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.

Fc gamma receptor IIa-H131R polymorphism and malaria susceptibility in sympatric ethnic groups, Fulani and Dogon of Mali.

It has been previously shown that there are some interethnic differences in susceptibility to malaria between two sympatric ethnic groups of Mali, the Fulani and the Dogon. The lower susceptibility to Plasmodium falciparum malaria seen in the Fulani has not been fully explained by genetic polymorphisms previously known to be associated with malaria resistance, including haemoglobin S (HbS), haemoglobin C (HbC), alpha-thalassaemia and glucose-6-phosphate dehydrogenase (G6PD) deficiency. Given the observed differences in the distribution of FcγRIIa allotypes among different ethnic groups and with malaria susceptibility that have been reported, we analysed the rs1801274-R131H polymorphism in the FcγRIIa gene in a study of Dogon and Fulani in Mali (n = 939). We confirm that the Fulani have less parasite densities, less parasite prevalence, more spleen enlargement and higher levels of total IgG antibodies (anti-CSP, anti-AMA1, anti-MSP1 and anti-MSP2) and more total IgE (P < 0.05) compared with the Dogon ethnic group. Furthermore, the Fulani exhibit higher frequencies of the blood group O (56.5%) compared with the Dogon (43.5%) (P < 0.001). With regard to the FcγRIIa polymorphism and allele frequency, the Fulani group have a higher frequency of the H allele (Fulani 0.474, Dogon 0.341, P < 0.0001), which was associated with greater total IgE production (P = 0.004). Our findings show that the FcγRIIa polymorphism might have an implication in the relative protection seen in the Fulani tribe, with confirmatory studies required in other malaria endemic settings.

[Management Of Blader Exstrophy In Children At The CHU Gabriel Touré]. / Prise En Charge De l'Exstrophie Vesicale Dans Le Service De Chirurgie Pediatrique : CHU Gabriel Toure.

AIMS: To describe the clinical and evolutionary aspects of the primary closure of exstrophy at the CHU Gabriel Touré. MATERIALS AND METHODS: This was a retrospective and prospective study carried out from January 2014 to December 2019 in all the children admitted and operated on for bladder exstrophy at the CHU Gabriel Touré. RESULTS: We collected 35 cases of exstrophy, ie25 boys and 10 girls. The mean age at diagnosis was 4.8 months. The bladder plate was both normal and budded, ie 28.6% of cases. Plaque infection was found in 45.7%. A malformation was associated in 34.3% of cases. Primary plaque closure was achieved in all of our patients. Postoperative morbidity was 28.6% of cases and mortality 11.4% of cases. CONCLUSION: Bladder exstrophy is a rare malformation of the urogenital sphere, its management is complex and its mortality is not null.

OBJECTIFS: Décrire les aspects cliniques et évolutifs de la fermeture primaire de l'exstrophie au CHU Gabriel Touré. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude rétrospective et prospective réalisée de janvier 2014 à décembre 2019 chez tous les enfants admis et opérés pour exstrophie vésicale au CHU Gabriel Touré. RÉSULTATS: Nous avons colligés 35 cas d'exstrophie soit 25 garçons et 10 filles. L'âge moyen au moment du diagnostic était de 4,8 mois. La plaque vésicale était au tant normale que bourgeonnée soit 28,6 % des cas. Une infection de la plaque a été retrouvée dans 45,7%. Une malformation était associée dans 34,3% des cas. La fermeture primaire de la plaque a été réalisée chez tous nos patients. La morbidité post opératoire était de 28,6% des cas et la mortalité, 11,4% des cas. CONCLUSION: L'exstrophie vésicale est une malformation rare de la sphère urogénitale, sa prise en charge est complexe et sa mortalité n'est pas nulle.

FcγRIIa polymorphism and anti-malaria-specific IgG and IgG subclass responses in populations differing in susceptibility to malaria in Burkina Faso.

FcγRIIa is known to be polymorphic; and certain variants are associated with different susceptibilities to malaria. Studies involving the Fulani ethnic group reported an ethnic difference in FcγRIIa-R131H genotype frequencies between the Fulani and other sympatric groups. No previous studies have addressed these questions in Burkina Faso. This study aimed to assess the influence of FcγRIIa-R131H polymorphism on anti-falciparum malaria IgG and IgG subclass responses in the Fulani and the Mossi ethnic groups living in Burkina Faso. Healthy adults more than 20 years old belonging to the Mossi or the Fulani ethnic groups were enrolled for the assessment of selected parasitological, immunological and genetic variables in relation to their susceptibility to malaria. The prevalence of the Plasmodium falciparum infection frequency was relatively low in the Fulani ethnic group compared to the Mossi ethnic group. For all tested antigens, the Fulani had higher antibody levels than the Mossi group. In both ethnic groups, a similar distribution of FcγRIIa R131H polymorphism was found. Individuals with the R allele of FcγRIIa had higher antibody levels than those with the H allele. This study confirmed that malaria infection affected less the Fulani group than the Mossi group. FcγRIIa-R131H allele distribution is similar in both ethnic groups, and higher antibody levels are associated with the FcγRIIa R allele compared to the H allele.

[Place of malaria among febrile illnesses in two ethnic tribes living in sympatry in Mali from 1998 to 2008]. / Place du paludisme dans les syndromes fébriles dans deux groupes ethniques vivant en sympatrie au Mali de 1998 à 2008.

