Clinical, paraclinical and genetic aspects of autosomal recessive cerebellar ataxias (ARCA) in Mali

Introduction

Autosomal recessive cerebellar ataxias (ARCA) are a group of rare and heterogynous neurodegenerative diseases mainly characterized by unbalance and walking difficulty and movement incoordination.

Objectives

To clinically and paraclinically characterize ARCA in the department of Neurology at the Teaching Hospital of Point G and identify the underlying genetic defect.

Patients and method

We have conducted a longitudinal and prospective study from January 2018 to December 2020. Patients with ARCA phenotype seen in the Department of Neurology at the Teaching Hospital of Point "G" were enrolled.

Results

We have enrolled 7 families totaling 13 patients after giving an informed verbal and written consent. The sex ratio was 2.2 in favor of males, Kayes region and Fulani ethnic group were respectively the most represented region and ethnic group.Walking difficulty represented the major symptom followed by loss of vibration and joint sense, nystagmus, dysarthria and skeletal deformities. Alpha-foetoprotein level was high in one patient. Genetic testing confirmed Friedreich ataxia in one family and was not conclusive in 4 families.

Conclusion

This study showed that ARCA are not uncommon in Mali and genetic testing is crucial to confirm the diagnosis.

[Progressive myoclonic epilepsy in the department of neurology of the University Teaching hospital Point "G"]

Background

Progressive Myoclonic Epilepsy (PME) is a heterogeneous group of pathologies associating epileptic seizures and other neurological and non-neurological disorders.

Objectives

We aim to characterize patients with symptoms of PME and identify the underlying genetic disorder.

Methods

After informed consent, the patients seen in the protocol for hereditary neurological diseases and presenting signs of epilepsy without a secondary cause were clinically evaluated over a three-year period in the Department of Neurology of the CHU Point "G". EEG, brain imaging and laboratory tests were performed to consolidate our diagnosis. DNA was extracted for genetic analysis.

Results

141 families including five families with PME totaling eight cases were enrolled. The predominant symptoms in our patients were myoclonus in 87.5% (N = 8), followed by GTCS and cognitive impairment in 50%, each. A notion of parental consanguinity was found in 60% and autosomal recessive transmission evoked in 80% (N = 5). The EEG was pathological in 62.5% and imaging showed ponto-cerebellar atrophy in 25% (N = 8). The combination of sodium valproate and clonazepam was the main treatment. One case of death was recorded.

Conclusion

We report cases of PME in Mali with a possibility of discovering new genes.

[Infection with the Hepatitis B virus in pregnant women in the Gynecology and Obstetrics Department of the Gabriel Touré University Hospital Center]

PURPOSE

The purpose of this study was to study hepatitis B virus infection in pregnant women.

METHOD

This was a one-year descriptive cross-sectional study carried out in the Gynecology-Obstetrics Department of the Gabriel Touré University Hospital.

RESULT

During this period, 796 pregnant people were seen in antenatal consultations. Ween rolled 500 pregnant women in whom the search for HBs Ag was carried out, a rate of 62.81%. Of these pregnant 85 had HBs Ag a prevalence of 17%. The average age of these women was 26.9±5.6 years. Our patients were paucipare sin 52.9%. Of these, 17.7% had a family history of chronic liver disease and 37.6% had once given birth in a referral health centre. Blood transfusion, polygamous focus and tattooing/scarification were the risk factors associated with HBs Ag carriage. Alarming clinical signs were absent in 95.2% of cases. Hepatic cytolysis and anaemia were foundin 28.8% and 76.3% of cases respectively; viral replication was observed in 13.6% of pregnant women with a high viral loadin 37.2%. Abdominal ultra sound was normal in 90.8% of cases and esophageal varices were present in 6% of women who performed eso-gastroduduedenal fibroscopy. Fibrosis was significant according to an APRI score in 3.4%.

CONCLUSION

The prevalence of HBs A in pregnant women followed remains high.

[Clinical and laboratory features of recessive Limb Girdle Muscular dystrophies in the Department Neurology of University Hospital of Point G]

INTRODUCTION

Limb-Girdle Muscular dystrophies (LGMD) is a group of inherited diseases characterized by predominantly proximal and limb muscle weakness. These are rare diseases that have not been well studied in sub-saharan Africa. The aim of our was the clinical and paraclinical characterization of patients with recessive LGMD at the Department of Neurology of the Teaching Hospital of Point G.

PATIENTS AND METHODS

We conducted a longitudinal prospective study which took place from March 2014 to May 2019. Patients with recessive LGMD phenotype were enrolled. Sociodemographic, clinical and laboratory data were analyzed.

