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The Polytraumatized in the Emergency Hosting Service and the Service of Resuscitation Gabriel Touré Mali  [PDF]
Diop Thierno Madane, Magane Moustapha Issa, Almeimoune Abdoulhamidou, Dembélé AlajiSeidou, Dabo Aminata, Ouattara Kassoum, Dembélé Bakary Tientigui, Traoré Alhassane, Togo Adegné, Diango Mahamane Djibo
Surgical Science (SS) , 2018, DOI: 10.4236/ss.2018.94018
Abstract: Summary: Polytrauma is the leading cause of death in the under-40 population. They are accompanied by major morbidity with severe sequelae. The polytraumatized is defined as a serious trauma with several bodily injuries, at least one of which is life-threatening in the very short term. The initial hospital care must not barely delay and directly affect the prognosis. In developing countries, the absence of pre-hospital medicine means that mortality is still very high, which leads us to initiate this work, which aims to study the epidemiological and clinical aspects of polytrauma in emergency and in resuscitation of Gabriel Toure University Hospital. Material and Methods: This was a retrospective study that took place over a period of ten (10) months from February to November 2016. We included all patients received for polytrauma emergency hosting service. The data were collected using a surveycard. Results: During our study period, we collected a total of 200 polytraumatized cases out of a total of 16,141 patients admitted to the emergency hosting service, a prevalence of 1.3%. The age group of 20 - 29 years was the most represented with average age of 32.39 years. The male sex was predominant with 65% with a sex ratio of 1.9. The students were the most represented with 24%. The trauma occurred at 22.5% between 8:00 and 12:00 am, the public road was the main place of the trauma with 57.5% of the cases. Two-wheeled vehicles were involved in the accident in 68.9% of cases. The delay between trauma and admission was minus 6 hours in 70.5% of cases, 15.5% had a Glasgow lessthan 8% and 44.5% PAS < 90 mmHg. The polytrauma associated with a cranial + limb and cranial + abdominal were the most represented with respectively 37.5% and 25%. The damage control suegery was performed in 79% of patients. The mortality was 31% and hemorrhagic shock was the most common etiology of these deaths with 51.6%. Conclusion: The polytrauma is clinical situation putting the patients vital prognosis at stake. The haemorrhage is the origin of the student mortality. The installation of rigorous diagnostic system and a pre-hospital medicine will reduce the morbi-mortality.
Post-Operative Peritonitis: Diagnostic Problems, Morbidity and Mortality in Developing Countries  [PDF]
Alhassane Traoré, Bakary Tientigui Dembélé, Adégné Togo, Lassana Kanté, Madiassa Konaté, Ibrahima Diakité, Simo Notue Fabienne Laurence, Boubacar Karembé, Abdoulaye Diarra, Amadou Traoré, Mahamane Djibo Diango, Gangaly Diallo
Surgical Science (SS) , 2014, DOI: 10.4236/ss.2014.58059

Goal: To study the diagnostic difficulties and post-operative morbidity and mortality of peritonitis. Patients and Methods: Retrospective study about the records of adult patients operated on between 1999 and 2013 whose diagnosis of post-operative peritonitis was made. Results: We achieved 23,573 lanterns and recorded 148 cases of postoperative peritonitis or 0.62%. The medium age was 37.1 ± 17.7 years and the sex ratio was 1.2. The delay between the initial intervention and reoperation was less than 5 days. Factors occurrence of postoperative peritonitis were those related to the initial surgery: septic context 70.8%, emergency surgery 81.1% under the seat mesocolic 25% and 20.3% initial surgical technique. The diagnosis was made preoperatively in 62.2% (n = 92). Ultrasound has found an effusion in 29.7% (n = 44). Cytobactériologic review identified germs in 85.1% (n = 126) and sterile in 12.9% of patients (n = 22). The most frequent etiologies were: 22.9% anastigmatic leak (n = 34), the phoenix abscess in 17.6% (n = 26), iatrogenic perforation 13.5% (n = 20) and digestive fistula 25% (n = 37). Other causes were the stoical necrosis 12.2% (n = 18) and evisceration 8.8% (n = 13). We performed a digestive stoma in 61% (n = 89), a closure of the abdomen bolsters in 8.8% (n = 13), a suture in iatrogenic perforation in 13.5% (n = 20) and washing with drainage in patients with phoenix abscess in 17.6% (n = 26). Morbidity was 22.3% and 53.4% mortality. Conclusion: The diagnosis of post-operative peritonitis is difficult in a developing country. Morbidity and mortality is high. Improved diagnostic tools are needed.