In Africa, malaria is responsible for 25-40% of all outpatient visits and 20-50% of all hospitalizations. In malaria-endemic areas, individuals do not behave the same toward the outcome of clinical malaria. The aim of this study is to determine the prevalence of malaria in the locality among the different ethnic groups, evaluate the place of malaria among febrile illnesses, and assess the relationship between fever and parasite density of Plasmodium falciparum. Studies on susceptibility to malaria between the Fulani and Dogon groups in Mali were conducted in Mantéourou and the surrounding villages from 1998 to 2008. We carried out six cross-sectional studies during the malaria transmission and longitudinal surveys (July to December depending on the year) during the 10-year duration. In longitudinal studies, clinical data on malaria and other diseases frequently observed in the population were recorded. It appears from this work that malaria is the leading cause of febrile syndromes. We observed a significant reduction in malaria morbidity in the study population from 1998 to 2008. The pyrogenic threshold of parasitaemia was 1,000 parasites/mm(3) of blood in the Dogon and 5,000 parasites/mm(3) of blood in the Fulani.We have also found that high parasitical densities were not always associated with fever. Malaria morbidity was higher among the Dogon than in Fulani. The immunogenetic factors might account for this difference in susceptibility to malaria between Fulani and Dogon in the area under study. With regard to this study, it is important to take into account the ethnic origin of subjects when interpreting data of clinical and malarial vaccine trials.

[Humoral immune anti-Plasmodium falciparum AMA1 and MSP1 response in two ethnic groups living in sympatry in Mali]. / Réponse humorale anti-Plasmodium falciparum AMA1 et MSP1 dans deux groupes ethniques vivant en sympatrie au Mali.

Fulani of Mali are known for their lower susceptibility to Plasmodium falciparum malaria than their neighbours, the Dogon, despite similar transmission conditions. However, the mechanisms underlying these differences are poorly understood, particularly those concerning antigenspecific immune responses. The Apical Membrane Antigen 1 (AMA1) and the Merozoite Surface Antigen 1 (MSP1) are two malaria vaccine candidates, which play a pivotal role during the invasion of parasites into erythrocytes, and in the case of AMA1, of hepatocytes. Therefore, we analyzed the level of anti-AMA1 and anti-MSP1 antibodies (FVO and 3D7 alleles), by using ELISA (Enzyme Linked Immuno Sorbent Assay) to investigate whether there are differences between the two ethnic groups. Our results show that the splenic rate, the level of anti-AMA1 and anti-MSP1 were significantly higher in Fulani compared to Dogon; while the parasite rate was lower in Fulani group compared to Dogon. Our results suggest that the lower susceptibility of Fulani to malaria could be due to the higher specific humoral responses against AMA1 and MSP 1 in Fulani's ethnic group compared to Dogon.

[Relationship between malaria and anemia in two ethnic groups living in sympatry in Mali]. / Relation entre l'anémie et le paludisme dans deux groupes ethniques vivant en sympatrie au Mali.

Studies performed in Burkina Faso and Mali showed differences in susceptibility to malaria between the Fulani and other sympatric ethnic groups, the Mossi and Dogon. We carried out a longitudinal survey and three cross-sectional studies from 2003 to 2005 in order to assess the prevalence of anemia in Dogon and Fulani. The distribution of the study population by sex was comparable between the two ethnic groups (p = ns). The Fulani are mainly cattle breeders and the Dogons, farmers. They were exposed to similar entomological inoculation rates, and studies on "knowledge, attitude, and practices" showed no difference between the two ethnic groups. The cross-sectional studies were performed during the intense malaria transmission season (in September 2003 and 2005) and during the dry season (in March 2004). Longitudinal clinical follow-up studies were performed from August to December 2005 using the WHO 28 days in vivo test, after administration of a curative dose of antimalarial drugs to patients with mild malaria. During the cross-sectional studies, both Fulani men and women had significantly lower hemoglobin levels than their Dogon counterparts; this difference was most evident in the women (in 2005: 9.4 g/dl in Fulani vs 10.7 g/dl in Dogon, p = 0.0002). Clinical longitudinal follow-up data showed that Fulani children aged 10-14 years have lower hemoglobin levels than Dogon children. At day 0, the mean of hemoglobin level was 9.6 g/dl in Dogon children vs. 8.7 g/dl in Fulani children (p = 0.01). At day 28, after malaria treatment, we also observed a significant difference in hemoglobin levels in children (10.6 g/dl in Dogon vs 9.3 g/dl in Fulani, p < 0.001). A stronger association between anemia and spleen enlargement was found in the Fulani (53.2% with spleen enlargement) than in the Dogon (32.9%) [p = 0.005]. The Fulani suffer more from anemia than the Dogon, despite their lower susceptibility to malaria. The difference in anemia between Dogon and Fulani must be further investigated to determine possible factors involved in malaria susceptibility.

[Knowledges And Practices Of Iron Prescription By The Pediatric Ward In CHU Gabriel Touré Of Bamako, Mali]. / Connaissances Et Pratiques De La Prescription Du Fer Par Le Personnel Du Service De Pediatrie Du Chu Gabriel Toure De Bamako.

GOAL: To assess knowledges and practices on iron prescription in pediatric ward in CHU Gabriel Touré of Bamako, Mali. TOOLS AND METHODS: It was a prospective and transversal study canied out. We submitted questionnaire and analyzed the case history of to the children aged 1-60 months old who received iron during the study period from 1rstto 30 July 2012. The prescriptators' consent were solicited and obtained at first of all. RESULTS: Fifty prestators were interviewed among them 10 pediatricians (20%), 31 pediatrics' resident (62 %), 2 generalists physicians (4%), 7 medical student (14%). One hundred 100 were analyzed medical records. More than half of the prestators known the need of iron in children. Thirty percent have received iron at 8 to 10mg/kg. The medication duration wasn't indicating in 92% of patients. In our context prestators well know about meaning and the needs of iron in children bout they're limited on iron food sources and iron storage. CONCLUSION: The well theorical knowledge on indications and prescription roules on iron in children didn't escape from miss practices in its prescription. Moreover works should analyze the reasons of discrepancies.

