[Community acute bacterial pneumonitis of the subject age in pulmonology at the Point-g hospital and university center, Bamako-Mali]. / La pneumopathie aigue bacterienne communautaire du sujet age en pneumologie au centre hospitalier et universitaire du Point-g, Bamako-Mali.

INTRODUCTION: Community-acquired acute bacterial pneumonia (ABP) is an acute, non-suppurative, non-tuberculosis lower respiratory infection of the lung parenchyma acquired within the community. They have an atypical clinical presentation and a poor prognosis in the elderly. MATERIALS AND METHODS: This was a prospective cross-sectional study conducted in the Pneumology department of the University Hospital Center (CHU) of Point-G, from October 30, 2018 to September 30, 2019. The objective was to determine the clinical, etiological, therapeutic and progression of BAP in the elderly. Were included any age ≥ 65 years, presenting clinical and radiological signs of a PAB. RESULTS: During the study period, 85 patients met the inclusion criteria out of 178 hospitalized. The sex ratio was 3/1. About 2/3 were smokers and 11% were HIV positive. Fever was not constant recorded in 51.76% of cases. Respiratory signs were dominated by cough (96.47%), dyspnea (94.11%) and extra respiratory by impaired consciousness. Klebsiella pneumoniae was the most found germ. The most commonly used antibiotic was amoxicillin-clavulanic acid. The average length of hospitalization was 9 days. Mortality was 19%. CONCLUSION: The PAB in the elderly is of a frustrating clinical symptomatology. It is serious with excess mortality.

INTRODUCTION: Les pneumopathies aiguës bactériennes (PAB) communautaires sont des infections respiratoires basses aiguës, non suppurées, non tuberculeuses du parenchyme pulmonaire acquises au sein de la communauté. Elles ont une présentation clinique atypique et un mauvais pronostic chez le sujet âgé. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale prospective menée au service de pneumologie du centre hospitalier universitaire (CHU) du Point-G, du 30 Octobre 2018 au 30 Septembre 2019. L'objectif était de déterminer les particularités cliniques, étiologiques, thérapeutiques et évolutives de la PAB chez le sujet âgé. Ont été inclus tout âge ≥ 65 ans, présentant des signes cliniques et radiologiques d'une PAB. RÉSULTATS: Durant la période d'étude 85 patients répondaient aux critères d'inclusion sur 178 hospitalisés. Le sex-ratio était de 3/1. Environ 2/3 étaient tabagiques et 11% était positif au VIH. La fièvre n'était pas constante enregistrée dans 51,76% des cas. Les signes respiratoires étaient dominés par la toux (96, 47%), la dyspnée (94, 11%) et extra respiratoires par le trouble de la conscience. Le Klebsiellapneumoniae était le germe le plus retrouvé. L'antibiotique le plus utilisé était l'amoxicilline-acide clavulanique. La durée moyenne d'hospitalisation était de 9 jours. La mortalité était de 19%. CONCLUSION: La PAB chez le sujet âgé est d'une symptomatologie clinique frustre. Elle est grave avec une surmortalité.

La pneumopathie aigue bactérienne communautaire du sujet âge en pneumologie au centre hospitalier et universitaire du point-g, Bamako-mali / Community acute bacterial pneumonitis of the subject age in pulmonology at the Point-g hospital and university center, Bamako- Mali

Introduction : Les pneumopathies aiguës bactériennes (PAB) communautaires sont des infections respiratoires basses aiguës, non suppurées, non tuberculeuses du parenchyme pulmonaire acquises au sein de la communauté. Elles ont une présentation clinique atypique et un mauvais pronostic chez le sujet âgé. Matériels et Méthodes : Il s'agissait d'une étude transversale prospective menée au service de pneumologie du centre hospitalier universitaire (CHU) du Point-G, du 30 Octobre 2018 au 30 Septembre 2019. L'objectif était de déterminer les particularités cliniques, étiologiques, thérapeutiques et évolutives de la PAB chez le sujet âgé. Ont été inclus tout âge ≥ 65 ans, présentant des signes cliniques et radiologiques d'une PAB Résultats : Durant la période d'étude 85 patients répondaient aux critères d'inclusion sur 178 hospitalisés. Le sex-ratio était de 3/1. Environ 2/3 étaient tabagiques et 11% était positif au VIH. La fièvre n'était pas constante enregistrée dans 51,76% des cas. Les signes respiratoires étaient dominés par la toux (96, 47%), la dyspnée (94, 11%) et extra respiratoires par le trouble de la conscience. Le Klebsiellapneumoniae était le germe le plus retrouvé. L'antibiotique le plus utilisé était l'amoxicilline-acide clavulanique. La durée moyenne d'hospitalisation était de 9 jours. La mortalité était de 19%. Conclusion: La PAB chez le sujet âgé est d'une symptomatologie clinique frustre. Elle est grave avec une surmortalité

