Profil métabolique des patients hypertendus pris en charge dans le service de cardiologie du CHU mère-enfant ?le Luxembourg" / Metabolic profile of hypertensive patients treated in the cardiology department of the university teaching hospital le Luxembourg

Objectif : Évaluer le profil du syndrome métabolique (SM) dans une population hypertendue au Mali. Patients et méthodes : Étude prospective du 1er juin 2022 au 31 juin 2022, dans le service de cardiologie du CHU Mère ­enfant le Luxembourg de Bamako. Notre échantillon d'étude était composé de patients hypertendus adultes, âgés de 18 ans et plus, reçus en consultation externe. Les patients étaient inclus dans notre étude après consentement éclairé. Le SM a été établi sur la base des définitions de l'International Diabetes Federation (IDF). Résultats : Sur 520 patients, 238 ont été inclus dans notre étude. La prévalence du SM était de 30,2 % selon les critères de l'IDF. On notait une prédominance féminine (66 %).L'âge moyen était de 57 ± 5 ans.L'HTA grade II était majoritaire avec 39%.Soixantequinze pourcent des patients avec syndrome métabolique ont présenté 3 facteurs de risque.L'AVC ischémique a été la complication la plus retrouvée avec un taux de 12%.La bithérapie était indiquée chez 59,23% des patients. Les inhibiteurs calciques ont été les plus prescrits avec un taux de74,5%. Le SM constitue une réalité au Mali. Des mesures adéquates de prévention sont nécessaires afin de limiter sa progression

Objective: To assess the profile of metabolic syndrome (MS) in a hypertensive population in Mali. Patients and methods: Prospective study from June 1, 2022 to June 31, 2022, in the cardiology department of the Mother-Child University Hospital in Bamako, Luxembourg. Our study sample consisted of adult hypertensive patients, aged 18 years and older, received as an outpatient. Patients were included in our study after informed consent. The SM was established based on International Diabetes Federation (IDF) definitions. Results: Out of 520 patients, 238 were included in our study. The prevalence of SM was 30.2% according to IDF criteria. There was a female predominance (66%). The mean age was 57 ± 5 years. Grade II hypertension was in the majority with 39%. Seventy-five percent of patients with metabolic syndrome had 3 risk factors. Ischemic stroke was the most common complication with a rate of 12%. Dual therapy was indicated in 59.23% of patients. Calcium channel blockers were the most prescribed with a rate of 74.5%. SM is a reality in Mali. Adequate preventive measures are necessary to limit its progression

Genome Scan of Rice Landrace Populations Collected Across Time Revealed Climate Changes' Selective Footprints in the Genes Network Regulating Flowering Time.

Analyses of the genetic bases of plant adaptation to climate changes, using genome-scan approaches, are often conducted on natural populations, under hypothesis of out-crossing reproductive regime. We report here on a study based on diachronic sampling (1980 and 2011) of the autogamous crop species, Oryza sativa and Oryza glaberrima, in the tropical forest and the Sudanian savannah of West Africa. First, using historical meteorological data we confirmed changes in temperatures (+ 1 °C on average) and rainfall regime (less predictable and reduced amount) in the target areas. Second, phenotyping the populations for phenology, we observed significantly earlier heading time in the 2010 samples. Third, implementing two genome-scan methods (one of which specially developed for selfing species) on genotyping by sequencing genotypic data of the two populations, we detected 31 independent selection footprints. Gene ontology analysis detected significant enrichment of these selection footprints in genes involved in reproductive processes. Some of them bore known heading time QTLs and genes, including OsGI, Hd1 and OsphyB. This rapid adaptive evolution, originated from subtle changes in the standing variation in genetic network regulating heading time, did not translate into predominance of multilocus genotypes, as it is often the case in selfing plants, and into notable selective sweeps. The high adaptive potential observed results from the multiline genetic structure of the rice landraces, and the rather large and imbricated genetic diversity of the rice meta-population at the farm, the village and the region levels, that hosted the adaptive variants in multiple genetic backgrounds before the advent of the environmental selective pressure. Our results illustrate the evolution of in situ diversity through processes of human and natural selection, and provide a model for rice breeding and cultivars deployment strategies aiming resilience to climate changes. It also calls for further development of population genetic models for adaptation of plant populations to environmental changes. To our best knowledge, this is the first study dealing with climate-changes' selective footprint in crops.

