Treatment outcomes and associated factors for hospitalization of children treated for acute malnutrition under the OptiMA simplified protocol: a prospective observational cohort in rural Niger.

Introduction: Globally, access to treatment for severe and moderate acute malnutrition is very low, in part because different protocols and products are used in separate programs. New approaches, defining acute malnutrition (AM) as mid-upper arm circumference (MUAC) < 125 mm or oedema, are being investigated to compare effectiveness to current programs. Optimizing Malnutrition treatment (OptiMA) is one such strategy that treats AM with one product - ready-to-use therapeutic food, or RUTF - at reduced dosage as the child improves. Methods: This study aimed to determine whether OptiMA achieved effectiveness benchmarks established in the Nigerien National Nutrition protocol. A prospective cohort study of children in the rural Mirriah district evaluated outcomes among children 6-59 months with uncomplicated AM treated under OptiMA. In a parallel, unconnected program in one of the two trial sites, all non-malnourished children 6-23 months of age were provided small quantity lipid-based nutritional supplements (SQ-LNS). A multivariate logistic regression identified factors associated with hospitalization. Results: From July-December 2019, 1,105 children were included for analysis. Prior to treatment, 39.3% of children received SQ-LNS. Recovery, non-response, and mortality rates were 82.3%, 12.6%, and 0.7%, respectively, and the hospitalization rate was 15.1%. Children who received SQ-LNS before an episode of AM were 43% less likely to be hospitalized (ORa=0.57; 0.39-0.85, p = 0.004). Discussion: OptiMA had acceptable recovery compared to the Nigerien reference but non-response was high. Children who received SQ-LNS before treatment under OptiMA were less likely to be hospitalized, showing potential health benefits of combining simplified treatment protocols with food-based prevention in an area with a high burden of malnutrition such as rural Niger.

[Chronic otitis media complicated by Bezold's abscess and lateral sinus thrombophlebitis]. / Otite moyenne chronique compliquee d'un abces de Bezold et d'une thrombophlebite du sinus lateral : prise en charge d'un cas.

INTRODUCTION: Mastoiditis is a complication of otitis media and is defined as inflammation (usually infectious) of the mastoid air cells. Its incidence is 1.2 cases per 100,000 in children under 15 years of age, with a higher incidence in infants and a slight male predominance. OBSERVATION: This was a 15-year-old girl, a student living in Bamako, with a history of recurrent otitis suppurativa since childhood. The onset of symptoms was seven weeks after her admission, marked by a left purulent otorrhea of medium abundance of progressive onset associated with unquantified fever, anterior rhinorrhea and hypoacusis without vertigo or tinnitus. The general examination on admission revealed a vigilant patient with a fair general condition, the conjunctiva were well stained with a temperature of 39°c and good hemodynamic constants. The ENT clinical examination revealed a cervico-facial and left retro auricular swelling without disappearance of the retro auricular groove with pre-toric and latero-cervical extension, painful to palpation, firm consistency, skin in front of it with an infiltrated aspect (figure 1). Left otoscopy revealed an obstructive inflammatory stenosis of the external auditory canal (EAC). Cervical CT scan revealed a large phlegmonous abscess in the laterocervix and left pharynx measuring 108 x 58.5 mm (Figure 2 a and b). The patient had received intravenous (IV) bi-antibiotic therapy and effective anticoagulation with low molecular weight heparin. The evolution was marked at one week after the cervicotomy by a significant regression of the left laterocervical swelling and of the clinical and biological inflammatory syndrome. CONCLUSION: The diagnostic and therapeutic delay of chronic otitis media and ear washing can have often serious complications. In front of any latero-cervical mass in a context of otitis, it is necessary to think of a Bezold abscess. The management is well codified according to the literature.