Traumatic Perforation of the Small Intestine in General Surgery of the CHU Gabriel Touré  [PDF]
Alhassane Traoré, Bakary Tientigui Dembélé, Ibrahima Diakité, Adégné Togo, Lassana Kanté, Amadou Traoré, Madiassa Konaté, Boubacar Karembé, Abdoulaye Diarra, Amadou Bah, Boubacar Sidibé, Tany Koné, Astan Koné, Nouténé Koné, Djibo Mahamane Diango, Gangaly Diallo
Surgical Science (SS) , 2017, DOI: 10.4236/ss.2017.89045
Abstract: Goal: To determine hospital frequency, to describe the clinical and therapeutic aspects and to determine the prognosis. Patients and Methods: This was a retrospective and prospective study carried out in the General Surgery Department from 1 January 1999 to 31 December 2015. Inclusion criteria: 1) open or closed trauma of the abdomen with perforation of the small bowel; 2) clinical examination (abdominal pain, vomiting, fever, abdominal contracture, evisceration, intraoperative findings); 3) paraclinical examinations: pneumoperitoneum on the abdominal X-ray without preparation (ASP) and CT scan. Exclusion Criteria: Abdominal trauma without perforation of the small bowel. We selected 128 patients operated for traumatic perforation of the small bowel. The data was entered and analyzed using Word, Excel 2007 and Statistical Package and Social Science Windows 16.0. The statistical analysis consisted in the calculation of the different frequencies of the variables studied. We used the Khi2 test with significance level P < 0.05. Results: We recorded 119 men versus 9 women and the sex ratio was 13.22. The mean age was 25 years with extremes varying between 15 and 70 years. The majority of patients 57.7% (74 cases) came from the capital, 46.1% (59 cases) were workers, 26.6% (34 cases) of the students. The average time to admission was 29 hours. The main etiologies were road traffic accidents 36.7% (47 cases), stabbing 21.9% (28 cases), firearm 14.8% (19 cases), and sports accidents 10.1% (13 cases). The main clinical signs were abdominal pain 48.44% (62 cases), abdominal contracture 60% (76 cases), disappearance of pre-liver dullness 66.36% (84 cases), and Douglas painful 74.4% (94 cases). The abdominal X-ray without preparation (A.S.P) allowed to objectify a pneumoperitoneum in 45.31% and the scanner a liquid effusion in 45.31% with the associated lesions in 37.5% (48 cases). The surgical treatment consisted of 60.15% suture excision (77 cases), 25% anastomosis resection (32 cases) and a 15% stoma (19 cases). The average length of hospital stay was 9 days with extremes of 1 to 60 days. The morbidity was 10.15% at the site of surgical site (OS) infection 17.4% (8 cases), postoperative peritonitis 3.1% (4 cases) and evisceration 0.8% (1 case). Mortality was 17.18% due to septic shock and multivisceral failure. Conclusion: Traumatic perforation of the small bowel is an emergency. Young people are more victims. The prognosis depends on the speed of diagnosis and management. Emphasis should be
Prevalence and Factors Associated with the Anxio-Depressive Symptoms of the Families of Patients in Intensive Care Unit at Gabriel Toure University Hospital, Bamako, Mali  [PDF]
Almeimoune Abdoulhamidou, Mangane Moustapha, Diop Madane Thierno, Démbele Seydou Aladji, Kassogue André, Sogoba Youssouf, Dabo Aminata, Diallo Daouda, Diallo Boubacar, Souleymane Coulibaly, Diallo H. Seybou, Maiga Youssoufa, Diango Djibo Mahamane
Neuroscience & Medicine (NM) , 2018, DOI: 10.4236/nm.2018.93015
Abstract: Introduction: Hospitalization in intensive care is a source of stress and anxiety for close to the patients. Anxio-depressive symptoms appear to be common in intensive care and their prevalence is poorly evaluated. The objective of this study was to evaluate the prevalence of anxio-depressive symptoms in families. Materials and method: Observational prospective study in families of patients hospitalized in the intensive care unit for a period of 5 months. Symptoms of anxiety and depression were measured using Hospital Anxiety and Depression Scale (HADS) during hospitalization. Anxiety and depression were defined by a score greater than 