BUT: Evaluer les connaissances et les pratiques relatives à la prescription du fer dans le service de pédiatrie du Centre Hospitalier Universitaire Gabriel Touré (CHU-GT) de Bamako, Mali. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale réalisée du 1 er au 30 Juillet 2012 à la pédiatrie. Nous avons soumis un questionnaire aux prestataires et analysé les dossiers des enfants âgés de 1 à 60 mois hospitalisés ayant reçu du fer. Le consentement des prescripteurs à été demandé et obtenu au préalable. RÉSULTATS: nous avons enquêté cinquante prestataires dont 10 pédiatres (20%), 31 médecins CES de pédiatrie (62 %), 2 médecins généralistes (4%), 7 étudiants en fin de cycle médical (14%) et analysé 100 dossiers. Trente pour cent des prestataires ont correctement défini le fer. Plus de la moitié des prestataires connaissaient les besoins en fer chez l'enfant. Les réserves en fer étaient connues de 42% des prestataires. Huit pour cent des prestataires savaient que les fers apportés par l'alimentation étaient le fer héminique ou le fer non héminique. Trente pourcent des malades ont reçu le fer à la dose de 8 à 10mg/kg. La durée du traitement n'a pas été précisée chez 92% des malades. CONCLUSION: Dans notre contexte la bonne connaissance théorique des indications et des règles de prescription du fer chez l'enfant n'excluait pas les mauvaises pratiques de sa prescription. D'autres travaux devraient analyser les raisons de cette discordance.

Excision in girls: Life-threatening acute complications in girls within 7 days of excision: Experience of the Pediatric Department of the University Hospital Gabriel Toure in Bamako, Mali.

The practice of excision in girls poses a significant risk to their health. The objective of this study was to determine the immediate acute complications associated with this practice. PATIENTS AND METHODS: This was a retrospective descriptive study over a period of 15 months including all girls aged 0-15 years hospitalized for acute complications related to excision within 7 days of the practice in the pediatric department of the University Hospital Gabriel Toure. RESULTS: We collected 17 patient files. The median consultation time was 43 h. The main reason for consultation was post-excision bleeding in 76.4% of the cases. Pallor associated with respiratory distress was found in almost all cases. On admission, four girls (23.5%) were comatose and five girls (29.4%) showed signs of shock. The reasons for hospitalization were hemorrhage associated with post-excisional sepsis (52.9%), complicated shock anemia (23.5%), and severe post-excision anemia (23.5%). The average hemoglobin level was 5.5 g/dL; there was severe anemia in 94.1% of the girls (Hb <7g/dl). All the girls received blood transfusions with red blood cell concentrate. The other treatments received were local care (100%), administration of analgesics (100%), antibiotic therapy (82.4%), and oxygen therapy (41.2%). The outcome was unfavorable in two patients (11.8% deaths). CONCLUSION: This study shows the seriousness of the immediate complications associated with the practice of excision.

[Cryptogenic stroke management : where are we ?] / Prise en charge de l'AVC cryptogénique : où en sommes-nous ?

Cryptogenic stroke is an old definition that designates an ischemic stroke with no identifiable cause. The term of the embolic stroke of undetermined source was then introduced to identify non-lacunar strokes in whom thromboembolism was the likely mechanism. This subgroup of cryptogenic strokes remains heterogeneous with many potential and possibly associated embolic causes. Covert atrial fibrillation is probably less often involved than initially expected, in contrast to intracranial and extracranial atherosclerosis. The cardiologist should be involved in the search of underlying causes of ischemic stroke by helping the neurologist to identify the most likely diagnosis. Further research is necessary to select populations that may benefit from more effective and individualized treatment.

[Socio-demographic, clinical, and therapeutic aspects of adolescents treated and followed for HIV infection at the Hospital Gabriel Toure paediatric center]. / Profil epidemio-clinique et therapeutique du VIH de l'adolescent au departement de pediatrie du chu Gabriel Toure.

HIV infection is a chronic infectious disease requiring long-term management and regular follow-up of patients. OBJECTIVES: The aims of this study was to describe the socio-demographic, clinical, biological and therapeutic aspects of adolescents treated and followed for HIV infection at the Hospital Gabriel Toure paediatric center. PATIENTS AND METHODS: From 01/01/2001 to 31/12/2017, the medical records of children followed for HIV infection until adolescence were analyzed. It was a descriptive and analytical retrospective study. RESULTS: One thousand five hundred and fourteen patients received antiretroviral treatment and 587 were still in follow-up on 31 December 2017, including 393 adolescents (sex-ratio = 1.2). The median age was 14.25 years and 55.1% of children had lost at least one parent. HIV serology was positive among mothers in 61.7% of cases (n=342), and 63% of them were on ARVs. Sixty-eight per cent of children were WHO Stage III or IV at the time of ART initiation. The median age at onset of ART was 53 months (26-96 months). The combination of 2 nucleotide reverse transcriptase inhibitors (NRTIs) with a non-nucleotide reverse transcriptase inhibitor (NNRTI) was used in 89% of patients. The median CD4 count before ARV treatment was 438/mm3. The average duration of follow-up under treatment was 9.8 ± 3.4 years. Fifty-one percent of adolescents had undetectable viral load. There was a correlation between the initiation of a second line of treatment and treatment failure (p<0.001). CONCLUSION: The adherence of adolescents to ARV treatment requires the implementation of innovative strategies to improve the therapeutic success rate.