INTRODUCTION: Une mastoïdite est une complication des otites moyennes, elle est définie par une inflammation (en général infectieuse) des cellules aériennes mastoïdiennes. Son incidence est de 1,2 cas pour 100 000 chez les enfants de moins de 15 ans, avec une incidence plus élevée chez les nourrissons et une légère prédominance masculine. OBSERVATION: Il s'agissait d'une jeune fille de 15 ans, élève résidant à Bamako, aux antécédents d'otite suppurée à répétition depuis l'enfance. Le début de la symptomatologie remontait à sept semaines de son admission, marqué par une otorrhée purulente gauche de moyenne abondance d'installation progressive associée à une fièvre non quantifiée, rhinorrhée antérieure et une hypoacousie sans vertige ni acouphène. L'examen général à l'entrée retrouvait, une patiente vigilante, avec un état général passable, les conjonctives étaient bien colorées avec une température à 39°c et des bonnes constantes hémodynamiques. L'examen clinique ORL retrouvait une tuméfactioncervico-faciale etrétro auriculaire gauche sans disparition du sillon retro auriculaire avec extension prétorienne et latero-cervicale, douloureuse à la palpation, de consistance ferme, peau en regard d'aspect infiltré (figure 1). L'otoscopie gauche a retrouvé une sténose inflammatoire obstructive du conduit auditif externe (CAE). La TDM cervicale retrouvait un abcès important phlegmoneux latéro-cervical et pharyngé gauche mesurant 108 x 58,5 mm (Figure 2 a et b). La patiente avait bénéficié d'une bi antibiothérapie par voie intraveineuse (IV) et d'une anticoagulation efficace par héparine à bas poids moléculaire.L'évolution a été marquée à une semaine de la cervicotomie par une régression importante de la tuméfaction latéro-cervicale gauche et du syndrome inflammatoire clinique et biologique. CONCLUSION: Le retard diagnostique et thérapeutique des otites moyennes chroniqueset le lavage de l'oreille peutavoir des complications souvent graves. Devant toute masse latéro-cervicale dans un contexte d'otite, il faut penser à un abcès de Bezold. La prise en charge est bien codifiée selon la littérature.

[Cerebral toxoplasmosis in the infectious diseases department of the CHU du Point G in people living with HIV]. / La toxoplasmose cerebrale dans le service de maladies infectieuses du CHU du Point G chez les personnes vivant avec le VIH.

Toxoplasmosis is defined as a cosmopolitan protozoan disease caused by an obligate intracellular coccidia, Toxoplasma gondii. The advent of HIV infection has made cerebral toxoplasmosis one of the most widespread neurological opportunistic infections. METHOD: We conducted a descriptive cross-sectional study with retrospective review of files of cerebral toxoplasmosis on HIV infected patients who had been hospitalized in the infectious diseases department of Point G University Hospital between January 1st, 2014 and September 30th, 2019. RESULTS: During the study period, the frequency of cerebral toxoplasmosis was 10.1% and in 46.4% of the patients, the diagnosis led to the discovery of HIV co-infection. The clinical features were characterized by fever, headaches, and motor deficit at 86.6%, 84.5% and 69.1% respectively. Roundel image on computed tomography was most represented and was found in 24.4% of patients. Anti-toxoplasma treatment based on trimethoprim /sulfamethoxazole (TMP/SMX) associated with folinic acid was initiated in 78 patients out of 90, but 19 patients had a contraindication or adverse effects to this combination and were treated with clindamycin. HAART was initiated in 31 patients out of 45 (68.9%) newly diagnosed. The overall prognosis was limited with a mortality rate of 42%. CONCLUSION: The prevalence of cerebral toxoplasmosis was high in our study, 10.1%. To reduce this prevalence, chemoprophylaxis should be initiated in all HIV-infected patients with a CD4 count below 200 cells/mm3.

INTRODUCTION: La toxoplasmose est une protozoose cosmopolite due à Toxoplasmagondii. Avec l'avènement du VIH, la toxoplasmose cérébrale est une des infections opportunistes neurologiques les plus répandues. MÉTHODE: Nous avons mené une étude transversaledescriptive à collecte rétrospective portant sur des cas de toxoplasmoses cérébrales sur terrain d'immunodépression aux VIH ayant séjourné en hospitalisation dans le service des maladies infectieuses du CHU de Point G du 1er janvier 2014 au 30 septembre 2019. RÉSULTATS: La prévalence de la toxoplasmose cérébrale était de 10,1%. Chez 46,4% des patients, le diagnostic de toxoplasmose cérébrale avait permis la découverte d'une coïnfection à VIH. Le tableau clinique était dominé par la fièvre, les céphalées et le déficit moteur soit respectivement 86,6%, 84,5% et 69,1%. L'image en cocarde à la tomodensitométrie a été retrouvée chez 24,4% des patients. Le traitement anti-toxoplasmique à base de triméthoprime/sulfaméthoxazole (TMP/ SMX) associée à l'acide folinique a été conduit chez 78 patients sur 90. Dix-neuf patients avaient une contre-indication ou des effets indésirables à l'association TMP/ SMX et ont été traités par la clindamycine. Le traitement ARV a été initié chez trente-un patients sur 45 nouvellement dépistés soit 68,9%. Le pronostic chez nos patients était réservé et marqué par une mortalité de 42%. CONCLUSION: La prévalence de la toxoplasmose cérébrale était élevée dans notre étude soit 10,1%. Pour diminuer cette prévalence, la chimio-prophylaxie doit être instaurée chez tous les patients infectés par le VIH et ayant un taux de CD4 inférieur à 200 cellules/mm3.