Prise en charge anesthésiologique de l'anévrisme cérébral au Mali / Anesthesiological management of cerebral aneurysm in Mali

Objectif : Décrire la prise en charge anesthésiologique de l'anévrisme cérébral au Mali. Patients et Méthodes : étude descriptive à recueil historique de 8 ans (Novembre 2012 à Octobre 2020) au CHU « Hôpital du Mali ¼ des patients opérés pour anévrisme cérébral avec un dossier médical complet. La saisie et l'analyse ont été effectuées par SSPS version 25. Résultats : Durant la période d'étude, 32 patients répondaient à nos critères soit une prévalence de 2,1%. L'âge moyen était de 45,2 ± 12,5 ans. Le ratio femme-homme était de 2,55. Les patients résidaient à Bamako dans 71,9 %. L'HTA était l'antécédent médical le plus fréquent. Les patients étaient de grade I de WFNS dans 87,5%. La classe ASA II représentait 84,4%. Une prémédication a été faite dans 96,9%. Une anesthésie générale a été faite chez tous les patients. Une antibioprophylaxie a été faite chez tous les patients. La perte sanguine moyenne était de 737,3 ± 460,5 ml. Une transfusion per opératoire a été prescrite dans 46,8%. L'évènement indésirable per opératoire était cardiovasculaire dans 96,9 %. La durée moyenne de la chirurgie était de 267,1±77,1 minute. Celle de l'anesthésie était de 427,9 minutes. En réanimation, une complication a été observée dans 34,4%. La mortalité était de 25%. La durée moyenne de séjour était de 6,3 jours. Conclusion: Au Mali la prise en charge de l'anévrysme cérébral est en progrès malgré une mortalité encore élevée.

Objective: To Describe the anesthesiological management of cerebral aneurysm in Mali. Patients and Methods: This was an observational study, descriptive with historical collection of 8 years (November 2012 to October 2020) at the department of the university hospital "Hôpital du Mali" concerning 32 patients operated for cerebral aneurysm with a complete medical file. Input and analysis were performed by SSPS version 25. Results: During the study period, 32 patients met our criteria, a prevalence of 2.1%. The median age was 45.2 ± 12.5 years. The female-to-male ratio was 2.55. Patients resided in Bamako in 71.9%. High blood pressure was the most common medical history. Patients were grade I WFNS in 87.5o_ièvg%. ASA class II accounted for 84.4%. Premedication was done in 96.9%. General anesthesia was applied to all patients. Antibiotic prophylaxis was given to all patients. The average blood loss was 737.3 ± 460.5 ml. An intraoperative transfusion was prescribed in 46.8%. The intraoperative adverse event was cardiovascular in 96.9%. The average duration of surgery was 267.1±77.1 minutes. That of anesthesia was 427.9 minutes. In intensive care, a complication was observed in 34.4%. Mortality was 25%. The average length of stay was 6.3 days. Conclusion: In Mali, the management of cerebral aneurysm is progressing despite still high mortality.

Toward Health System Recovery in the Aftermath of Ebola Outbreak in Guinea: New Approaches for Improved Knowledge of Target Populations at the Community Level.

BACKGROUND: Before the COVID-19 pandemic, Guinea has been the epicenter of the huge West Africa Ebola outbreak (2014-2016), that impact heavily the health system. Demographic information is one of the most basic data sources for health systems and services delivery, and yet can be very difficult to obtain with any accuracy. The objectives were to contribute among other to: (i) a determination of the catchment area (health coverage area and responsibility) of the Kirikilan health facility (PCM); (ii) geocoded mapping to find out exactly where these populations per sector of Kirikilan neighborhood lives; (iii) an approach for regular and systematic annual demographic follow up of target populations. METHODS: The study was a 3-year community-based survey with annual follow up of the population within the quartier of Kirikilan in Dubreka Prefecture in Guinea. It was an exhaustive enumeration of the population, sector by sector of the quartier, then there was no sampling size neither estimation. RESULTS: In October 2017 as a baseline of the study, the enumeration showed the total population was 8824 persons, 936 compounds, 1435 households, and the breakdown by sub quartier (sector) has been performed. It's showed the interest of the mapping of the target populations with geo-referenced localization. The annual follow up by demographic enumerus showed a dramatic increase of the size of the population, including strong migration of the evicted population due to urbanization purpose in some districts of Conakry, the capital. CONCLUSION: The study showed the importance of the enumeration and follow up of the target populations, but also of the setting up community data based to improve the district health information system (DHIS 2) in Guinea. The approach has a best practice could be an importunity to improve data sharing, mapping, health quality access, and affordability for a sustainable health toward universal health coverage.

First Malian series of surgery for rheumatic valve disease: opening of the centre, clinical features and peri-operative realities.

