[Fracture of the penis at teaching university hospital Luxemburg in Mali : two cases report]. / La fracture de la verge a propos de 2 cas au service d'urologie du CHU Luxembourg/Mali.

The fracture of the penis is a rare andrological emergency. We report 2 cases of fracture of the penis including one by false-no coitus. These were young adults aged 34 and 40 respectively. The painful swelling with deviation of the penis was the dominant symptomatology of the clinical picture of the 2 patients. Surgical management was performed with favorable functional results in both cases. The long-term functional prognosis of the fracture of the penis depends on the speed of its management.

La fracture de la verge est une urgence andrologique rare. Nous rapportons 2 cas de fracture de la verge dont un par faux-pas de coït. Il s'agissait d'adultes jeunes âgés respectivement de 34 ans et 40 ans. La tuméfaction douloureuse avec déviation de la verge a été la symptomatologie dominante du tableau clinique des 2 patients. Une prise en charge chirurgicale a été réalisée avec des résultats fonctionnels favorables dans les 2 cas. Le pronostic fonctionnel à long terme de la fracture de la verge dépend de la célérité de sa prise en charge.

[Neurological complications of chronic alcoholism: study of 42 observations in Guinea]. / Complications neurologiques de l'alcoolisme chronique : étude de quarante-deux observations en Guinée.

Neurologic disorders related to chronic alcoholism in traditional areas of Guinea are frequent, but reports about them are rare. We conducted the first study in Guinea on this subject and retrospectively collected 42 cases of neurologic manifestations related to alcoholism over a 7-year period. The standard findings of the literature were confirmed in our population: peak frequency after the age of 40 years (82.8%) and clear male overrepresentation (M/F sex ratio: 13/1). All the standard signs and symptoms are reported, with a clear predominance of alcoholic polyneuropathy and hepatic encephalopathy. The study of nutritional status by both body mass index (BMI) and the Detsky criteria showed that these patients were severely malnourished. The brain MRI was a crucial contribution for diagnosing the standard central nervous system complications of alcoholism: Gayet Wernicke encephalopathy, Marchiafava-Bignami disease, Korsakoff syndrome, central pontine myelinolysis, and cerebellar degeneration.

Conduites suicidaires en milieu carceral a Conakry (Guinee Conakry)

Les conduites suicidaires en milieu carceral constituent un probleme majeur de sante publique a la prison civile de Conakry. Objectifs: Determiner la frequence des conduites suicidaires et d'identifier les facteurs pouvant conduire au suicide dans la prison civile de Conakry. Methodologie: Il s'agissait d'une etude prospective de type descriptif d'une duree de 6 mois ayant portee sur 133 detenus. Resultats: La frequence des conduites suicidaires chez les detenus etait de 66;17. La tranche d'age de 14 a 35 ans etait la plus touchee (83;96) avec une predominance masculine (91;73). Les detenus analphabetes et du niveau secondaire evoluant dans le secteur informel et les sans profession etaient majoritaires. Les motifs d'incarceration etaient varies ; le sejour carceral etait plus ou moins long alors que les detenus non juges etaient nombreux soit 82;71 de cas. Dans 54;14 de cas; les detenus avaient des antecedents de tentatives de suicide ; nous avons note les addictions dans 89;47 de cas ; les plaintes des detenus etaient surtout basees sur les troubles de l'appetit; l'insomnie; le decouragement; la baisse de l'estime de soi; la tristesse; l'anxiete; le pessimisme; les sentiments de honte et de remord; les idees suicidaires ; tous ces detenus presentaient une humeur depressive soit 100 de cas. Conclusion: Une etude portant sur toutes les prisons au niveau national semble indispensable pour mieux cerner l'ampleur du phenomene; elle devra etre suivie d'une analyse approfondie des differents facteurs impliques en vue d'apporter des solutions adaptees

[Problems of neonatal transfer to the pediatric service of the CHU Gabriel Touré of Bamako]. / Problematique du transfert neonatal vers le service de pediatrie du CHU Gabriel Toure de Bamako.

