilepsy hinders evidence-based diagnosis and management in Africa. This study suggests a need to focus on raising awareness to change these misconceptions.

[Progressive myoclonic epilepsy in the department of neurology of the University Teaching hospital Point "G"]. / EPILEPSIES MYOCLONIQUES PROGRESSIVES AU SERVICE DE NEUROLOGIE DU CENTRE HOSPITALIER UNIVERSITAIRE DU POINT "G".

Background: Progressive Myoclonic Epilepsy (PME) is a heterogeneous group of pathologies associating epileptic seizures and other neurological and non-neurological disorders. Objectives: We aim to characterize patients with symptoms of PME and identify the underlying genetic disorder. Methods: After informed consent, the patients seen in the protocol for hereditary neurological diseases and presenting signs of epilepsy without a secondary cause were clinically evaluated over a three-year period in the Department of Neurology of the CHU Point "G". EEG, brain imaging and laboratory tests were performed to consolidate our diagnosis. DNA was extracted for genetic analysis. Results: 141 families including five families with PME totaling eight cases were enrolled. The predominant symptoms in our patients were myoclonus in 87.5% (N = 8), followed by GTCS and cognitive impairment in 50%, each. A notion of parental consanguinity was found in 60% and autosomal recessive transmission evoked in 80% (N = 5). The EEG was pathological in 62.5% and imaging showed ponto-cerebellar atrophy in 25% (N = 8). The combination of sodium valproate and clonazepam was the main treatment. One case of death was recorded. Conclusion: We report cases of PME in Mali with a possibility of discovering new genes.

[Haemorrhagic Stroke after Snakebite Envenomation Resulting in Irreversible Blindness in a 6-Year-Old Child in Mali]. / Hémorragie Cérébrale Post Envenimation par Morsure de Serpent Responsable D'une Cécité Irréversible Chez Un Enfant de 6 Ans au Mali.

Introduction: Snakebite envenomation can cause serious damage. Here, we report the case of a six-year-old male child bitten by a snake. Clinical description: The child presented a gingivorrhagia, abdominal pain, bloody vomiting and severe headache from a snakebite. Neurological examination showed paralysis of the III cranial nerve associated with bilateral blindness and mydriasis, unreactive on the right. The brain scan revealed a left frontal hematoma. The course on antivenom was marked by the disappearance of clinical signs except blindness which remained 18 months after discharge. Discussion - Conclusion: The hemorrhagic syndrome evoked viper bite. Blindness is rarely seen as a result of viperine envenomation. In our case, the presence of intracranial hypertension, absence of ocular lesions and scanner were in favor of compression of the optic nerves which resulted in permanent blindness.

[Exceptional Neurological Complication of Snakebite Envenomation: A Case in Mali]. / Une complication neurologique exceptionnelle de l'envenimation par morsure de serpent : à propos d'un cas au Mali.

Envenomation by snakebite can lead to hematological, circulatory, digestive, renal, and neurological complications. Brain abscess after snakebite envenomation is exceptional and very rarely reported in the literature. In this article, we describe the clinical case of a 45-year-old woman with no particular history, admitted to our department for vigilance disturbances linked to a motor deficit on the right side and fever after viper bite on the left thumb. The clinical examination showed a marked biological inflammatory syndrome. The brain scan with iodine injection suggested a left fronto-parietal brain abscess. Tri-antibiotic therapy, combined with the administration of corticosteroids, resulted in favorable outcome.

Les envenimations par morsure de serpent peuvent entraîner des complications d'ordre hématologique, circulatoire, digestif, rénal et neurologique. Un abcès cérébral postenvenimation ophidienne est exceptionnel et très rarement rapporté dans la littérature. Nous rapportons le cas clinique d'une femme de 45 ans sans antécédent particulier, admise dans notre service pour un trouble de la vigilance associé à un déficit moteur de l'hémicorps droit dans un contexte fébrile faisant suite à une morsure du pouce gauche par une vipère. Le bilan objectivait un syndrome inflammatoire biologique marqué et la tomodensitométrie cérébrale avec injection d'iode faisait évoquer un abcès cérébral frontopariétal gauche. Une triantibiothérapie, couplée à une corticothérapie, a permis une évolution favorable des symptômes.