10. Factors associated with the onset of anxious-depressive symptoms were sought. The prevalence of post-traumatic stress disorder in close relatives was measured by the Impact Event Scale-Revised scale (IES-R). Results: A total of 107 patients were admitted to the intensive care unit, of which 49 families agreed to participate in our study. Overall mortality was 32.2% during this period. Fifty-eight (58) patients were not included for the following reasons: death or hospitalization of less than 48 hours, refusal of families, institution, and lack of parents speaking French. Forty-nine (49) relatives completed the HADS questionnaire. Forty-three families completed the IES-R questionnaire, a return rate of 87.7%. The prevalence of anxiety was 61.2% among parents in early hospitalization. The level of anxiety was significantly associated with male parents (p = 0.035) and those with lower education (p = 0.046). The prevalence of depressive symptoms in parents was evaluated 53% at D3. Education level (p = 0.048) and male parents (p = 0.048) appeared to be a significant depression factor. The prevalence of post-traumatic stress disorder was 55.1% among the relatives of the patients. The lack of co-morbidity in admission patients was significantly associated with the occurrence of post-traumatic stress disorder in the family. Conclusion: The prevalence of anxiety and depression symptoms was high in our study. Men were at greater risk of developing these symptoms. The parents of the patients carburized appear as a population with higher risk manifestation of psychological disorders; further research is needed in this group.
Blows and Voluntary Wounds of the Emergency Unite in Gabriel Toure Teaching Hospital in Bamako  [PDF]
Mangané Moustapha, Diop Thierno Madane, Almeimoune Abdoul Hamidou, Keita Soumaila, Dembelé Aladji Seydou, Youssouf Sogoba, Konaté Madiassa, Koita Siriman, Traoré Amadou, Issa Amadou, Badimi Siaka, Abdoulaye Kanté, Diallo Sadio, Sangaré Harouna, Dembelé Bakary Tientigui, Togo Adegné, Diango Djibo Mahamane
Surgical Science (SS) , 2018, DOI: 10.4236/ss.2018.99040
Abstract: Introduction: Voluntary assault and injuries are acts that damage the physical and psychological integrity of a human being. WHO in its global report on violence and health estimates that in 2000, 1.6 million people worldwide died as a result of self-harm, interpersonal or collective violence, resulting in an overall rate adjusted by age of 28.8 per 100,000 population. Because of the seriousness of this phenomenon and the heavy socio-economic and health consequences that they generate, it seemed important to us to undertake this study, which aimed to study the deliberate injuries in the emergency unite of the Gabriel Touré Teaching Hospital in Bamako. Material and methods: This was a descriptive and cross-sectional study with a prospective study from September 1st, 2016 to August 31st, 12 months, covering 295 patients, including any patient received for voluntary injury consultation with a workable medical record and/or a full investigation record with or without requisition. Our data were collected on individual survey cards and subsequently analyzed with Word, Excel, IBM SPSS Statistics 22 software. Results: The majority of victims of assault and bodily injury were male with 83.1%; with a sex ratio of 4.9, the 18 to 28 age group was the most concerned with 163 cases of the 295 cases in our study, 55.2%. The extremes were 6 and 100 years old with an ectype at 11.08. The most affected ethnic group was Bambara with 38.6% (n = 114) followed by Fulani with 15.6% (n = 46). Students were the most affected at 24.7% (n = 73), followed by traders at 10%. The victims coming from outside Bamako are the most predominant with 22.4% (n = 66) followed by those of commune IV of Bamako 15.6% (n = 46). In 92.2% of the cases the mechanism was direct with n = 272. Of the lesions recorded in our study, wounds came first with 53.2% of cases. Radiography was the most used imaging at 44.7% (n = 89) followed by computed tomography at 34.7% (n = 69). The hemoperitoneum objectified by abdominal ultrasound represented 29.3% (n = 12). Fractures embarrure associated with bruising-hemorrhagic bruises were the most predominant with 13.4% (n = 10) objectified by brain scan. Conclusion: We note that the phenomenon of violence has reached worrying proportions, especially among young adults, particularly among students and is observed in all so-cio-professional layers. The polymorphism of these injuries caused by the predominant use of knives must draw the attention of our authorities to take measures to reduce these