L'infection à VIH est une maladie chronique infectieuse nécessitant une prise en charge longue et un suivi régulier des patients. OBJECTIFS: L'objectif de ce travail était de décrire les aspects socio-démographiques, clinico-biologiques et thérapeutiques du VIH chez l'adolescentau centre d'excellence pédiatrique de prise en charge du CHU Gabriel Toure. PATIENTS ET MÉTHODES: Il s'agissait d'une étude transversale avec recueil rétrospectif de données, qui s'est déroulée du 01/01/2001 au 31/12/2017. C'était une étudetransversale à visée analytique portant sur les dossiers des adolescents d'au moins10 ans. RÉSULTATS: Trois cent quatre-vingt-treize (393) adolescents d'au moins10 ansont été inclus. La sérologie VIH était positive chez les mères dans 61,7% des cas (n=342), et 63% d'entre elles étaient sous ARV. Soixante-huit pour cent des enfants étaient classés stade III ou IV de l'OMS au moment de la mise sous TARV. L'association de 2 inhibiteurs nucléosidiques de la transcriptase inverse (INTI) à un inhibiteur non nucléotidique de la transcriptase inverse (INNTI) a été utilisée chez 89% des patients. Le taux de CD4 médian avant la mise sous traitement ARV était de 438/mm3 La durée moyenne de suivi sous traitement était de 9,8 ± 3,4 ans. Cinquante un pourcent (51%) des adolescents étaient en succès thérapeutique avec une charge virale indétectable (< 1000 copies/ml). Il y avait une corrélation entre l'instauration d'une seconde ligne de traitement et l'échec thérapeutique (p<0,001). CONCLUSION: L'adhésion des adolescents au traitement ARV nécessite la mise en place de stratégies innovantes permettant d'améliorer le taux de succès thérapeutique.

[Health-care related infections in pediatric surgery of the teaching hospital Gabriel Toure, Bamako, Mali]. / Infections associees aux soins en chirurgie pediatrique au CHU Gabriel Toure, Bamako, Mali.

OBJECTIVES: to identify the main causative agents of infection associated with care and their susceptibility to antibiotics used and to identify risk factors for care-associated infection. MATERIAL AND METHODS: This was a cross-sectional study with prospective data collection, conducted from 1 November 2016 to 1 April 2017 among all children admitted to the pediatric surgery department. Non-consenting parents and cases of necrosectomy were included in this study. RESULTS: Our study involved 200 patients, 30 of whom presented a care-associated infection (15% infection rate). The average age of patients with infection was 56.33 ± 48.66 months (1 and 180 months). The main pathogens responsible for infection of the operative site were: Escherischia coli (4 cases), Acinetobacterbaumanii (3 cases), Klebsiella pneumoniae (2 cases), Staphylococcus aureus (2 cases), Enterobacter cloacae (1case), Pseudomonas aeruginosa (1 case) and Enterobacter faecalis (1 case). In the burned patients, the organisms found were: Acinetobacter baumanii (7 cases), Klebsiella pneumoniae (6 cases), Staphylococcus aureus (6 cases), Escherischia coli (4 cases), Pseudomonas aeruginosa (2 cases) and Enterobacter faecalis (2 cases). Escherichia coli was noted in urinary tract infection. Antibiotics tested were amoxicillin, amoxicillin-clavulanic acid, ceftriaxone, imipenem, gentamicin and ciprofloxacin. The mode of recruitment and the duration of hospitalization were the risk factors noted. CONCLUSION: The infection associated with care is a frequent occurrence in our practice. These infections mainly occur at the operating sites. The germs found were: Acinetobacter, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus. They are all sensitive to imipenem and resistant to amoxicillin. The infection remains formidable in health care. It is essential to give special attention to the prevention of infectious risk, especially in the surgical setting.

OBJECTIFS: déterminer les principaux germes responsables d'infection associée aux soins et leurs sensibilités aux antibiotiques utilisés et d'identifier les facteurs de risque d'infection associée aux soins. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale avec recueil prospectif des données, réalisée du 1er Novembre 2016 au 1er Avril 2017 chez tous les enfants admis au service de chirurgie pédiatrique. Les parents non consentants et les cas de nécrosectomie n'ont été inclus à cette étude. RÉSULTATS: Notre étude a concerné 200 patients, parmi lesquels 30 ont présenté une infection associée aux soins (taux d'infection de 15%). L'âge moyen des patients avec infection a été de 56.33± 48.66 mois (1 et 180 mois) .Les principaux germes responsables de l'infection du site opératoire ont été : Escherischia coli (4 cas), Acinetobacter baumanii (3 cas), Klebsiella pneumoniae (2 cas), Staphylococcus aureus (2 cas), Enterobacter cloacae (1cas), Pseudomonas aeruginosa (1 cas) et Enterobacter faecalis (1 cas). Chez les patients brûlés les germes retrouvés ont été: Acinetobacter baumanii (7 cas), Klebsiella pneumoniae (6 cas), Staphylococcus aureus (6 cas), Escherischia coli (4 cas), Pseudomonas aeruginosa (2 cas) et Enterobacter faecalis (2 cas). L'Escherischia coli a été noté dans le cas d'infection urinaire.Les antibiotiques testés étaient : l'amoxicilline, l'association amoxicilline-acide clavulanique, leceftriaxone, l'imipenème, la gentamicine et la ciprofloxacine. Le mode de recrutement et la durée d'hospitalisation ont été les facteurs de risque notés. CONCLUSION: L'infection associée aux soins est un événement fréquent dans notre pratique. Ces infections surviennent majoritairement sur les sites opératoires.Les germes retrouvés ont été : Acinetobacters, Escherischia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa,Staphylococcus aureus.Ils sont tous sensibles à l'imipenème et résistants à l'amoxicilline.L'infection demeure redoutable en milieu de soins. Il est essentiel d'accorder à la prévention du risque infectieux une attention particulière surtout en milieu chirurgical.

