Profils comparés des cancers du sein selon le type au CHU Gabriel Touré, Bamako Mali, entre 2018 et 2022 / Comparative profiles of breast cancers according to tumor type at the Gabriel Touré University Hospital, Bamako Mali, between 2018 and 2022

Introduction : Peu de travaux sont consacrés au cancer du sein malgré son fardeau élevé dans notre contexte. Ainsi, les objectifs de ce travail étaient de : préciser les caractéristiques sociodémographiques et cliniques des cancers du sein et déterminer les facteurs influençant la survie du cancer du sein au Centre Hospitalier Universitaire (CHU) Gabriel Touré. Méthodes : Il s'agissait d'une étude de cohorte rétrospective réalisée au CHU Gabriel Touré entre le 1er janvier 2018 au 31 décembre 2022. Les cas de cancer du sein histologiquement confirmés ont été inclus et repartis en trois groupes anatomo-cliniques (Tumeur non T4 [NT4], cancer localement avancé [CLA] et cancer inflammatoire du sein [CI]). Les proportions des différentes modalités des variables catégorielles / qualitatives ont été comparées à l'aide des tests du Khi² de Pearson ou Exact de Fisher. Des courbes de densité de fréquence ont été produites selon les trois types et comparées à l'aide de la statistique de Kruskal Wallis.Les courbes de Kaplan ­ Meier ont été produites pour l'étude de la survie et la régression de Cox a été utilisée pour identifier les facteurs influençant la survie du cancer du sein. Les Hazard Ratio ajustés (HRA) et leurs intervalles de confiance à 95% (IC à 95%) ont été produits. Résultats : Au total 255 cas de cancer du sein ont été inclus dans cette étude. L'âge moyen était de 46,9 ans. Quel que soit le type anatomo-clinique un pic de densité de fréquence apparaissait avant 40 ans. Les NT4 et les CLA étaient plus fréquemment observés sur le sein droit, tandis que le CI survenait sur le sein gauche (p < 0,001). Les proportions de comorbidités étaient comparables entre les trois groupes. La durée médiane de survie était de 9 mois et le taux global de survie à 5 ans était < 40%. L'antécédent d'infertilité et le CI influençaient significativement la survie avec des HRA de 1,63 [1,01 ­ 2,63] et 1,68 [1,09 ­ 2,59] respectivement. Conclusion : Le cancer d u sein au CHU Gabriel Touré est caractérisé par une survenue précoce et un mauvais pronostic d'où la nécessité d'un diagnostic précoce et une prise en charge de qualité.

Background: Few studies have been conducted on breast cancer despite its high burden in our context. Therefore, this study aimed to: (1) specify the sociodemographic and clinical characteristics of breast cancer; and (2) determine the factors associated with breast cancer survival at Gabriel Touré University Hospital (CHU). Methods: This was a retrospective cohort study conducted at CHU Gabriel Touré between January 1st2018 and 31st, December 2022. Histologically confirmed cases of breast cancer were included and divided into three anatomoclinical groups (non-T4 tumor [NT4], locally advanced cancer [LAC] and inflammatory breast cancer [IBC]). We used Pearson's Chi-square or Fisher's Exact tests to compare proportions. The frequency distributions using density plots were constructed for the three breast types. They were compared using the Kruskal Wallis statistic. Kaplan-Meier curves were estimated for the survival analysis and Cox regression was used to identify factors associated with breast cancer survival. Adjusted hazard ratios (AHRs) and their 95% confidence intervals (95% CIs) were computed. Results: A total of 255 cases of breast cancer were included in this study. The mean age was 46.9 years old. Whatever the anatomoclinical type, the density plot curve peaked before the age 40. NT4 and LAC were more frequently observed on the right breast, while IBC occurred on the left breast (p < 0.001). Comorbidity rates were comparable between the three groups. The median survival time was 9 months, and the overall 5-year survival rate was < 40%. Infertility history and IBC had a significant influence on survival, with AHRs of 1,63 [1,01 ­ 2,63] and 1,52 [1,04 ­ 2,22] respectively. Conclusion: Breast cancer at Gabriel Touré University Hospital is characterized by an early onset and a poor prognosis, suggesting that particular emphasis should be placed on early diagnosis and the quality of management.

Cancers inflammatoires du sein: aspects épidémiologiques au CHU Gabriel Touré à Bamako, Mali / Inflammatory breast cancers: epidemiological aspects at the Gabriel Touré university hospital in Bamako, Mali

Introduction : Le cancer inflammatoire du sein (CIS) est très rare dans le monde. Les objectifs de la présente étude étaient de déterminer la fréquence, de décrire les caractéristiques sociodémographiques et cliniques en fonction du type de CIS primitif ou secondaire, et d'établir le pronostic. Méthode : Nous avons réalisé une étude de cohorte rétrospective dans le service de Gynécologie-Obstétrique du CHU Gabriel TOURE (2015 ­ 2021).Les données ont été analysées à l'aide des statistiques descriptives et la méthode de Kaplan Meier a été utilisée pour produire les courbes de survies. Résultats : Nous avons identifié 100 cas de CIS parmi 588 cas de cancer du sein dont 23 cas de CIS primitif (3,9%) et 77 de CIS secondaire (13,1%). Les deux CIS apparaissaient à un âge relativement jeune avec un pic entre35 et 40 ans. A la différence du CIS primitif, le CIS secondaire présentait un deuxième pic entre 55 et 60 ans (test de Wilcoxon, p > 0,05). Le délai entre l'apparition des symptômes et le début de la maladie, était beaucoup plus court chez les cas du CIS primitif versus secondaire (p < 0,001). La survie globale et la survie spécifique selon le type de cancer inflammatoire étaient inférieures à 40% au bout de 60 mois. Conclusion : La fréquence du CIS était élevée dans notre contexte, mais dominée par l'inflammation secondaire. Quel que soit le type de CIS, le pronostic était sombre.