INTRODUCTION: Over the past two decades, the incidence of acute rheumatic fever (ARF) and chronic rheumatic heart disease (RHD) have dramatically declined in wealthier regions of the world as a result of preventative programmes, improved living standards and access to cardiac surgery. Nevertheless, ARF and RHD are still public health problems in less-developed regions of the world such as Oceania, south Asia and sub-Saharan Africa. AIM: We report on clinical, therapeutic and prognostic aspects as well as the difficulties encountered during this first series of surgery for rheumatic valve disease in Mali. METHODS: This was a prospective, descriptive study conducted at the Andre Festoc Cardiac Surgery Centre from September 2018 to August 2019. RESULTS: The frequency of patients having been operated on for rheumatic valve disease was 44.73% (68 patients). The mean age of the patients was 18 ± 10 years with extremes of five and 60 years. The gender ratio was 0.7. The delay to treatment was between one and three years for 39.7% of the patients. The main diagnoses found were: mitral regurgitation in 50% of patients, mitral stenosis in 16.2% and aortic regurgitation in 10.3%. Pulmonary artery systolic pressure was 35-50 mmHg in 19.1% of patients and more than 50 mmHg in 25%. The median cardiopulmonary bypass time was 132 minutes (60-276) and median extubation time was three hours (0-96). The main complications were cardiac, renal, neurological, respiratory, gastrointestinal and infectious. In the immediate postoperative period, we recorded three deaths, which is a mortality rate of 4.4%. CONCLUSIONS: Humanitarian efforts have led non-governmental organisations (NGOs) to launch surgical programmes in low-and middle-income countries in an attempt to fill the gap in these fragile healthcare systems. Cardiac surgery requires much expertise from the medical staff, as well as many material and financial resources. Empowerment of the local team is a challenge that is being realised since taking these essential steps of companionship with the NGO la Chaine de l'Espoir.

[Care of covid-19 patients at the dermatology hospital of Bamako]. / Prise en charge des patients covid-19 a l'hopital de dermatologie de Bamako.

AIM: To assess the COVID-19 patients' treatment duration according to the place of treatment at the Dermatology Hospital of Bamako (DHB). METHODS: This was a cross-sectional study comparing the management of COVID-19 PCR-positive patients in the hospital to that of those managed at home from March 2020 to April 2021 until two consecutive negative PCR 48 hours apart. RESULTS: Among the 1109 patients, 369 were hospitalized, 497 followed at home. As of April 31, 2021, 81.2% (900/1109) of the patients recovered, 1.3% (14/1109) were transferred to another health structure, and 2.5% (28/1109) died. No statistically significant difference was observed between the mean duration of the treatment for patients treated at home (10 days) in (95% CI, 9.69-10.3) and those managed at hospital (10 days95% CI, 9.76-10.23) (Mantel-Cox test, p= 0.060). CONCLUSION: These results suggest that the place of treatment do not influence the time to recovery. This is particularly important given the current burden of COVID-19 management on the health workforce.

OBJECTIF: Evaluer la durée du traitement des patients COVID-19 selon le lieu de pris en charge à l'Hôpital de Dermatologie de Bamako (HDB). MÉTHODOLOGIE: Il s'agissait d'une étude transversale comparant la prise en charge des patients COVID-19 PCR-positifs à l'hôpital à celle à domicile de mars 2020 à avril 2021 jusqu'à l'obtention de deux tests PCR négatifs consécutifs à 48 heures d'intervalle. RÉSULTATS: Parmi les 1109 patients, 369 ont été hospitalisés, 497 suivis à domicile. Au 31 avril 2021, 81,2% (900/1109) des patients se sont rétablis, 1,3% (14/1109) ont été transférés dans une autre structure de santé et 2,5% (28/1109) sont décédés. Aucune différence statistiquement significative n'a été observée entre la durée moyenne du traitement pour les patients traités à domicile (10 jours) en (IC 95 %, 9,69-10,3) et ceux pris en charge à l'hôpital (10 jours IC 95 %, 9,76-10,23) (test de Mantel-Cox, p= 0,060). CONCLUSION: Ces résultats suggèrent que le lieu de traitement n'influence pas le temps de récupération. Ceci est particulièrement important étant donné la charge actuelle de la gestion des COVID-19 sur le personnel de santé.

[Recurrent retroperitoneal hematoma due to viperine envenomation: case study]. / Hématome rétro-péritonéal consécutif à une envenimation vipérine: à propos d'un cas.

Ophidian envenomations are a public health problem in Africa, causing 20.000 annual deaths. This mortality reflects the difficulties in the management of these complications, in particular of bleeding complications. We report the case of Mr SL, aged 35 years, farmer, victim of snake bite causing haemorrhagic syndrome followed by a progressive onset of acute abdomen. Ultrasound objectified high abundant effusion. Effusion puncture was performed which showed unclotting blood. Given the re-establishment of the hemoperitoneum after three doses of antivenin serum as well as the coagulation of the samples collected using drying tube, exploratory laparotomy was performed on day 9. It showed retroperitoneal hematoma, with bulging appearance, in the mesocolon which flowed in the peritoneal cavity. Aspiration of 1500ml of blood and rinsing with physiological serum were performed. The postoperative course was uneventful. The patient was transferred to the department of surgery three days after surgery and was discharged on day 19.