[Management of Acute Malnutrition in Children in a Sahelian Secondary Hospital]. / Prise en charge de la Malnutrition Aigüe chez l'enfant dans un Hopital Secondaire Sahelien.

Malnutrition among children under five is a major public health problem in low-income countries, and contributes significantly to mortality in this age group. The purpose of this work was to evaluate the epidemiological and clinical profile of malnourished children at the Nara hospital in north of Mali. METHOD: It was a retrospective and descriptive study, from 01/01/2016 to 31/12/2016. Children aged 6 months to 59 months admitted for acute malnutrition were included. RESULTS: Four hundred and sixty-one children had malnutrition, representing 15% of consultations and 50% of hospitalizations. The median age was 26 months (2 months-93 months). The sex ratio was 0.92 (M = 222, F = 239). Nineteen percent of the patients had progressive weaning (n = 90), and it was brutal in 371 patients (80%). The distribution of patients according to the Z-score was as follows: Z-score <-1 (n = 15, 3%), Z-score <-2 (n = 46, 10%), Z-score <-3 (n = 400, 87%). Mean MUAC was 105 mm (99mm-124mm). Hypoglycemia was noted in 45% (n = 204). The marasmus cases accounted for 80% (n = 367) kwashiorkor 10% (n = 48). The mixed form of malnutrition accounted for 10% (n = 46). The disease associated with malnutrition were pneumonia (n = 219, 47%), malaria (n = 115, 25%) and gastroenteritis (n = 68, 15%). The F75 milk was administered predominantly for 3 months in 93% of cases. For phase 2 of treatment, Plumpy Nut and F100 milk were respectively administered in 88% and 12%. The nutritional recovery rate was 95% (n = 435). Five percent of the patients died (n = 26). Pneumonia was the cause of death in 85% of cases. The cure rate for marasmus and kwashiorkor cases was respectively 94% and 93%. CONCLUSION: Acute malnutrition remains frequent in the Sahelian environment. Better knowledge of mothers about weaning and dietary diversification will improve the nutritional status of children.

La malnutrition chez les enfants de moins de cinq ans est un problème majeur de santé publique dans les pays à faibles revenus, et contribue de manière significative à la mortalité dans cette tranche d'âge. Le but de ce travail était d'évaluer le profil épidémio- clinique et thérapeutique des enfants malnutris pris en charge au centre de santé de référence de Nara. MÉTHODE: IL s'est agi d'une étude rétrospective et descriptive, allant du 01/01/2016 au 31/12/2016. Tous les enfants d'âge compris entre 6 mois et 59 mois, admis pour malnutrition aigüe ont été inclus. RÉSULTATS: La malnutrition a été diagnostiquée chez quatre cent soixante un enfant, soit 15% des consultations et 50% des hospitalisations. L'âge médian était de 26 mois (2 mois-93 mois). Le sex ratio était 0,92 (M=222 ; F=239).Dix-neuf pour cent des patients ont eu un sevrage progressif (n=90), et il a été brutal chez 371 patients, soit 80%. La répartition des patients selon le Z-score était le suivant : Z-score < -1 (n=15 ; 3%), Z-score < -2 (n=46 ; 10%), Z-score < -3 (n=400 ; 87%). Le périmètre brachial moyen était de 105 mm (99mm-124mm). A l'admission, l'hypoglycémie a été notée chez 45% (n=204). Les cas de marasme représentaient 80% (n=367) kwashiorkor 10% (n=48). La forme mixte de la malnutrition a représentée 10% (n=46). Les pathologies associées à la malnutrition étaient : les pneumopathies (n=219 ; 47%), le paludisme (n=115 ; 25%) et les gastroentérites (n=68 ; 15%).Le F75 a été administré majoritairement pendant 3 mois dans 93% des cas. Pour la phase 2 du traitement, le Plumpy Nut et le F100 ont été respectivement administré à 88% et 12%. Le taux de récupération nutritionnelle était de 95% (n=435). Cinq pour cent des patients sont décédés (n=26). La pneumonie a été la cause du décès dans 85% des cas. Le taux de guérison pour les cas de marasme et de kwashiorkor était respectivement de 94% et 93%. CONCLUSION: la malnutrition aigüe demeure fréquente et préoccupante en milieu pédiatrique sahelien. Une meilleure connaissance des mères sur le sevrage et la diversification alimentaire permettront d'améliorer l'état nutritionnel des enfants.

Childhood brain tumors in Mali.

to assess epidemiologic and clinical aspects of childhood brain tumors in Mali. a retrospective, descriptive study of children aged 0-15 years with brain tumors, conducted in the pediatrics department of the Gabriel Touré University Hospital Center in Bamako, Mali, from January 31, 2007 to December 3, 2012. In all, 41 cases of brain tumors were recorded during this period (mean: 5.5 years old; range: 1-12 years). Brain tumors were most frequent in the children aged 2-5 years (53.7%) and among boys (53.7%). Late stage at presentation was relatively frequent (34.1%) with a mean time to diagnosis of 10 months. Features of elevated intracranial pressure were the most frequent mode of revelation of primary tumors (26.8%). Supratentorial tumors accounted for 83% of the cases, and gliomas were most frequently (29.3%) identified on computed tomography. Only five patients underwent surgical tumor removal. A broader study including the other hospitals in Bamako could help to assess more accurately the epidemiology of pediatric brain tumors in Mali.