Introduction: Inflammatory breast cancer (IBC) is very rare worldwide. The objectives of the present study were to determine the frequency, to describe the socio-demographic and clinical characteristics according to the type of CIS (primary and secondary), and to establish the prognosis. Method: We conducted a retrospective cohort study in the Gynecology-Obstetrics unit of CHU Gabriel Touré (2015 - 2021). Data were analyzed using descriptive statistics and the Kaplan Meier method was used to produce survival curves. Results: We identified 100 cases of IBC among 588 breast cancer cases including 23 cases of primary IBC (3.59%) and 77 cases of secondary IBC (13.1%). The two types of IBC appeared in a relatively younger and peaked between 35 and 40 years old. Contrary to primary IBC, secondary IBC exhibited a second peak between 55 and 60 years old (Wilcoxon rank, test p > 0.05). The time between symptom onset to disease progression was significantly shorter in primary IBC cases versus secondary one (p < 0.001). Overall survival and specific survival according to the type of IBC were less than 40% after 60 months of followed up. Conclusion: The incidence of IBC was high in our setting but dominated by secondary IBC. Whatever the type of IBC, the prognosis was poor

Ebola virus disease in children in Conakry and Coyah Ebola treatment centers and risk factors associated with death.

OBJECTIVE: To study Ebola virus disease (EVD) in children aged 15 years and below, and to identify risk factors associated with death. PATIENTS AND METHODS: Retrospective, multicenter, descriptive, and analytical study of files of children aged 15 years and below in Ebola treatment centers (ETC) of Donka from March 2014 to May 2015. We included all files of children aged 15 years and below hospitalized for EVD in the two ETCs. RESULTS: A total of 739 patients hospitalized in both ETCs, 146 children aged 15 years and below (20%) were registered during the study period. The mean age of children was 6.73±4.26 years. Most children were aged above five years (65.8%) and the mean time to consultation was 4.34±3.21 days. The main clinical signs were asthenia (78.8%), fever (75.3%), anorexia (53.4%), headache (45.9%), vomiting (41.8%), abdominal pain (29.5%), and diarrhea (28.8%). The case fatality was 48%, including 54.3% in Coyah and 45% in Conakry. Older age (aOR=0.83, 95% CI [0.76-0.95]), fever (aOR=3.28, 95% CI [1.22-8.87]), diarrhea (aOR=2.98, 95% CI [1.19-4.48]), and hemorrhage (aOR=3.13, 95% CI [1.00-10.38]) were independently associated with death due to EVD. CONCLUSION: EVD remains serious especially in children, with high case fatality. Risk factors independently associated with death were young age, diarrhea, hemorrhage, and fever. Particular attention to these risk factors and vaccination will contribute to improving the prognosis of EVD in children.

[Appendiceal Duplication In A Patient Operated For Chilled Appendix Breastplate At Gao Regional Hospital]. / Duplication Appendiculaire Chez Une Patiente Operee Pour Plastron Appendiculaire Refroidi A L'Hopital Regional De Gao, A Propos D'Un Cas.

Appendiceal duplication is the very rare malformation. It was first described by Picoli in 1892. It is a condition that is most often seen in the first years of life, sometimes some forms may remain asymptomatic and only occur in adulthood. We report the case of appendiceal duplication in a patient operated for chilled appendix breastplate at Gao Regional Hospital. CONCLUSION: appendiceal duplication is a rare abnormal abnormality of intraoperative discovery in general. Each surgeon must think about it during an appendectomy.

La duplication appendiculaire est une malformation très rare. Elle a été décrite pour la première fois par Picoli en 1892. C'est une affection qui se manifeste le plus souvent dans les premières années de vie, parfois certaines formes peuvent rester asymptomatiques et ne s'expriment qu'à l'âge adulte. Nous rapportons le cas de duplication appendiculaire chez une patiente opérée pour plastron appendiculaire refroidi à l'hôpital régional de Gao. CONCLUSION: la duplication appendiculaire est une anomalie malformative rare de découverte per opératoire en général. Chaque chirurgien doit y penser au cours d'une appendicectomie.

The predictor of mortality outcome in adult patients with Ebola virus disease during the 2014-2015 outbreak in Guinea.

The purpose of this study was to examine the association of any demographic and clinical factors with mortality outcome among adult patients with Ebola virus disease (EVD) in Guinea. This retrospective observational study analyzed medical records of laboratory confirmed EVD adult patients during the 2014-2015 EVD outbreak in Guinea. The associations between any demographic or clinical variables and mortality outcome of EVD were assessed using univariate and multivariate logistic regression analyses. Of 2,310 EVD adult patients included for analysis, the overall case fatality rate was 68.1%. Univariate analyses identified factors possibly associated with mortality outcome, including patient age (p < 0.001), history of visiting or close contact with a suspected or confirmed EVD patient (p = 0.035), and seven clinical symptoms on admission, i.e., fever (p = 0.003), hiccups (p < 0.001), vomiting (p = 0.003), diarrhea (p < 0.001), cough (p = 0.001), sore throat (p = 0.016), and unexplained bleeding (p = 0.021). The multivariate analysis showed that patient age was independently associated with mortality outcome of EVD (OR = 1.06; 95%CI = 1.03-1.09; p < 0.001), while none the of clinical symptoms on admission were significantly associated with the mortality outcome. Our analysis indicates that older age was the only independent factor associated with death among EVD adult patients in Guinea. This suggests that older EVD patients should receive intensive medical care and be carefully monitored.