[Frequency of skin consultations in the activities of internal medicine service at national hospital of Point G in bamako]. / Fréquence des consultations dermatologiques dans les activités du service de médecine interne de l'hôpital national du point g a bamako.

AIM: To investigate epidemiologic clinical, paraclinical and therapeutic appearances of skin diseases identified in the Internal Medicine Department. PATIENTS AND METHODS: This was a retrospective descriptive study on records collected from January 1st, 1997 to September 30th, 2000. Have been selected records of patients who consulted and / or hospitalized for a dermatological reason. RESULTS: The average age was 36.42 ± 16.52 years. Female sex predominated with 55.06% for a ratio of 0.81. Dermatological consultation represented 30.41% of the activities of Internal Medicine. The pruritic dermatoses predominated (60.12%) among those infectious etiologies (45.46%), inflammatory dermatoses reaction (26.49%), dermatitis tumor (10.39%), autoimmune dermatoses (6.56%) and vasculitis (1.19%). Prurigo, herpes zoster and Kaposi's sarcoma with frequencies of 22.41%, 16.38% and 12.93% were most often associated with HIV / AIDS. The therapy consisted of prescription antiseptic, topical corticosteroids of compounding, antibiotic and antifungal orally. CONCLUSION: Skin conditions are often common in internal medicine, infectious causes and especially reaction. Kaposi's sarcoma because of its association with HIV is common skin tumor identified. The usual drugs remain effective.

BUT: Étudier les aspects épidémioclinique, paraclinique et thérapeutique des affections cutanées recensées dans le service de Médecine Interne. PATIENTS ET MÉTHODE: Il s'agissait d'une étude rétrospective descriptive portant sur les dossiers colligés du 1er Janvier 1997 au 30 Septembre 2000. Ont été retenus les dossiers des patients ayant consulté et/ou hospitalisé pour un motif dermatologique. RÉSULTATS: La moyenne d'âge était de 36,42±16,52 ans. Le sexe féminin prédominait avec 55,06% pour un ratio de 0,81. La consultation dermatologique représentait 30,41% des activités du service de Médecine Interne. Les dermatoses prurigineuses ont prédominé (60,12%) parmi celles de cause infectieuse (45,46%), les dermatoses réactionnelles inflammatoires (26,49%); les dermatoses tumorales (10,39%); les dermatoses auto-immunes (6,56%) et les vascularites (1,19%). Le prurigo, le zona et la maladie de Kaposi avec des fréquences respectives de 22,41%; 16,38% et 12,93% étaient le plus souvent associés au VIH/SIDA. La thérapeutique a consisté à la prescription d'antiseptique, de dermocorticoïdes, de préparation magistrale, d'antibiotique et d'antimycosique per os. CONCLUSION: Les affections dermatologiques sont souvent fréquentes en Médecine Interne, de causes surtout infectieuse et réactionnelle. La maladie de Kaposi en raison de son association avec le VIH, est la fréquente tumeur cutanée recensée. Les médicaments usuels demeurent efficaces.

[Cutaneous drug eruption at hospital in Bamako]. / Toxidermie Medicamenteuse En Milieu Hospitalier A Bamako.

INTRODUCTION: The incidences of cutaneous drug eruption constitute a real public health problem. OBJECTIVE: The aim of this study was to describe the cutaneous drug eruption in Gabriel Touré Hospital in Bamako. MATERIAL AND METHOD: This is a prospective longitudinal study from 1 July 2005 to August 31, 2006. The study included patients with a lesion cutaneous Contemporary taking medication, without other cause and consent. RESULTS: We included 61 cases of toxdermies. The mean age was 28 ± 14.8 years with extremes of 18 and 77 years. The sex ratio was 2.4 for women. Self-medication was most often found in 51% of cases. The fixed drug eruption (EPF) with 26 cases (30.6%); acne with 23 cases (27%), erythema multiforme with 14 cases (16.5%) are the predominant manifestations toxidermy. The causative drugs are molecules with 12.6% with analgesics, NSAIDs with 12.6%, 13.6% with ARVs; sulfonamides with 9.5% with 7.4% beta-lactam; anticonvulsants with 5.2%. The therapeutic management was simple for minor forms. Severe forms have been hospitalized and often the help of intensive care and ophthalmology. Mortality was 2.3%. CONCLUSION: The toxidermy exist in Mali with a frequency more and more increasing. We recommend the systematic toxidermy consultations especially among HIV patients in Mali.

