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.

[Strokein type 2 diabetic patients in the internal medicine department of the Teaching Hospital of Point G]. / Accident vasculaire cerebral (AVC) chez les patients diabetiques de type 2 dans le service de medecine interne du CHU du Point G.

INTRODUCTION: Diabetes is a chronic hyperglycemia which can be discovered with specific organic complications particularly affecting the eyes, kidneys, nerves, heart and vessels. Globally, the prevalence of stroke in people with diabetes is approximately 10%. OBJECTIVE: Study the epidemiological and clinical aspects of stroke in patients with type 2 diabetes. METHODOLOGY: We made a descriptive and analytical study by a retrospective survey over a period of 10 years, in the department of internal medicine at the university Hospital ofPoint G. We focused on all hospitalized patients with type 2 diabetes, in whom the diagnosis of stroke was retained. RESULTS: At the end of the study 24 patients out of 492 diabetes hospitalized in to the period met our inclusion criteria, representing a frequence of 4.9%. The mean age was 64.67 ± 13.409 years with a sex-ratio of 1.4. The reason for hospitalization was muscle weakness in 54.2% of patients. Eighty-seven point five percent (87.5%) of patients were already known to have diabetes before the weakness. Stroke was the mode of discovery of diabetes in 12.5%. Over 70% of our patients had hyperglycemia at the time of admission. Ischemic stroke was seen in 75% of patients. CONCLUSION: Stroke is a great complication of diabetes witch, can be a way discovery of type 2 diabetes.

INTRODUCTION: Le diabète est une hyperglycémie chronique qui peut être découvert avec des complications organiques spécifiques touchant particulièrement les yeux, les reins, les nerfs, le cœur et les vaisseaux.L'AVC en ai une de ces complications. À l'échelle mondiale, la prévalence de l'AVC chez les diabétiques est d'environ 10%. OBJECTIF: Étudier les aspects épidémiologiques et cliniques de l'accident vasculaire cérébral chez les patients diabétiques de type 2. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive et analytique sur la base d'une enquête rétrospective de 10 ans, dans le service de médecine interne du CHU du Point G. Elle a porté sur tous les patients diabétiques de type 2 hospitalisés dans le service de médecine interne, chez qui le diagnostic de l'AVC a été retenu. RÉSULTATS: Au terme del'étude 24 patients répondants à nos critères sur 492 diabétiques soit une fréquence de 4,9%. L'âge moyen était de 64,67 ± 13,409 ans avec un sex-ratio de 1,4. Le motif d'hospitalisation était un déficit moteur chez 54,2% des patients. Quatre-vingt-sept virgule cinq pourcent (87,5%) des patients étaient déjà connus diabétiques avant le déficit. L'AVC a été le mode de découverte du diabète chez 12,5%. Plus de 70% de nos patients avaient une hyperglycémieau moment à l'admission. L'AVC ischémique était observé chez 87,5% des patients. CONCLUSION: L'AVC est une complication redoutable du diabète, il peut être le mode de découverte d'un diabète de type 2.

[Descriptive study of COVID-19 cases in the third Municipality of Bamako, from March 26 to August 27, 2020]. / Etude descriptive des cas de COVID-19 en Commune III de Bamako du 26 Mars au 27 Aout 2020.

INTRODUCTION: A public health emergency of international concern, COVID-19 is an acute respiratory disease responsible in eight months of approximately 843,158 deaths worldwide, including 29,425 deaths in Africa. The objective was to describe the COVID-19 cases in the health district of Commune III of Bamako. METHODS: This was a descriptive cross-sectional study of COVID-19 surveillance data from March 26 to August 27, 2020. Our variables were extracted from the surveillance database and analyzed on Epi-Info 7.2. Frequencies, rates and proportions were calculated. RESULTS: A positivity rate of 14.86% identified 126 confirmed cases out of an 848 notified suspect. The median age of confirmed cases was 34 years with a minimum of 8 months and a maximum of 93 years. The sex ratio was 2.7 males to females. Civil servants accounted for 32.54% of the positive cases. All the health subdistricts have recorded positive cases. The lethality was 7.94% affecting those over 65 years old. Among asymptomatic people 10.75% were confirmed positive for COVID-19. CONCLUSION: Our study suggests that young males were more likely to be infected with COVID-19. We recommend systematic screening of all contacts and involvement of the community in surveillance.

