[Targeted newborn screening for sickle-cell anemia: Sickling test (Emmel test) boundaries in the prenatal assessment in West African area]. / Dépistage néonatal ciblé de la drépanocytose : limites du test de falciformation (test d'Emmel) dans le bilan prénatal en zone ouest africaine.

BACKGROUND: Newborn screening for sickle cell anemia is necessary in Africa where the disease is more frequent. Hemoglobin electrophoresis is used for screening, but is limited by a high cost and difficult access. Sickling test (Emmel test), which is more affordable and technically more accessible, is often requested for prenatal assessment of pregnant women in West African areas to reserve screening for newborns from mothers in whom the positive sickling test attests the presence of hemoglobin S. This study aims to evaluate the number of undetected sickle cell anemia newborns by a screening policy targeting only newborns from mothers in whom a sickling test would have been positive. METHODS: From 2010 to 2012, in Bamako, Mali, West Africa, 2489 newborns were routinely screened for sickle cell anemia at the umbilical cord or heel by isoelectrofocusing and, if necessary, by high-performance liquid chromatography. These newborns were born from 2420 mothers whose hemoglobin was studied by isoelectrofocusing. The data was recorded and processed using Excel software version 14.0.0. We calculated the frequency of the sickle cell gene in mothers and newborns as well as the number of SCA newborns from heterozygous or C homozygous mothers. RESULTS: Of the 2489 newborns, 16 had sickle cell anemia (6 SS and 10 SC); 198 had the sickle cell trait; 139 were AC and 1 was CC. Of the 10 newborns with SC profile, 3 were born from mothers not carrying the S gene but the C gene of hemoglobin and in which an Emmel test would have been negative. CONCLUSION: Targeted newborn screening, based on the results of sickling test in pregnant women, would misdiagnose more than one of six sickle cell anemia newborns who would not benefit from early care. Cost-effectiveness studies of routine newborn screening for sickle cell anemia should lead to a better screening strategy in contexts where hemoglobin S and other hemoglobin defect genes coexist.

[Portal cavernoma at child about two observations]. / Cavernome portal chez l'enfant a propos de deux observations.

We report two observations of portal cavernoma diagnosed successively in Bamako and Dakar. The first is a 6-year-old male admitted to the service for ascites and abdominal pain. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The clinical examination noted a moderate skin-mucosal pallor, asthenia. The biological assessment returned to moderate normochrome anemia with impaired pancreatic function while renal and hepatic functions were maintained. The abdominal scan performed after two low-contribution abdominal ultrasounds, objected signs in favor of a portal cavernoma with perisplenic and gastric varicose veins. The second is an 8-year-old male child born from an unborn marriage and from a followed pregnancy with premature delivery. His pathological history includes a notion of prematurity that required a stay in neonatology with umbilical catheterization and repeated abdominal pain. He had an acute abdominal episode in March 2015 justifying a surgical hospitalization for suspicion of appendicitis. At admission the clinical parameters (weight, height, temperature, cranial perimeter and temperature) were within the norms for age. The abdominal ultrasound prescribed for this was suggestive of portal cavernoma, later confirmed by abdominal computed tomography.

Nous rapportons deux observations de cavernome portal diagnostiqué successivement à Bamako et à Dakar. Le premier est un enfant de 6 ans de sexe masculin admis dans le service pour ascite et douleurs abdominales. L'examen clinique notait une pâleur cutanéo-muqueuse modérée, une asthénie. Le bilan biologique retrouvait une anémie modérée normochrome normocytaire avec une fonction pancréatique perturbée tandis que les fonctions rénales et hépatiques étaient conservées. Le scanner abdominal réalisé après deux échographies abdominales peu contributives, objectivait des signes en faveur d'un cavernome portal avec varice péri-splénique et gastrique. Le second est un enfant de 8 ans de sexe masculin né d'un mariage non consanguin et issu d'une grossesse suivie avec accouchement prématuré. Il est le 3e enfant de sa fratrie et scolarisé. On retrouve dans ses antécédents pathologiques une notion de prématurité ayant nécessitée un séjour en néonatologie avec cathétérisme ombilical et des douleurs abdominales à répétition. L'enfant a commencé à se plaindre de douleurs abdominales récurrentes vers l'âge de 6 ans. Douleurs de siège péri ombilical sans réveil nocturne dans un contexte de constipation chronique d'allure fonctionnelle. Il a fait un épisode abdominal aigu justifiant une hospitalisation en chirurgie pour suspicion d'appendicite. A l'admission les paramètres cliniques (poids, taille, température, périmètre crânien et température) étaient dans les normes pour l'âge. L'échographie abdominale prescrite à cet effet était évocatrice de cavernome porte, confirmé par la suite par la tomodensitométrie abdominale.

