[Gunshot wounds of low urinary tract in period of security crisis at the Sominé Dolo Hospital of Mopti (Mali): Epidemiological and diagnostic aspects]. / Blessures par arme à feu du bas appareil urinaire en période de crise sécuritaire à l'hôpital Sominé Dolo de Mopti (Mali) : aspects épidémiologiques et diagnostiques.

INTRODUCTION: Firearm injuries to the lower urinary tract are injuries resulting from an energy transfer from a projectile fired by a firearm or a blast from a firearm, to the bladder, prostate, urethra and terminal ureter. Our objective was to describe the epidemiological and diagnostic aspects in the context of a security crisis. PATIENTS AND METHOD: This was a descriptive cross-sectional study of lower urinary tract firearm injuries at Sominé Dolo Hospital in Mopti from January 2017 to December 2021. RESULTS: In five years, 29 traumas of the lower urinary tract have been collected, about 6 cases per year. The mean age of patients was 27.48 years, the sex ratio was 13.5/1. The main circumstances of occurrence were intercommunal violence 51.72 %, war wounds 31.03 %. Injuries were inflicted by rifles in 62.1 % and improvised explosive devices in 37.9 %. The main modes of discovery were acute urine retention, hematuria and penoscrotal wounds respectively in 31.03 %, 20.69 %, 17.24 %. The organs affected were the urethra in 58.62 %, the bladder, 37.93 %, the prostate 3.45 %. Associated non-urological lesions present in 68.96 % (n=20) were dominated by intestinal lesions and pelvic fractures. CONCLUSION: Firearm injuries to the lower urinary tract are rare despite the context of the security crisis. They affect young men, are mostly linked to intercommunal violence, and are dominated by urethral and bladder injuries.

Corps étrangers chroniques dans l'œsophage chez l'enfant / Chronic foreign bodies in the oesophagus in children

Les ingestions de corps étrangers sont des accidents fréquents en pédiatrie. La plupart sont sans grande conséquence sauf ceux qui sont enclavés dans l'œsophage. Nous rapportons 2 cas de pile bouton intraœsophagienne chez 2 enfants âgés de: 4ans de sexe masculin et 2 ans de sexe féminin. Le motif de consultation dans les deux cas était la dysphagie aux solides. La fibroscopie broncho-oesophagienne a été effectuée dans les 2 cas avec échec d'extraction conduisant à une extraction chirurgicale par voie de thoracotomie chez le garçon et de cervicotomie chez la fille. Une sténose œsophagienne est survenue à 2 mois dans les suites opératoires chez le garçon. L'évolution a été favorable après dilatation aux bougies de Rehbein modifiées. Chez la fille en postopératoire un œdème laryngé est survenu et a nécessité des séances de nébulisations. L'évolution a été favorable chez les 2 enfants avec un recul de 5 ans et de 2 mois. Conclusion: Les piles boutons sont des corps étrangers particuliers qu'il faut extraire en urgence. L'oesophagoscopie reste le moyen le plus fréquemment employé mais la chirurgie reste le dernier recourt avec des possibilités de complication.

Ingestion of foreign bodies is a common accident in paediatrics. Most of them are of little consequence except for those that are enclosed in the esophagus. We report 2 cases of intraesophageal button stacks in 2 children aged 4 years' male and 2 years female. The reason for consultation in both cases was solid dysphagia. Bronchoesophageal fibroscopy was performed in both cases with failed extraction leading to surgical extraction by thoracotomy in boys and cervicotomy in girls. Esophageal stenosis occurred at 2 months of age in the postoperative period in boys. The development was favourable after expansion at the modified Rehbein candles. In the postoperative girl, laryngeal edema occurred and required nebulization sessions. The evolution was favorable in the 2 children with a follow-up of 5 years and 2 months. Conclusion: Button batteries are special foreign bodies that need to be removed urgently. Esophagoscopy remains the most frequently used method, but surgery remains the last resort with the possibility of complications.

[Comparison of the performance of viral load screening from plasma and from the oneblotting paper (Oudried Blood Spot), protocol in people living with the human immunodeficiency virus (PLHIV) in Bamako]. / Comparaison des valeurs de charges virales realisees sur plasma et sur goutte de sang seche Oudried Blood Spot(DBS) chez les personnes vivant avec levirus de l'immunodeficience humaine (VIH) a Bamako.