Giant Intracranial Arachnoid Cyst Causing Acute Neurologic Symptoms  [PDF]
Youssouf Sogoba, Boubacar Sogoba, Seybou Hassane Diallo, Drissa Kanikomo, Djenè Kourouma, Oumar Coulibaly, Issa Amadou, Moustapha Mangané, Hamidou Almeimoune, Madani Thierno Diop, Youssoufa Maiga, Broulaye Samaké, Djibo M. Diango
World Journal of Neuroscience (WJNS) , 2018, DOI: 10.4236/wjns.2018.83029
Abstract: Intracranial arachnoid cysts (IAC) are benign lesions containing cerebrospinal fluid (CSF). Most of them are clinically silent and remain static in size. However some may present with mild and slow progressive symptoms caused by the cyst. The authors present the case of 54-year-old woman who presented with acute symptoms of severe headache, vomiting, and gait disturbance of 2 day’s duration. She had no history of head trauma. On admission, neurological examination revealed that the patient had a Glasgow Coma Scale score of 15, and a left side hemiplegia. A CT scan revealed a hypodense fluid collection in the right frontoparietal region that mimicked an arachnoid cyst. The symptoms were improved after an emergency marsupialisation via craniotomy.
Management of Spinal Schwannomas in Gabriel Touré Hospital: Review of 11 Cases  [PDF]
Youssouf Sogoba, Boubacar Sogoba, Drissa Kanikomo, Seybou Hassane Diallo, Djenè Kourouma, Oumar Coulibaly, Issa Amadou, Moustapha Mangané, Hamidou Almeimoune, Madani Thierno Diop, Youssoufa Maiga, Broulaye Samaké, Djibo M. Diango
Surgical Science (SS) , 2018, DOI: 10.4236/ss.2018.98031
Abstract: Background: Spinal schwannomas are common tumors of spinal neoplasm and account for about 25% of intradural spinal cord tumors in adults. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. In this report, the authors present the incidence, clinical presentation, localization, and results of surgically treated spinal schwannomas. The results of a literature review are also presented. Methods: Eleven consecutive patients with histologically confirmed spinal schwannomas were treated from January 2013 to December 2016 in the neurosurgical department of Gabriel Touré Hospital, Bamako, Mali. Neuroradiological diagnosis was made, CT scan in 7 patients, and MRI in 4 patients. All patients were operated on via the posterior approach. All cases were surgically excised, and they were confirmed to be schwannomas by pathologists. The patients were followed for 6 to 38 months (mean 28 months). Functional outcome was assessed using the motor grade and sensory change. Results: There were 11 patients with 7 (63.6%) males and 4 (36.4%) females. The mean age was 40.3 years (range 23 - 62 years). The most common symptom at the time of diagnosis was radicular pain in 9 (81.8%) patients followed by motor weakness in 8 (72.7%) patients. The most frequent site of spinal schwannomas was the thoracic region in 5 (45.5%) patients. During surgery, Gross-total resec-tion was achieved in 8 patients (72.7%) and subtotal removal in 3 (27.3%) patients. Histological findings were benign schwannoma in all cases. Postoperative complications developed in two patients, including one with cerebrospinal fluid leakage and other one with wound infection. In the short-term follow-up period, most of the patients (90.9%) appeared to be improved in comparison with their preoperative neurological status. There was no operative mortality. Conclusion: In this study, the clinical manifestations and surgical results of 11 cases of spinal schwannoma have been reviewed. Early diagnosis and appropriate treatment are essential for good outcome.