INTRODUCTION: Urgence de santé publique de portée internationale, la COVID-19 est une maladie respiratoire aiguë responsable en huit mois d'environ 843 158 décès dans le monde dont 29 425 décès en Afrique. L'objectif était de décrire les cas de la COVID-19 en Commune III de Bamako. MÉTHODES: Il s'agissait d'une étude transversale descriptive des données de surveillance de la COVID-19 du 26 Mars au 27 Août 2020. Nos variables ont été extraites de la base de données de surveillance et analysées sur Epi-Info 7.2. Les fréquences, taux et proportions ont été calculés. RÉSULTATS: Un taux de positivité de 14,86% a permis d'identifier 126 cas confirmés sur un 848 suspect notifié. L'âge médian des cas confirmés était de 34 ans avec un minimum de 8 mois et un maximum de 93 ans. Le sex-ratio était de 2,7 en faveur des hommes. Les fonctionnaires représentaient 32,54% des positifs. Toutes les aires de santé ont enregistré des cas confirmés. La létalité était de 7,94% affectant les plus de 65 ans. Parmi les personnes asymptomatiques 10,75% ont été confirmés positives à la COVID-19. CONCLUSION: Notre étude suggère que les jeunes de sexe masculin étaient plus susceptibles d'être infectés par la COVID-19. Nous recommandons le dépistage systématique de tous les contacts et une implication de la communauté dans la surveillance.

[Morbidities of psychiatric disorders among women prisoners of the "Bollé" detention and reintegration center for women (CSDRF)]. / Morbidites psychiatriques chez les detenues du centre specialise de detention et de reinsertion des femmes « Bolle ¼ (CSDRF).

INTRODUCTION: The objective of this work was to determine the frequency of mental disorders among female inmates of the C.S.D.R.F "Bollé". METHOD: This was a descriptive, cross-cutting, prospective study that took place from August to September 2016 at (C.S.D.R.F) "Bollé" in Bamako. It concerned all female inmates present during the study period. The data were collected from pre-established fact sheets, the administration of the Mental Health Screening Questionnaire (MSQ) and clinical variables according to ICD10 criteria. RESULTS: In total, 85 of inmates, or 74% (N-115) agreed to participate in the study. The 14-24 age group accounted for 61.0%. Singles accounted for 56.5% and 95.3% of female inmates had no previous prison history. Seventy-four percent were in pre-trial detention 12.6% had psychotic disorders. Personality disorders were observed in 11.8%. An inmate was on the committee. Thyme disorders were present in 4.7% of female inmates. Drug abuse was observed in 2.4% of female inmates. CONCLUSION: Detention can trigger, promote or aggravate a mental disorder.

INTRODUCTION: L'objectif de ce travail était de déterminer la fréquence des troubles psychiques chez les détenues du C.S.D.R.F « Bollé ¼. MÉTHODE: Il s'agissait d'une étude descriptive, transversale, prospective qui s'est déroulée d'Août à Septembre 2016 au (C.S.D.R.F) « Bollé ¼ de Bamako. Elle a concerné toutes les détenues présentes pendant la période d'étude. Les données ont été collectées sur des fiches d'enquête préétablies, l'administration du Questionnaire de Dépistage en Santé Mentale (QDSM) et des variables cliniques selon les critères du CIM10. RÉSULTATS: Au total, 85 détenues, soit 74 % (N=115) ont accepté de participer à l'étude. La tranche d'âge de 14-24 ans représentait 61,0%. Les célibataires représentaient 56,5% et 95,3% des détenues étaient sans antécédent carcéral. Soixante quatorze pourcent (74%) étaient en détention provisoire 12,6% présentaient des troubles psychotiques. Les troubles de la personnalité étaient observés chez 11,8%. Une détenue présentait la comitialité. Les troubles thymiques étaient présents chez 4,7% des détenues. L'usage abusif de drogue avait été observé chez 2,4% des détenues. CONCLUSION: La détention peut déclencher, favoriser ou aggraver un trouble psychique.

[Stroke in type 2 diabetic patients in the internal medicine department of the Teaching Hospital of Point G]. / Accident vasculaire cerebral (avc) chez les patients diabetiques de type 2 dans le service de medecine interne du CHU du Point G.