Peoples' attitude toward COVID-19 vaccine, acceptance, and social trust among African and Middle East countries.

Background: To end the COVID-19 pandemic, a large part of the world must be immune to the virus by vaccination. Therefore, this study aimed to gauge intent to be vaccinated against COVID-19 among ordinary people and to identify attitudes towards vaccines and barriers for vaccine acceptance. Methods: The study population comprises 1880 people residing in different countries that answer a prepared questionnaire. The questionnaire topics are demographics, historical issues, participants' attitudes and beliefs regarding vaccines, concerns, and vaccine hesitancy. Results: Attitudes and beliefs relating to vaccines in general, and the COVID-19 vaccine, were ascertained. Overall, 66.81% of the contributors would like to be vaccinated against COVID-19, while %33.19 did not intend to be vaccinated. Reasons for COVID-19 vaccine hesitancy included concern regarding vaccine side effects, fear of getting sick from the uptake of the vaccine, and the absence of accurate vaccine promotion news. Individuals with higher education believe that India (68.6%) produces the best vaccine (P <0.001), while healthcare workers think the Chinese vaccine (44.2%) is the best (P =0.020). Individuals with higher education have not been vaccinated, not be healthcare workers, and females were the most contributors to effective of the vaccine in reducing mortality from COVID-19 disease. Conclusion: Given the degree of hesitancy against COVID-19 vaccination, a multifaceted approach to facilitate vaccine uptake that includes vaccine education, behavioral change strategies, and health promotion, is paramount.

[Soft palate perforation during endemic syphilis, a case study]. / Perforation du palais mou au cours de la syphilis endemique (un cas).

The authors report a case of soft palate perforation during endemic syphilis. The diagnosis of endemic syphilis was based on the absence of factor in favor of venereal syphilis, highly positive results suggesting VDRL/TPHA association, histology of velar perforation banks and the satisfactory response with closure of the perforation velar after 4 weeks of treatment with Benzathine benzylpenicillin.

Les auteurs rapportent un cas de perforation du palais mou au cours de la syphilis endémique. Le diagnostic de la syphilis endémique a été posé sur la base de l'absence de facteurs enfaveur de la syphilis vénérienne, du résultat fortement positif du couplage VDRL/TPHA, des données de l'histologie des berges de la perforation et de la réponse satisfaisante avec la fermeture vélaire à 4 semaines de traitement par benzathine Benzyle Pénicilline.

[Mediastinitis complicating cervical cellulite: 8 cases observed in the ear, nose and throat department of the Gabriel Toure university hospital, Bamako (Mali)]. / Mediastinite compliquant une cellulite cervicale : a propos de 8 cas observes dans le service orl du chu Gabriel Toure de Bamako (Mali).

OBJECTIVE: The objective of this work was to analyze the diagnostic circumstances and the therapeutic management of mediastinal disease of a cervical origin. PATIENTS AND METHODS: We conducted a longitudinal prospective and retrospective descriptive study in the ENT department of the Gabriel Touré Hospital in Bamako, involving the records of patients treated for mediastinitis complicating cervical cellulite from January 2011 to April 2014. RESULTS: Eight patients met our inclusion criteria. The median age was 29 years, the standard deviation was 10.23 years with extremes of 25 and 57 years. All were initially admitted for dental reasons. The median time to consultation was 13 days with extremes of 10 days and 1 month. Six patients had non-steroidal anti-inflammatory drugs before entry into the service. Cervical and thoracic CT scan was used to guide diagnosis in all cases. Seven patients underwent mediastinal drainage through cervicotomy, 3 patients underwent percutaneous pleural drainage under ultrasound guidance. We had two deaths. CONCLUSION: Mediastinitis in cervical cellulitis is a serious infectious disease where the mortality rate remains high. Mediastinal drainage was performed by cervical route. Prevention is based on the awareness and the importance of dental hygiene and getting proper and early treatment for dental cavities.