[Caracteristics Of Severe Malaria In Child From 0 To 5 Years At The Hospital Of Sikasso In Mali]. / Caracteristiques Du Paludisme Grave Chez Les Enfants De 0 à 5 Ans A L'Hopital De Sikasso Au Mali.

In Mali, malaria is a major public health problem. The region of Sikasso is classified according to the geo-climatic facies as a zone with a long seasonal transmission of malaria greater than 6 months. OBJECTIVE: To describe the epidemiological, clinical and therapeutic characteristics of children aged 0- 5 years hospitalized for severe malaria in the pediatric ward of the Sikasso hospital. Variables analyzed were epidemiological, clinical, paraclinical, therapeutic and evolutionary. PATIENTS AND METHODS: This is a retrospective, 12-month (January-December 2014) cross-sectional study of all 0-5-year-olds hospitalized for severe malaria at the Sikasso Regional Hospital. RESULTS: The hospital frequency of severe malaria was 55.82%. The age group of 12-35 months was the most concerned (45.3%). The peak frequency was in August (21.2%). Anemic, mixed (anemia and neurological) and neurological forms were the most frequent. Artemether and quinine were the antimalarials used. The use of a blood transfusion was frequent (82.8%). The lethality was 10% and the mixed form (anemia and neurology) was the most lethal ((P<10-6). CONCLUSION: Malaria remains a national concern in Mali. Improving the quality of care and prevention must be a priority to reduce the lethality that remains high.

Au Mali, le paludisme constitue un problème majeur de santé publique. La région de Sikasso est classée selon le faciès géo climatique comme étant une zone à transmission saisonnière longue du paludisme supérieure à 6 mois. OBJECTIF: Décrire les caractéristiques épidémiologiques, et cliniques des enfants âgés de 0 à 5 ans hospitalisés pour paludisme grave au service de pédiatrie de l'hôpital de Sikasso. PATIENTS ET MÉTHODS: Il s'agit d'une étude transversale rétrospective sur douze mois (janvier-décembre 2014) de tous les enfants âgés de 0-5 ans hospitalisés pour paludisme grave à l'hôpital régional de Sikasso. Les variables analysées étaient épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutifs. RÉSULTATS: La fréquence hospitalière du paludisme grave a été de 55,82%.La tranche d'âge de 12-35 mois a été la plus concernée (45,3%). Le pic de fréquence des cas a été atteint au mois d'aout (21,2%). Les formesanémique, mixte (anémie et neurologique) etneurologique ont été les plus fréquentes. L'artéméther et la quinine ont été les antipaludiques utilisés. Le recours à une transfusion sanguine a été fréquente (82,8%).La létalité est de10% et la forme mixte (anémie et neurologique) a été la plus létale ((P<10−6). CONCLUSION: Le paludisme reste une préoccupation nationale au Mali. L'amélioration de la qualité de la prise en charge et la prévention doivent êtreune priorité pour diminuer la létalité qui reste élevée.

[Accidental household poisoning of the child at the Gabriel Toure university hospital center in Bamako]. / Les intoxications accidentelles domestiques de l'enfant au Chu Gabriel Toure.

INTRODUCTION: Household accidental child poisonings are frequent pediatric medical emergencies in developing countries. OBJECTIVE: To study the epidemiological, etiological, clinical and therapeutic aspects of acute accidental domestic poisoning in children aged 0 to 15 years admitted to the pediatric emergency department of Gabriel Toure. METHOD: This was a prospective, descriptive study that ran from January 1, 2014 to December 31, 2014. All patients aged 0 to 15 years admitted to pediatric emergencies for acute intoxication were included. RESULTS: A hundred cases of acute accidental poisoning were collected. Children under five accounted for 94%. The majority of mothers was housewives and had custody of children (83%). Forty-nine percent of the mothers were unschooled. The place of storage of the product was indoor in 96% of cases. The product was taken by the child himself (88%). A gesture at the scene of the accident was reported in 68% of cases, the ingestion of milk (72%) and water (10%) were the first acts used. The hospital was the first resort (72%). The time between taking the product and admission to hospital was 1 to 5 hours in 58% of cases. Vomiting (37 cases), agitation (17 cases) and respiratory distress (16 cases) were the most common symptoms. Domestic products (48%) followed by drugs (33%) ranked first among the families of poisons. Caustic soda (18%) and bleach (17%) were the most commonly found intoxication products. The evolution was good with a cure without sequelae (93%). CONCLUSION: Accidental acute intoxications to household products are common in Mali. The hospital admission deadline is still long; the actions taken by patients at the accident site often aggravate their states but are largely done by the parents before the use of health care.