Introduction: Community-acquired acute bacterial pneumonia (ABP) is an acute, non-suppurative, non-tuberculosis lower respiratory infection of the lung parenchyma acquired within the community. They have an atypical clinical presentation and a poor prognosis in the elderly. Materials and Methods: This was a prospective cross-sectional study conducted in the Pneumology department of the University Hospital Center (CHU) of Point-G, from October 30, 2018, to September 30, 2019. The objective was to determine the clinical, etiological, therapeutic and progression of BAP in the elderly. Were included any age ≥ 65 years, presenting clinical and radiological signs of a PAB. Results During the study period, 85 patients met the inclusion criteria out of 178 hospitalized. The sex ratio was 3/1. About 2/3 were smokers and 11% were HIV positive. Fever was not constant recorded in 51.76% of cases. Respiratory signs were dominated by cough (96.47%), dyspnea (94.11%) and extra respiratory by impaired consciousness. Klebsiella pneumoniae was the most found germ. The most commonly used antibiotic was amoxicillin-clavulanic acid. The average length of hospitalization was 9 days. Mortality was 19%. Conclusion: The PAB in the elderly is of a frustrating clinical symptomatology. It is serious with excess mortality

[Spontaneous triple pregnancy on bicicatricial uterus in the referral health center of commune II of Bamako, Mali]. / Grossesse triple spontanee sur uterus bicicatriciel au centre de sante de reference de la commune II de Bamako, Mali.

The trimellar pregnancy on bicicatricial uterus is a rare situation. It can be associated with many maternal-fetal complications. Given these risks, some teams opt for an embryonic reduction. We report a case of spontaneous trimellar pregnancy on bicicatricial uterus. This was a 38 year-old patient, third pregnancy, second birth, 2 alive with a history of 2 caesareans. The evolution of the pregnancy was marked by a urinary tract infection at 34 weeks of gestation. The caesarean section performed at 36 weeks of gestation allowed the birth of 3 newborns, 2 of which were females in 2000 and 1900 grams, and one male weighing 2400 grams. The postpartum was marked by a rapidly resolved eclampsia crisis.

La survenue d'une grossesse triméllaire sur un utérus bicicatriciel est une situation rare. Elle peut être associée à de nombreuses complications materno-fœtales. Compte tenu de ces risques, certaines équipes optent pour une réduction embryonnaire. Nous rapportons un cas de grossesse triméllaire spontanée sur utérus bicicatriciel. Il s'agissait d'une patiente de 38 ans 3è geste, 2è pare avec 2 enfants vivants, ayant un antécédent de 2 césariennes. L'évolution de la grossesse a été marquée par une infection urinaire à 34 SA. La césarienne pratiquée à 36 SA a permit la naissance de 3 nouveaunés dont 2 de sexes féminins de 2000 et 1900g et un de sexe masculin pesant 2400g. Les suites de couches ont été marquées par une crise d'éclampsie rapidement résolue.

[Epidemiological, clinical and evolutionary aspects of severe traumatic brain injury in the multipurpose intensive care unit of Gabriel Touré Teaching Hospital]. / Aspects epidemiologiques, cliniques et evolutifs des traumatises cranio-encephaliques graves au service de reanimation polyvalente du CHU Gabriel Toure.

