[Epidemio-clinicalappearances of care-associated infections in the resuscitation unit of Gabriel Touré teaching hospital (Bamako)]. / Aspects epidemio-cliniques des infections associees aux soins (IAS) dans le service de reanimation du CHU Gabriel Toure.

An infection is said to be associated with care (IAS) when it occurs during or after a patient's management (PEC). A delay of at least 48 hours after admission is commonly accepted to distinguish a nosocomial infection from a community infection.in 2009, WHO estimated that 1.4 million people were sick in the world afterhospital-acquired infections. This prevalence remains largely underestimated in Sub - Saharan Africa, and particularly in Mali, which led us to initiatethiswork, whichaimed to describe the epidemiological and clinical aspects of nosocomial infections, determine their frequency and identify the germs responsible. MATERIAL AND METHODS: This was a prospective study, over 12 months from January 1st to December 31st, 2016, in the resuscitation department of CHU Gabriel Touré. Including all patients with a temperature greater than or equal to 38 ° C occurring after at least 48 hours of admission. The data were collected through the surveycards and medical records. The input and analysis made respectivelyfrom Epi info software and the 2016 Office Pack (Word, Excel, Power Point). RESULTS: Duringourstudy of 200 hospitalized patients we collected 35 IAS cases, aprevalence of 17.5%. The male sex was predominant with 60.5% and a sex ratio = 1.53. The average age was 34.28 ± 19.11 yearsold. The traumatized head with 10 cases (28.5%) were the most represented, followed by surgery postoperative 7 cases (20%) and burned 5 cases (14.2%). We carried out 51 samples (15 bronchial samples all positive, 13 ECBUs of which 11 positive, 7 blood cultures, one positive, 12 swabs all positive). The diagnoses retainedwere: ventilated lungdisease 12 cases (34.3%), urinary infection alone 8 cases (22.9%), 6 cases (17.1%) of surgical site infection, 6 cases (17.1%) ) of soft tissue infection and 3 cases (8.6%) of pneumopathy associated with urinary tract infection. The germs found were multidrug-resistant bacilli (BMR), for bronchial samples (Klebsialla pneumoniae, Acinetobacter baumanii, Echerichia coli). ECBU were found 08 cases of Echerichia coliand 01 case of enterococcusfaecalus, and 2 cases of association Echerichia coli and enterococcus faecalus; blood cultures: staphylococcus aureus. The swabsfound: Klebsialla pneumonia, Echerichia coli, Acinetobacter baumanii enterobacter, cloecae, Staphylococcus aureus, Providencia stuartii, Proteus mirabilis. The average duration of treatment of patients with IAS was 8 days with extremes of 2 to 15 days. The mortality was 57.1%. CONCLUSION: This study allowed us to notice a resistance of different germs to antibiotics. It is therefore necessary to change the behavior of our health care facilities in order to meet this challenge.