OBJECTIF: L'objectif de ce travail était d'analyser les circonstances de diagnostic et la prise en charge thérapeutique des affections médiastinales à point de départ cervical. PATIENTS ET MÉTHODES: Nous avons mené une étude descriptive longitudinale pro et rétrospective dans le service d'ORL du CHU Gabriel Touré de Bamako et qui a concerné les dossiers des patients traités pour médiastinite compliquant une cellulite cervico-faciale de janvier 2011 à Avril 2014. RÉSULTATS: Huit patients ont répondu à nos critères d'inclusion. L'âge médian était de 29 ans, l'écart type était de 10,23 ans avec des extrêmes de 25 et 57 ans. La porte d'entrée a été dentaire dans tous les cas. Le délai médian de consultation était de 13 jours avec des extrêmes de 10 et 1 mois. Six patients avaient eu des antiinflammatoires non stéroïdiens avant leur admission dans le service. Le scanner a permis d'orienter diagnostic, en montrant des signes en faveur de médiastinite, dans tous les cas. Sept patients ont bénéficié d'un drainage du médiastin par voie de cervicotomie, 3 patients ont bénéficié d'un drainage pleural percutané sous guidage échographique. Nous avons eu deux décès. CONCLUSION: La médiastinite au cours de la cellulite cervicale représente une pathologie infectieuse grave avec une mortalité qui reste élevée. Le drainage médiastinal a été effectué par voie cervicale. La prévention repose sur la sensibilisation de la population et sur l'importance de l'hygiène dentaire et la prise en charge correcte et précoce des caries dentaires.

[Cervico-facial cellulitis during pregnancy: about a series of 10 cases in Mali]. / Cellulite cervico-faciale au cours de la grossesse. À propos d'une série de 10 cas au Mali.

The objective of this work was to analyze the predisposing factors, diagnostic and therapeutic aspects of cervico-facial cellulitis on pregnancies and to determine maternal-fetal prognosis. We conducted a longitudinal observational descriptive study from January 2011 to March 2013 including records from pregnant women with cervicofacial cellulitis treated at the Oto-Rhino-Laryngology (ORL) and cervico-facial surgery department at Gabriel Touré Hospital in Bamako. Ten women met our inclusion criteria. The median age was 23 years. The entry way was dental in all cases. Three women had taken antibiotics and 3 others antibiotics associated with non steroidal anti-inflammatory. The medico-surgical treatment had permitted to cure 8 cases. Two cases of death were recorded and 4 cases of stillbirths. The cervico-facial cellulitis during pregnancy is a serious pathology that can be life-threatening to the mother and or child. Prevention is based on the control of dental status and informing women about the importance of dental hygiene.

[Giant mucocele maxillary sinus: About a case]. / Mucocele geante du sinus maxillaire: A propos d'un cas.

The maxillary mucocele sinus are rare and may extend outside the sinus and cause a facial deformity and orbital manifestations. OBSERVATION: We report a case of giant mucocele of the right maxillary sinus from a 48 year old man. The history of disease has found a right cheek tumefaction. hypoesthesia of the right hemifacial, nasal obstruction lasting for 2 years. CT scan of the facial confirmed diagnosis by showing a cystic mass of the right maxillairy sinus bulging into the right nasal cavity with bone thinning without bone lysis. The treatement is removal of the mucocelique pochet by Caldwell-Luc under general anesthesia and allowed disparition of symptoms. CONCLUSION: Africa the Caldwell-Luc seems to us preferable because of diagnosis tardif the origin of the importance of the expansion.

INTRODUCTION: Les mucocèles du sinus maxillaire sont rares et peuvent s'étendre en dehors du sinus et entrainer une déformation faciale et des manifestations orbitaires. OBSERVATION: Nous rapportons un cas de mucocèle géante du sinus maxillaire droit chez un homme de 48 ans. L'histoire de la maladie a retrouvé une tuméfaction jugale droite, une hypoesthésie de l'hémiface droite, une obstruction nasale évoluant depuis 2 ans. Le scanner du massif facial a confirmé le diagnostic en montrant une masse kystique du sinus maxillaire droit bombant dans la fosse nasale, avec amincissement des parois osseuses, sans lyse osseuse. Le traitement, a consisté à l'exérèse de la poche mucocélique par voie de Caldwell-Luc sous anesthésie générale, et a permis la disparition de la symptomatologie. CONCLUSION: En Afrique le Caldwell-Luc nous semble préférable du fait du diagnostic tardif à l'origine de l'importance de l'expansion.

[Reference values of neonatal erythrocyte and leukocyte count in Bamako, Mali]. / Valeurs de Référence érythrocytaires et leucocytaires chez le Nouveau-né à Bamako, Mali.