Association of HLA alleles with Plasmodium falciparum severity in Malian children.

Pre-erythrocytic immunity to Plasmodium falciparum malaria is likely to be mediated by T-cell recognition of malaria epitopes presented on infected host cells via class I and II major histocompatibility complex (MHC) antigens. To test for associations of human leukocyte antigen (HLA) alleles with disease severity, we performed high-resolution typing of HLA class I and II loci and compared the distributions of alleles of HLA-A, -B, -C and -DRB1 loci in 359 Malian children of Dogon ethnicity with uncomplicated or severe malaria. We observed that alleles A*30:01 and A*33:01 had higher frequency in the group of patients with cerebral disease compared to patients with uncomplicated disease [A*30:01: gf = 0.2031 vs gf = 0.1064, odds ratio (OR) = 3.17, P = 0.004, confidence interval (CI) (1.94-5.19)] and [A*33:01: gf = 0.0781 vs gf = 0.0266, 4.21, P = 0.005, CI (1.89-9.84)], respectively. The A*30:01 and A*33:01 alleles share some sequence motifs and A*30:01 appears to have a unique peptide binding repertoire compared to other A*30 group alleles. Computer algorithms predicted malaria peptides with strong binding affinity for HLA-A*30:01 and HLA-A*33:01 but not to closely related alleles. In conclusion, we identified A*30:01 and A*33:01 as potential susceptibility factors for cerebral malaria, providing further evidence that polymorphism of MHC genes results in altered malaria susceptibility.

[Ct scan diagnosis of polyostotic fibrous dysplasia with maxillofacial dysmorphia: a case report]. / Diagnostic tomodensitometrique d'une dysplasie fibreuse polyostotique avec dysmorphie maxillo-faciale : a propos d'un cas.

We report a rare case of polyostotic fibrous dysplasia with maxillofacial dysmorphia diagnosed in the radiology department at Hopital Sominé Dolo of Mopti. The aim was to describe the role of medical imaging including the CT scan in its diagnosis. He was a 42-year-old man of rural origin with poor socio-economic conditions. He was sent to us for a craniofacial CT scan for assessment of a maxillofacial mass. This CT scan showed a thickening of the diploid of the vault and the cranial base with osteocondensation and osteolytic lesions at the maxillofacial level. An extension assessment showed polyostotic involvement. His diagnosis is based on medical imaging and in particular CT scan. Three types of radiological aspects are evocative: a homogeneous or heterogeneous clarity, a smoke-like appearance and a slightly condensed appearance. Complications observed were deformities, fracture of the femoral neck and aesthetic damage.

Nous rapportons un cas rare de dysplasie fibreuse polyostotique avec dysmorphie maxillo-faciale diagnostiqué au service de radiologie à l'hôpital Sominé Dolo de Mopti. Le but était de décrire le rôle de l'imagerie médicale notamment le scanner dans son diagnostic. Il s'agissait d'un homme âgé de 42 ans, de provenance rurale avec des conditions socio-économiques défavorables. Il nous a été adressé pour un scanner crâniofacial pour bilan d'une masse maxillo-faciale. Cette exploration scanographique avait objectivé un épaississement du diploé de la voûte et de la base crânienne avec ostéocondensation et des lésions ostéolytiques soufflantes au niveau maxillo-facial. Un bilan d'extension a objectivé une atteinte polyostotique. Son diagnostic repose sur l'imagerie médicale et en particulier la tomodensitométrie. Trois types d'aspects radiologiques sont évocateurs: une clarté homogène ou hétérogène, un aspect en volutes de fumée et un aspect légèrement condensé. Les complications observées étaient les déformations, la fracture du col fémoral et le préjudice esthétique.

[Management of Hyperprolactinemia at the Hôpital du Mali]. / Prise en charge de l'Hyperprolactinemie à l'Hôpital du Mali.