INTRODUCTION: Diabetes is a chronic hyperglycemia which can be discovered with specific organic complications particularly affecting the eyes, kidneys, nerves, heart and vessels. Globally, the prevalence of stroke in people with diabetes is approximately 10%. OBJECTIVE: Study the epidemiological and clinical aspects of stroke in patients with type 2 diabetes. METHODOLOGY: We made a descriptive and analytical study by a retrospective survey over a period of 10 years, in the department of internal medicine at the university Hospital ofPoint G. We focused on all hospitalized patients with type 2 diabetes, in whom the diagnosis of stroke was retained. RESULTS: At the end of the study 24 patients out of 492 diabetes hospitalized in to the period met our inclusion criteria, representing a frequence of 4.9%. The mean age was 64.67 ± 13.409 years with a sex-ratio of 1.4. The reason for hospitalization was muscle weakness in 54.2% of patients. Eighty-seven point five percent (87.5%) of patients were already known to have diabetes before the weakness. Stroke was the mode of discovery of diabetes in 12.5%. Over 70% of our patients had hyperglycemia at the time of admission. Ischemic stroke was seen in 75% of patients. CONCLUSION: Stroke is a great complication of diabetes witch, can be a way discovery of type 2 diabetes.

INTRODUCTION: Le diabète est une hyperglycémie chronique qui peut être découvert avec des complications organiques spécifiques touchant particulièrement les yeux, les reins, les nerfs, le coeur et les vaisseaux.L'AVC en ai une de ces complications. À l'échelle mondiale, la prévalence de l'AVC chez les diabétiques est d'environ 10%. OBJECTIF: Étudier les aspects épidémiologiques et cliniques de l'accident vasculaire cérébral chez les patients diabétiques de type 2. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive et analytique sur la base d'une enquête rétrospective de 10 ans, dans le service de médecine interne du CHU du Point G. Elle a porté sur tous les patients diabétiques de type 2 hospitalisés dans le service de médecine interne, chez qui le diagnostic de l'AVC a été retenu. RÉSULTATS: Au terme del'étude 24 patients répondants à nos critères sur 492 diabétiques soit une fréquence de 4,9%. L'âge moyen était de 64,67 ± 13,409 ans avec un sex-ratio de 1,4. Le motif d'hospitalisation était un déficit moteur chez 54,2% des patients. Quatre-vingt-sept virgule cinq pourcent (87,5%) des patients étaient déjà connus diabétiques avant le déficit. L'AVC a été le mode de découverte du diabète chez 12,5%. Plus de 70% de nos patients avaient une hyperglycémieau moment à l'admission. L'AVC ischémique était observé chez 87,5% des patients. CONCLUSION: L'AVC est une complication redoutable du diabète, il peut être le mode de découverte d'un diabète de type 2.

Moringa olifeira Lam. Stimulates Activation of the Insulin-Dependent Akt Pathway. Antidiabetic Effect in a Diet-Induced Obesity (DIO) Mouse Model.

We investigated the antidiabetic effect of Moringa olifeira Lam. in a diet-induced obesity (DIO) mouse model. Six mice were randomly selected as normal controls. Moringa olifeira Lam. leaf extract at a dose of 200, 400 or 600 mg/kg body weight, glibenclamide (Glib) at the dose of 10 mg/kg (positive control) and distilled water at 10 ml/kg (control group) were administered orally by gastric intubation, and each group consisted of six mice. Insulinsensitive tissues (liver, skeletal muscle) were collected to investigate antidiabetic effects and examine the plant's molecular mechanisms. Moringa olifeira Lam. leaf extract prevented weight gain. It also reduced blood glucose in DIO mice. Glib and Moringa olifeira Lam. leaf extract, 400 mg/kg, treatments restored insulin levels towards normal values (P < 0.05 versus diabetic control group). Western immunoblot analysis of different tissues, collected at the end of the study, demonstrated that Moringa olifeira Lam. stimulated activation of the insulin-dependent Akt pathway and increased the protein content of Glut 4 in skeletal muscle. The improvement of hepatic steatosis observed in DIO-treated mice was associated with a decrease in the hepatic content of SREBP-1, a transcription factor involved in de novo lipogenesis. The hepatic PPARα protein content in the plant extract- treated mice remained significantly higher than those of the control group (P < 0.05). In conclusion, this study provides the first evidence for direct action of Moringa olifeira Lam. on pancreatic ß-cells, enhancing glucose-stimulated insulin secretion. This correlated with hypoglycaemic effects in diabetic mice associated with restored levels of plasma insulin.