Les intoxications accidentelles domestiques de l'enfant sont des urgences médicales pédiatriques fréquentes dans les pays en développement. Le but de notre travail était d'étudier les aspects épidémiologiques, étiologiques, cliniques et thérapeutiques des intoxications aiguës accidentelles domestiques chez les enfants âgés de 0 à 15 ans admis aux urgences pédiatriques du CHU Gabriel Touré. MÉTHODE: Il s'agissait d'une étude descriptive à collecte prospective qui s'est déroulée du 01 janvier 2014 au 31 décembre 2014. Ont été inclus tous les patients âgés de 0 à 15 ans admis aux urgences pédiatriques pour intoxications aiguës accidentelles. RÉSULTATS: Cent cas d'intoxications accidentelles aiguës ont étés colligés. Les enfants âgés de moins de cinq ans représentaient 94%. La majorité des mères était des femmes au foyer et avait la garde des enfants (83%). Quarante-neuf pour cent des mères n'étaient pas scolarisées. Le lieu de stockage du produit était intradomiciliaire dans 96% des cas. Le produit était pris par l'enfant lui-même (88%). Un geste sur le lieu de l'accident était rapporté dans 68% des cas, l'ingestion de lait (72 %) et de l'eau (10%) avaient été les premiers gestes utilisés. L'hôpital était le lieu du premier recours (72%). La durée entre la prise du produit et l'admission à l'hôpital était de 1 à 5 heures dans 58% des cas. Les vomissements (37 cas), l'agitation (17 cas) et la détresse respiratoire (16 cas) étaient les symptômes les plus rencontrés. La soude caustique (18%) et l'eau de javel (17 %) étaient les produits d'intoxication les plus retrouvés. Les produits domestiques (48%) suivis des médicaments (33%) venaient en tête parmi les familles de toxiques. L'évolution était bonne avec une guérison sans séquelle (93%). CONCLUSION: Les intoxications aiguës accidentelles aux produits domestiques sont courantes au Mali. Le délai d'admission à l'hôpital reste toujours long, les gestes inappropriés apportés aux patients sur le lieu de l'accident aggravent souvent le tableau mais sont largement effectués par les parents avant le recours aux soins de santé.

Constipation de l'enfant dans un service de pédiatrie générale à Bamako / Childhood constipation in a general pediatrics Unit in Bamako

Introduction : La constipation est un symptôme qui correspond à une anomalie des selles ou de leur élimination : elles sont trop volumineuses ou trop dures, trop rares, ou leur élimination est douloureuse, voire incomplète. Objectif : le but de cette étude était de déterminer la fréquence, les facteurs favorisants, les signes et les modalités thérapeutiques de la constipation de l'enfant dans le département de pédiatrie du CHU Gabriel Touré. Patients et Méthode : Il s'agissait d'une étude transversale descriptive à collecte prospective allant du 1 avril 2019 au 31 Janvier 2020. Ont été inclus tous les patients de 0 à 15 ans ayant consulté dans le département de pédiatrie pour constipation et répondant aux critères de Rome IV. Résultat : Nous avions enregistré 75 patients.Lafréquence hospitalière était de 0,23 %. La tranche d'âge d'un mois à deux ans représentait 61,3% des patients, l'âge moyen était de 27,7 +/- 43 mois. Le sexe masculin prédominait avec 58,7%. La constipation était le motif de consultation le plus fréquent avec 62,6%. Une selle par semaine a été retrouvée chez 77,3 % des patients. La douleur à la défécation a été retrouvée chez 65,3 % des patients. La constipation était fonctionnelle chez 69,3% des patients. La maladie de Hirschsprung était la cause de la constipation organique chez 65,2% des patients. Les laxatifs ont été prescrits chez 64 % des patients à la consultation. Conclusion: La constipation est une pathologie fréquente qui touche les enfants à tout âge. Elle est d'origine fonctionnelle dans la majeure partie des cas.

Introduction: Constipation is a symptom that corresponds to an anomaly of the stools or their elimination: they are too bulky or too hard, too rare, or their elimination is painful, even incomplete. Objective: was to determine the frequency, the contributing factors, the signs and the therapeutic methods of constipation in children in the pediatric department of the CHU Gabriel Touré. Patients and Method: This was a descriptive cross-sectional study with prospective collection from April 1, 2019 to January 31, 2020. All patients aged 0 to 15 who consulted in the pediatric department for constipation and responding to the Rome IV criteria. Result: We registered 75 patients. The hospital frequency of 0.23%. The age group from one month to two years represented 61.3% of the patients, the average age was 27.7 +/- 43 months. The male gender predominated with 58.7%. Constipation alone was the most common reason for consultation with 62.6%. One stool per week was found in 77.3% of patients. Pain on defecation was found in 65.3% of patients. Constipation was functional in 69.3% of patients. Hirschsprung disease was the cause of organic constipation in 65.2% of patients. Laxatives were prescribed in 64% of patients at the consultation. Conclusion: Constipation is a frequent pathology that affects children at all ages. It is of functional origin in most case

Aspects épidémiologiques, cliniques et thérapeutiques de l'asthme de l'enfant dans le département de pédiatrie du CHU Gabriel Touré / Epidemiological, clinical and therapeutic aspects of childhood asthma in the department of pediatrics of the Gabriel Touré university hospital

Introduction: L'asthme est la maladie chronique de l'enfant la plus fréquente. Il estl'une des principales causes de consultations aux urgences, d'hospitalisation et d'absentéisme scolaire.L'asthme est un véritable problème de santé publique. La prévalence de cette maladie ne cesse d'augmenter dans le monde entier. Patients et méthode : Nous avions mené une étude prospective, auprès des enfants asthmatiques sur une période d'une année, de Janvier 2018à décembre 2018. Résultats : Nous avions recensé105 patients asthmatiques pour un total de 14344 consultations soit une fréquence de 0,73%. Le sex ratio était de 1.9, La tranche d'âge 2-5 ans était la plus fréquente soit 52%, l'âge de la première crise se situait généralement entre 1 et 2 ans soit 75.24%. Nous avions observé que près de 22% des crises survenaient au mois de décembre (21.90%). La fumée et l'humiditéétaient les principaux facteurs déclenchants. Tous les malades avaient bénéficié de la nébulisation par lesB 2 mimétiques. Conclusion : l'éducation de l'enfant asthmatique ainsi que de sa famille et la mise en place de protocoles standards de prise en charge pourraient réduire de façon considérable la morbidité liée à l'asthme dans nos pays

Introduction : Asthma is the most common chronic disease of children. It is a leading cause of emergency room visits, hospitalization and school absenteeism. Asthma is a real public health problem. The prevalence of this disease is increasing worldwide. Patients and method: We had conducted a prospective study, among children with asthma over a period of one year, from January 2018 to December 2018. Results: We counted 105 asthmatic patients for a total of 14344 consultations, or a frequency of 0,73%. The sex ratio was 1,9, the age group 2-5 years was the most frequent, (52%), the age of the first attack was generally between 1 and 2 years, ( 75,24%). We observed that almost 22% of the attacks occurred in December (21,90%). Smoke and humidity were the main triggers. All the patients had benefited from nebulization with B 2 mimetics. Conclusion: Education of asthmatic children, their families and the establishment of standard management protocols could significantly reduce asthmarelated morbidity in our countries.