INTRODUCTION: Hyperprolactinemia, which is a supra-physiological secretion of prolactin, is the most common anterior pituitary disorder encountered in clinical practice. Its incidence and prevalence are poorly defined in Africa and the rest of the world. The objectives were to study the clinical, paraclinical, etiological and therapeutic aspects of hyperprolactinemia at the Mali hospital. METHODOLOGY: This was a 5-year cross-sectional study. Data collection was retrospective (July 2011 to October 2015) and prospective (December 2015 to July 2016). RESULTS: We collected 37 cases of hyperprolactinemia. The sex ratio was 0.85. The average age was 37.32 years with extremes ranging from 15 to 74 years. The clinical picture was dominated in women by amenorrhea (80%), galactorrhea (70%), headache (55%), hypofertility (50%), visual disorders (25%) and in men by decreased libido (64.7%), gynecomastia (47.1%), headache (47.1%), visual disorders (41.2%) and erection disorders (29.4%). Basal prolactinemia was greater than 100ng/ml in 45.9% of patients. Cerebral CT had objectified: 11 cases of macroadenomas and 5 cases of pituitary microadenomas. The main causes of hyperprolactinemia were: prolactin pituitary adenoma (43.24%); hypothyroidism (5.40%) and estrogen-progestin use in 5.40%. For treatment, 64.9% of patients were placed on cabergoline; 27% on bromocriptine and 8.10% on simple clinical and biological monitoring. CONCLUSION: Hyperprolactinemia is a condition that exists in our health care facilities. Clinicians should consider this in the face of galactorrhea amenorrhea or decreased libido. It is also necessary to improve the technical platform for better care.

INTRODUCTION: L'hyperprolactinémie, qui est une sécrétion supra physiologique de prolactine est en clinique le désordre hypophysaire antérieur le plus fréquemment rencontré. Son incidence et sa prévalence sont peu définies, en Afrique et dans le reste du Monde. Les objectifs étaient d'étudier les aspects cliniques, paracliniques, étiologiques et thérapeutiques de l'hyperprolactinémie à l'hôpital du Mali. MÉTHODOLOGIE: Il s'agissait d'une étude transversale de 5 ans. La collecte des données a été rétrospective (juillet 2011 à octobre 2015) et prospective (décembre 2015 à juillet 2016). RÉSULTATS: Nous avons colligés 37 cas d'hyperprolactinémie. Le sex ratio était de 0,85. L'âge moyen était 37,32 ans avec des extrêmes allant de 15 à 74 ans. Le tableau clinique était dominé chez les femmes par l'aménorrhée (80%), la galactorrhée (70%), les céphalées (55%), l'hypofertilité (50%), les troubles visuels (25%) et chez les hommes par la baisse de la libido (64,7%), la gynécomastie (47,1%), les céphalées (47,1%), les troubles visuels (41,2%) et les troubles de l'érection (29,4%). La prolactinémie basale était supérieure à 100ng/ml chez 45,9% des patients. La tomodensitométrie cérébrale avait objectivé : 11 cas de macroadénomes et 5 cas de microadénomes hypophysaires. Les principales causes de l'hyperprolactinémie étaient : l'adénome hypophysaire à prolactine (43,24%) ; l'hypothyroïdie (5,40%) et la prise d'oestroprogestatifs chez 5,40%. Pour le traitement, 64,9% des patients étaient mis sous cabergoline ; 27% sous bromocriptine et 8,10% sous simple surveillance clinique et biologique. CONCLUSION: L'hyperprolactinémie est une pathologie qui existe dans nos structures de santé. Les cliniciens doivent y penser devant une aménorrhée galactorrhée ou une baisse de la libido. Il est aussi nécessaire d'améliorer le plateau technique pour une meilleure prise en charge.

[Dysthyroidism in children and adolescents at the Mali hospital]. / Dysthyroïdie chez les enfants et les adolescents à l'hôpital du Mali.