[Quantitative And Morphological Abnormalities Of Blood Cells Counts Among Customers Received VCT Unit Of The Central Laboratory Of The CHU Of Yopougon]. / Anomalies Quantitatives Et Morphologiques De L'Hemogramme Chez Les Clients Reçus A L'Unite De CDV Du Laboratoire Central Du CHU De Yopougon.

INTRODUCTION: The hematologic abnormalities constitute a reccuring problem in the general population. The HIV infection is a favourable situation for the potentiation of these various hematologic disorders. The aim of the study was to describe the quantitative and qualitative aspects of the three blood lines of our population of study. MATERIAL AND METHOD: It was a prospective cross-sectional study of descriptive type having concerned the people received at the central laboratory of CHU de Yopougon for voluntary tracking from September 1st to September 30th, 2015. RESULTS: We colliged 154 people among whom, a female prevalence was noted with a sex ratio M/F of 0.64. The age bracket from 18 to 29 years was represented (50%) with a 32.94 years median age ± 10 with the 18 and 75 years extremes represented by 50% of single people. The HIV infection prevalence was 20.37%. Anaemia was the most frequent hematologic abnormality (44.44%) its hypochromic microcitic form microcytic (50%) especially. The HIV positive patients had primarily a normochromic normocytic non regenerative anaemia (27.27%). Among HIV positive patients, 23 (65.22%) had a leuconeutropenia combined with lymphopenia at 23 (65.22%) and 12 had bicytopenia which consisted of thrombocytopenia and anaemia. A morphological abnormality of the three blood lines (red blood cells, white blood cells and platelets) was found in 57.41% of our subjects. CONCLUSION: To be in apparent good health, does not exclude the hematologic abnormalities presence. But an HIV infection presence, even in the absence of specific treatment, increases the risk or the degree of severity of these different qualitative and quantitative abnormalities.

INTRODUCTION: Les anomalies hématologiques constituent un problème récurrent dans la population générale. L'infection par le VIH est une situation propice pour la potentialisation de ces différents désordres hématologiques. L'objectif de l'étude était de décrire les aspects quantitatifs et qualitatifs des trois lignées sanguines de notre population d'étude. MATÉRIEL ET MÉTHODE: Etude transversale prospective de type descriptif ayant concerné les personnes reçues au laboratoire central du CHU de Yopougon pour le dépistage volontaire du 1er septembre au 30 septembre 2015. RÉSULTATS: Nous avons colligé 154 personnes parmi lesquelles, une prédominance féminine a été notée avec un sex ratio H/F de 0,64. La tranche d'âge de 18 à 29 ans était la plus représentée (50%) avec un âge moyen de 32,94 ans ± 10 avec les extrêmes de 18 et 75 ans représentée par 50% de célibataires. La prévalence de la séropositivité au VIH était de 20,37%. L'anémie était l'anomalie hématologique la plus fréquente (44,44%) surtout la forme hypochrome microcytaire (50%). Les personnes vivant avec le VIH avaient essentiellement une anémie normochrome normocytaire (27,27%) arégénérative. Une leucopénie avec lymphopénie avait été observée chez 23 (65,22%) tous infectés par le VIH et 12 cas de bicytopénie faite de thrombopénie et d'anémie avaient été observés. Des anomalies morphologiques portant sur les trois lignées sanguines (globules rouges, globules blancs et plaquettes) ont été retrouvées chez 57,41% de nos sujets. CONCLUSION: Etre en bonne santé apparente, n'exclut pas la présence d'anomalies hématologiques. Mais l'association d'une infection par le VIH, même en l'absence de traitement spécifique, augmente le risque ou le degré de sévérité de ces différentes anomalies qualitatives et quantitatives.

Sleep quality assessment in 35 Parkinson's disease patients in the Fann Teaching Hospital, Dakar, Senegal.