Among traumas, cranial involvement occupies a special place due to their severity and the importance of the sequelae that they can cause. They are said to be serious when the Glasgow Scale (GCS) ≤ 8. The frequency of severe brain injury in the population in African studies ranges from 3.5 to 7. Mortality is, however, poorly known in developing countries, which led us to initiate this work, which aimed to study the epidemiological, clinical and evolutionary aspects of severe traumatic brain injury in the multipurpose intensive care unit of Gabriel Touré University Hospital. MATERIAL AND METHOD: 24-month retrospective study, descriptive and analytical, including all severe traumatic brain injury patients hospitalized in the resuscitation department of Gabriel Touré University Hospital during this study period. RESULTS: During the periodof 1165 patients admitted to the service, 72 were hospitalized for severe cranio-encephalic trauma for a prevalence of 6%. The age group of 21 - 40 years was the majority with (23) or 44.4% and the average age was 30.93 ± 18.8 years with extremes of 8 months and 79 years.The male sex was predominant with (65) or 90.3%, and a sex ratio of 9.28. During our study, (57) or 79.2% of serious traumatic brain injuries were due to road accidents with motorcycle-motorcycle collisions as a mechanism in (20) or 27.8%. Shopkeepers, and students were the most affected social strata with respectively (22) or 30.6% and (20) or 27.8%. Patient transport was provided by non-medical ambulances for (31) or 43.1% and admission time was between 30 minutes and 6 hours in (16) or 22.2% of cases. (62) or 86.1% had GCS between 6-8 and bilateral mydriasis was present in (10) or 13.9% of patients. (9)or 12.5% of patients had hypotension (systolic blood pressure<90 mm Hg) on admission and average blood pressure<90 mmHg was observed in (32) or 44.4% of patients. (23) or 31.9% had a SPO2 <90%. Cranio-encephalic scanning was performed in 62 or 86.1% and discovered as lesions (25) or 34.9% hemorrhagic contusions followed by extradural hematomas (13) or 18.1%. (63) or 87.5%, patients were intubated-ventilated-sedated in addition to resuscitation. (28) or 38.9% of patients had undergone a surgical intervention with (9) or 12.5% having osmotherapy.The evolution was marked by death of (48) or 66.7%. CONCLUSION: Severe cranio-encephalic trauma represents a major cause of morbidity and mortality. The establishment of pre-hospital medicine will allow better care and reduction of mortality by early and continuous management of ACSOS and respiratory and / or hemodynamic distress, which are very often associated with severe TCE.

Parmi les traumatismes, les atteintes crâniennes occupent une place particulière du fait de leur gravité et de l'importance des séquelles qu'elles peuvent entraîner. Ils sont dits graves quand le score de Glasgow (GCS) ≤ 8. La fréquence des traumatismes crânio-encéphaliques (TCE) graves au sein de la population dans les études africaines varie entre 3,5 et 7. La mortalité est cependant mal connue dans les pays en voie de développement ce qui nous a conduit à initier ce travail qui avait pour objetd'étudier les aspects épidémiologiques, cliniques et évolution des traumatisés crâniens graves au service de réanimation polyvalente du centre hospitalier universitaire Gabriel Touré. MATÉRIEL ET MÉTHODE: Etude, descriptive et analytique à collecte rétrospective s'étant déroulée sur 24 mois, incluant tous les patients traumatisés crânio-encéphaliques graves hospitalisés dans le service de réanimation du centre hospitalier universitaire Gabriel Touré durant cette période d'étude. RÉSULTATS: Durant la période sur 1165 patients admis dans le service.72 ont été hospitalisés pour traumatisme crânio-encéphalique grave soit une prévalence de 6%. La tranche d'âge de 21 - 40 ans était majoritaire avec(32) soit 44,4% et l'âge moyen était de 30,93 ±18,8 ans avec des extrêmes de 8 mois et 79 ans. Le sexe masculin était prédominant avec (65) soit 90,3%, et un sex-ratio de 9,28. Durant notre étude (57) soit 79,2% des TCE graves étaient dus aux accidents de la voie publique avec comme mécanisme les collisions moto-moto dans (20) soit27,8%. Les commerçants, et les élèves et étudiants étaient les couches sociales les plus touchées avec respectivement(22) soit 30,6% et (20) soit 27,8%. Le transport était assuré par des ambulances non médicalisées à(31) soit 43,1% et le délai d'admission était compris entre 30 minutes et 6 heures dans (16) soit 22,2% des cas.(62) soit 86,1% avaient GCS entre 6-8 et une mydriase bilatérale était présente chez (10) soit 13,9 % des patients. (9) soit 12,5% des patients avaient présenté une hypotension (pression artérielle systolique< 90 mm Hg) à l'admission et une pression artérielle systolique ≤ 90 mm Hg avait été observée chez (32) soit 44,4% des patients. Durant notre (23) soit 31,9% avaient une SPO2 < 90%. Le scanner cranio-encéphalique a été réalisé chez (62) soit 86,1% et retrouvait comme lésions, les contusions hémorragiques (25) soit 34,9% suivis des hématomes extraduraux (13) soit 18,1%.(63) soit 87,5% des patients ontété intubés -ventilés-sédatés en plus à des mesures de réanimation. (28) soit 38,9% des patients avaient subi une intervention chirurgicale associée chez (9) soit 12,5% à une osmothérapie. L'évolution a été marquée par une létalité de (48) soit 66,7%. CONCLUSION: Les traumatismes crânio-encéphaliques graves représentent une cause majeure de morbi-mortalité. La mise en place d'une médecine préhospitalière permettra une meilleure prise en charge et la réduction de lamortalité.Par une prise en charge précoce et continue des ACSOS et des détressés respiratoires et/ou hémodynamiques qui sont très souvent associées au TCE grave.