INTRODUCTION: Dysthyroidism (hyperthyroidism or hypothyroidism) in children and adolescents is much rarer than in adults. The purpose of our study was to study the epidemiological, clinical, paraclinical, etiological and etiological aspects and to specify the therapeutic and evolutionary modalities of this condition. METHOD: This was a five-year descriptive, retrospective and prospective study of children and adolescents under 18 years of age with dysthyroidism. RESULTS: We collected 90 children and adolescents with dysthyroidism (hyperthyroidism 77.8% (n=70) and hypothyroidism 22.2% (n=20). For hyperthyroidism (n=70): the average age was 13.07 years and the sex ratio was 0.16. The family history of dysthyroidism was found in 24.3% (n=17). Clinical manifestations were dominated by tachycardia 88.57% (n=62), weight loss 87.14% (n=61), vibrating pulse 87.14% (n=61) and palpitation 81.42% (n=57). Bilateral exophthalmos was present in 70% of patients (n=49) with palpebral retraction in 51.42% (n=56). Goitre was present in 54 patients (77.1%). It was diffuse in 62.9% (n=44) and nodular in 12.9% (n=9). Basedow's disease represented the first etiology with 84.3% (n=59), followed by toxic multinodular goitre12, 9% (n=9). Sixty-eight patients (97.1%) received medical treatment with synthetic antithyroid drugs. Clinical remission was achieved in 64.3% (n=45) and 54.3% of patients were in biological euthyroidism at 6 months follow-up. For hypothyroidism (n=20): the average age was 10.70 years and the sex ratio was 0.53. Six family cases of hypothyroidism and three cases of family goitre were found. The clinical picture was dominated by signs of hypo metabolism at hypersomnia type 95% (n=19) and anorexia 75% (n=15). The skin was dry in 60% (n=12). A staturo-weight delay in 65% (n=13), behavioural disorders in 55% (n=11), weight gain in 40% (n=8) and puberty delay in 10% (n=2). Goitre was nodular in 25% (n=5) with cervical adenopathy present in 15% (n=3). Hashimoto's thyroiditis accounted for 45% (n=9) of etiologies followed by iodine deficiency disorders in 15% (n=3) and iatrogenic causes (2 cases of thyroidectomy). All patients were started on hormone replacement therapy for life. Five patients with large multinodular goiter received total thyroidectomy in addition to medical treatment. Euthyroidism was observed in 55% (n=11) of patients at 6 months follow-up. CONCLUSION: Dysthyroidism in children and adolescents exists in our health facilities. Its management is deficient because of the technical and financial platform. Our public health decision-makers must help implement a screening strategy to facilitate faster diagnosis and treatment.

INTRODUCTION: La dysthyroïdie (hyperthyroïdie ou hypothyroïdie) chez l'enfant et l'adolescent est beaucoup plus rare que chez l'adulte. Notre étude avait pour but d'étudier les aspects épidémiologiques, cliniques, paracliniques, étiologiques et de préciser les modalités thérapeutiques et évolutives de cette affection. MÉTHODE: Il s'agissait d'une étude descriptive, rétrospective et prospective de cinq ans portant sur les enfants et adolescents âgés de moins de 18 ans présentant une dysthyroïdie. RÉSULTATS: Nous avons colligé 90 enfants et adolescents présentant une dysthyroïdie (hyperthyroïdie 77,8% (n=70) et hypothyroïdie 22,2% (n=20).Pour l'hyperthyroïdie (n=70) : l'âge moyen était de 13,07 ans et le sex ratio de 0,16. L'antécédent familial de dysthyroïdie était retrouvé dans 24,3% (n=17). Les manifestations cliniques étaient dominées par la tachycardie 88,57% (n=62), l'amaigrissement 87,14% (n=61), le pouls vibrant 87,14% (n=61) et la palpitation 81,42% (n=57).L'exophtalmie bilatérale était présente chez 70% des patients (n=49) avec rétraction palpébrale dans 51,42% (n=56). Le goitre était présent chez 54 patients (77,1%). Il était diffus dans 62,9% (n=44) et nodulaire dans 12,9% (n=9). La maladie de Basedow représentait la première étiologie avec 84,3% (n=59), suivie du goitre multinodulaire toxique12, 9% (n=9). Soixante-huit patients (97,1%) ont bénéficié d'un traitement médical par antithyroïdien de synthèse. La rémission clinique était obtenue chez 64,3% (n=45) et 54,3% des patients étaient en euthyroïdie biologique au bout 6 mois de suivi. Pour l'hypothyroïdie (n=20) : l'âge moyen était de 10,70 ans et le sex ratio à 0,53. Six cas familiaux d'hypothyroïdie et trois cas de goitre familial étaient retrouvés. Le tableau clinique était dominé par les signes d'hypo métabolisme à type d'hypersomnie 95% (n=19) et d'anorexie 75% (n=15). La peau était sèche dans 60% (n=12). Un retard staturo-pondéral dans 65% (n=13), les troubles du comportement dans 55% (n=11), la prise pondérale chez 40% (n=8) et le retard pubertaire chez 10% (n=2). Le goitre était nodulaire chez 25% (n=5) avec présence d'adénopathies cervicales dans 15% (n=3). La thyroïdite d'Hashimoto représentait 45% (n=9) des étiologies suivies des troubles dus à la carence iodée dans 15% (n=3) et des causes iatrogéniques (2 cas de thyroïdectomie). Tous les patients ont été mis sous traitement hormonal substitutif à vie. Cinq patients ayant un volumineux goitre multinodulaire ont bénéficié en plus du traitement médical une thyroïdectomie totale. L'euthyroïdie était observée chez 55% (n=11) des patients au bout 6 mois de suivi. CONCLUSION: La dysthyroïdie chez les enfants et les adolescents existe dans nos structures de santé. Sa prise en charge est déficiente à cause du plateau technique et financier. Nos décideurs en santé publique doivent aider à la mise en place d'une stratégie de dépistage pour faciliter le diagnostic et le traitement plus rapide.