[Healthcare associated infections in the neurosurgical department of Gabriel Touré teaching Hospital in Bamako]. / Les infections associees aux soins dans le service de neurochirurgie du CHU Gabriel Toure a Bamako.

INTRODUCTION: Healthcare-associated infections or nosocomial infections are a public health problem due to their frequency, severity and economic impact. They cause an increase of the morbidity, the mortality, the hospital stay and the expenses of taking care of the patients. According to the WHO, 7.1 million people are affected each year, of which about 100,000 die. AIM OF STUDY: The aim of this study was to determine the frequency of healthcare-associated infections in the Neurosurgery Department of Gabriel Touré University teaching Hospital and to identify the risk factors associated with these infections. MATERIAL AND METHODS: This was an epidemiological, descriptive, analytic, cross-sectional and prospective study lasting 6 months from May 29 to November 30, 2016. The study focused on patients who stayed more than 48 hours in the Neurosurgical department Gabriel Touré teaching hospital. The collected data focused on the clinical and biological characteristics of the patients during their hospitalization. The maximum size of the sample was 200 patients. A sample was taken for each type of infection. The criteria used for the diagnosis of Healthcare-associated infections were those of the CDC (Center for Disease Control) and the realization of a thick drop in our context. The chi-square test was used for the comparison of qualitative variables and Kruskal Wallis and Anova for quantitative variables. The materiality threshold has been set to a value of p less than 0.05. RESULTS: At the end of our study, we had 34 infected patients out of 200, a rate of 17%. The significant risk factors found in our study were: high age (p = 0.04), ASA class (p = 0.002), pre-surgical shaving (p = 0.02), long duration surgical intervention (p = 0.002) and long hospital stay (p = 0.004). The types of infections associated with the care found were: urinary in 18 (53%) cases, respiratory in 9 (26%) cases, operative site in 6 (18%) cases and 1 (3%) cases of bacteremia. The bacterial spectrum of these infections was dominated by Negative Gram Bacilli, among which Escherichia coli in 11 (32.3%) cases. The clinical course of patients treated for these infections was marked by healing in 31 (91.2%) cases, complications in 2 (5.9%) cases, and death in 1 (2.9%) case. CONCLUSION: The prevalence of Healthcare-associated infections in our department remains high compared to that found in developed countries. This study allowed us to identify the main risk factors associated with these infections. A stricter adherence to the rules of hygiene and prevention of Healthcare-associated infections is needed to reduce this rate.