[Multidrug-resistant tuberculosis (MDR-TB) in a black African carceral area: Experience of Mali]. / Tuberculose multi-résistante (TB-MR) en milieu carcéral noir africain : expérience du Mali.

INTRODUCTION: Prison constitutes a risk factor for the emergence of multi-drug resistance of tuberculosis (MDR-TB). The aim of this work was to study MDR-TB in a black African carceral center. MATERIAL AND METHODS: Prospective study from January to December 2016 at the central house of arrest for men, Bamako. The study population was composed of tuberculous detainee. The suspicion of MDR-TB was done in any tuberculosis case remained positive in the second month of first-line treatment or in contact with an MDR-TB case. RESULT: Among 1622 detainee, 21 cases of pulmonary tuberculosis were notified (1.29%), with an annual incidence of 13 cases/1000 detainee, they were 16 cases of SP-PTB (microscopy smear positive tuberculosis) and five cases of microscopy smear negative tuberculosis. The mean age was 28±7 years, extremes of 18 and 46 years. A negative association was found between the notion of smoking and occupation in the occurrence of tuberculosis (OR=0.036, [95% CI: 0.03-0.04], P=0.03. Among the 21 tuberculosis cases notified, one confirmed case of MDR-TB was detected (4.7%). In the first semester of 2016 cohort, we notified a cure rate of 87.5% (7/8 SP-PTB cases), and the confirmed MDR-TB case on treatment (21-month regimen), evolution enameled of pulmonary and hearing sequelae at seven months treatment. CONCLUSION: It was the first case of MDR-TB detected in a prison in Mali. Late diagnosis, evolution is enameled of sequelae and side effects.

[Respiratory diseases in black African carceral area]. / Pathologies respiratoires en milieu carcéral noir africain.

INTRODUCTION: The measures for people in specific situations such as prisoners are part of the Millennium Development Goals (MDGs). The objective of this study was to assess respiratory pathologies in a black African carceral center. METHODS: Retrospective study about the prevalence of respiratory pathologies in the arrest central house for men in Bamako (Mali), from May 2012 to April 2013. The admission records have served as data checking support on detainee's records. Statistical significance was investigated by the SAS 9.3 software with a threshold of 5%. RESULTS: Of 2740 admissions, 207 concerned respiratory pathologies (7.5%). All men, were of mean age 30±13 years (range 19-71). The respiratory diseases found were: pneumonia (33.8%), chronic bronchitis (26.6%), acute respiratory infection (14%), asthma (13.5%) and tuberculosis (5.3%). A definite diagnosis was made in 42% of cases. A tobacco intoxication was found in all age groups (CI 95%, R-square=0.01), without significant difference between the occurrence of cough in smoking and non-smoking men. CONCLUSION: According to their relative frequencies, the management of respiratory diseases requires collaboration between carceral health facilities and pneumological specialized services.

[Some reflections on the classification of African obstetric fistulas]. / Quelques réflexions sur la classification de la fistule obstétricale africaine.