[Epidemiological And Clinical Survey Of The Diabetes Sweetens In A Center Of Health Of Reference Of Sikasso]. / Etude Epidemiologique Et Clinique Du Diabete Sucre Dans Un Centre De Sante De Reference De Sikasso.

GOAL: To study the diabetes sweetened in farming environment in the sanitary district of Selingue (CS Ref of Selingue). MATERIALS AND METHODS: It was about a descriptive survey done from January 01 to June 30, 2016 with a prospective compilation of data in the center of health of reference of Selingue (CS Ref of Selingue). All our patients benefitted from a complete clinical exam with research of factor of risk and reverberation of the diabetes.The statistical test used was Chi-square 2 with a threshold of significance p ≤ 0.05. RESULTS: Among the 1 525 patients collected, 84 were diabetic is a hospitable frequency of 5, 51% and the average age of 51, 43 years ±12, 25.The sex ratio was 1, 33. Diabetes type 2 was in 98% of cases. We did not record specific diabetes or gestational diabetes. A sedentary lifestyle was found in 70, 23% of the cases followed by Dyslipidemia with 42.85% of the cases. 1.2% of our patients presented an AOMI, a fifth of our patients have suffered from erectile dysfunction, 2/3 had a diabetic neuropathy and 4% had a wound. (P: 0.048) neuropathy and nephropathy (p: 0.016) diabetic were correlated with blood sugar imbalance. CONCLUSION: the gravity, the inaccessibility and the cost raised of the follow-up balances in Selingue limit the hold in charge of the diabetes in this sanitary district.

BUT: Etudier le diabète sucré en milieu rural dans le district sanitaire de Sélingué (CS Réf Sélingué). MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude descriptive effectuée du 01 janvier au 30 juin 2016 avec un recueil prospectif des données au Centre de Santé de Référence de Sélingué (CS Réf de Sélingué). Tous nos patients ont bénéficié d'un examen clinique complet avec recherche de facteurs de risque et de retentissement du diabète. Le test statistique utilisé était le Khi 2 avec un seuil de significativité p ≤ 0,05. RÉSULTATS: Parmi les 1 525 dossiers de patients colligés, 84 était diabétiques soit une fréquence hospitalière de 5,51 % et l'âge moyen de 51,43 ans ± 12,25. Le sex ratio était de 1, 33. Le diabète était de type 2 dans 98% des cas. La sédentarité était retrouvée dans 70,23 % des cas suivie de la dyslipidémie avec 42,85 % des cas. 1,2 % de nos patients ont présenté une AOMI, un cinquième de nos patients ont souffert d'une dysfonction érectile, 2/3 avaient une neuropathie diabétique et 4 % avait une plaie. La neuropathie (p: 0,048) et la néphropathie (p: 0,016) diabétique étaient corrélées au déséquilibre glycémique. CONCLUSION: La gravité, l'inaccessibilité et le coût élevé des bilans de suivi à Sélingué limitent la prise en charge du diabète dans ce district sanitaire.

[Prevalence and risk factors for sickle retinopathy in a sub-Saharan comprehensive Sickle Cell Center]. / Prévalence et facteurs de risque de la rétinopathie drépanocytaire dans un centre de suivi drépanocytaire d'Afrique subsaharienne.