[Hyperthyroidism in children. Experience in internal medicine in Mali]. / Hyperthyroïdie chez l'enfant. Expérience d'un service de médecine interne au Mali.

INTRODUCTION: Thyroid pathology is frequent in Mali, which is an endemic zone for goiter. But this pathology rarely occurs in children. The purpose of our study was to characterize this illness among children in Mali. METHODS: We report on patients aged less than 15-year old who presented with clinical signs and symptoms with hyperthyroidism at the medicine service at Hospital de Point G from January 1999 and December 2005 to determine the characteristics of hyperthyroidism. RESULTS: The frequency was 9.6 per thousand (38/3972), with an average age of 12.5+/-3.34-year. The sex ratio was 3 girls/1 boys. The most common symptoms were tachycardia (n=30, 78.9%), palpitations (n=15, 34.4%). 31 patients (81.5%) presented with exophthalmoses, 93.5% being bilateral. Weight loss was present in 31.5% (n=12). Goiter was present in 37 patients (97.4%). The goiter was diffuse in 27 patients (73%) and nodular in 10 (27.%). The presence of goiter caused signs of compression in the neck in half of the cases: dyspnea and dysphonia were the most common consequences. TSH less than 0.05 microUI/1 was used to confirm the diagnosis. Graves's disease was the most common cause (n=32, 84.2%), followed by toxic adenoma (n=4, 10.5%). Other causes included toxic multinodular goiter and thyroiditis. Etiologies were independent of sex and age: (p=0.95). All patients were started on medical therapy upon diagnosis. 7 patients (18.4%) were lost to follow-up during the 6 months of treatment. Remission was obtained in 26 patients (83.9%), and relapse occurred in 5 patients (16.1%). CONCLUSION: The frequency of hyperthyroidism in children in Mali is a problem in a goiter endemic zone like Mali. Poor general health in children and signs and symptoms of neck compression are markers of progressive disease.

Endemic goitre: a research protocol elaboration for eradication.

The iodine deficiency (ID), which affects 1 person out of 6, is relatively neglected by the responsible of Public Health Service, particularly in developing countries. Consequences of ID are far from being negligible: mental retardation, hypofertility, hyperplasia, carcinoma, early ageing and, in very exposed areas, endemic cretinism. Nevertheless, eradication is easy and cheap but it requires rigorous protocols and control of results. The elaboration of these protocols is complex because it must be adapted to environment, population and financial possibilities of concerned countries. Based on our experience in this field, we propose a combined protocol, between the Public Health too liberal approach and that of too expensive research, which can be adapted to several situations.

Epidemiology and prophylaxis of endemic goitre in the Bwa village of Sirao (Mali).

A study was conducted in Mali, in some villages exposed to iodine deficiency disorders (IDD). To treat and, above all, prevent endemic goitre, Lipiodol UF was dispensed in two ways: by intra-muscular injection (475 mg I) or by oral administration (48 mg I to 240 mg I). In two cases, hormone levels regained normal values and thyroid hypertrophies regressed significantly. Nevertheless, the impact of the treatment on the size of the goitres seems to be in favour of injections; which is probably due to the fact that in the village which received Lipiodol UF per os, many goitres were nodular.

Treatment by iodized oil (Lipiodol UF) of a population in Mali suffering from endemic goiter.

In order to reduce the prevalence of goiter in a village of Mali liable to iodine deficiency, an iodized product (Lipiodol Ultra Fluide) was orally administered to their inhabitants. Taking into account a series of demographic variables and goiter types, a protocol was conducted using Lipiodol at three different dosage levels. Six months after the treatment, the hormone levels regained normal values, whereas only the smallest dose reduces the volume of goiters significantly.

[Prevalence of pulmonary tuberculosis and HIV infection in the district of Diré in Mali]. / Prévalences de la tuberculose pulmonaire et de l'infection par le VIH dans le cercle de Diré au Mali.