UNLABELLED: While the English-speaking world may have reached a consensus about Kees Waaldjik's classification of obstetric fistulas, no unanimity around this classification exists among French-speaking medical workers. The objective of this review is to propose a classification, based on long experience in the care of these women, by setting up a comparison with Waaldjik's. Our classification takes two criteria into account: (1) the environment of the fistula, that is: (a) fistula with a soft (relatively unscarred) vagina, b) fistula with vaginal sclerosis (bands or adhesions, vaginal stenosis or atresia), (c) vesicovaginal fistula associated with a (high or low) rectovaginal fistula or perineal lacerations (first, second or third degree); (2) the anatomical site of fistula, of which there are five types: (a) type I: fistula of the vesicovaginal wall, (b) type II: vesico-cervico-urethral fistula, with two major subgroups: type IIA (without destruction of the urethra) and type IIB (with destruction of the urethra), type IIA being subdivided in three subgroups: IIAa, IIAB and cIAI, (c) type III fistulae trigono-Neck utero-vaginal, (d) type IV: complex mixed fistula, (e) type V, high fistulas: the vesico-cervical-uterine fistula and classical vesicouterine. CONCLUSION: Our classification is simple, not simplistic, with some resemblance to that of Waaldjjik.

[Study of factors influencing clinical outcomes of obstetric urogenital fistula surgery at the Point G University Hospital of Bamako, Mali]. / Etude des facteurs influençant les resultats clinique de la chirurgie de la fistule uro-genitale obstetricale au CHU de l'Hopital du point G Bamako Mali.

The aim of this study was to identify factors influencing the clinical outcomes of surgery of obstetric urogenital genital fistula. This was a cross sectional study, which focused on factors influencing results in the treatment of urogenital fistula, from January 2011 to January 2012 at the urology department of the Point-G University Hospital. This study involved 115 patients suffering from urogenital fistula. Cure of urogenital fistula accounted for 17% of the bloc's activities. Closure of the fistula was achieved in 68.7% of cases. This result was influenced by certain factors. Including factors related to condition of the tissue peri-fistula (good trophic tissue, or fibrosis peri-fistula). Fistulas operated primarily peri-sinus tissue remodeling were closed in 71.42% of cases. Factors related to the patient and care: those carried out for the first time have a success rate of 68.42%, only 47.62% of success in patients who presented after five years. Factors related to clinicopathological seat: fistula vesicovaginal septum and cervical-vaginal urethrovaginal reported a success rate of 76.92%. Care-related factors include: the experience of the surgeon, surgeons of the urology service have a 76.19% success rate against 25% from other surgeons. The incision fistula was related to the clinicopathological seat, so the trigonal-vaginal fistulas and uretero addressed by the upper route have been successful in 85%. In addition to these factors the postoperative follow-up, the instruments, the suture thread, the operating table, and the lighting in the room have also improved the results.

Le but de cette étude était d'identifier les facteurs influençant les résultats cliniques de la chirurgie de la fistule uro- génitale obstétricale. Il s'agissait d'une étude transversale, qui a porté sur les facteurs influençant les résultats dans la prise en charge de fistule uro-génitale, allant du janvier 2011 au janvier 2012 au service d'urologie du CHU du Point-G. Cette étude a concerné 115 patientes souffrantes de fistule uro-génitale. La cure de la fistule uro-génitale a représenté 17 % des activités du bloc. La fermeture de la fistule a été obtenue dans 68,7% des cas. Ce résultat a été influencé par certains facteurs, dont les facteurs liés à l'état du tissu péri-fistuleux (bonne trophicité du tissu, ou fibrose péri-fistuleux). Les fistules opérées avant tout remaniement tissulaire péri-fistuleux ont été fermées dans 71,42 % des cas. Les facteurs liés à la patiente et aux soins : celles opérées pour la première fois ont un taux de réussite de 68,42 %, seulement 47,62 % de succès chez les patientes qui se sont présentées après cinq ans. Les facteurs liés au siège anatomo-clinique : les fistules de la cloison vésico-vaginale et cervico-urétro-vaginale ont occupé un taux de succès de 76,92 %. Les facteurs liés aux soins regroupent : l'expérience du chirurgien, les chirurgiens du service d'urologie contrairement aux autres chirurgiens ont 76,19 % de réussite contre 25%. La voie d'abord de la fistule était en rapport avec le siège anatomo-clinique, ainsi les fistules trigonales et urétéro-vaginales abordées par la voie haute ont été réussies dans 85 %. En plus de ces facteurs le suivi post-opératoire, les instruments, les fils de suture, la table opératoire, l'éclairage de la salle ont améliorée aussi les résultats.