INTRODUCTION: Les infections associées aux soins (IAS) ou infections nosocomiales constituent un problème de santé publique par leur fréquence, leur gravité et leur retentissement économique. Elles causent une augmentation de la morbidité, la mortalité, le séjour hospitalier et les frais de prise en charge des malades.Selon l'OMS, 7,1 millions de personnes seraient affectées par les IAS chaque année parmi lesquelles environ 100000 meurent de suites de ces ISA. BUT: Le but de cette étude était de déterminer la fréquence des infections associées aux soins dans le service de Neurochirurgie du CHU Gabriel Touré et d'identifier les facteurs de risque associés à ces infections. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude prospective d'une durée de 6 mois allant du 29 Mai au 30 Novembre 2016. L'étude a porté sur les patients ayant séjourné plus de 48 heures dans le service de Neurochirurgie du CHU Gabriel Touré.Les données collectées ont porté sur les caractéristiques cliniques et biologiques des patients au cours de leur hospitalisation.La taille maximum de l'échantillon a été de 200 malades. Un prélèvement a été fait pour chaque type d'infection.Les critères utilisés pour le diagnostic de l'IAS étaient ceux du CDC (Center for Disease Control) d'Atlanta ainsi que la réalisation d'une goutte épaisse dans notre contexte.Le test de khi2 a été utilisé pour la comparaison des variables qualitatives et Kruskal Wallis et Anova pour les variables quantitatives. Le seuil de signification a été fixé à une valeur de p inférieure à 0,05. RÉSULTATS: Au terme de notre étude nous avons eu 34 patients infectés sur 200, soit un taux de 17%. Les différents facteurs de risque significatifs retrouvés dans notre étude ont été : l'âge élevé (p=0,04), la classe ASA (p=0,002), le rasage pré-chirurgical (p=0,02), la longue durée de l'intervention chirurgicale (p=0,002) ainsi que la longue durée d'hospitalisation (p=0,004). Les types d'infections associées aux soins retrouvés ont été : urinaires dans 18 (53 %) cas, respiratoires dans 9 (26%) cas, site opératoire dans 6 (18%) cas et 1 (3%) cas de bactériémie. Le spectre bactérien de ces infections était dominé par les Bacilles Gram Négatifs parmi lesquels l'Escherichia coli dans 11 (32,3%) cas.L'évolution clinique des patients traités pour ces infections a été marquée par la guérison dans 31 (91,2%) cas, les complications dans 2 (5,9%) cas et le décès dans 1(2,9%) cas. CONCLUSION: La prévalence des infections associées aux soins dans notre service reste élevée par rapport à celle retrouvée dans les pays développés. Cette étude nous a permis d'identifier les principaux facteurs de risque associés à ces infections. Une observance plus stricte des règles d'hygiène et de prévention des IAS s'impose pour faire baisser ce taux.

[Impact of migraine on life quality in school environment in Bamako, Mali]. / Migraine et qualite de vie en milieu scolaire dans le district de Bamako au Mali.

INTRODUCTION: Migraine is a disabiliting disease accounting for 3%. Its prevalence and impact on the schoolar population deserves to be known. METHODOLOGY: This is a five-month cross-sectional and descriptive study of students under 23 years of age at the high school in Bamako, Mali. The sampling was exhaustive and the population was stratified into school classes. Data related to the impact and disability of migraine were collected from a survey sheet integrating internationally validated items (GRIM, MIDAS, Headache Impact Test). RESULTS: The prevalence of migraine was 21.0%. The sex ratio was 0.58. The average age was 17 years. Headache was pulsatile in 88.3% of cases, exacerbated by physical activities in 5.4%, unilateral topography in 73.2% of students. Phonophobia, photophobia were the most described signs of accompaniment. The intensity of pain was between 9 -10 in 69.5%. School absenteeism was ranged from 1 to 14 days in 91.2% of cases. CONCLUSION: Migraine is a real public health concern in schools in Bamako because of its prevalence and its impact on academic performance.

INTRODUCTION: La migraine est responsable de 3% d'invalidité. Sa prévalence et son impact dans la population scolaire mérite d'être connus. MÉTHODOLOGIE: Il s'agit d'une étude transversale et descriptive sur cinq mois, auprès des élèves de moins de 23 ans d'un lycée du district de Bamako au Mali. L'échantillonnage était exhaustif et la population a été stratifiée en classe scolaire. Les données en rapport avec le retentissement et le handicap de la migraine ont été recueillies à partir d'une fiche d'enquête intégrant les items validés à l'échelle internationale (GRIM, MIDAS, Headache Impact- Test). RÉSULTATS: La prévalence de la migraine était de 21,0%.Le sex-ratio était de 0,58. L'âge moyen était de 17ans. La douleur était pulsatile dans 88,3% des cas, exacerbée par les activités physiques dans 5,4%, de topographie unilatérale chez 73,2% des élèves. La phonophobie, la photophobie étaient les signes d'accompagnement les plus décrits. L'intensité de la douleur était entre 9 -10 chez 69,5%. Dans 91,2 des cas on notait un absentéisme scolaire allant de 1 à 14 jours. CONCLUSION: La migraine constitue un véritable problème de santé publique en milieu scolaire à Bamako par sa prévalence et son impact sur le rendement scolaire.