UNLABELLED: Neonatal morbidity and mortality is a real concern in our context. Several factors including the organization of the reference contribute to it. Our work was aimed at studying the conditions of newborns transfer of the towards the service of pediatrics of teaching hospital Gabriel Touré. MATERIAL AND METHODS: Our study proceeded from October 15th, 2006 to January 15th, 2007 in the unit of neonatology of the service of Pediatrics of the CHU of the Hospital Gabriel Touré. It was a cross sectional and descriptive study. All the newborns referred by a health structure were included. RESULTS: We included 760 referred newborns out of 1072 neonatal admissions which means a frequency of reference of 71%. In 91.6% of the cases, the newborn were referred on the very day of their birth. Prematurity (29%), perinatal anoxia (24%), respiratory distress (13.9%) were the main reasons for reference. In no case, the service of pediatrics was contacted in advance by the referring health agent. More than half of the cases (58.6%), the public transport was used. Ambulance car transported 17.4% of the newborns. All the newborns came held in the arms of a member of their family. The referring agent was a physician in 70.3% of cases. Hypothermia was found for all the newborns (759/760) when being received. More half of the newborns (56.4%) had a small weight at birth and the quarter (25.8%) was resuscited. Lethality was 32%. Mother illiteracy, small weight at birth, the outborn birth were factors related to neonatal mortality. CONCLUSION: In our context, the reduction of neonatal morbidity and mortality has to go through an improvement of the reference system.

[Treatment of sickle cell pain]. / Prise en charge de la douleur au cours de la drepanocytose selon les criteres OMS.

OBJECTIVES: Evaluate the efficiency of the treatment of pain by analgesic according to World Health Organization (WHO). PATIENTS AND METHODS: We made a descriptive and analytic study in majors sickellers in pain crisis admitted in the service of paediatric of the hospital Gabriel Touré Bamako from January 2005 to January 2006. The efficiency of the treatment by painkiller was evaluated at second hour and at the 24 hour. RESULTS: Our study concerned 70 children with major of sickle cell of both sexes and aged from 6 to 15 years in pain crisis. In 87.1% pain disappeared with painkillers palier I (paracetamol) and 12.9% had necessitated to pass to palier II (buprenorphine) an 64.3% our patients the pain disappeared in a period less than 12 hours with an average of 3 hours against only 35.7% soothed in a period more than 12 hours with average of 64 hours 3 minutes. Pain from the head and limbal region were the most sensible to the treatment. CONCLUSION: The treatment of pain by palier according to who is efficient in children sickeller.

[Morbidity and mortality in the pediatric service at Gabriel Toure's University Hospital in Mali]. / Morbidite et Mortalite dans le Service de Pediatrie du Chu Gabriel Toure au Mali.

The aim of this work was to study morbidity and mortality before implementing the setting up of the pediatric service of Bamako. Involved in the study were all the children hospitalized during 12 months that is a total of 2000 cases among which 57.3% boys and 42.8% girls. Our study indicated that only 25% of children (509/2000) were referred. The most encountered pathologies were : malaria 898 (44.9%), ARI 528 (26.4%), diarrhea 224 (11.2%), malnutrition 269 (13.4%) and anemia 239 (11.9%). Mortality rate in hospital was 7.1 % and the main causes of deaths were : malaria (23.9% of death cases), diarrhea (20.4%) and malnutrition (31.7%). Thus we have recorded 8.3% of deaths for a period of resort beyond 3 days, compare to 3.3 % for a resort of less than 24 hours. (x² = 8.10, p= 0.017 ). The pediatric service operated as a center for first contact. In the framework of the establishment of this project, organizational efforts should allow to receive only referred cases.

[Persistent neurological sequelae due to cerebral malaria in a cohort of children from Mali]. / Séquelles neurologiques persistantes dues au paludisme cérébral dans une cohorte d'enfants au Mali.