INTRODUCTION: The use of blotting paper as a support for quantification of viral load could improve the virological monitoring of patients on Human Immunodeficiency Virus treatment in Mali. The urgency is obvious to us that the coverage in charge is only 10% for the achievement of the 3rd 90. OBJECTIVE: To assess the performance of viral load screening (sensitivity, specificity, concordance) of DBS from the one spot DBS protocol according to plasma in people living with the human immunodeficiency virus (PLHIV) in Bamako. METHODS: A total of 130 blotting papers were made from blood samples received from five sites for monitoring live persons with HIV. These blotting papers thus made were analyzed with the Abbott m2000 apparatus for the purpose of quantifying the viral load with plasma as reference sample. The extraction was done with the m2000SP automatic extractor, following the protocol 1.0 mL HIV-RNA DBS Protocol for paper. Furthermore, the extraction of plasma RNA on the m2000SP was done according to the 0.6 mL HIV-1 RNA protocol. RESULTS: With 130 samples with detectable viral loads, we obtained a correlation of r = 0.837 (p <0.001). In addition, the average difference between the viral load on blotting paper and plasma was 0.512 log / virological copies with a kappa coefficient = 0.708. The threshold of 1000 copies / mL defined as virological success in our study allowed us to obtain a sensitivity of 87% and a specificity of 100%. CONCLUSION: Decentralized zones or virological plasma monitoring is not accessible, the new Protocol one spot of Abbott laboratory offers an interesting opportunity for the follow-up of these patients with good performance at the threshold of 1000 copies. The use of DBS as a virological support can contribute effectively to the achievement of the 3rd 90.

INTRODUCTION: L'utilisation du papier buvard comme support de quantification de la charge virale pourrait améliorer le suivi virologique des patients sous traitement antirétroviral (ARV) au Mali. L'urgence s'impose à nous vula couverture en charge faible(10%) pour l'atteinte du 3ème 90. OBJECTIF: Evaluer les performances de dépistage de la charge virale (sensibilité, spécificité, concordance) des DBS issus du protocole one spot DBS en fonction du plasma chez les personnes vivant avec le virus de l'immunodéficience humaine (PVVIH) à Bamako. MÉTHODES: Au total, 130 papiers buvards ont été confectionnés à partir d'échantillons sanguin reçus de cinq sites de suivi des personnes vivant avec le virus de l'immunodéficience humaine. Ces papiers buvards ainsi confectionnés ont été analysés avec l'appareil Abbott m2000 en vue de la quantification de la charge virale avec comme échantillon de référence le plasma. L'extraction a été faite avec l'extracteur automatique m2000SP, suivant le protocole 1.0 mL HIV-RNA DBS Protocol pour le papier buvard. Par ailleurs, l'extraction de l'acideribonucléique (ARN) plasmatique sur le m2000SP a été faite selon le protocole 0.6 mL HIV-1 RNA. RÉSULTATS: Avec les 130 échantillons avec des charges virales détectables, nous avons obtenu une corrélation de r= 0.837(p<0,001). Par ailleurs, la différence moyenne entre la charge virale sur papier buvard et sur plasma était de 0,512 log/copies virologique avec un coefficient kappa= 0,708. Le seuil de 1000 copies/mL défini comme succès virologique dans notre étude nous a permis d'obtenir une sensibilité de 100% et une spécificité de 87%. CONCLUSION: Dans les zones décentralisées où le suivi virologique sur plasma n'est pas accessible, le nouveau Protocol one spot du laboratoire Abbott offre une opportunité intéressante pour le suivi de ces patients avec de bonne performance au seuil des 1000 copies. Aussi, l'utilisation du DBS comme support virologique peut contribuer efficacement à l'atteinte du 3ème 90.

[Compliance's assessment of ultrasound and x-ray requests at Mopti's Sominé Dolo hospital]. / Evaluation de la conformite des demandes d'echographie et de radiographie a l'hopital Somine Dolo de Mopti.

OBJECTIVE: To assess the compliance of requests for ultrasound and radiography examinations at Mopti's hospital. MATERIALS AND METHODS: This was a cross-sectional study from January 2018 to June 2018. The variables analyzed were the different compliance criteria grouped into administrative, clinical and minor.The data analysis was done with SPSS version 20 and Excel 2013 software. RESULTS: Out of 2000 requests, radiography represented 61.05% compared to 38.95% of ultrasound cases. The administrative criteria were completed in more than 95% of the cases. The purpose of the review was absent in 95% of the requests. The non-compliance rate for the requests was 95.65%. The requests of general practitioners, specialists and medical assistants were respectively non-compliant with 93.62%; 95.68% and 100%. CONCLUSION: At the end of this study, we observed an insufficiency in the quality of prescriptions for requests for medical imaging examinations with a high rate of non-compliance. This could lead to examination practice not suited to the clinical situation, interpretation errors, complications for the patient and high and unnecessary economic cost.