Une infection est dite associée aux soins (IAS) lorsqu'elle survient au cours ou au décours d'une prise en charge (PEC) d'un patient. Un délai d'au moins 48 heures après admission est communément accepté pour distinguer une infection nosocomiale d'une infection communautaire. En 2009, l'OMS estimait que 1,4 millions de personnes étaient malades dans le Monde de suite d'infections contractées en milieu hospitalier. Cette prévalence reste largement sous-estimée en Afrique Sub-saharienne et particulièrement au Mali ce qui nous a conduit à initier ce travail qui avait pour object de décrire les aspects épidémio - cliniques des infections nosocomiales déterminer leur fréquence et d'identifier les germes responsables. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude prospective, sur 12 mois allant du 1er Janvier 2016 au 31 décembre 2016 au service de réanimation de CHU Gabriel Touré, incluanttous les patients présentant une température corporelle supérieure ou égale à 38°C apparaissant après au moins 48 heures d'admission. Les données ont été collectées par le biais des fiches d'enquêtes et des dossiers médicaux. La saisie et l'analyse faites respectivement à partir logiciel Epi info. RÉSULTATS: Durant notre étude sur 200 patients hospitalisésnous avons enregisytré 35 cas IASsoit une prévalence de 17,5%. Le sexe masculin était prédominant avec 60,5% et unsexratio=1,53. La moyenne d'âge était de 34,28 ans± 19,11 ans.Les traumatisés crâniens avec 10 cas (28,5%) étaient les plus représentés, suivis des post opératoire de chirurgie 7 cas (20%) et des brulés 5 cas (14,2%).Nous avons réalisé 51 prélèvements (15 prélèvements bronchiques tous positifs, 11 ECBU dont 11 positifs,7 hémocultures dont unepositive, 12 écouvillonnages tous positifs).Les diagnostics retenus étaient : les pneumopathies acquises sous ventilation 12 cas (34,3%), l'infection urinaire seule 8 cas (22,9 %), 6 cas (17,1%) d'infection du site opératoire, 6 cas (17,1%) d'infection des parties molles et 3 cas(8,6%) de pneumopathie associée à une infection urinaire. Les germes retrouvés étaient des bacilles multi-résistantes (BMR), pour les prélèvements bronchiques (Klebsialla pneumoniae, Acinetobacter baumanii, Echerichia coli). Les ECBU ont retrouvé 08 cas de Echerichia coli et 01 cas d'enterococcus faecalus, et 2 cas associant Echerichia coli et l'enterococcus faecalus.l'hémoculture : staphylococcus aureus. Les écouvillonnages ont retrouvé, Klebsialla pneumonie, Echerichia coli, Acinetobacter baumanii enterobacter, cloecae, Staphylococcus aureus, Providencia stuartii, Proteus mirabilis. La durée moyenne du traitement des patients avec IAS était de 8jours avec des extrêmes de 2 à 15 jours. La mortalité était de 57,1%. CONCLUSION: Cette étude nous a permis de constater une résistance des différents germes aux antibiotiques. Il faut donc un changement de comportement au niveau de la pratique des soins de nos structures sanitaires pour relever ce défi.

Impact of IMCI training and language used by provider on quality of counseling provided to parents of sick children in Bougouni District, Mali.

This study evaluates the impact of the Integrated Management Of Childhood Illness (IMCI) training on quality of counseling provided to caregivers about administration of antimalarials to their children. Ten community health centers in southern Mali were randomized to either training or comparison arms of the study, and health providers' consultations with caregivers were observed. Out of a 10-point counseling scale (Cronbach's alpha=0.77), IMCI-trained providers completed an average of 1.47 (95% CI, -0.25, 3.2) more tasks than did providers who had not received IMCI training in a linear regression analysis that accounted for intra-provider correlations. Drug consultations done in both French and the local language, Bambara, had higher scores than those conducted exclusively in Bambara. The effect of providers receiving IMCI training was more pronounced in bilingual consultations, with an average increase of 2.49 (95% CI, 0.76, 4.22) in IMCI, bilingual consultations, and average increase of 0.87 (95% CI, -0.95, 2.69) in IMCI monolingual (Bambara) consultations as compared to non-IMCI-trained providers in monolingual consultations. IMCI training showed a non-significant trend overall in improving drug counseling provided to caregivers, with significant improvements in bilingual consultations. The IMCI program in Mali should consider strategies such as role-playing of counseling in Bambara or other local languages during training to improve patient-provider communication. Similar problems related to counseling by health workers in local languages are likely to be present throughout Africa, and warrant further study.