INTRODUCTION: Retinopathy is a chronic complication with severe functional consequences in patients with sickle cell disease. Its prevalence is not well known in sub-Saharan Africa because of the absence of screening. We report here the results of a routine screening for sickle retinopathy in a Comprehensive Sickle Cell Center in Sub-Saharan Africa. METHODS: Screening of sickle retinopathy was carried out in all sickle cell patients aged 10 and over, followed between 2010 and 2012. Retinopathy was screened by dilated indirect fundoscopic examination and retinal angiography, if necessary. The gender, age and hematological parameters of patients with sickle retinopathy were compared with those of controls randomly selected from the cohort of sickle cell patients without retinopathy followed during the same period. RESULTS: The overall prevalence of sickle cell retinopathy was 8.8% (142/1604): 12.4% (91/731) in SC, 5.2% (38/734) in SS, 9.4% (5/53) in Sß°-thalassemia patients and 9.3% (8/86) in Sß+-thalassemia patients. Proliferative retinopathy was more common in SC patients (P<0.01). High levels of hemoglobin or of hematocrit were associated with retinopathy in all patients and with proliferative retinopathy in SC patients. In SS or Sß0thalassemia patients, high leukocyte count was associated with proliferative retinopathy. Low fetal hemoglobin level was associated with retinopathy in all groups. CONCLUSION: The prevalence of sickle cell retinopathy is high and negatively associated to the level of fetal hemoglobin. The efficiency of a routine screening for sickle cell retinopathy must be assessed in Africa as well as the benefit of phlebotomy and hydroxyurea therapy as a preventive treatments.

[Screening of cerebral vasculopathy in sickle cell anemia children using transcranial Doppler]. / Dépistage de la vasculopathie cérébrale drépanocytaire par doppler transcrânien au Mali.

Cerebral vasculopathy exposes patients to a high risk of stroke, a major complication of sickle cell disease (SCD) associated with a high risk of death and disability. Transcranial doppler (TCD) ultrasonography used to identify SCD patients at risk of stroke may contribute to significantly reducing morbidity and mortality in these patients by indicating appropriate treatment. From March 2008 to February 2013, we conducted systematic screening for cerebral vasculopathy using TCD in 572 SCD patients (including 375 SS, 144 SC, 26 S/ß(0), and 27 S/ß(+) thalassemia patients) aged 1-17 years in a comprehensive center for follow-up and research on sickle cell disease in Bamako, Mali. After exclusion of 30 inadequate results and one case of abnormal TCD observed in a multiple organ failure patient, we found an abnormal or conditional TCD in 18% of 541 children examined in a steady state. The highest prevalence of abnormal cases concerned homozygous SS patients (8.1%). No case of abnormal or conditional TCD was observed in children with S/ß(+) thalassemia. Hemoglobin concentrations were significantly lower in patients with conditional or abnormal TCD (P<0.01). In a subgroup of 68 patients with conditional TCD, nine (13%) converted to abnormal TCD over 1 year. In this subgroup of 68 conditional TCD patients, a decrease or increase in baseline hemoglobin concentration was predictive of conditional or abnormal TCD at the follow-up visit. Progression towards conditional TCD was observed in four patients (0.9%) who initially had normal TCD. Children with abnormal TCD had, whenever possible, a monthly exchange transfusion program. One case of transient stroke in the context of P. falciparum malaria with low hemoglobin concentration and one death were observed. These findings highlight the need for systematic TCD in sickle cell disease monitoring and implementing regular blood transfusion programs in the context of limited access to regular and secure blood transfusions.

Prise en charge de l'hyperprolactinemieà l'hôpital du Mali

Introduction:L'hyperprolactinémie, qui est une sécrétion supra physiologique de prolactine est en clinique le désordre hypophysaire antérieur le plus fréquemment rencontré. Son incidence et sa prévalence sont peu définies, en Afrique et dans le reste du Monde.Les objectifs étaient d'étudier les aspects cliniques, paracliniques, étiologiques et thérapeutiques de l'hyperprolactinémie à l'hôpital du Mali.Méthodologie :Il s'agissait d'une étude transversale de 5 ans. La collecte des données a été rétrospective (juillet 2011 à octobre 2015) et prospective (décembre 2015 à juillet 2016).Résultats:Nous avons colligés 37 cas d'hyperprolactinémie. Le sex ratio était de 0,85. L'âge moyen était 37,32ans avec des extrêmes allant de 15 à 74 ans. Le tableau clinique était dominé chez les femmes par l'aménorrhée (80%), la galactorrhée (70%), les céphalées (55%), l'hypofertilité (50%), les troubles visuels (25%) et chez les hommes par la baisse de la libido (64,7%), la gynécomastie (47,1%), lescéphalées (47,1%), les troubles visuels (41,2%) et les troubles de l'érection (29,4%). La prolactinémie basale était supérieure à 100ng/mlchez 45,9% des patients. La tomodensitométrie cérébrale avait objectivé : 11 cas de macroadénomes et 5 cas demicroadénomes hypophysaires. Les principals causes de l'hyperprolactinémie étaient : l'adénome hypophysaire à prolactine (43,24%) ;l'hypothyroïdie(5,40%) et la prise d'oestroprogestatifs chez 5,40%. Pour le traitement, 64,9% des patients étaient mis sous cabergoline ; 27% sous bromocriptine et8,10% sous simple surveillance clinique et biologique.Conclusion:L'hyperprolactinémie est une pathologie qui existe dans nos structures de santé. Les cliniciens doivent y penser devant une aménorrhée galactorrhée ou une baisse de la libido. Il est aussi nécessaire d'améliorer le plateau technique pour une meilleure prise en charge

