[Well-digger's lung in Mali during the decade of 2001-2010]. / Poumon de puisatier au Mali pendant la décennie 2001-2010.

INTRODUCTION: The well-digger is a craftsman who hollows wells often manually; this trade can be source of inhalation of the particles of silica. The whole of the radio clinical signs linked to this profession is known under the term "Well-digger's lung". The goal was to study the radio clinical aspects and progression in black African's pulmonological environment. METHODS: Retrospective and descriptive study concerning the respiratory involvement of well-diggers in the Pulmonology service of the Teaching Hospital of Bamako, from January 2001 to December 2010. The admission registers were used as data verification support. RESULTS: Among 4158 admissions for lung affection, we have collected 39 cases of well-digger's lung (0.9%), all young male adults. The average of exposition period was 13 ± 9 years, correlated to the patient's age (p<0.001). The principal reason of consultation was dyspnea (94.8%). The complications were frequent (cardiac, infectious, pleural). The radiological pictures were made of bilateral big opacities associated with small opacities. The evolution was unfavorable in the majority of the cases. CONCLUSION: The well-digger's lung is a young adult pneumoconiosis linked to the inhalation of the particles of silica during the trade (profession) of well-digger that complicates frequently in chronic respiratory insufficiency.

[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.

[Pleural puncture biopsy in the aetiological diagnosis of pleurisy]. / Ponction biopsie pleurale dans le diagnostic étiologique des pleurésies.

INTRODUCTION: Pleurisy represents a worrying situation because of the difficulty of aetiological diagnosis. The aim of this study was to evaluate the contribution of pleural puncture biopsy (PPB) in the diagnosis of pleurisy. METHODS: A prospective study of the contribution of the pleural puncture biopsy in the pulmonary service of Bamako (Mali) from 2005 to 2009. PPB was used in the investigation of exudative, non-purulent pleurisy of unknown aetiology. Castelin biopsy forceps were used. RESULTS: Pleurisy was the reason for 20% of the total admissions of 6374 patients. The PPB was performed in 390 patients or 30.6% of the cases of pleurisy. The HIV test was performed in 341 patients (87.4%), of whom 72 cases (21.1%) were positive. The pleural biopsies were: lymphocytic (68.7%), mixed cellular (17.1%). Histological interpretation was possible in 367 biopsy specimens, a yield of 94.1%. Tuberculous granulomata were found in 65.1% with a close relationship to HIV status (P<0.004). Pleural cancer was found in 16.1%. CONCLUSION: The PPB is easy to perform at a low cost. It permits the diagnosis of tuberculous and neoplastic pleurisy, particularly in low income countries with a high prevalence of TB/HIV.

[Indications for admitting patients with respiratory conditions in Sub-Saharan Africa]. / Motifs d'admission des patients en milieu pneumologique noir africain.

INTRODUCTION: Respiratory diseases are the cause of a larger number of consultations than any other organ pathology; and general practitioners therefore spend considerable time treating them. The aim of this work was to investigate the indication for admission to hospital in patients with respiratory disease in a Sub-Saharan African context. PATIENTS: This was a retrospective observational study of the indications for admission to the pneumology department of the University Hospital of Point G. in Bamako, between January 2000 and December 2009. Admission registers were used to verify data recorded in patients' medical records. RESULTS: Twelve thousand six hundred and forty records were collected; 8621 men and 4019 women, mean age 49±13.5 years. 80.3% of admissions were for respiratory diseases and 19.7% for non-respiratory diseases largely cardiovascular and digestive conditions. The admission diagnosis and definitive diagnoses were dominated by tuberculosis, which made up 67% and 60% of cases respectively (P=0.000). The diagnosis was not specified in 2% of cases. CONCLUSION: The reason for admission to the respiratory service varied and included a proportion of non-respiratory diseases. We meet respiratory and non-respiratory affections. Among pulmonary diseases, tuberculosis, bacterial pneumonia and pleurisy are the main reasons for admission.