Aspects épidémiologiques et cliniques des pathologies naso-sinusiennes en consultation dans une structure de santé de proximité de Bamako

Introduction : La pathologie naso-sinusienne occupe une place importante en ORL. Sa prise en charge passe par une étude de données de la circonscription concernée. Ce travail avait pour but d'établir le profil épidémiologique, et clinique des pathologies naso-sinusiennes. Matériels et méthode : Il s'agissait d'une étude transversale descriptive menée en consultation sur une période de six mois allant de janvier 2018 à juin 2018 dans l'unité d'ORL-CCF du Centre de Santé de Référence de la Commune V de Bamako. Ont été inclus tout patient venu pour la première fois en consultation dans ladite unité pour pathologie naso-sinusienne. Résultats : Les pathologies naso-sinusiennes ont représenté 12,62% des consultations qui s'élevaient à 1656 patients. Nous avons recensé 60,3% de femmes et 39,7% d'hommes. La tranche d'âge 21-30 ans a constitué 25,8% des cas. L'âge moyen a été de 29 ans, avec des extrêmes de 11 jours et 80 ans. Les motifs de consultation ont été l'obstruction nasale (41,6%), l'épistaxis (19,2%), et les rhinorrhées 12,4%. Les rhinites ont représenté 59,8%, les sinusites 20,1%, les corps étrangers et les épistaxis chacun 7,6% des diagnostics. Un cas de tuberculose nasale a été observé. Conclusion : Les pathologies naso-sinusiennes sont dominées par la pathologie inflammatoire et infectieuse

First documented case of Devic's neuromyelitis optica in Niger

Devic's neuromyelitis optica is a chronic inflammatory demyelinating disease of the central nervous system that mainly affects spinal cord, optic nerve and brain regions with high aquaporin 4 antigen expression. We report the first documented case of Devic's neuromyelitis optica in Niger. It was a 66-year-old black man who had presented a rapidly progressive flaccid tetraplegia associated with vesico-sphincteral disorders, in whom magnetic resonance imaging had shown longitudinally extensive transverse cervical myelitis with positive anti-NMO antibodies

Comorbidities and Neuromyelitis Optica - Spectrum Diseases : What are the current Data ?

Neuromyelitis optica (NMO-SD) or Devic disease is an acute transverse myelitis associated with an optic neuritis united -or bilateral. It is an inflammatory disease very disabling evolving by thrust. The long-term prognosis is also difficult to predict due to comorbidities which determine the evolution and the quality of life of patients. The objective of our study was to determine the different types of co-morbidities found in patients with NMO -SD.Methods: It was a descriptive study through a review of the literature on PubMed with the combination (Neuromyelitis optica, comorbidity). The data analysis was made on the software SPSS 23 Results: Total 27 articles were published and available on PubMed (June 2017). Among these 27 work we included ten (10) specific studies of co-morbidities in the NMO-SD. Three categories of illnesses have been reported in these 10 articles including coexisting diseases with the NMO-SD without any risk factor common or similar

[Myeloradiculitis due to Schistosoma haematobium: about an observation in Dakar (Senegal)]. / Myéloradiculite à Schistosoma haematobium : à propos d'une observation à Dakar (Sénégal).