Surgical Repair of Encephaloceles in Gabriel Touré Hospital: Review of 17 Cases  [PDF]
Youssouf Sogoba, Drissa Kanikomo, Boubacar Sogoba, Djenè Kourouma, Oumar Coulibaly, Issa Amadou, Seybou Hassane Diallo, Moustapha Mangané, Hamidou Almeimoune Maiga, Madani Thierno Diop, Belco Maiga, Leonie Diakité, Fousseyni Traoré, Youssoufa Maiga, Yacaria Coulibaly, Broulaye Samaké, Djibo M. Diango
Open Journal of Modern Neurosurgery (OJMN) , 2018, DOI: 10.4236/ojmn.2018.84033
Abstract: Background: Encephaloceles are congenital neural tube defects characterized by the protrusion of meninges and/or brain tissue from a defect in the skull. The incidence of the disease is about 0.8 - 5.6/10,000 live births. They are classified based on the location and type of skull defect as occipital encephalocele, encephalocele of the cranial vault, frontoethmoidal encephalocele, and basal encephaloceles. Surgical reduction being the first line treatment and resection of herniated structures may be necessary when the encephalocele is large. In the present study, the authors present their experience in treating 17 patients with encephaloceles. Methods: This study is a retrospective analysis of 17 patients from January 2013 to December 2016 in Gabriel Touré Hospital, Bamako, Mali. A history was obtained from the family at presentation. Medical information before and during the pregnancy was compiled. All patients underwent CT scan as a routine preoperative imaging study, to evaluate the encephalocele and to plan the surgical procedure. The following data were recorded for analysis: age, sex, location of encephalocele, neurological status, operative method, postoperative complications and surgical results. Results: There were 10 (58.8%) female and 7 (41.2%) male patients. The patients ranged in age from 3 days to 36 months. The most common site of encephalocele sac was the occipital region in 14 (82.4%) cases followed by the frontal region in 2 (11.8%) cases and the vertex in 1 (5.9%) case. The sac size was less than 3 cm in 5 (17.6%) cases, 3 - 5 cm in 8 (47.1%) cases and more than 5 cm in 4 (23.5%) cases. Three (17.6%) children presented with CSF leakage. Hydrocephalus was present in the preoperative period in 6 (35.3%) cases; all of them required VP shunt procedure. None of the cases had a preoperative neurologic deficit. Surgical excision was performed in all cases. In the postoperative period, meningitis developed in 2 cases (11.8%), wound infection in 1 case (5.9%) and seizure in 1 case (5.9%). Three patients (17.6%) died during postoperative follow-up. Postoperative hydrocephalus occurred in 1 (5.88%) patient requiring a VP shunt. Conclusion: Encephaloceles are commonly seen in the practice of neurosurgery in the world as well as in Mali. In this study, the clinical manifestations and surgical results of 17 cases have been reviewed. We recommend early repair and excision of encephaloceles to avoid rupture or skin excoriation.