Tuberculose vertébrale (Mal de Pott) : aspects épidémio-clinique, radiologique et évolutif au CHU du Point-G

La spondylodiscite tuberculeuse ou Mal de Pott est la forme la plus fréquente des tuberculoses ostéoarticulaires dans les pays à forte prévalence de tuberculose et de VIH/SIDA, mais le diagnostic de certitude reste difficile. Le but de ce travail était d'étudier les aspects épidémio clinique, radiologique et évolutif du Mal de Pott en l'absence de preuve bactériologique et histologique. Méthode : Il s'agit d'une rétrospective ayant porté sur des dossiers colligés dans le service de pneumophtisiologie du CHU de Point-G, de Janvier 2005 à Décembre 2009. Ont été retenus, tous les dossiers portant le diagnostic de tuberculose vertébrale probable et dont le traitement antibacillaire a été institué. Résultats : Au total, 178 cas de Mal de Pott ont été enregistrés sur 3560 cas de tuberculoses toutes formes soit 5%, avec une moyenne de 35± 6 cas par an. Nous avons noté une prédominance masculine (102 hommes contre 76 femmes) soit un sex-ratio de 1,3. L'âge moyen des patients était de 41 ± 15 ans. Les signes régulièrement retrouvés par leurs fréquences de plus de 80% sont : altération de l'état générale, asthénie, fièvre vespérale, la douleur rachidienne inflammatoire, VS élevée, spondylodiscite, retour à l'apyrexie, amélioration de l'état général. La sérologie VIH était positive dans 5,2% des 152 patients dépistés. Conclusion : Le Mal de Pott est en augmentation progressive. Le diagnostic est très souvent de présomption. Aussi, faut-il savoir débuter à temps un traitement antituberculeux, afin de minimiser les séquelles post-thérapeutiques

[The socio-economic impact of asthmatic disease at Bamako about 131 cases]. / Impact socio-economique de la maladie asthmatique a Bamako a propos de 131 cas.

With an aim of evaluating the socio-economic impact of the asthmatic disease in Mali, a cross-sectional study was carried out of July 1st to September 30, 2006 in the district of Bamako. The study proceeded with the service of Pneumo-phthisiology of the CHU of the point G and in 4 of the 6 drawn health center of reference of the district to the fate. 131 asthmatic patients were indexed on 1595 consultations is a frequency of 8, 24%. The average age was 31 years, the sex-ratio was of 1,2 in favour of the men. August recorded the greatest number of consultation is 50.4%. The antecedent of family asthma was found in 46, 6% of the cases, the nicotinism in 13% of the cases. The average therapeutic cost per annum rose of 75.750 is 115, 47 EUROS without hospitalization with 222.750 FCFA (339, 57 EUROS) FCFA with hospitalization. The hospital expenses rose on average to. 147000 FCFA (224, 09 EUROS) that is to say 66, 21% of the costs of assumption of responsibility. The intermediate duration of hospitalization was 5,5 days 1 to 4 days without activity was noted at 50.4% of the cases, on average 312 days of absence. The professional damage was announced in 13, 7%. The economic burden was supported by the father in 29% of the cases. In 42% of the cases in charge one of expenditure was civil servant. Asthma is a social disease from its impact on the family economy.

[Profile of deceased patients who died as a result of microscopy-positive pulmonary tuberculosis: impact of HIV status]. / Profil des patients decedes de tuberculose pulmonaire a microscopie positif (TPM+): influence du statut VIH.