In 1990, a study was made in the district of Diré, North Mali in West Africa, to determine the prevalence of pulmonary tuberculosis and HIV infections in general population. From 1,814 subjects tested, 1.1% (n = 20) have active pulmonary tuberculosis and 0.2% (n = 4) were seropositive with HIV1 or HIV1 + 2. No relation was made between the two diseases.

Compte-rendu fibroscopique de 188 lesions oesogastro-duodenales chez les 5-20 ans a l'Hopital du Point G - Bamako

Ce travail est une etude retrospective effectuee a partir des registres du Service d'Endoscopie digestive de l'Hopital du Point G. Il s'est etendu de janvier 1993 a mars 1995. L'objectif a ete d'evaluer la frequence des affections oeso-gastro-duodenales chez les sujets de 5 a 20 ans. Sur 5633 endoscopies realisees; la pathologie oeso-gastro-duodenale a ete analysee chez les sujets de 20 ans : soit 302 sujets (5;5 pour cent de la pathologie totale). Au total; 188 etaient pathologiques (62;3 pour cent de la population etudiee et 3;3 pour cent de l`ensemble des examens effectues). La tranche d`age de 16 a 20 ans a ete la plus representee; 66;4 pour cent (n = 125) et celle de 5 a 10 ans la moins representee; 2;7 pour cent (n = 5). Les hommes ont constitue 49;5 pour cent (n = 93) et les femmes 50;5 pour cent (n = 95) de la population etudiee. Les sujets de 5 a 15 ans representent 13;2 pour cent (n = 25) et les plus de 15 ans; 86;8 pour cent (n = 163). Il est ressorti de cette etude que les lesions gastriques predominaient

Haemoglobinopathies C and S in the Dogons.

The distribution of haemoglobins C and S was studied in a population of caste and non caste Dogons living in villages located on the plateau and scree regions in the Sangha department of Mali. Results showed a 15.77% prevalence of haemoglobinopathy AC. Haemoglobin C was found in both plateau and scree villages and equally among caste and non caste Dogons, while the homozygous form CC was absent in non Dogons. The prevalence of haemoglobinopathy AS was extremely low with a calculated frequency of 3.05%, allele S being restricted to areas where one is likely to encounter populations other than the Dogon people. Homozygotes SS were not detected and the phenotype SC was only rarely identified. An overall analysis of these data not only suggests that allele S is of recent introduction in the Dogons but also raises the question as to whether their origin is not the voltaic rather than the Manding plateau. Studies of marriage patterns and haplotypes currently in progress should enable resolution of this controversy.

[Prevention of iodine deficiency disorders in children in the rural African zone]. / Prévention des troubles dus aux carences en iode chez les enfants en zone rurale Africaine.

The effectiveness of iodinated silicone polymers placed in bore wells for combating goiter in children under 15 years of age was evaluated in two villages in Mali. Of the 581 included children, 367 did and 214 did not receive supplemental iodine. Overall, follow-up data at one year were available for 86% of study subjects. At baseline, Goiter was present in 43.3% of the children in the supplemental iodine group and in 69.2% of controls. Stage G1B predominated in both sexes. After one year, 36% of the goiters had resolved in the supplement group. Effectiveness of iodine supplementation was greater in young children with small goiters. Urinary iodine levels returned to normal by the third month. Iodine levels in the supplemented water remained above 50 micrograms/l throughout the year; daily intake of iodine was 50 to 100 micrograms. In the unsupplemented village, 21 new cases of goiter occurred, for an annual incidence of 40%.

[Transmission of hepatitis B virus from mother to child in Bamako-Mali]. / Transmission du virus B de l'hépatite de la mère a l'enfant a Bamako au Mali.

Results of a study about mother-infant transmission of hepatitis B virus (HBV) confirm the high degree of positivity of HBV markers in Bamako, Republic of Mali. Among 372 sera of mother-newborn pairs, seroprevalence of HBs Ag has been around 11% in mothers. The lack of anti HBc IgM in all sera agree probably with a relative old contamination. Pre-S2 epitope marker has been found in more than 70% of HBs Ag positive mothers and 50% of their children. Large discordance has been noted between the prevalence rate of this marker and the HBe Ag and viral DNA, other markers of HBV replication. Further studies are necessary for the clear understanding of HBV transmission systems in our country.