Nervous localisations of schistosomiasis are rare. We report the case of a 25 year-old Senegalese patient admitted for a progressive myeloradiculitis onset, over a one week period. The diagnosis of Schistosoma haematobium myeloradiculitis was made in front of a positive serum serology for S. haematobium, presence of S. haematobium eggs in urine, hyperproteinorachia, endemicity of S. haematobium in the region where the patient was originating and a past medical history of macroscopic hematuria in a context of river bathing. There was also no arguments for another cause to these neurological manifestations. Our patient was treated with praziquantel, prednisone and physiotherapy. Evolution was marked 6 weeks after the beginning of treatment by a significant improvement of motor deficit, enabling the patient to walk again. There was also a regression of genitosphincter dysfunction. Work-up for patients presenting with paraplegia in tropical countries, should also include search for S. heamatobium infection.

Designing slanted soil system for greywater treatment for irrigation purposes in rural area of arid regions.

To solve the unpleasant disposal of greywater in rural area and allow its collection for reuse in gardening, a slanted soil treatment system (SSTS) was designed and installed in two households. Granitic gravel of 1-9 mm size was used as the filter medium. The aim of this study was to design a SSTS and assess its suitability as a treatment system allowing greywater reuse in gardening. The efficiency of the SSTS was assessed based on organic matter and bacterial pollution removal. The developed SSTS allowed the collection of greywater from three main sources (shower, dishwashing and laundry) in rural area. The SSTS is efficient in removing at least 50% of suspended solids, chemical oxygen demand and biological oxygen demand. The study highlighted that, contrary to the common perception, greywater streams in rural area are heavily polluted with faecal indicators. The removal efficiency of faecal indicators was lower than 2 log units, and the bacteriological quality of the effluents is generally higher than the WHO reuse guidelines for restricted irrigation. Longer retention time is required to increase the efficiency. The possibility of reusing the treated greywater as irrigation water is discussed on the basis of various qualitative parameters. The SSTS is a promising greywater treatment system for small communities in the rural area in the Sahelian region. To increase the treatment efficiency, future research will focus on the characteristics of the SSTS, the grain size and the establishment of a pretreatment step.

[Indications and anomalies of extended electrocardiogram recording (24 hours) at the Gabriel Toure university hospital in Bamako]. / Les indications et anomalies de l'enregistrement de longue duree (24 heures) de l'electrocardiogramme au CHU Gabriel Toure de Bamako.

AIM: To specify indications and main anomalies of the 24 hours electrocardiogram in Bamako. METHODOLOGY: The study was retrospective and conducted from 1st January 2008 to 31st July 2013, on patients whose file comprised a readable recording holter. The Holter recordings were analyzed by the software synetec (syneview 2) of ELA medical. Patients data were analyzed by SPSS 18 and redaction made using Word 2010. RESULTS: 90.2% of the recordings were retained. Mean Age of the sample was of 44,02 ± 16,95 years, the sex-ratio H: F 1,18 with 79.3% of patients coming from the services of cardiology. The indications were: palpitations (32.6%), suspicions of disorder of the rate/rhythm (27.2%), loss of consciousness, cerebral vascular accidents ischemic each one 15.2% and seeks of cause of faintness in (9.8%). An anomaly was found for the indications of disorder of the cardiac rhythm, palpitations, the cerebral vascular accidents ischemic, fainting and the losses of consciousness in resp. 80%, 66.6%, 28.5%, 22.2% and 14.2%. CONCLUSION: The 24 hours electrocardiographic recording is an examination of a great value in looking for cardiac rhythm disorders field of the disorders of the cardiac rhythm. Its provision will have to be effective in the university structures and the evolution towards the forms at longer duration quickly undertaken in Mali.