Innervation from the claustrum of the frontal association and motor areas: axonal transport studies in the cat.

The anatomical organization of the projections from the claustrum to the motor and prefrontal cortical areas of the cat's brain was investigated. Both retrograde (single horseradish peroxidase or double fluorochrome deposits in the cortex) and anterograde (peroxidase-labeled wheat germ agglutinin deposits in the claustrum) tracing techniques were used. Within the claustrum, the neurons projecting to each sector of the frontal cortex were found to be distributed according to specific patterns of segregation and overlap. Spatial segregation was particularly marked between the cell populations projecting to the various sectors of area 4. The cells projecting to the subareas of area 6 and prefrontal cortex displayed a less marked but definite segregation. The neuronal populations projecting to some sectors of areas 4, 5, and the primary somatosensory cortex known to contain homotopical representations of the body map were found intermingled in the same small claustral portions. The few double-labeled neurons found after closely adjacent fluorochrome injections indicates that, in spite of their profuse intracortical branching, claustral axons spread little within the boundaries of a single architectonic area. Anterograde transport experiments showed that claustral fibers end primarily in layers IIIb/IV, VI, and I, whereas layer V is spared. This pattern is homogeneous throughout the frontal cortex. The possible role of the claustrum as a subcortical site for organized interactions amongst wide arrays of functionally related zones of the cerebral cortex is thereby suggested.

Case report: life-threatening hypoglycaemia associated with sulfadoxine-pyrimethamine, a commonly used antimalarial drug.

Due to chloroquine resistance, several African countries have changed their first-line malaria treatment to sulfadoxine-pyrimethamine (SP). In this report, we present a case of hypoglycaemic coma associated with SP, an adverse reaction that is likely to be underreported and expected to occur with greater frequency as the use of SP increases.

[Seroprevalence of human immunodeficiency virus infection (HIV) in Mali on 3,496 sera]. / Etude de la séroprévalence de l'infection par le virus de l'immunodéficience humaine (VIH) au Mali sur 3,496 sérums.

Our main objective has been geared toward the appreciation of the importance of the infection by human immunodeficiency virus in Mali. Our study was based on 3,496 sera deducted from March 1987 to January 1989. All positive sera at ELISA have been confirmed by Western Blot. The total seroprevalence of the study is 8.41%. This fact has been noticed higher in prostitutes, young men, more in women than in men in widows and divorced couples, in traders, in travellers of high endemic countries. The seropositivity is proportional to the number of sexual partners. The heterosexual way of transmission has been dominant. There has been no relationship between seropositivity and transfusion, antecedent of surgery, sexually transmitted diseases, of sexual intercourse type. The HIV2 has been more frequent than HIV1. Taking into account the importance of this infection, precautionary measures must be taken to avoid an evolution toward a catastrophic situation.

[ORL manifestations observed in AIDS. Apropos of 65 cases]. / Manifestations orl observées au cours du SIDA. A propos de 65 observations.

We realized a clinical study in 65 patients with acquired immunodeficiency syndrome, aged from 3 to 62 years old (mean, 34 years) (34 males and 31 females) interned or showed in consultations at the hospital Gabriel Touré in Bamako, Mali (departments of ENT diseases and of internal medicine), in order to analyse and to state precisely different otorhinolaryngologic manifestations in AIDS. Oropharyngeal candidiasis was the most prevalent otorhinolaryngologic manifestation (57 %). Other less common lesions were suppurative otitis media (29 %), atrophic pharyngitis (18,5 %), sinusitis (11 %), Kaposi's sarcoma (5 %) localized above all on the palate: they are however a frequent sign of infection by HIV. The manifestations merit a particular attention by otorhinolaryngologist because, although they have few influence on the general evolution of the disease, they appear as additional manifestations of infectious risks in AIDS patients.

[Gastrointestinal manifestations of AIDS in adults in Mali]. / Manifestations digestives du sida chez l'adulte au Mali.