OBJECTIF: Evaluer la conformité des demandes d'examens d'échographie et de radiographie à l'hôpital de Mopti. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale de Janvier 2018 à juin 2018. Les variables analysées étaient les différents critères de conformité regroupés en critères administratifs, cliniques et mineurs.L'analyse des données a été faite avec les logiciels SPSS version 20 et Excel 2013. RÉSULTATS: Sur 2000 demandes, la radiographie représentait 61,05 % contre 38,95 % de cas d'échographie.Les critères administratifs étaient renseignés dans plus de 95% des cas. La finalité de l'examen était absente dans 95% des demandes. Le taux de non-conformité des demandes était 95,65 %. Les demandes des médecins généralistes, des spécialistes et des assistants médicaux étaient respectivement non conformes avec 93,62%; 95,68% et 100%. CONCLUSION: Au terme de cette étude nous avons observé une insuffisance dans la qualité des prescriptions des demandes des examens d'imagerie médicale avec un taux de non-conformité élevé. Ceci pourrait être à l'origine d'une pratique d'examen non adaptée à la situation clinique, des erreurs d'interprétation, des complications pour le patient et d'un coût économique élevé et inutile.

Tuberculosis specific responses following therapy for TB: Impact of HIV co-infection.

Characterizing perturbations in the immune response to tuberculosis in HIV can develop insights into the pathogenesis of coinfection. HIV+ TB+ and TB monoinfected (TB+) subjects recruited from clinics in Bamako prior to initiation of TB treatment were evaluated at time-points following initiation of therapy. Flow cytometry assessed CD4+/CD8+ T cell subsets and activation markers CD38/HLA-DR. Antigen specific responses to TB proteins were assessed by intracellular cytokine detection and proliferation. HIV+ TB+ subjects had significantly higher markers of immune activation in the CD4+ and CD8+ T cells compared to TB+ subjects. HIV+ TB+ had lower numbers of TB-specific CD4+ T cells at baseline. Plasma IFNγ levels were similar between HIV+ TB+ and TB+ subjects. No differences were observed in in-vitro proliferative capacity to TB antigens between HIV+ TB+ and TB+ subjects. Subjects with HIV+ TB+ coinfection demonstrate in vivo expansion of TB-specific CD4+ T cells. Immunodeficiency associated with CD4+ T cell depletion may be less significant compared to immunosuppression associated with HIV viremia or untreated TB infection.

Serum protein electrophoresis: any role in monitoring for antiretroviral therapy?

BACKGROUND: Developing world are always looking for monitoring tools during reagent shortage and equipments troubles which are very frequent. The aim of this study was to evaluate Serum Protein Electrophoresis (SPE) as a marker for assessing HIV treatment response. METHODS: A cross-sectional study was conducted with 220 participants in four distinct groups: Symptomatic HIV positive patients [specifically those on antiretroviral treatment (ART) versus those not on ART] asymptomatic HIV positive patients, and healthy blood donors. Five serum protein fractions (Albumin, Alpha-1, Alpha-2, Beta, and Gamma) were compared between these groups after measuring the density of the fractions. RESULTS: Concentration of gamma globulin was lowest among healthy blood donors, intermediate and comparable among asymptomatic HIV positive and symptomatic HIV positive on ART and highest among untreated symptomatic HIV positive. Concentration of gamma globulin was inversely correlated with the disease stage (p < 0.001). CONCLUSION: In this study, conducted in a setting where the burden of infectious diseases is high, the density of gamma globulin and albumin fractions were significantly associated with HIV status, and among HIV positive patients, with stage of HIV disease and ART. These results suggest that the feasibility of using SPE for monitoring the response of ART in low resource settings should be further explored.

Seroprevalence of HIV/HBV coinfection in Malian blood donors.

OBJECTIVES: A cross-sectional study was conducted to assess the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and their coinfection among blood donors at the National Blood Transfusion Center in Bamako, Mali, from November 2001 to July 2002. METHODS: Enzyme-linked immunosorbent assay techniques with reagents from Bio-Rad (France) were used to test the blood samples. RESULTS: 11,592 blood donors were tested for HIV and HBV surface antigens. The prevalence of HIV was 4.5% and the prevalence of HBV was 14.9%. The HIV/HBV coinfection rate was only 1.13% in this population. CONCLUSION: The coinfection rate was unexpectedly low in this blood donor population where monoinfection with HIV or HBV prevalence was high.