BUT: Préciser les indications et les principales anomalies du Holter électrocardiographique à Bamako. MÉTHODOLOGIE: L'étude était retrospective allant du 1er janvier 2008 au 31 juillet 2013 et portait sur des patients dont le dossier comportait un enregistrement holter bien lisible. Les enregistrements Holter étaient analysés par le logiciel synetec (syneview 2) de la société ELA médical. Les données des patients ont été analysées par SPSS 18 et saisies sur Word 2010. RÉSULTATS: 90,2% des examens holter effectués ont été retenus. L'âge moyen de l'échantillon était de 44,02 ± 16,95 ans, le sex-ratio H:F 1,18 avec 79,3% de patients provenant des services de cardiologie.Les indications étaient: palpitations ( 32,6%), suspicions de trouble du rythme (27,2 %), perte de connaissance, accidents vasculaires cérébraux ischémiques chacun 15,2% et recherche de cause de malaise dans (9,8%). Une anomalie était retrouvée pour les indications de trouble du rythme cardiaque, les palpitations, les accidents vasculaires cérébraux ischémiques, les malaises et les pertes de connaissance dans resp. 80%, 66,6, 28,5%, 22,2% et 14,2%. CONCLUSION: L'enregistrement Holter électrocardiographique de 24 heures est un examen d'une grande valeur dans le domaine des troubles du rythme cardiaque. Sa mise à disposition devra être effective dans les structures universitaires et l'évolution vers les formes à durée plus longue rapidement entreprise au Mali.

[Clinical and therapeutic aspects of brain abscesses: 17 cases reviewed at the Gabriel Toure teaching hospital In Bamako]. / Aspects cliniques et therapeutiques des abces cerebraux: 17 cas colliges au CHU Gabriel Toure a Bamako.

OBJECTIVE: The purpose of this study was to determine the incidence, clinical features, localization, and therapeutic aspects of the evolution of the brain abscess. PATIENTS AND METHODS: This was a retrospective study which included patients admitted for brain abscess at the Gabriel Touré Hospital in Bamako between January 2007 and September 2010. RESULTS: We collated the data of 17 patients. Fever was the predominant symptom in 14 patients and headache in 13. The main clinical signs were hemiparesis (11 patients) and vomiting (8 patients). The origin of infection was especially posttraumatic in 5 patients, locoregional by contiguity in 5 where 3 whose originated in the sinuses. All patients received triple antibiotic therapy. The surgical management by trépanoponction was indicated in 16 patients. The clinical outcome was favorable in 14 patients. Three patients died. CONCLUSION: Brain abscess is a common condition in Mali. Despite improved diagnostics and treatment of patients, mortality remains high hence the interest of prevention through early diagnosis and treatment of infectious ORL.

BUT: L'objectif de cette étude était de déterminer la fréquence, les aspects cliniques, la localisation, les aspects thérapeutiques et l'évolution de l'abcès cérébral. PATIENTS ET MÉTHODES: Il s'agissait d'une étude rétrospective incluait les patients admis pour abcès cérébral au CHU Gabriel Touré à Bamako entre janvier 2007 et septembre 2010. RÉSULTATS: Nous avons colligé 17 patients. La fièvre était le symptôme prédominant chez 14 patients et les céphalées chez 13 patients. Les principaux signes cliniques étaient l'hémiparésie (11 patients) et les vomissements (8 patients). L'origine de l'infection était surtout post traumatique chez 5 patients, locorégionale par contiguïté chez 5 dont 3 à point de départ sinusien. Tous nos patients ont bénéficié d'une triple antibiothérapie. La prise en charge chirurgicale par la trépanoponction était indiquée chez 16 patients. L'évolution clinique a été favorable chez 14 patients. Trois patients sont décédés. CONCLUSION: L'abcès cérébral est une pathologie fréquente au Mali. En dépit de l'amélioration des moyens diagnostiques et du traitement des patients, la mortalité reste élevée d'où l'intérêt de la prévention par le diagnostic et le traitement précoce des foyers infectieux de la sphère ORL.

[Neuropathic pain during tuberculosis treatment in Bamako (Mali)]. / Douleur neuropathique au cours du traitement antituberculeux à Bamako (Mali).