INTRODUCTION: Sleep disorders are diverse in Parkinson's disease. We aimed to assess the quality of sleep in patients with Parkinson's disease in an African population. METHODS: In a transversal and prospective study from April to June 2014, all parkinsonian patients followed at the Fann Teaching Hospital Neurology Clinic (Dakar, Senegal) were assessed using the Hoehn and Yahr's scale and filled out the following questionnaires: Parkinson's disease sleep scale (PDSS), the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). A PDSS score<82 (or a subscore<5) and a PSQI score>5 indicated poor quality or impaired sleep. An ESS score>10 indicated excessive daytime sleepiness. We used the Pearson coefficient to search for correlation between age, disease stage, disease duration, and the importance of sleep impairment. RESULTS: Hoehn and Yahr staging was 2.42±0.90 in the 35 patients (60% male, mean age 65.7±7.4years, disease duration 32.4±23.4months). The mean total PDSS score was 99.5±24.1 and 74.3% of the patients had an abnormally high PSQI score, indicating high frequency and intensity of sleep disorders. Most frequent disorders were pain or cramps interrupting sleep, night waking to urinate and fatigue or sleepiness on waking. Patients exhibited excessive diurnal sleepiness in 22.9% of the cases; they often had an abnormal PSQI score. Both the total PDSS score and the difficulty to sleep increased with disease stage, but not with age or disease duration. CONCLUSION: We found evidence of major alteration of sleep quality in Senegalese Parkinson patients.

Social Network and Health Researchers and Professionals Mobility in Africa: Lessons Learned from AFRICA BUILD Project.

OBJECTIVE: Promote mobility between South-South and South-North for improving level of researchers, staff and students through a platform. METHODS: The methodology is based a filling of a questionnaire about offer or demand. Material is composed a computer connected Internet. RESULT: we registered about 203 demands and 31 offers from partners.43 mobilities were executed completely. CONCLUSION: The results indicate a real need of mobility for researchers and health professionals in Africa. The important number of mobility demands made by external researchers and professionals (from outside the AFRICA BUILD Consortium) may be constrained by the difficulty to find adequate funding.

Clinical and genetic analysis of spinocerebellar ataxia in Mali.

BACKGROUND: Autosomal dominant cerebellar ataxia, currently denominated spinocerebellar ataxia (SCAs), represents a heterogeneous group of neurodegenerative disorders affecting the cerebellum and its connections. We describe the clinical and molecular findings in 16 patients originating from Malian families, who suffer from progressive cerebellar ataxia syndrome. METHODS AND RESULTS: Molecular analysis allows genetic profiles of SCA to be distinguished. In seven patients, SCA type 2 (CAG) mutation was expanded from 39 to 43 repeats. SCA type 7 (CAG) mutation was confirmed in six patients. Mutations were expanded from 49 to 59 repeats. In three patients, SCA type3 was diagnosed and CAG mutation was expanded to 73 repeats. CONCLUSIONS: Our data suggest that the most frequent types of SCA are SCA2 and SCA7. However, further studies are needed to confirm these preliminary results.

Hereditary spastic paraplegia and amyotrophy associated with a novel locus on chromosome 19.

We identified a family in Mali with two sisters affected by spastic paraplegia. In addition to spasticity and weakness of the lower limbs, the patients had marked atrophy of the distal upper extremities. Homozygosity mapping using single nucleotide polymorphism arrays showed that the sisters shared a region of extended homozygosity at chromosome 19p13.11-q12 that was not shared by controls. These findings indicate a clinically and genetically distinct form of hereditary spastic paraplegia with amyotrophy, designated SPG43.

Novel mutation in the NHLRC1 gene in a Malian family with a severe phenotype of Lafora disease.

We studied a Malian family with parental consanguinity and two of eight siblings affected with late-childhood-onset progressive myoclonus epilepsy and cognitive decline, consistent with the diagnosis of Lafora disease. Genetic analysis showed a novel homozygous single-nucleotide variant in the NHLRC1 gene, c.560A>C, producing the missense change H187P. The changed amino acid is highly conserved, and the mutation impairs malin's ability to degrade laforin in vitro. Pathological evaluation showed manifestations of Lafora disease in the entire brain, with particularly severe involvement of the pallidum, thalamus, and cerebellum. Our findings document Lafora disease with severe manifestations in the West African population.

[Ovarian fibroma associated with Demons-Meigs syndrome and elevated CA 125]. / Fibrome de l'ovaire associé à un syndrome de Demons-Meigs et à une élévation du CA 125.

We report a rare case of ovarian fibroma in a young woman. When ovarian masse is associated with Meigs' syndrome and elevated CA 125 serum level a malignant process may be suspected. But a negative cytological examination of ascitic effusion and absence of peritoneal implant recommend performing limited surgical procedures.

The effect of supplementation with fresh browse of Ziziphus mauritiana or Combretum aculeatum on feed intake, nitrogen utilization and growth of grazing range sheep.