[Does human distomiasis due to Fasiola gigantica exist in the delta of the Niger river in Mali? (apropos of a serological survey)]. / La distomatose humaine à Fasciola gigantica existe-t-elle dans la zone inondée de l'Office du Niger au Mali? (à propos d'une enquête sérologique).

Finding of specific anti-Fasciola antibodies in persons living in the central area of the delta of Niger shows that human fascioliasis is a reality in Mali. Fasciola gigantica, the single species affecting livestock is probably the parasite concerned. We think that this parasitic disease in humans is underestimated, obscured by schistosomiasis which is hyperendemic in the country. Complementary studies are much needed for better identification of the problem.

[Evolution of endemic goiter in Malian women and children after a year of enrichment of drinking water with iodine using diffusers made of silicone]. / Evolution du goitre endémique chez les femmes et les enfants maliens après un an d'enrichissement de l'eau de boisson en iode par des diffuseurs en silicone.

A new method for iodine deficiency disorders prevention is tested during one year in a rural area of Mali. Silicone and sodium iodide made diffusers are set up inside 2 villages' drillings. Their efficiency is compared with a placebo. Supervision criteria are evolution of goiter, rates of iodine in water and ioduria of the population, specially women and children. In the treated villages a decrease of goiters' size of the younger people is observed. Iodine rates in treated drillings water stay during 12 months between 150 and 300 micrograms/l with a minimum intake of 150 micrograms/day/person. The means of ioduria rates from less than 25 micrograms/l before treatment (severe deficiency) increase to more than 100 micrograms/l after six months of treatment (no deficiency).

[Prevalence of hepatitis B virus in women of childbearing age in Mali]. / Prévalence du virus de l'hépatite B chez les femmes en age de procréer au Mali.

A serological investigation on adult female in Mali show a high degree of positivity of hepatitis B virus (HBV) markers, of which 42% HBs Ag +. Only 6% exhibit active replication. The low prevalence of anti-HBs (+) with a high degree of anti-HB (+) explain a high incidence of infection with a low immune response to HBs antigen. The existence of anti-Delta (+) asymptomatic carriers is an additional support to a vaccination programme.

[Evaluation of the health status of nomadic and semi-nomadic populations of the Gourma-Mali: epidemiologic approach. II. Overall results and conclusions]. / Evaluation de l'état sanitaire des populations nomades et semi-nomades du Gourma-Mali--approche épidémiologique II.--Résultats globaux et conclusion.

The authors report the main clues of morbidity, infant mortality, fecundity as well as the main endemic affections detected in the nomadic and seminomadic populations in Gourma that they have noticed during a descriptive epidemiological investigation. The worse clues of general morbidity come from children and among the ethnic groups studied from those of the Tamachèques and the Maures. Malaria, brucellosis, treponematosis (bejel) have a high rate of frequency. The few cases of tuberculosis detected incidentally encourage to search for the real effect of this affection. Urinary schistosomiasis is present in Gossi where durable ponds exist. Intestinal helminthiasis, tineas, and hemoglobinopathies seem not to be problems of public health in the area. Pterygiums and conjunctivitis are frequent while trachoma is absent in Gourma.

[Evaluation of the health status of nomadic and semi-nomadic populations of the Gourma-Mali: epidemiologic approach. I. Introduction, material and methods]. / Evaluation de l'état sanitaire des populations nomades et semi-nomades du Gourma-Mali--approche épidémiologique. I.--Présentation-matériel et méthode.

The authors set out the methodology and the practical way used in transverse epidemiological investigation with a descriptive aim which was made in natural area: Gourma-Mali. This part of the Sahel, hard to reach, is placed deep in the bend of the Niger river. The population is estimated at 100.000. The weather, ecological and human conditions have been unsettled by the drought. Sometimes, it was difficult to collect the data among the nomadic and seminomadic populations (Tamachèques, Peuls, Maures, Bellahs, Sonraïs). This investigation shows well the practical problems that this kind of study sets out in difficult bioclimatological and ethnological conditions.