Etude des facteurs influencant les resultats cliniques de la chirurgie de la fistule uro-genitale obstetricale au CHU de l'hopital du Point G Bamako Mali

Le but de cette etude etait d'identifier les facteurs influencant les resultats cliniques de la chirurgie de la fistule uro- genitale obstetricale. Il s'agissait d'une etude transversale; qui a porte sur les facteurs influencant les resultats dans la prise en charge de fistule uro-genitale; allant du janvier 2011 au janvier 2012 au service d'urologie du CHU du Point-G. Cette etude a concerne 115 patientes souffrantes de fistule uro-genitale. La cure de la fistule uro-genitale a represente 17 % des activites du bloc. La fermeture de la fistule a ete obtenue dans 68;7% des cas. Ce resultat a ete influence par certains facteurs; dont les facteurs lies a l'etat du tissu peri-fistuleux (bonne trophicite du tissu; ou fibrose peri-fistuleux). Les fistules operees avant tout remaniement tissulaire peri-fistuleux ont ete fermees dans 71;42 % des cas. Les facteurs lies a la patiente et aux soins : celles operees pour la premiere fois ont un taux de reussite de 68;42 %; seulement 47;62 % de succes chez les patientes qui se sont presentees apres cinq ans. Les facteurs lies au siege anatomo-clinique : les fistules de la cloison vesico-vaginale et cervico-uretro-vaginale ont occupe un taux de succes de 76;92 %. Les facteurs lies aux soins regroupent : l'experience du chirurgien; les chirurgiens du service d'urologie contrairement aux autres chirurgiens ont 76;19 % de reussite contre 25%. La voie d'abord de la fistule etait en rapport avec le siege anatomo-clinique; ainsi les fistules trigonales et uretero-vaginales abordees par la voie haute ont ete reussies dans 85 %. En plus de ces facteurs le suivi post-operatoire; les instruments; les fils de suture; la table operatoire; l'eclairage de la salle ont amelioree aussi les resultats

Streptococcus pneumoniae invasive infections in Burkina Faso, 2007 to 2011.

OBJECTIVE: We had for aim to determine the epidemiology of meningeal and lung invasive infections due to Streptococcus pneumoniae in Burkina Faso. MATERIAL AND METHODS: We screened for S. pneumoniae with the usual bacteriology techniques and with real time polymerase chain reaction (rt-PCR) in 7917 samples of cerebrospinal fluid (CSF) and pleural fluid (PF) collected in the Ouagadougou Yalgado Ouedraogo Teaching Hospital, from 2007 to 2011. RESULTS: S. pneumoniae was identified in 476 (6%) samples including 455 (5.7%) in CSF and 21 (0.3%) in PF. Sixty-seven percent of invasive infections occurred in patients 15 years of age or less, without any significant sex ratio difference. The infections occurred most frequently between January and August, with the first and most important peak between January and May (dry season) and the second peak between June and August (at the beginning of rain season). The introduction of rt-PCR proved the under diagnosing of invasive infections by usual bacteriological methods (latex agglutination assay and culture). CONCLUSION: Invasive pneumococcal infections occur mainly in patients 15 years of age or less, without any difference in sex ratio and with peaks in the dry season. Vaccinal schedules should include all age ranges in Burkina Faso.

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

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

[Social integration of women operated for obstetric urogenital fistula]. / Intégration sociale des femmes opérées de fistule urogénitale obstétricale.

OBJECTIVE: To study the social integration of women supported in the urology department of the University Hospital of Point G for obstetric urogenital fistula. PATIENTS AND METHOD: Prospective study conducted over a period of 13 months from June 2008 to June 2009 in the Department of Urology at the University Hospital of Point G. The study included all patients who have been operated on at least twice for obstetric fistula genitourinary. Records of surgical, medical records and tracking sheets for each patient were the media database. RESULTS: Situation before treatment: before surgical treatment, 76.92% of patients were rejected by their spouses. The family attended the patient in 84.62% of cases. Situation after treatment: after treatment, 90.31% of women with fistula lived in the matrimonial home or family. The resumption of business activity was announced by 11.2% of patients. Among the women, 93.7% participated in housework. The number of patient intervention ranged from two to five. Healing (fistula closed and no sphincter dysfunction) was complete in 50% of cases. Among the women, 11.54% had sphincter dysfunction after closure of the fistula, which makes a total of fistula closed more than 61% after at least two attempts. CONCLUSION: The urogenital fistulas are not a fatal disease but is a real handicap for women who suffer to conduct a socio-cultural and economic mainstream. Generally excluded from the ongoing operations of the company, these women are more integrated after successful surgical treatment of the fistula.