Reference values for blood cell count are not established at birth in Mali. This study aimed to determine reference values for erythrocyte and leukocyte at birth in Bamako. Blood was collected from the umbilical cord immediately following its clamping and studied for complete blood cell count in 481 newborns with a birth weight > 2500g, Apgar score ≤ 7 at 5 or 10 minutes, without abnormal hemoglobin mutations and whose mothers were willing in Bamako, Mali. Other than the median and mean values, 2.5 and 97.5 percentiles were calculated. The findings suggest that the normal reference values following a timely clamping of the umbilical cord were (mean ± 1SD and range): RBC = 4,00 ± 0,46.1012/L (3,13 - 4,89), Hb = 14,12 ± 1,49 g/dL (11,20 - 17,00), Hct = 40,27 ± 4,71% (31,62 - 50,18), MCV = 101 ± 5 fl (91 - 112), MCHC = 35,37 ± 2,16 pg/cellule (30,70 - 39,59), MCH = 35,06 ± 0,93 g/dL (33,40 - 36,90), RDW = 17,79 ± 7,33% (15,50 - 20,39), Reticulocytes (109/L) = 133,081 ± 29,95 (66,62 - 200,86), GB (109/L) = 13,24 ± 7,23 (7,20 - 23,70), PMN (109/L) = 7,16 ± 4,70 (3,07 - 14,22), PME (109/L) = 0,28 ± 0,26 (0 - 0,98), PMB(109/L) = 0,05 ± 0,09 (0 - 0,31), Lymphocytes (109/L) = 4,49 ± 2,45 (1,96 - 9,42), Monocytes (109/L) = 1,06 ± 0,73 (0,21 - 2,54), myelocytes = 1.43 ± 1.51%, erythroblasts = 4.52 ± 7.83%. It should be noted that male babies had a lower neutrophil count than female newborns. By taking into account these results when interpreting the blood cell count in Malian newborn infants, costly misdiagnoses should be considerably decreased in a population struggling with low incomes.

Les valeurs de référence de l'hémogramme ne sont pas établies à la naissance au Mali. Cette étude détermine les valeurs de référence érythrocytaires et leucocytaires du nouveau-né à Bamako. Le sang du cordon ombilical a été prélevé après clampage sans délai et étudié pour les paramètres érythrocytaires et leucocytaires chez 481 nouveau-nés à terme avec un poids de naissance > 2500g, un score d'Apgar ≥ 7 à 5 ou 10 minutes, sans mutant de l'hémoglobine et dont les mamans étaient consentantes, à Bamako, Mali. Outre les valeurs médianes et moyennes, les percentiles 2,5 et 97,5 ont été calculés. Les valeurs considérées comme normes de référence locales après un clampage sans délai du cordon ombilical (moyenne ± 1SD et extrêmes) sont : GR = 4,00 ± 0,46.1012/L (3,13 ­ 4,89), Hb = 14,12 ± 1,49 g/dL (11,20 ­ 17,00), Ht = 40,27 ± 4,71% (31,62 ­ 50,18), VGM = 101 ± 5 fl (91 ­ 112), TCMH = 35,37 ± 2,16 pg/cellule (30,70 ­ 39,59), CCMH = 35,06 ± 0,93 g/dL (33,40 ­ 36,90), IDR = 17,79 ± 7,33% (15,50 ­ 20,39), Réticulocytes (109/L) = 133,081 ± 29,95 (66,62 ­ 200,86), GB (109/L) = 13,24 ± 7,23 (7,20 ­ 23,70), PNN (109/L) = 7,16 ± 4,70 (3,07 ­ 14,22), PE (109/L) = 0,28 ± 0,26 (0 ­ 0,98), PB (109/L) = 0,05 ± 0,09 (0 ­ 0,31), Lymphocytes (109/L) = 4,49 ± 2,45 (1,96 ­ 9,42), Monocytes (109/L) = 1,06 ± 0,73 (0,21 ­ 2,54), myélocytes = 1,43 ± 1,51%, érythroblastes = 4,52 ± 7,83%. A noter un taux des polynucléaires neutrophiles plus bas chez le garçon que chez la fille. Ces valeurs diffèrent de celles rapportées pour d'autres populations. La prise en compte de ces résultats dans l'interprétation de l'hémogramme du nouveau-né au Mali, devrait éviter des erreurs de diagnostic et des explorations par excès chez une population à faibles revenues.