New Rapid Diagnostic Tests for Neisseria meningitidis Serogroups A, W135, C, and Y
Suzanne Chanteau ,Sylvie Dartevelle,Ali Elhadj Mahamane,Saacou Djibo,Pascal Boisier,Farida Nato
PLOS Medicine , 2006, DOI: 10.1371/journal.pmed.0030337
Abstract: Background Outbreaks of meningococcal meningitis (meningitis caused by Neisseria meningitidis) are a major public health concern in the African “meningitis belt,” which includes 21 countries from Senegal to Ethiopia. Of the several species that can cause meningitis, N. meningitidis is the most important cause of epidemics in this region. In choosing the appropriate vaccine, accurate N. meningitidis serogroup determination is key. To this end, we developed and evaluated two duplex rapid diagnostic tests (RDTs) for detecting N. meningitidis polysaccharide (PS) antigens of several important serogroups. Methods and Findings Mouse monoclonal IgG antibodies against N. meningitidis PS A, W135/Y, Y, and C were used to develop two immunochromatography duplex RDTs, RDT1 (to detect serogroups A and W135/Y) and RDT2 (to detect serogroups C and Y). Standards for Reporting of Diagnostic Accuracy criteria were used to determine diagnostic accuracy of RDTs on reference strains and cerebrospinal fluid (CSF) samples using culture and PCR, respectively, as reference tests. The cutoffs were 105 cfu/ml for reference strains and 1 ng/ml for PS. Sensitivities and specificities were 100% for reference strains, and 93.8%–100% for CSF serogroups A, W135, and Y in CSF. For CSF serogroup A, the positive and negative likelihood ratios (± 95% confidence intervals [CIs]) were 31.867 (16.1–63.1) and 0.065 (0.04–0.104), respectively, and the diagnostic odds ratio (± 95% CI) was 492.9 (207.2–1,172.5). For CSF serogroups W135 and Y, the positive likelihood ratio was 159.6 (51.7–493.3) Both RDTs were equally reliable at 25 °C and 45 °C. Conclusions These RDTs are important new bedside diagnostic tools for surveillance of meningococcus serogroups A and W135, the two serogroups that are responsible for major epidemics in Africa.
Evaluation and use of surveillance system data toward the identification of high-risk areas for potential cholera vaccination: a case study from Niger
Jose Guerra, Bachir Mayana, Ali Djibo, Mahamane L Manzo, Augusto E Llosa, Rebecca F Grais
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-231
Abstract: We evaluated the cholera surveillance data using a standard CDC protocol, through interviews with heads of the system, and a review of cholera data collected between 2006–2009. The surveillance system was found to be sufficiently reliable to be able to utilize the data for the detection of high risk areas for cholera vaccination. Temporal, geographic and socio-demographic analyses of cholera cases indicated that between 2006 and 2009, 433 cholera cases were reported in the Maradi region of Niger. Two deprived neighborhoods of the region’s capital city, Bagalam and Yandaka, represented 1% of the regional population and 21% of the cholera cases, reaching a yearly incidence rate of 3 per 1000 in 2006 and 2008, respectively.The results of this evaluation suggest that the reporting sensitivity of the surveillance system is sufficient, to appropriately classify the region as cholera endemic. Additionally, two overcrowded neighborhoods in the regional capital met WHO criteria for consideration for cholera vaccination.In 2008, Africa accounted for 94% of the cholera cases reported to the World Health Organization (WHO). Niger reported a small fraction of these cases, although certain areas of the country face repeated epidemics [1,2]. From 2000 to 2008, Niger reported cholera outbreaks every year, mainly in the south of the country and totaling close to 6000 cases [2]. The region of Maradi has the highest population density in the country and regularly reports cholera cases [2].Two safe and effective oral cholera vaccines (Dukoral and Shanchol) are now available and prequalified by WHO [3-5], with some evidence of induced herd immunity [6,7]. To optimize implementation in cholera-endemic areas, WHO guidance recommends targeting oral cholera vaccination to areas where culture-confirmed cholera has been detected in at least 3 of the past 5?years; and incidence rates are at least 1/1000 population in any of these years or high-risk areas or groups have been identified using in
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