RESULTS

We enrolled 46 families (67 patients), i.e. a frequency of 16.7% among the neurodegenerative diseases seen in the service. Among them, 45.6% came from the Sikasso region. Autosomal recessive inheritance pattern was suspected in 67.4% of the families. Symptoms appeared mainly in the first decade of life. Proximal muscle weakness was found in almost all patients. Cardiac examination showed dilated cardiomyopathy in 4.5% of cases.

CONCLUSION

Limb-Girdle muscular dystrophy is a disabling disease that is found in Mali. Further study of these cases could elucidate the underlying genetic defects.

[Factors associated with mental disorders in the psychiatric department of the university hospital centre of Point G in Mali.]

INTRODUCTION

Mental health is a state of equilibrium and well-being, any alteration of which leads to the appearance of a state of distress and/or mental disorder.

OBJECTIVE

The objective of this work was to study familial and environmental factors associated with mental disorders.

MATERIALS AND METHODS

A cross-sectional study was conducted in the Psychiatry Department of the Point G University Hospital Center from April 1, 2016 to March 31, 2017 among outpatients with a psychiatric disorder in whom factors associated with psychiatric disorders were studied.

RESULTS

We included 288 patients. The median age was 33.0 years. The sex ratio was 1.88 in favor of males. Married patients accounted for 45.5%. First born uterine siblings accounted for 26.7%. Patients born of an inbreeding alliance accounted for 25.7%. Cases with a family history of a psychiatric disorder represented 59.0% and those who spent their childhood with their parents accounted for 64.2%. Cases of psychoactive substance use prior to the onset of the mental disorder accounted for 42.7%. The main psychosocial stress factors that preceded the onset of the mental disorder were grief (46.2%) and family conflict (22.6%). Psychotic disorders accounted for 77.8%.

CONCLUSION

Our results show an association of mental disorders with family history of psychiatric disorder among patients followed in psychiatry. Further studies, such as genetic association may prove useful.

[Epidemiology and prognosis of eclampsia in Bougouni]

OBJECTIVES

The objectives were to describe the epidemiological and prognostic aspects of eclampsia in the Bougouni reference health center.

METHODS

This was a transversal prospective, descriptive study from January 1 to December 31, 2015 in the gynecology-obstetrics department of Bougouni reference health center. Were included, all pregnant or postpartum women diagnosed with eclampsia during the study period.

RESULTS

The frequency of eclampsia was 2.54%. They were adolescent girls in 50% of cases, primigest in 62.5% of cases, unschooled in 67.5% of cases, having not performed any antenatal care in 70% of cases. Eclampsia occurred in antepartum in 37.5% of cases, in 5% in perpartum and in 57.5% in postpartum. Therapeutically, nicardipine with 72.5% and nifedipine with 22.5% were the antihypertensive drugs used. As for anticonvulsants, magnesium sulfate (MgSO4) was used in 92.5% and diazepam in 7.5%. The maternal-fetal prognosis was marked by 2.5% of maternal death, 27% of prematurity and 27.5% of fetal death in utero.

CONCLUSION

Eclampsia is a dreadful pathology with serious maternal and fetal complications.

[Materno-Fetal Prognosis Of Anemia In Bougouni]

GOAL

The goal was to assess the maternal-fetal prognosis of anemia in pregnant women in the Bougouni reference health center.

METHODS

We carried out a prospective descriptive and analytical cross-sectional study from January 1 to December 31, 2013 at the Bougouni reference health center. It covered all pregnant women with a hemoglobin level below 11g/dl regardless of the outcome of the pregnancy.

RESULTS

The prevalence of anemia in pregnant women was 33.2%. They were women married to peasants in 88.6% of cases, unschooled in 93.2% of cases, having not done antenal care in 56.8% of cases. Malaria was the most common etiology in 75% of cases. Anemia was severe in 61.4% of cases. The maternal-fetal prognosis was dominated by 3.3% of maternal death, 12.5% of abortion, 7.6% of prematurity and 6.8% of fetal death in utero.

CONCLUSION

Anemia in pregnant women is the source of many maternal-fetal complications.

[Infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré]

OBJECTIF

the purpose of this work was to study the infections associated with the care in the department of gynecology - obstetrics of the University Hospital Center Gabriel Touré (CHU G. Touré).