BACKGROUND: The incidence of tuberculosis is high in Africa. It is treated with medications that can trigger neuropathic pain and thus negatively affect patients' quality of life and treatment compliance. The aim of this study was to investigate neuropathic pain due to antituberculosis drugs in patients without HIV infection. METHODS: This prospective study, conducted in the pulmonology department of the University Hospital of Point G, Mali, included patients taking antituberculosis drugs who had negative HIV tests and no other potential cause of neuropathic pain. Diagnosis of neuropathic pain relied on the DN4 questionnaire (4 questions for neuropathic pain) and its assessment on a visual analog scale (VAS) and the Lattinen test. RESULTS: During the study period, 423 subjects were admitted to our department, 103 (24.4%) with tuberculosis. Eighty met the inclusion criteria. The sex ratio (male to female) was 2.5. Their mean age was 39 years (range: 13-80). In all, 13 (16.25%) reported neuropathic pain. Burning sensations in the plantar region, with or without paresthesia, were the presenting symptoms in 10 of them. All patients began a treatment based on amitriptyline, vitamin B6, and physical therapy and all reported improvement within 2 months. CONCLUSION: Neuropathic pain occurs independently of age, sex or the specific antituberculosis regimen, as long as it includes isoniazid. Stopping or modifying the treatment regimen is not necessary. In our context, in view of the difficulties in identifying slow acetylators, the routine addition of vitamin B6 to all treatment protocols should be discussed.

[Polyneuropathies of pregnancy and the postpartum period in Burkina Faso]. / Les polyneuropathies de la grossesse et du post-partum au Burkina Faso.

Polyneuropathies of pregnancy and the postpartum period are considered rare but also understudied in Sub-Saharan Africa. They are usually related to a thiamine deficiency in under- or malnourished women. Our aim was to study the clinical and etiological factors of this disease in the Yalgado Ouédraogo University Hospital of Ouagadougou in Burkina Faso. Our prospective cross-sectional study lasted for 20 months, from August 2008 to April 2010. During the period, 27 women received this diagnosis. Their mean age was 27.5 years (range: 20 to 38). All but two (92%) had no or a very small or a modest income. Their monotonous diet was based on local cereals and available irregularly. Almost all (24/27, 89%) had developed one or more diseases during pregnancy, primarily excessive vomiting (70%) and severe anorexia (89%). Sensory symptoms were present in 70% of cases, and sensorimotor symptoms in 30%. The cause was always a deficiency-related polyneuropathy. All patients were treated with vitamin B complex and all symptoms disappeared by the third month of treatment. We conclude that polyneuropathies during pregnancy and during the postpartum delivery occur in women eating an unbalanced diet and living in a deprived social and economic situation and that it is manifested by serious vomiting and anorexia.

[Miliary tuberculosis in Mali during the decade 2000-2009]. / Miliaire tuberculeuse au Mali pendant la décennie 2000-2009.

In order to describe the epidemio-clinical and evolutionary aspects of miliary tuberculosis (TB) in Mali, a retrospective study of 10 years (1 January 2000 to December 31, 2009) was conducted in the service of pneumo-phtisiology at the university hospital of point G. It concerned all patients with radiological images compatible with miliary TB, signs of bacillary impregnation, bacillus or not, treated with antituberculosis drugs. Of 3630 TB patients all forms recorded during the study period, 183 miliary were recorded (5%) including 117 men and 66 women. Young adults between 29-45 years were more represented (52%). The average diagnostic delay was 3.7 months. The symptomatology was dominated by the fever (100%), cough (90.1%) and asthenia (86.3%), anorexia (81.9%). The radiological images types of micronodular opacities were the most frequent in 147 cases (80.3%) against 36 cases of (19.7%) macronodular types. Bacteriological examination of sputum was negative in 139 patients (76%) and positive in 44 patients (24%). There was a statistically significant relationship between the presence of an excavation in Chest radiography and smear positivity (P<0.001). The clinical improvement observed (55.7%) depended on the time of the diagnosis (P<0.001). The serology HIV was positive at 29 patients on 124 tested. Also, in areas with high prevalence TB/HIV, any miliary fever in the absence of other obvious etiologies should undertake without delay TB proper treatment.