Resilience from the ground up: how are local resilience perceptions and global frameworks aligned?

Numerous resilience measurement frameworks for climate programmes have emerged over the past decade to operationalise the concept and aggregate results within and between programmes. Proxies of resilience, including subjective measures using perception data, have been proposed to measure resilience, but there is limited evidence on their validity and use for policy and practice. This article draws on research on the Decentralising Climate Funds project of the Building Resilience and Adaptation to Climate Extremes and Disasters programme, which supports communities in Mali and Senegal to improve climate resilience through locally controlled adaptation funds. It explores attributes of resilience from this bottom-up perspective to assess its predictors and alignment with food security, as a proxy of well-being. We find different patterns when comparing resilience and the well-being proxy, illustrating that the interplay between the two is still unclear. Results also point to the importance of contextualising resilience, raising implications for aggregating results.

Synthesis and structure-activity relationship of 1- and 2-substituted-1,2,3-triazole letrozole-based analogues as aromatase inhibitors.

A series of bis- and mono-benzonitrile or phenyl analogues of letrozole 1, bearing (1,2,3 and 1,2,5)-triazole or imidazole, were synthesized and screened for their anti-aromatase activities. The unsubstituted 1,2,3-triazole 10a derivative displayed inhibitory activity comparable with that of the aromatase inhibitor, letrozole 1. Compound 10a, bearing a 1,2,3-triazole, is also 10000-times more tightly binding than the corresponding analogue 25 bearing a 1,2,5-triazole, which confirms the importance of a nitrogen atom at position 3 or 4 of the 5-membered ring needed for high activity. The effect on human epithelial adrenocortical carcinoma cell line (H295R) proliferation was also evaluated. The compound 10j (IC(50) = 4.64 µM), a letrozole 1 analogue bearing para-cyanophenoxymethylene-1,2,3-triazole decreased proliferation rates of H295R cells by 76 and 99% in 24 and 72 h respectively. Computer calculations, using quantum ab initio structures, suggest a possible correlation between anti-aromatase activity and the distance between the nitrogen in position 3 or 4 of triazole nitrogen and the cyano group nitrogen.

Daily doses of biologically active UV radiation retrieved from commonly available parameters.

A multiple linear correlation is done between atmospheric transmissivity for four biologically active radiation daily doses (UVB, erythemal, DNA and plant damage) T, and three parameters (daily sunshine fraction sigma, cosine of the daily minimum solar zenith angle mu min and daily total ozone column omega). T is defined as the ratio of a daily dose to its extra-atmospheric value. The data used are spectral UV measurements (390-400 nm at 0.5 nm step) recorded along year 2000 and over 8 months of year 2001 at Briançon Station (Alps, 1300 m above sea level) that forms part of the French UV network. The coefficients obtained from year 2000 correlation permit to retrieve daily doses for year 2001 with an average error running from 3 to 9% for monthly mean values and from 2 to 4.5% for 3-monthly mean values, depending on daily dose type. The retrieval of yearly mean value gives an error between 4 and 7.5%. Retrieving the daily dose of a given day, where sigma > or = 0.2, introduces error running from 16 to 32% depending on daily dose. An attempt to retrieve the yearly mean UVB daily dose for a northern France site, from the previous coefficients, gives encouraging results.

Retrieval of the ultraviolet aerosol optical depth during a spring campaign in the Bavarian Alps.

A measurement campaign was organized in March 1999 in the Bavarian Alps as part of the European project, Characteristics of the UV Radiation Field in the Alps (CUVRA), to analyze the effect of altitude, aerosols, and snow cover on ground-level UV spectral irradiance. We present the results of simultaneous measurements of aerosol optical depth (AOD) made at various sites on two cloudless days in March 1999. The two days exhibited different aerosol conditions. Results derived from spectral measurements of UV irradiance are compared with data from filter radiometer measurements made at discrete wavelengths extending from the UV to the near IR. The different methods generated values for the AOD that were in good agreement. This result confirms that one can use either method to retrieve the AOD with an uncertainty of approximately 0.03-0.05. On 18 March, high turbidity was observed at low altitude (400-nm AOD approximately 0.5 at 700 m above sea level), and the AOD decreased regularly with altitude; on 24 March, the turbidity was much less (0.11 at 700 m above sea level). On both days very low AODs (0.05-0.09) were measured at 3000 m above sea level. The spectral dependence of the AOD is often parameterized by the angstrom relationship; the alpha parameter is generally difficult or impossible to retrieve from spectral measurements because of the relatively narrow wavelength range (320-400 nm), and only one of the spectro-radiometers used during the campaign permits this retrieval. In most cases, during this field campaign, alpha was found by filter sunphotometers to be 1.1-1.5.