PATIENTS AND METHODS

This was an epidemiological, descriptive, and analytical study carried out in the gynecology-obstetrics department of G. Touré University Hospital, from April 11, 2016 to August 29, 2016 (4 monthset 18 days), with a prospective collection of data that focused on the characteristics clinical and laboratory-based care-associated infections in patients during their hospitalization. Included in the study were all hospitalized patients (operated or not) in the gynecology obstetrics department, who agreed to participate in the study. The criteria used to diagnose the infection associated with care were those of the CDC Atlanta and making a thick drop in our context. Operative wound monitoring was performed until the 30th postoperative day.

RESULTS

We recorded 200 patients, including 138 operated and 62 nonoperated patients, of which 30 patients developed a care-associated infection at a rate of 15%. The mean age of the patients who presented an infection was 32.52 years ± 13.36 years against 29.36 years ± 10.28 years for the patients who did not present the infection. Seven point five percent of the evacuees had an infection associated with care. The most common types of infections were surgical site infection with 56.60% followed by malaria with 23.30% and urinary tract infection with 20.00%. Escherichia coli and Acinetobacter baumaniiwere the most recovered germs. Isolated organisms were 100% resistant to Amoxicillin, 88.88% were resistant to Ciprofloxacin and 77.77% were resistant to Amoxicillin + Clavulanic acid. The average duration of hospitalization for patients who developed the infection was 14.70 days with extremes of 5 and 46 days. The mortality rate was 1.50%. The average cost of management of patients who developed the infection was 119837 FCFA; the extremes were 17750 and 825750 FCFA and the standard deviation of 174998 CFA francs.

CONCLUSION

the infections associated with the care remain frequent in our service and dominated by the infections of the operating site. The isolated organisms were all 100% resistant to Amoxicillin in 88.88% Ciprofloxacin.

[Pregnancy and delivery for women aged 40 years and over at the reference health center of commune II of Bamako district, Mali]

GOAL

The aim of this study was to compare the maternal-fetal prognosis of pregnancies at 40 years of age and above with that of pregnancies obtained before 40 years of age in the obstetric gynecology department of the reference health center of commune II of Bamako district.

MATERIALS AND METHODS

This was a prospective cohort study that was conducted at the maternity ward of Reference Health Center of Commune II of Bamako district from 1st January to 31 December 2012. Were included in our study as patients exposed, all the pregnant women of 40 years and over and as unexposed patients, pregnant women aged 20-39 who gave birth in our service. Teenage pregnancies were not included in this study. The statistical tests used were Pearson's Khi2 and Fisher's test with a significance level of 5%.

RESULTS

The frequency of pregnancy among women aged 40 and over was 1.68%. These were large multiparas unschooled patients in 60% of cases, with hypertension in 6.7% of cases. Pregnancy in her patients was associated with a high rate of caesarean section in 16.7% of cases, term overrun in 6.7% of cases, seat presentation in 6.7% of cases, macrosomia in 6.7% of cases and fetal malformation in 1.7% of cases.

CONCLUSION

Slight account of its many maternal-fetal complications, pregnancies in women 40 years and older deserve special attention.

Pulmonary tuberculosis among diabetic patients in internal medicine at point g hospital, bamako - mali

Summary The depression of cellular immunity among diabetic patients exposes them to tuberculosis considered as one of the major diseases of immune-depressive people. The purpose of our study was to evaluate the frequency, gravity, treatment and evolution of pulmonary tuberculosis among our patients affected with diabetes. For that purpose, two descriptive retrospective and prospective studies were undertaken from January 1982 to December 1992 in the Internal Medicine (Internal medicine) department of Hospital of Point G, the national hospital. Thus, 54 diabetics patients hospitalised out of 1 365 had tuberculosis at a frequency rate of 3,95%. The average age of our patients was 49 years +/- 12 and the sex ratio was 2,18 in favour of men. The infection was also more frequent in diabetes type 1 (51,9%) then in type 2 (48,1%), and concerned mainly men (68.51%) who were more than 37 years old (57.41%). Clinically, the common signs to both affections were prevalent namely asthenia: 85,2%, anorexia: 53,7%, weight loss: 66,7%, associated to cough: 81,5% and to dyspnea: 29,6%. However, for a third of the patients (22,2%), tuberculosis was discovered during a systematic check up. All the patients had a glycemia higher than 8mmol/l, with extremes up to 8mmol/l and 32mmol/l, 63% of patient had a febricula. The intradermo cutaneous reaction to tuberculosis (IDR) was negative in 44,4%. The bacilloscopy during direct testing or through the liquid obtained by casing was positive in 64,82%. Tubercular lesions were localised at the top: 91,8%, with an equal attack of the two lungs. During the treatment six products were mainly used comprising Rifampicine (R) isoniazid (INH or H), Streptomycine (S), Ethambutol (E), Thiacetazone (T), and Pyrazinamide (Z). Insulin treatment was done on all patients until tuberculosis was cured. The evolution was favourable after 2 to 3 months of treatment for 48 patients (88,88%) among whom 4: (8,33%) fell sick again. Six patients out of 54 died, i.e. 11,12%.