Prise en Charge des femmes enceintes infectees par le VIH dans le service de gynecologie et d'obstetrique de l'hopital Gabriel Toure: a propos de 72 cas

L'infection a VIH constitue un grave probleme de sante publique et sa prise en charge s'inscrit dans la gestion d'une maladie au long court. L'association VIH et Grossesse reste une situation a haut risque par ses complications maternelles et foetales. Il nous a paru necessaire d'evaluer les risques lies a l'evolution de la grossesse chez les femmes VIH positifs afin d'ameliorer la prise en charge de ces femmes. Cette etude descriptive a concerne 72 femmes prises en charge dans notre service et la morbidite maternelle etait autour de 30Plusieurs complications maternelles et foetales sont plus souvent rencontrees chez les patientes qui ont un taux de CD4 bas et non mises sous traitement antiretroviral pendant la grossesse et dans le post-partum. Les consultations prenatales et le depistage systematique constituent des moyens privilegies pour la lutte contre cette pandemie

Increases in correct administration of chloroquine in the home and referral of sick children to health facilities through a community-based intervention in Bougouni District, Mali.

Save the Children/USA in collaboration with the Ministry of Health of Mali has established over 300 village drug kits in southern Mali since 1996. A cluster-randomized trial was conducted between November 2001 and February 2002 in 10 health zones of Bougouni District to evaluate an intervention to (i) improve the skills of the village drug kit managers to counsel parents on correct home administration of chloroquine (CQ), and (ii) increase the referral of sick children to community health centres (CHC). Children's carers were interviewed 5 d after the sale of CQ about knowledge of danger signs requiring referral, quality of counselling, administration of CQ, and referral. The intervention was associated with significant increases in knowledge of danger signs requiring referral, reported quality of counselling by the manger of the drug kit, and correct administration of CQ in the home. Parents reported that 42.1% of children in the intervention group were referred to the CHC by the drug kit manager compared with 11.2% in the comparison group (odds ratio = 7.12, 95% CI 2.62-19.38). CHC registers indicated that 87.0% of referrals recorded in drug kit referral notebooks arrived at the health centre. Further research is needed to increase the effectiveness of the counselling and the community referral mechanism tested in this study.

Adrenal tyrosine hydroxylase activation in the developing rat: influence of the thyroid status.

Adrenal tyrosine hydroxylase activation was elicited in developing control, hypo- and hyperthyroid rats by insulin-hypoglycaemia. Rats were deeply anaesthetized with chloroform at a low concentration, since intrinsic tyrosine hydroxylase activation was very low with this technique, as compared to Ketamine injection or chloroform at a high concentration. The study of time-course of tyrosine hydroxylase activation showed that the maximum value was observed 2 h after insulin administration. In control animals, tyrosine hydroxylase activation increased between 4 and 20 days, and then decreased. Hypothyroidism is associated with a decreased tyrosine hydroxylase activation between 4 and 50 days, as compared to controls and hyperthyroidism with an increased activation between 6 and 30 days. While tyrosine hydroxylase from saline-treated rats exhibits two different forms (with two apparent Km values for the cofactor), enzyme from insulin-treated animals was present in a single form with a Km corresponding to the low Km value of the saline-injected rats. At 6 and 14 days, hypothyroidism increases tyrosine hydroxylase Km values as compared to euthyroid animals.

[Estrus synchronization in cattle by means of chlormadinone acetate ("Bovisynchron" Jenapharm) in the tropics. II. First results of the estrus synchronization of cattle with "Bovisynchron" at the Republic of Mali]. / Synchronisation des chaleurs de bovins par acétate de chlormadinon ("Bovisynchron" jenapharm) sous les tropiques Deuxiéme partie: les premiers résultats de la synchronisation de chaleur chez les bovins avec "Bovisynchron" en République du Mali

The first experiments are reported on oestrus synchronization in cattle in the Republic of Mali. The animals recieved Bovisynchron twice a day orally over a period of 15 days. The synchronization effect was marked; insemination was performed on the 5th and 6th day p.s. The intensity of the oestrus and especially the results of pregnancy are in close relationship to the breeding conditions and the general status of the animals. The oestrus synchronization is considered a favourable biotechnical method for regulating the reproduction provided that the animals are kept stationary or temporarily stationary.