INTRODUCTION: Several neurological complications are associated with cerebral malaria (CM). However, few long-term data from childhood survivors have been published. METHODS: A cross-sectional study was carried out in Mali among children followed from 1999 to 2002 after serious and complicated malaria. Our aim was to evaluate the persistent neurological sequelae associated with CM. RESULTS: This study concerned 101 subjects who had had CM. Mean age was 5.6+/-3.6 years. Twenty-eight children presented persistent neurological sequelae (27.7p.cent). Among them eight (7.9p.cent) children had developed these sequelae just after CM and 20 (19.8p.cent) a few months later: headaches, mental retardation, speech delay, bucco-facial dyspraxia, diplegia and frontal syndrome (one case each), dystonia (two cases), epilepsy (five cases) and behavior and attention disorders (15 cases). CONCLUSIONS: In this study, we show that neurological signs due to CM can persist in the long run. Long-term follow-up and proper management after CM are essential.

[Blackwater fever in children during cerebral malaria: 3 case reports in Bamako]. / La fièvre bilieuse hémoglobinurique chez l'enfant: à propos de 3 observations à Bamako.

BACKGROUND: Blackwater fever is a rare but serious form of malaria in children. Diagnosis relies on clinical symptoms and on the color of the urines. OBJECTIVES: To describe blackwater fever in children, a disease whose prevalence seems to be increasing. METHOD: We report 3 cases of blackwater fever observed in our institution. RESULTS: In 2 cases, acute renal insufficiency with oligoanuria was observed. In all the 3 cases, treatment with quinine was stopped and replaced by injectable artemether. Evolution was dependent on renal function, and included in 1 patient neurological sequels consisting in aphasia. CONCLUSION: Blackwater fever is a severe affection whose diagnosis should be evoked using the color of urine. Evolution is usually favorable in the pediatric population, when adequate care can be provided.

[Knowledge, attitudes, and practices of adolescents in an urban school environment in Bamako, Mali, around family planning, sexually transmitted infections, and AIDS]. / Connaissances et pratiques des eleves d'un lycee de Bamako en matiere de contraception et prevention des ist.

We undertook a study amongst adolescents from Mabile High School in Bamako, Mali. The goal of the study was to determine the knowledge, attitudes and practices of high school students around STI/AIDS and family planning. It was a transversal study using a stratified sampling method. A total of 322 students between ten and 19 years of age were included in the study (191 boys, 131 girls) This study demonstrates that high school students do not often family planning services (only 13.4% of those who knew of the existence of such used them). The method of contraception most often used is still the condom (92.5%). HIV is the most well know STI (97.5%) followed by gonorrhea (45%). An absence of communication between adolescents and their parents around family planning and STI/AIDS was apparent in that information was most often received on these topics through the media (96.3% for family planning, 97.5% for AIDS) followed by friends (72.4% for family planning and 81.7% for AIDS). 59.3% of the students are sexually active. Of sexually active students, 41.3% have had sexual relations with a casual partner and 75.9% with at last two partners. Given their high number of partners and a lack of systematic condom usage, it is apparent that sexually active high school students practice high risk sexual behaviors. It is therefore crucial to develop methods to lead to an improvement in behaviors amongst adolescents.

[Acute accidental poisoning in children at the pediatrics service of the Gabriel Touré hospital]. / Intoxication aiguë accidentelle chez l'enfant au service de pédiatrie de l'hôpital Gabriel Touré.

The accidental intoxications constitute more and more a serious problem among young children in the developing countries because of their frequency and difficulties for taking care of those victims. The objective of our work was to study acute intoxications among children in order to determine the frequency, to identify the products in question and to determine the impact of those accidents in the future life of the victims. The study was carried out in the Paediatric Service of the CHU Gabriel Touré from January 2001 to June 2002. We enrolled 89 children from 0 to 15 years of age. Information on our patients was recorded on investigational questionnaire and completed with data from their entry and hospitalization records. Among 8237 children hospitalized during the study period, 89 of them had acute intoxication i.e. 1.08%. Children less than five years of age were more frequent with 85.4% with a male prevalence of 61.8%. Antimalarial drugs and petroleum were the most accused products. Administration of milk and provoked vomiting were the attitudes and practices of the entourage of the victims when intoxication occurs. The evolution was favourable in 67.2% of the cases with a hospital lethality of 13.7%.

Thrombospondin related adhesive protein (TRAP), a potential malaria vaccine candidate.