[Issues inherent to the management of disorders of sex development in Point G Hospital]. / Problématique de la prise en charge des anomalies de la différenciation sexuelle dans le service d'urologie : CHU Point G.

Abnormal sexual development causes unconformity between gender identity and gender role. In countries with low socio-economic level, the optimal management is difficult. The aim of this study was to evaluate the frequency, the genital anatomy appearance, the diagnostic and the surgical management of disorders of sex development (DSD) discovered during the adolescence. Between January 2005 and November 2006 (23 months), five patients with abnormal sexual development were identified in Point G Hospital. First-line testing included biology measurement and imaging. A surgical management was systematically offered. Median age was 19.5±11.8 years (6-31). All patients were initially assigned male. Sexual dimorphic with genital ambiguity was the first reason of consultation (three children to five). One patient had male breast development and one had pelvic pain. All clinical evaluation suggested genital ambiguity. The diagnostic was female pseudohermaphrodism in three cases, true hermaphrodism in one case and hypogonadism for one patient. A masculinizing genital surgery was performed in three cases. The other patients refused the treatment or were out of sight. Intersex disorders are relatively rare in Mali with a prevalence of 2.30‰ in our hospital. This study highlighted the lack of financial means and local resources for optimal clinical management of individuals with DSD.

[Tuberculosis in the elderly: Epidemiology and outcomes of ambulatory followed-up in Abidjan]. / La tuberculose du sujet âgé : épidémiologie et devenir des patients suivis en ambulatoire à Abidjan.

BACKGROUND: Very few works approach elderly's tuberculosis (TB) in developing countries. The aim of this study is to present elderly's TB epidemiology and the outcomes of the ambulatory follow-up of the tuberculous patients aged more than 65years old (TBE) compared to the TB among patients less than 65years old (TBY). METHODS: Our study is retrospective covering period of January 1999 to June 2006 activities of Adjamé's antituberculous center. It is a comparative study between patients of at least 65 years and patients of less than 65years when the diagnosis of TB was made. RESULTS: Among 36,923 cases of TB, the proportion of TBE is 2.33%. In case of TBE, the sex-ratio is 2.16 versus 1.50 among TBY (P<0.001). Localization of TB is pulmonary in 61.70% among TBE versus 67.26% among TBY (P=0.058). Among elderly's TB, the osteoarticular localization is more frequent. TB-VIH co-infection prevalence is estimated to 9.05% among elderly's TB versus 44.38% among patients of less than 65 years (P<0.001). The therapeutic success rate within elderly patients is 52.16% years versus 61.42% when it was patients of less than 65 years. The proportion of lost at follow-up and the rate of patient transfers within the elderly's TB are the most raised. CONCLUSION: The elderly's TB is rare with a more masculine predominance. TB-VIH co-infection is not important among elderly's TB. The aged patient follow-up must be improved.

[Dynamic of respiratory pathology in a service of pneumology in black Africa in the context of HIV infection from 1998 to 2007]. / Dynamique de la pathologie respiratoire dans un service de pneumologie en Afrique noire dans le contexte de l'infection à VIH de 1998 à 2007.

INTRODUCTION: The pneumology in developing countries is practiced in a singular context: population mostly younger, endemic tuberculosis, high prevalence of HIV infection and growing pollution. OBJECTIVE: The aim of this study is to present respiratory pathology evolution in hospitalization of pneumology department in black Africa. METHODOLOGY: Our study is retrospective and descriptive. We consulted the register of hospitalization activities from January 1998 to December 2007. RESULTS: The age group of 20-49 years represents 78.36% of all patients. Tuberculosis (TB) remains the first affection from 1998 to 2007 with a frequency varying between 38.2% and 45.2%. The cases of pneumonia are in regression since 2001, but cases of febrile alveolar interstitial pneumonia (FAIP) increase. The pathologies bound to tobacco addiction are rare. HIV infection is associated to TB (82.86%), to pneumonia (77.22%), to FAIP (92.23%). On 832 cases of death recorded, 46.15% of deaths are assigned to TB, 15.98% to pneumonia and 14.66% to FAIP. The global lethality of the TB and the pneumonia is respectively 20.1% and 17.6%. The one of FAIP is 32.5%. Mortality attributable to TB and pneumonia decreases progressively but the one attributable to FAIP remains important. CONCLUSION: Respiratory pathology is dominated by TB, pneumonia and FAIP. These pathologies associated to HIV infection cause a strong mortality.