The influence of 0, 60 or 120 min access to a grove of either Ziziphus mauritiana (Ziziphus) or Combretum aculeatum (Combretum) on forage intake and on the digestibility, growth and excretion of nutrients was determined using 40 Oudah rams grazing for 7 h/day on poor-quality dry season pasture in the Sahel. The effects of browse species and browsing duration (0, 30, 60 or 120 min) on the ruminal ammonia content were also evaluated using 8 mature fistulated rams. Ziziphus increased both total digestible organic matter and total dry matter intakes per (kg live weight)0.75 without decreasing herbage intake, whereas 60 or 120 min access to Combretum reduced herbage intake by 6.3% and 4.2%, respectively. The digestibility of the diet decreased (p < 0.05) with the duration of access to the groves. Despite the provision of more nitrogen (N) than in the control diet, ruminal NH3-N decreased 24 h after browsing commenced. The reduced live weight gain of sheep browsing Combretum may indicate more deleterious compounds in Combretum than in Ziziphus. Ziziphus appears to have more potential than Combretum to increase sheep production in low-input crop/livestock systems.

Evidence of behaviour change following a hygiene promotion programme in Burkina Faso.

OBJECTIVES: To determine whether a large, 3-year hygiene promotion programme in Bobo-Dioulasso, Burkina Faso, was effective in changing behaviours associated with the spread of diarrhoeal diseases. The programme was tailored to local customs, targeted specific types of behaviour, built on existing motivation for hygiene, and used locally appropriate channels of communication. METHODS: Two population surveys recorded the coverage of the programme among target audiences (mothers of children aged 0-35 months). Four surveys were carried out: three prior to the programme and one in 1998 (after the programme had been running for 3 years), using structured observation of hygiene behaviours in the participants' homes to document changes in target behaviours. FINDINGS: After the programme had run for 3 years, three-quarters of the mothers targeted had had contact with programme activities. Half could cite the two main messages of the programme correctly. Although the safe disposal of children's stools changed little between 1995 and 1998 (80% pre-intervention, 84% post-intervention), hand-washing with soap after cleaning a child's bottom rose from 13% to 31%. The proportion of mothers who washed their hands with soap after using the latrine increased from 1% to 17%. CONCLUSION: Hygiene promotion programmes can change behaviour and are more likely to be effective if they are built on local research and use locally appropriate channels of communication repeatedly and for an extended time.

[Contraception by subcutaneous Norplant implants. 300 cases]. / Contraception par les implants sous-cutanés Norplant. A propos de 300 cas.

It is a prospective study for the evaluation of the efficiency and the acceptability of Norplant contraceptive subdermal implants within the Senegalese female population. Three hundred women were selected on the basis of precise criteria between December 1986 and July 1991. Every patient included in the study signed a form of voluntary consent with the agreement of the consort, and was bound to come to control examinations until the removal of the implants. The insertion was made under local anaesthesia between the 1st and the 7th day of the cycle, or starting from the 6th week of post-partum in the other cases. The average age of patients was 32, and the average parity four children. 50 percent of women did not want any other children. The average insertion time is 4.8 minutes. The analysis of side-effects on 248 regularly followed women mostly reveals menstrual troubles like amenorrhea, spottings, menorrhagia. The fitful local prurigo was noted in 35 cases, and accidental pregnancy in 4 cases. The removal of implants within the first six months was made on 11 women (4.4%). As such, the Norplant implants constitutes a highly efficient method, well tolerated by Senegalese women.

[Emergency obstetrical hysterectomy]. / L'hystérectomie obstétricale d'urgence.

Hysterectomy on pregnant uterus is a mutilating procedure used by obstetrician only when he haven't choice in case of major complications of pregnancy or delivery. This retrospective study worked on 35 cases of obstetrical hysterectomy performed on 22 months period (January 94-October 95). The frequency of the procedure among all the in hospital deliveries was 0.45%. The mean age of the patients was 31 years, and the mean parity was 7. 77.5% of the women were referred from over surrounding hospitals where natural deliveries had failed. We performed the hysterectomy because of uncontrolled haemorrhage in 71.7%, and infection in 25.8%. Sub-total hysterectomy was performed in 82.8%. Maternal mortality was 20%. Hysterectomy is very mutilating, but is a life rescueing procedure behind a lifethreatening complication of pregnancy or delivery. The best strategy to prevent the necessity of hysterectomy, is to develop the early obstetrical reference program that unfortunately is not yet in practice in our health care system.