We have investigated whether naturally induced immunity to Plasmodium falciparum thrombospondin related adhesive protein contributes to protection against malaria in humans. We have carried out a case control study in children living in an endemic region of West Africa to reveal associations between PfTRAP seroprevalence and the risk of cerebral malaria. Sera collected from the case and control groups were analysed by ELISA to compare their serum reactivity against PfTRAP, the circumsporozoite protein and the merozoite surface protein 1. Children with uncomplicated malaria had a significantly higher PfTRAP seroprevalence when compared to children with cerebral malaria. The risk of developing cerebral malaria appeared to depend on the reciprocal relationship between sporozoite inoculation rates and humoral immunity against PfTRAP. Our results suggest that naturally induced humoral immunity against PfTRAP contributes to the development of protection against severe malaria. Experimentally induced immunity against TRAP in different rodent models has consistently proven to elicit a high degree of protection against malaria. This together with the functional properties of TRAP and data describing CD4 and CD8 epitopes for PfTRAP indicate that this molecule could increase the protective efficiency of available sporozoite malaria vaccines.

Natural polymorphism in the thrombospondin-related adhesive protein of Plasmodium falciparum.

We have developed a typing system using natural sequence variation in the thrombospondin-related adhesive protein (TRAP) gene of Plasmodium falciparum. This method permits a haplotype to be assigned to any particular TRAP gene. We have applied this method to a hospital-based, case control-study in Mali. Previous sequence variation and conservation in TRAP has been confirmed. Particular TRAP haplotypes can be used as geographic hallmarks. Because of the high level of conflict between characters, we have examined the phylogenetic relationships between parasites using a network approach. Having received patient samples from urban and periurban areas of Bamako, the majority of haplotypes were closely related and distinct from TRAP sequences present in other continents. This suggests that the structure of TRAP can only tolerate a limited number of sequence variations to preserve its function but that this is sufficient to allow the parasite to evade the host's immune system until a long-lived immune response can be maintained. It may also reflect host genetics in that certain variants may escape the host immune response more efficiently than others. For vaccine design, sequences from the major regional variants may need to be considered in the production of effective subunit vaccines.

A comparison of the incidence of severe malaria in Malian children with normal and C-trait hemoglobin profiles.

Although a protective effect against malaria has been demonstrated for several hemoglobin variants, no selective factor is established for the high incidence of HbC in regions of West Africa. Here we report a survey of hemoglobin profiles among children admitted with symptomatic and severe malaria to the Gabriel Touré Hospital in Bamako, Mali, where the frequency of the HbC gene is 8-10%. Children with AC and AA profiles presented with severe malaria at comparable rates, indicating lack of protection by the heterozygous state. Two admitted children, one of whom presented with cerebral malaria, were found to have SC profiles. No CC homozygotes were detected in the study cohort.

Apport de l'échographie dans le diagnostic de l'hydrocéphalie chez le nourrisson: à propos de 55 cas

Les aspects radiologiques de l'hydrocéphalie ont été décrits chez les nourrissons de 0 a 26 mois; d'octobre 1992 à décembre 1995: une série rétrospective de 55 cas d'hydrocéphalie ont été diagnostiques sur 120 enfants (45;8 pour cent) adresses a la radiologie pour échographie transfontanellaire au cours du bilan de méningite; de souffrance cérébrale ou de prématurité. Les nourrissons étaient âgés de 0 a 26 mois. La tranche d'âge la plus touchée a été celle des nourrissons de 0 a 6 mois (18/55 cas soit 32;7 pour cent). Le sexe ratio était de 0;34 en faveur des filles (14/41). L'étiologie la plus fréquente a été la méningite bactérienne. En plus de l'échographie transfontanellaire deux enfants ont bénéficié de la radiographie du crâne. La dilatation des ventricules latéraux a été plus fréquente (44/55 soit 80 pour cent des cas); et 20 pour cent des cas restants étaient des dilatations triventriculaires (ventricules latéraux et troisième ventricule). Les aspects échographiques sont dominés par une collection anechogene. Rarement il a été retrouve l'aspect hypoéchogène contenant de fins échos ou l'aspect hyperéchogène periventriculaire témoignant d'une ventriculite. Le traitement de l'étiologie méningitique a été essentiellement médical. Les grosses hydrocéphalies ne sont pas traitées faute de neurochirurgie