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

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

[Cystic lymphangioma of the scrotum]. / Le lymphangiome kystique du scrotum a propos d'un cas.

The cystic lymphangioma is a relatively frequent affection. The scrotum is the least common sites. It is a benign tumor discovered during an examination or in a fortuitous way. The diagnosis is done with ultrasonography and the treatment of the limited and circumscribed cases, is a surgical excision. We reported the case of a child of 2 years old which was presented to the surgery emergency for the scrotum traumatism. The clinical and paraclinical exams founded a cystic mass. After mass excision, histopathology founded a cystic lymphangioma.

[Bilharziasis and urinary lithiasis: a study of 23 cases at the Gabriel Toure Hospital]. / Bilharziose urinaire et lithogenese: etude de 23 cas au CHU Gabriel Toure.

AIMS: Describe the clinical and therapeutic aspects of urinary stone on bilharziosis in the teaching hospital Gabriel Toure. METHOD: It was about a prospective study done from January 1st to December 31, 2007 on all patients presenting a urinary stone with history of bilharziosis treated in the service of urology at the teaching hospital Gabriel Toure. Lost patients during the study were not included. RESULTS: We brought together 23 cases of urinary stone on history of urinary bilharziosis. The mean age of our patients was 31 years with extreme of 10 and 64 years. Sex-ratio was 22 for men. Renal colic was the most frequent motive of consultation (30.4%). Fiver has been detected in 56.5% of cases.Stone has a renal localisation in 10 patients (43.5%), ureteral in 9 patients (39.1%) and vesical in 4(17.4%). Urine analysis has found following germs: Schistosoma haematobium (4 cases), positive cocci gram (3 cases), Enterococcus faecalis (1 case) and negative cocci gram (1 case). Moderate renal insufficiency has been detected in 4 patients (17.4%). Treatment has been surgical in 21 patients(91.3%). Nephrolithotomy was done in 7 patients (33.3%), ureterolithotomy in 7 others, cystolithotomyin 3 patients (14.3%), nephrectomy in 2 patients (9.5%), uretero-vesical reimplantation in 2 others. CONCLUSION: The assessment of bilharziosis may decrease the frequency and prevent numerous and disastrous complications of urinary bilharziosis.

[Spinal tuberculosis (Pott's disease): epidemiological, clinical, radiological and evolutionary aspects at the University Hospital of Point G]. / Tuberculose vertebrale (mal de Pott): aspects epidemio clinique, radiologique et evolutif au CHU du Point-G.

UNLABELLED: The spinal tuberculosis or Pott's disease is the most common form of osteoarticular tuberculosis in countries with high prevalence of tuberculosis and HIV / AIDS, but the definitive diagnosis remains difficult. The aim of this work was to study the epidemiological, clinical, radiological and evolutionary aspects of Pott's disease in the absence of evidence bacteriologically and histologically. METHOD: This is a retrospective study focused on records collected in the service of pneumo-phtisiology UHC of Point G, January 2005-December 2009. Were selected, all folders with the probable diagnosis of spinal tuberculosis and whose antibiotic treatment was instituted. RESULTS: In total, 178 cases of Pott's disease were reported on 3560 cases of tuberculosis all forms 5%, with an average of 35 ± 6 cases per year. We noted a male predominance (102 men against 76 women) with a sex ratio of 1.3. The average age of patients was 41 ± 15 years. Signs regularly found with their high frequencies more than 80% are impaired general condition, tiredness, vesperal fever, inflammatory spinal pain, elevated velocity settling, spondylodiscitis, back to the apyrexia, improving general health. HIV serology was positive in 5.2% of 152 patients tested. CONCLUSION: Pott's disease is increasing gradually. The diagnosis is often very presumptive. Also, must you know the time to start TB treatment, for minimizing the post-treatment sequelae.

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

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