Schistomiasis morbidity to hospital ward of hospital of point g in Bamako - Mali

Summary Aims The coinfection of the VIH and the schistosomiasis is affections brought back in schistosomiasis endemic area. We valued the level of morbidity partner to the schistosomiasis in hospital yard to patients hospitalized without distinction of immunological statute of patients. Patients and Methods Our study was retrospective and prospective. We included all patients hospitalized to internal Medicine and infectious diseases carriers of schistosomiasis to the mucous rectal biopsy and parasitologic exam of stools and urines between January 1998 and July 2005. Results Twenty-four patients were included in the survey of which 15 of masculine sex (62,50%) and 9 of feminine sex (37,50%). The sex ratio (H/F) = 1,66. The most tainted professions were pupils, peasants and housewives. Ten patients had benefited from the VIH tracking (41,66%) and 6 patients were seropositive for the VIH (25%). Sixty fifteen percent of patients accommodated Schistosoma haematobium (18 cases), 20,83% Schistosoma mansoni (5 cases) and 1 patient had a mixed infection. It doesn't exist a statistically difference between the frequency of species met (p = 0,061) . The main motives of hospitalization were the fever (12,50%), the hepatomegaly and splenomegaly, the ascite, the abdominal pain associated to the diarrhea and the diarrhea associated to an anemic syndrome with 8,20% for each of these motives. The most frequent clinical symptomatology was diarrhea (12,50%). The underlying pathologies more associated were the opportunist infections of the VIH (8,30%) the cirrhosis (12,50%), a syndrome amoebic dysentery syndrome (8,30%), a hepatic granuloma (8,30%). In the group of patients HIV positive the symptomatology was made of chronic and /or of glair - bloody diarrhea. One alone patient with a rate of CD4 = 279/mm3 presented prurigos in bouquet on the right flank. All patients without immunological statute distinction answered favorably to the treatment by the praziquantel. Conclusion The schistosomiasis stays even frequent in hospital yard of Bamako. The best understanding of the interaction between HIV and schistosomiasis is a pledge of the success of struggle programs in endemic area of schistosomiasis and of VIH.

Pulmonary tuberculosis among diabetic patients in internal medicine at Point G Hospital, Bamako - Mali

The depression of cellular immunity among diabetic patients exposes them to tuberculosis considered as one of the major diseases of immune-depressive people. The purpose of our study was to evaluate the frequency, gravity, treatment and evolution of pulmonary tuberculosis among our patients affected with diabetes. For that purpose, two descriptive retrospective and prospective studies were undertaken from January 1982 to December 1992 in the Internal Medicine (Internal medicine) department of Hospital of Point G, the national hospital. Thus, 54 diabetics patients hospitalised out of 1 365 had tuberculosis at a frequency rate of 3,95%. The average age of our patients was 49 years + 12 and the sex ratio was 2,18 in favour of men. The infection was also more frequent in diabetes type 1 (51,9%) then in type 2 (48,1%), and concerned mainly men (68.51%) who were more than 37 years old (57.41%). Clinically, the common signs to both affections were prevalent namely asthenia: 85,2%, anorexia: 53,7%, weight loss: 66,7%, associated to cough: 81,5% and to dyspnea: 29,6%. However, for a third of the patients (22,2%), tuberculosis was discovered during a systematic check up. All the patients had a glycemia higher than 8mmol/l, with extremes up to 8mmol/l and32mmol/l, 63% of patient had a febricula. The intradermo cutaneous reaction to tuberculosis (IDR) was negative in 44,4%. The bacilloscopy during direct testing or through the liquid obtained by casing was positive in 64,82%. Tubercular lesions were localised at the top: 91,8%, with an equal attack of the two lungs. During the treatment six products were mainly used comprising Rifampicine (R) isoniazid (INH or H), Streptomycine (S), Ethambutol (E), Thiacetazone (T), and Pyrazinamide (Z). Insulin treatment was done on all patients until tuberculosis was cured. The evolution was favourable after 2 to 3 months of treatment for 48 patients (88,88%) among whom 4: (8,33%) fell sick again. Six patients out of 54 died, i.e. 11,12%.