Valeurs de reference des erythrocytes et des leucocytes chez le nouveau-ne a Bamako; Mali

Les valeurs de reference de l'hemogramme ne sont pas etablies a la naissance au Mali. Cette etude determine les valeurs de reference erythrocytaires et leucocytaires du nouveau-ne a Bamako. Le sang du cordon ombilical a ete preleve apres clampage sans delai et etudie pour les parametres erythrocytaires et leucocytaires chez 481 nouveau-nes a terme avec un poids de naissance 2500g; un score d'Abgar ? 7 a 5ou 10 minutes; sans mutant de l'hemoglobine et dont les mamans etaient consentantes; a Bamako; Mali. Outre les valeurs medianes et moyennes; les percentiles 2;5 et 97;5 ont ete calcules. Les valeurs considerees comme normes de reference locales apres un clampage sans delai du cordon ombilical (moyenne _///} 1SD et extremes) sont : GR = 4;00 _///} 0;46.1012/L (3;13 - 4;89); Hb = 14;12 _///} 1;49 g/dL (11;20 - 17;00); Ht = 40;27 _///} 4;71 (31;62 - 50;18); VGM = 101 _///} 5 fl (91 - 112); TCMH = 35;37 _///} 2;16 pg/cellule (30;70 - 39;59); CCMH = 35;06 _///} 0;93 g/dL (33;40 - 36;90); IDR = 17;79 _///} 7;33 (15;50 - 20;39); Reticulocytes (109/L) = 133;081 _///} 29;95 (66;62 - 200;86); GB (109/L) = 13;24 _///} 7;23 (7;20 - 23;70); PNN (109/L) = 7;16 _///} 4;70 (3;07 - 14;22); PE (109/L) = 0;28 _///} 0;26 (0 - 0;98); PB (109/L) = 0;05 _///} 0;09 (0 - 0;31); Lymphocytes (109/L) = 4;49 _///} 2;45 (1;96 - 9;42); Monocytes (109/L) = 1;06 _///} 0;73 (0;21 - 2;54); myelocytes = 1;43 _///} 1;51; erythroblastes = 4;52 _///} 7;83. A noter un taux des polynucleaires neutrophiles plus bas chez le garcon que chez la fille. Ces valeurs different de celles rapportees pour d'autres populations. La prise en compte de ces resultats dans l'interpretation de l'hemogramme du nouveau-ne au Mali; devrait eviter des erreurs de diagnostic et des explorations par exces chez une population a faibles revenues

The Effectiveness of Gentamicin against Acanthamoeba Cysts in Vitro

Acanthamoeba is a free-living protozoa which causes serious ocular problem. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers and it can cause loss of vision and blindness if not treated properly. The objective of this research is to determine the effectiveness of gentamicin against six Acanthamoeba spp. isolates, of which three were clinical isolates (HS 6, HKL 95, HTH 73) and three environmental isolates (SMAL 7, SMAL 8, TTT 9). Cyst suspension from the chosen isolates were exposed to gentamicin. After 48 hours of incubation at temperature of 30°C and 37ºC, each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30oC and 37oC and the plates were examined daily until day 14 to look for the presence of Acanthamoeba trophozoites under inverted microscope. The presence of trophozoites indicated the ineffectiveness of gentamicin. Gentamicin was found to be effective against Acanthamoeba cysts from all the test strains at both incubation temperatures. The minimum cysticidal concentration (MCC) mean value of gentamicin was 0.193 mg/mL at 30oC and 0.229 mg/mL at 37oC. So, we concluded that gentamicin has cysticidal potential towards Acanthamoeba.

[Foreign bodies of the esophagus in the adult: report of 26 cases]. / Corps etrangers de l'oesophage chez l'adulte: à propos de 26 cas.

INTRODUCTION: The foreign bodies of the oesophagus see each other at any age. They are more frequent at the child's than at the adult. The cutting foreign bodies can constitute an urgency because of the risk of oesophagienne perforing or bleeding. OBJECTIVE: Bring report the epidemiological and clinical profile of the foreign bodies of the oesophagus in our practice, and underline the difficulties of coverage(care) at the adult. MATERIAL AND METHOD: A forward-looking study was realized of April, 2007 in Mars 2009 in the service ENT of the University hospital (CHU) Gabriel TOURE of Bamako concerning 26 grown-up patients presenting a foreign body of the oesophagus. RESULTS: Both sexes are affected in a equivalent way. The average age was of 32 years with extremes of 15 years and 65 years. The patients from 31 to 45 years old were the most touched. The false tooth was the foreign body most frequently met (58 %). Three patients presented complications has type of oesophagienne perforing (2) and of oeso-trachéale fistula (1) the outcome of which was fatal afterward. The oesophagoscopie in the stiff tube under general anesthesia allowed to extract 92 % of the foreign bodies. CONCLUSION: The foreign body of the oesophagus is a pathology so frequent at the adult and the diagnosis is mostly evident. Among the foreign bodies, false teeth raised problems of therapeutic coverage. The prevention passes by the regular medical supervision of false teeth, the training formation of the staff, the improvement of the technical trayp, and a good education of the patient.

[Head and neck injuries: 184 cases in Mali]. / Traumatologie cervico-faciale: 184 cas au Mali.