[Infectious ventriculitis in relation with neurocysticercosis in Burkina Faso]. / Ventriculite infectieuse secondaire à une neurocysticercose au Burkina Faso.

INTRODUCTION: Ventriculitis is an uncommon entity, which is defined as localized meningitis in the cerebral ventricles. It usually occurs in a context of immunodepression, where its presence may suggest primary brain lymphoma, certain viral infections including cytomegalovirus (CMV) and much more rarely, tuberculous meningitis. OBSERVATION: A 48-year-old immunocompetent male was admitted to the neurology department of the Ouagadougou teaching hospital with the diagnosis of infectious ventriculitis in relation with neurocysticercosis (NCC). The diagnosis was based on several arguments including brain CT scan (dilated lateral and third ventricles with ependymal enhancement and scattered parenchymatous cystic hypodensities exhibiting enhancement after contrast injection), the notion of exposure (the patient raised pigs), residence in an endemic zone of cysticercosis, and test results: CSF analysis (aseptic meningitis), positive ELISA for NCC in both CSF and blood. The good clinical and biological outcome after treatment with albendazole was another argument favoring the diagnosis. CONCLUSION: This illustrates the importance of searching for NCC in patients with ventriculitis residing in an endemic zone for cysticercosis.

Coma in the elderly: Etiological factors, management, and prognosis in the department of anesthesia and intensive care.

OBJECTIVE: To study the etiologies, therapeutic and prognosis factors of coma in the elderly in the Department of Anesthesia and Intensive Care of Gabriel TOURE Teaching Hospital, Mali. MATERIALS AND METHODS: This was a prospective descriptive study of all cases of coma in the elderly, registered from February 1, 2008 to January 31, 2009 at the Department of Anesthesiology CHU Gabriel Touré, Bamako. RESULTS: During the study period, 564 patients were admitted to the intensive care unit (ICU) in which 174 (30.85%) were older people. We collected 100 subjects with impaired consciousness, the object of our study, which represented 17.73% of all admissions in the Department of Anesthesiology during the study period and 57.47% of all admissions of older people; 66% of our subjects were male. Hypertensive patients accounted for 60% of cases. In 46% of cases, it was a coma from cardiovascular causes and in 28% of cases; it was a coma of metabolic origin. The diagnoses made in the wake of the care of the elderly in ICU were predominantly stroke (46%) and electrolyte disturbances (13%). The coma was sudden onset in 58% of cases, including 28 cases of stroke whether 48.27%. The prognosis was marked by a fatality with 51% of deaths in our sample. CONCLUSION: The prognosis improvement of the elderly in coma through to the introduction of proxy measures.

[Knowledge of epilepsy and practices of parents in Mali: a community study]. / Connaissances a propos de l'epilepsie et attitudes des parents d'enfant au Mali: etude communautaire.

The prevalence of epilepsy in Sub-Saharan Africa is about 15 per thousand; against 6 to 8 per thousand in industrialized countries. Health, social, economic conditions and misknowledge could explain this situation. The objective of this survey was to study the knowledge of parents of children with or without epilepsy about this disease in Mali. 423 adults were interviewed, 15% children with epilepsy. The mean age was 34 ± 9,3 years; females represents 60% of the population. 26% of interviewed subjects heard about epilepsy from their neighbourhood, 20% from traditional healers, 11% from health care professional; the tonic-clonic crisis was the most known form of the disease. 59% thought epilepsy to be contagious. The organicity of the disease was known by 51% of the population. 23 % of the population believed there was a link between the onset of the crisis and the presence of the hole moon. 78% of subjects have already seen at least one crisis of epilepsy, but only 33% have got an attitude of first help that was to pour fresh water on the face of the patient in 22% of cases. 57% of subject's acknowledge having as first recourse traditional medicine. The fight against epilepsy in Mali as in the others countries of the third world should go through information and education of the population, in particular parents.