[Pathologies of peritoneo-vaginal canal in pediatric surgery at the teaching hospital Gabriel Touré]. / Les Pathologies du Canal Peritoneo-Vaginal en Chirurgie Pediatrique du CHU Gabriel Toure.

The closure anomalies of the peritoneal-vaginal canal include several clinical entities, which are at the origin of various symptomatology. OBJECTIVE: To study the anatomo-clinical and therapeutic aspects of pathologies of the peritoneal-vaginal canal. MATERIALS AND METHOD: This was a prospective study from January 1st to December 31st, 2015 carried out in the pediatric surgery department of University Hospital Gabriel Touré. It covered all children aged 0-15 years old with a pathology of the peritoneal-vaginal canal operating in the department during the study period. This study did not include cases that were not operated on or not seen during the study period. RESULTS: During the study period, 2,699 children were treated in pediatric surgery, of which 150 cases of pathology of the peritoneal-vaginal canal had a hospital frequency of 5.5%. The average age was 3.25 ± 9.63 years. The sex ratio was 14. The reason for consultation was intermittent or permanent inguinal or inguino-scrotal swelling in all children. The pathology was discovered by the parents during the pushing efforts in 46.7%. Inguino-scrotal swelling was found on physical examination in 40% of cases. The right side was reached in 60% of the cases. Hernia accounted for 80.6% of these pathologies. We recorded 31 cases of strangulation and 11 cases of craze. Immediate operative follow-up was simple in 92% of patients. This rate was 96% after 6 months. CONCLUSION: Pathologies of the peritoneal-vaginal canal are very common in pediatric surgical practice. The first place of these pathologies is occupied by hernia. They preferentially affect male infants.

Les anomalies de fermeture du canal péritonéo-vaginal (CPV) regroupent plusieurs entités cliniques qui sont à l'origine d'une symptomatologie variée. OBJECTIF: étudier les aspects anatomo-cliniques et thérapeutiques des pathologies du canal péritonéo-vaginal. MATÉRIELS ET MÉTHODE: il s'agissait d'une étude prospective du 1er Janvier au 31 Décembre 2015 réalisée dans le service de chirurgie pédiatrique du CHU Gabriel Touré. Elle a porté sur tous les enfants de 0-15 ans présentant une pathologie du canal péritonéo-vaginal opérés dans le service pendant la période d'étude. N'ont pas fait partie de cette étude, les cas non opérés et ou non vus pendant la période d'études. RÉSULTATS: Durant la période d'étude 2699 enfants ont été pris en charge en chirurgie pédiatrique dont 150 cas de pathologies du canal péritonéo-vaginal soit une fréquence hospitalière de 5,5%. L'âge moyen était de 3,25± 9,63 ans. Le sexe ratio était de 14. Le motif de consultation était la tuméfaction inguinale ou inguino-scrotale intermittente ou permanente chez tous les enfants. La pathologie a été découverte par les parents lors des efforts de poussées dans 46,7%. La tuméfaction inguino-scrotale a été retrouvée à l'examen physique dans 40% des cas. Le côté droit était atteint dans 60% des cas. La hernie a représenté 80,6% de ces pathologies. Nous avons enregistré 31 cas d'étranglement et 11 cas d'engouement. Les suites opératoires immédiates ont été simples chez 92% des patients. Ce taux était de 96% après 6 mois. CONCLUSION: Les pathologies du CPV sont très fréquentes dans la pratique chirurgicale pédiatrique. La première place de ces pathologies est occupée par la hernie. Elles touchent préférentiellement les nourrissons de sexe masculin.

Spleen enlargement and genetic diversity of Plasmodium falciparum infection in two ethnic groups with different malaria susceptibility in Mali, West Africa.

The high resistance to malaria in the nomadic Fulani population needs further understanding. The ability to cope with multiclonal Plasmodium falciparum infections was assessed in a cross-sectional survey in the Fulani and the Dogon, their sympatric ethnic group in Mali. The Fulani had lower parasite prevalence and densities and more prominent spleen enlargement. Spleen rates in children aged 2-9 years were 75% in the Fulani and 44% in the Dogon (P<0.001). There was no difference in number of P. falciparum genotypes, defined by merozoite surface protein 2 polymorphism, with mean values of 2.25 and 2.11 (P=0.503) in the Dogon and Fulani, respectively. Spleen rate increased with parasite prevalence, density and number of co-infecting clones in asymptomatic Dogon. Moreover, splenomegaly was increased in individuals with clinical malaria in the Dogon, odds ratio 3.67 (95% CI 1.65-8.15, P=0.003), but not found in the Fulani, 1.36 (95% CI 0.53-3.48, P=0.633). The more susceptible Dogon population thus appear to respond with pronounced spleen enlargement to asymptomatic multiclonal infections and acute disease whereas the Fulani have generally enlarged spleens already functional for protection. The results emphasize the importance of spleen function in protective immunity to the polymorphic malaria parasite.