This prospective descriptive study was carried out from August 2007 to January 2008 in the emergency surgery department of Gabriel Touré Hospital in Bamako, Mali. A series of 184 patients treated for head and neck injuries was compiled. Patients presenting strictly neurosurgical lesions were excluded. Most of the patients included in this series were young single city-dwelling males (mean, age, 27 years; M/F sex ratio, 4.3. Most injuries were sustained in road traffic accidents (93%). The most common injuries were epistaxis and multiple fractures of facial bones, cervical spine and petrosal bone. These injuries ere often associated with avulsive wounds involving the external ear and nose. The main complication risks fell into four categories, i.e., circulatory loss, upper airway obstruction, functional and/or morphological impairment, and coma-related death (Glasgow score < 8). Shortage of medication and/or disposable treatment kits was a major handicap for optimal management of head and neck injuries.

[Medical handicap and otorhinolaryngologic foreign bodies about 4 original cases]. / Handicap et Corps Etrangers ORL, a propos de quatre observations originales.

The multiple variant of aero-digestive foreign bodies' pathology determine many complex aspects with regard to their physiopathology, nature, and their location. The presence of a medical handicap or any particular condition could increase morbidity and expose to major risks. We are reporting here about 4 cases including an esophagus foreign body in a leprosies patient, an esophago-gastric case in a mental disorder patient, and two laryngeal-tracheal-bronchial cases during epileptic episodes. From the rarity of such accidents in an adult to their happening during a loss of consciousness or a delirious state, the clinical history is always missing. The symptoms are atypical and may misguide. The classical penetration syndrome cannot be reported. Only a clinical examination carefully conducted and completed with targeted para clinical examinations can help make early diagnosis. Endoscopy of the Esophagus on one hand, and endoscopy of the trachea and lungs on the other hand were used to extract these foreign bodies.

Sensitivity of Acanthamoeba Cyst to AntimicrobialAgents

Introduction: Acanthamoeba is an ubiquitous free-living protozoa which causes serious ocular problems. Acanthamoeba keratitis is becoming more prevalent amongst contact lens wearers. The disease can cause loss of vision and blindness if not treated properly. The objective of this research is to study the sensitivity of six Acanthamoeba spp. isolates, of which three were from the clinical isolates (HKL 95, HTH 40 and HS 6) and the remaining three from environmental isolates (TTT 9, TL 3 and SMAL 8) to antimicrobial agents. Methods: The antimicrobial agents chosen for this purpose were polyhexamethylene biguanide and chlorhexidine. Cyst suspensions from the chosen isolates were exposed to PHMB and chlorhexidine respectively. After 48 hours incubation time at 30°c,each mixture was filtered and filtration membrane was put onto non-nutrient agar laid with Escherichia coli. The agar plates were incubated for three days at 30°c and examined daily until day 14 to detect the presence of Acanthamoeba trophozoites under the inverted microscope. The presence of thropozoites indicated the ineffectiveness of the antimicrobial agents. Results: Both of the antimicrobial agents tested were found to be effective against Acanthamoeba cysts from all the test starins. Polyhexamethylene biguanide gave minimum cysticidal concentration (MCC) mean value of 2.848mg/mL while chlorhexidine showed MCC mean value at a concentration of 3.988mg/mL. Conclusion: It can be concluded that the Acanthamoeba were sensitive to polyhexamethylene biguanide and chlorhexidine.

[Foreign body in the pharynx incidentally found]. / Corps etranger du pharynx de decouverte fortuite.

Diagnosis and therapeutic of foreign bodies of the oropharynx are not difficult in general. The diagnosis is usually obvious for the adult. We report a case of foreign body of the oropharynx observed in a patient, psychologically stable, which occurred two months after a traumatism. The patient was not aware of the existence of the foreign body. It was extracted two months after the accident by endo-oral track under general anaesthesia. The nature of the foreign body, the fortuity of its discovery and its presence for a long time reported here are of interest.

[Morbidity of the tumours of the sphere head and neck in Bamako]. / Morbidite par tumeurs de la sphere tete et cou a Bamako.