In order to study the profile of patients who died of pulmonary tuberculosis with positive smear under tuberculosis chemotherapy and the impact of HIV status, a prospective study over eight months from 1 November 2005 to 30 June 2006 was conducted in tuberculosis department CHU point G. Among patients hospitalized for tuberculosis all forms, 73 cases of pulmonary tuberculosis were recorded including 54 sputum smear-positive (73.9%). The analysis focused on 28 deaths among pulmonary tuberculosis smear positive (prevalence of 51,85%). The age group of 16-35 years was the most represented with a sex ratio of 2.5. The different causes of morbidity which had a negative influence on the lethality of TB patients in order of importance were: the extent of the lesions (71.4%), HIV/AIDS status (63.15%), smoking (50 %) and a history of tuberculosis (25%) (p = 0.02). The deaths occurred early during the first week of hospitalization. The search for morbidity factors in any patient with tuberculosis should be systematical to improve their care.

Profil des patients decedes D (TMP+) : influence du statut VIH

Dans le but d'etudier le profil de patients decedes de tuberculose pulmonaire a microscopie positive (TPM+) sous chimiotherapie antituberculeuse et l'influence du statut VIH; une etude prospective sur huit mois; du 1er novembre 2005 au 30 juin 2006 a ete menee dans le service de pneumo phtisiologie du CHU de point G. Parmi les malades hospitalises pour tuberculose toutes formes confondues; 73 cas de tuberculoses pulmonaires ont ete repertories dont 54 cas de tuberculose a frottis positif soit 73;9. L'analyse a porte sur 28 deces parmi les cas de tuberculose pulmonaire a frottis positif soit une prevalence de 51; 85. La tranche d'age de 16-35 ans etait la plus representee avec un sex-ratio de 2;5. Les differents facteurs de morbidite qui ont influence negativement sur la letalite des patients tuberculeux par ordre d importance etaient : l etendue des lesions (71;4); ; le statut VIH/SIDA ( 63;15) ; le tabagisme (50) et des antecedents de tuberculose (25) (p= 0;02). Les deces survenaient precocement au cours de la premiere semaine d'hospitalisation. La recherche des facteurs de morbidites chez tout patient tuberculeux devrait etre systematique pour ameliorer leur prise en charge globale

[HIV/AIDS impact in pulmonary tuberculosis with negative microscopy in pneumology service at Point "G" hospital]. / Impact du VIH/SIDA dans la tuberculose pulmonaire à microscopie négative (TPM-) dans le service de pneumophtisiologie à Bamako.

This study was opened and conducted from colligated patient folders during 5 years (from January 1999 to December 2003). The main objective was the description of epidemiological, diagnostically and prise and prise of charge aspects of microscopy negative pulmonary tuberculosis. Patients were enrolled in this study in accordance to WHO criteria. During these 5 years, pulmonary tuberculosis has constituted 72.2% on all froms of tuberculosis with 20.2% of microscopy negative pulmonary tuberculosis. The BCG vaccine scar has been observed in 50.8% of cases. The IDR was negative in 21.3% of cases; this rate was about 68.1% in HIV positive patients. More than 60% of the patients have more than 3 negative bacilloscopy. The 69.4% of our patients have been hospitalized and 64% have been treated with III category system.

Impact du VIH/SIDA dans la tuberculose pulmonaire à microscopie négative (TPM -) dans le service de pneumophtisiologie à Bamako

Il s'agit d'une étude ouverte sur des dossiers colligés durant une période de cinq ans ( Janvier 1999 à Décembre 2003), qui avait pour objectif principal de décrire les aspects épidémiologiques, diagnostiques et la prise en charge de la TPM - .Les patients sont inclus dans l'étude pour TPM- selon les critères de l'OMS. Pendant cette période de cinq ans, la tuberculose pulmonaire (TP) a constitué 72,1% des cas de tuberculoses toutes formes sur lesquelles 20,2% de TPM- . La cicatrice BCG était présente dans 50,8% des cas. L'IDR était négative dans 21,3% des cas, ce taux atteint 68,1% chez les patients VIH positifs. Plus de 60% de nos patients ont réalisé plus de 3 bacilloscopies qui sont restées négative. La sérologie VIH était positive chez 51,1% des patients testés. L'hospitalisation a concerné 69,4% de nos patients, 64% ont été traité par le régime de la catégorie III