Our main objective consists in evaluating the frequency of digestive signs and digestive opportunistic infections in AIDS patients with diarrhea. The prospective study occurred from January 1997 to July 1998 in Bamako hospitals. The patients underwent a clinical examination, blood and stools tests, and sometimes upper digestive endoscopy. Among 434 cases of AIDS, 426 patients (98%) had at least one digestive sign. The main digestive signs were diarrhea (80.1%), abdominal pains (62.2%), vomiting (47.2%) and dysphagea (36.6%). Isospora belli and Cryptosporidium parvum have been pointed up in respectively 9% and 16.3% of examined specimen. Echerichia coli was found in 8.6% of stool cultures and in 2.9% in the case of Salmonella Arizonae. Twenty cases of Kaposi's sarcoma were diagnosed and mycosis was found in 71.9% of patients. In conclusion, digestive change is a constant phenomenon in AIDS patients. Patients survival could be improved by early management, improvement of diagnosis and provisioning of medicines.

[Human immunodeficiency virus (HIV) infection in Mali]. / L'infection par le virus de l'immunodéficience humaine (VIH) au Mali.

This review summarises epidemiological and clinical data of HIV infection who was recognized in Mali since 1985. The most important rate of seropositivity for HIV is observed in the prostitutes group (40%). The estimated seroprevalence for adult population is between 1% and 5%. 46 cases for AIDS are reported in both sexes. The mean age is 35 years. Main signs are weight loss (91%), fever (80%), diarrhea (70%) and lymphadenopathy (50%). Three among the five cases of Kaposi's sarcoma are aggressive. 19.5% of AIDS have antibodies to HIV1, 41.3% to HIV2 and 39.1% to HIV1 and HIV2. Death rate is more than 50%. These data are compared with other countries of Africa.

[Anatomo-clinical study of chronic gastritis in Mali]. / Etude anatomo-clinique des gastrites chroniques au Mali.

The aim of our study was to evaluate the frequency of chronic gastritis and its anatomoclinical aspects in Mali. Within thirteen months of prospective study, we have recorded seventy four chronic gastritis histologically confirmed which represented 3.28% of the total oesogastroduodenal pathologies registered during the same period (2256 cases). Chronic gastritis has been most observed between 31 to 40 years (24.3%) and women were affected (sex ratio = 0.6). Households and civil servants were predominant. The precocious burning epigastralgy just after the meal was the main motive of the examination and chronic gastritis has been a fortuitous discovery. The basic alimentation included smoked or dried fish, peanuts, "tô" and salt. The most frequent endoscopic aspect was the congestive one. The duodenogastric reflux was not negligible. The diffuse form and antral localisation were more frequent. Five displasiae and four intestinal metaplasiae have been found.

[Frequency of glucose-6-phosphate dehydrogenase deficiency (A-376/202) in three Malian ethnic groups]. / Fréquence du déficit en glucose-6-phosphate déshydrogénase (A-376/202) dans trois groupes ethniques vivant en zone d'endémie palustre au Mali.

Erythrocyte G6PD deficiency is the most common worldwide enzymopathy. The aim of this study was to determine erythrocyte G6PD deficiency in 3 ethnic groups of Mali and to investigate whether erythrocyte G6PD deficiency was associated to the observed protection against malaria seen in Fulani ethnic group. The study was conducted in two different areas of Mali: in the Sahel region of Mopti where Fulani and Dogon live as sympatric ethnic groups and in the Sudanese savannah area where lives mostly the Malinke ethnic group. The study was conducted in 2007 in Koro and in 2008 in Naguilabougou. It included a total 90 Dogon, 42 Fulani and 80 Malinke ethnic groups. Malaria was diagnosed using microscopic examination after Giemsa-staining of thick and thin blood smear. G6PD deficiency (A-(376/202)) samples were identified using RFLP (Restriction Fragment Length Polymorphism) assay and analysis of PCR-amplified DNA amplicon. G6PD deficiency (A-(376/202)) rate was 11.1%, 2.4%, and 13.3% in Dogon, Fulani, and Malinke ethnic group respectively. Heterozygous state for G6PD (A-(376/202)) was found in 7.8% in Dogon; 2.4% in Fulani and 9.3% in Malinke ethnic groups while hemizygous state was found at the frequency of 2.2% in Dogon and 4% in Malinke. No homozygous state was found in our study population.We conclude that G6PD deficiency is not differing significantly between the three ethnic groups, Fulani, Dogon and Malinke.