This work reports the results of one year (November 2004-October 2005) descriptive study of tumours located in the head and neck areas in the ENT department of the University-Hospital of Gabriel Toure in Bamako. Were included in the study patients whose files showed epidemiology data: age, sex, profession, residence and period of the medical checking, and exposition factors: anatomic location, results of histology and image data of the tumours. Where excluded from the study the patients whose file were not completed and those that have had eye and brain tumours From the data base of the department, a total of 60 cases of tumours were monitored and 25 others cases were excluded according to the criteria. Among the 60 cases, 24 tumours (40%) were malign and 36 were benign. Goiter was the most found benign tumor according to the results of the hystology analysis. In most cases (15 out of 36, 41.67%) the histology analysis showed an colloid adenoma Other rare tumors like rhinoscleroma (5 cases out of 36, 13.89%), nose invertus papilloma (2 cases out of 36, 5.55%) where found. These were easily diagnosed and treated. In the group of malign tumors, the pharyngolaryngeal cancer was the most found (11 cases out of 24) and the most predominant histology of these cancers was the epidermoid carcinoma. Two of these cancers were found in patients below fifteen years of age, but no other risk factors like expositions was noted in the files of these two patients. Other malign tumors have been found: nose and sinusal cancers and thyroid carcinoma. In most cases these tumors were diagnosed at an advanced stage.

Corps etranger du pharynx de decouverte fortuite

Les corps etrangers de l'oropharynx posent rarement de difficultes tant sur le plan diagnostic que therapeutique. Le diagnostic est le plus souvent evident chez l'adulte. Nous rapportons un cas de corps etranger de l'oropharynx observe chez un patient; psychologiquement stable; au decours d'un traumatisme. Le patient a ete admis dans un tableau de dysphagie 2 mois apres le traumatisme. Le corps etranger etait meconnu par le patient. Il a ete extrait par voie endo-buccale sous anesthesie generale 2 mois apres le traumatisme. La nature; la decouverte fortuite et la longue duree de sejour rapportees ici en constituent l'interet

La traumatologie d'urgence de la tete et du cou en pratique tropicale sur 184 cas colliges dans le service des urgences de l'hopital Gabriel Toure de Bamako

But : rapporter les lesions d'origine traumatique tete et cou sur le plan epidemiologique et clinique Materiels et methode : Une etude prospective descriptive d'aout 2007 a janvier 2008 dans le service des urgences chirurgicales de l'hopital Gabriel a permis de colliger 184 patients; dont les criteres d'inclusion ont consiste a recruter tout patient presentant un traumatisme de la sphere tete et cou. Ont ete exclus les patients presentant des lesions purement neurochirurgicales et les lesions associees du reste du corps. Resultats : Les patients colliges etaient plus souvent de jeunes adultes (age moyen : 27 ans) de sexe masculin (sex ratio 4;3 en faveur des hommes) et celibataires residant en milieu urbain et victimes a 93d'accident de la voie publique. Les lesions observees ont consiste en des epistaxis; des fractures de siege et de trait multiples du massif facial; du rachis cervical et du rocher avec souvent plaies delabrantes de l'oreille externe et du nez. Les risques principaux encourus ont ete de 4 ordres : trouble circulatoire; risques d'obstruction des voies aeriennes superieures; deficit fonctionnel et/ou morphologiques et risque letal du fait d'un etat comateux (Glasgow inferieur a 8). La prise en charge bien codifiee a eu des contraintes majeures du fait que les actes d'imagerie; de biologie; de consommables chirurgicaux et de medicaments etaient entierement et prealablement reunis par les patients sur fond propre. Conclusion : L'absence de medicaments et/ou consommables conditionnes en kit specialises en charge de la gestion d'une urgence tete et cou est une distorsion majeure. Le recouvrement en amont et la confection de tels paquets meme au prix d'une politique d'assurance-sante generalisee sera un gage d'humanisation et de prise en charge de qualite dans nos differentes structures de sante

[Laryngo-pharyngeal cancer at a health service of last resort in Mali: anatomo-clinical and therapeutic aspects]. / Les cancers laryngo-pharynges dans un service de sante de dernier recours au Mali: aspects anatomo-cliniques et thérapeutiques.

The purpose of this study is to describe the clinical, anatomic and therapeutic aspects of laryngitis--pharyngeal cancers in Mali. It was a prospective, descriptive and cross sectional study which was help in the ORL and cervical facial department of the university hospital center Gabriel TOURE between April 2006 and March 2007. The study looked at 18 patients hospitalized for larynx or hypo pharynx cancer, diagnostic was confirmed histologically. The parameters (age, other favorable features, clinical signs, endoscopic aspect of the tumor, histological type and treatment type) have been analyzed. Men were the most affected (66.7%), with an average age of 58.17 year old. Chronic smoking has been the most evocated factor of risk (55.17) with an average consumation of 39.5 P/A. A delay in consultation was noticed (60% with a period greater than 1 year after the first symptoms appear). The burgeoning aspect (66.7%) end the carcinoma epidemic type of the tumor (94.7%) have dominated the anatomy pathologic table. Only 27.8% of patients had surgery because of late diagnosis.