[Epidemiological and prognostic aspects of obstructive renal deficiency in the nephrology department of the Point "G" hospital, Bamako, Mali]

INTRODUCTION

Obstructive renal failure or obstructive uropathy is an entity defined by the simultaneous presence of impaired renal function and dilated urinary excretory pathways in medical imaging. It accounts for 2 to 10% of the causes of acute renal failure (ARF). The purpose of this work was to evaluate the prevalence of this condition in our department.

METHOD

This was a retrospective study conducted from January 1, 2017 to June 30, 2018 in the said department. The parameters studied were age, sex, etiology, type of renal failure, actions performed, surgical results of the procedure, creatinine level before and after management, and death rate.

RESULTS

obstructive renal failure accounted for 7.32% of all hospitalizations during the study period. The sex ratio was 1.86 in favor of men. The average age was 48.99 ± 6.81 years with extremes of 7 and 102 years. The etiologies were dominated by lithiasis (43.4%). Renal failure was acute and chronic in 20.5% and 54.2% of cases, respectively. It was indeterminate in 25.3% of cases. The obstructive character of renal failure has been confirmed in medical imaging. Lithiases accounted for 43.4% of cases. For therapeutic management, our patients received urinary catheterization (38.6%), nephrostomy (34.9%), urological surgery (22.9%) and hemodialysis (22%). The evolution was favorable in 59% of the cases.

CONCLUSION

Obstructions of the upper urinary tract are becoming more frequent in our medical practice. They occur mainly in patients with lithiasis. There is a large proportion of kidney failure requiring hemodialysis.

[Prevalence of the kidney disease at the emergency department of hospital Fousseyni Daou of Kayes]

INTRODUCTION

Kidney disease (KD) is defined as a set of functional, morphological and histological kidney abnormalities. It is a truly global public health problem. Its prevalence is estimated to be 50 times that of end-stage renal disease (ESRD). In Kayes, there is no data on the prevalence of kidney disease, hence the interest of this study.

OBJECTIVES

to determine the prevalence of renal disease, its main causes and the main factors of aggravation of this pathology in the emergency department at hospital Fousseyni DAOU of Kayes.

METHODOLOGY

Retrospective cross-sectional study carried out from January 1, 2014 to February 1, 2015. We included all hospitalized patients in whom a renal damage marker (elevation of plasma creatinine, urinary sediment abnormality, ultrasound, histology and significant proteinuria) has been found.

RESULTS

the prevalence of kidney disease was 9.9% (109/1099). Eighty-nine met the inclusion criteria. The study population was composed of 47 women (52.8%) and 42 men (47.2%), with a sex ratio of 0.89 in favor of women. The average age was 40.09 years with a predominance of patients in the age group [40-59]. The main reasons for consultation were hypercreatininaemia (48.3%), edematous syndrome (16.9%), low back pain (10.1%). High blood pressure (55.1%) and lower extremity edema (46.1%) were the medical history frequently found in our study. The kidney disease found was in order of growth: chronic renal failure (51%); acute renal failure (28%); proteinuria (16%), hematuria (3%), morphological abnormality of the kidneys (2%). Tubulointerstitial nephropathy represented 64% of acute renal failure with P = 0.000306. Vascular nephropathy constituted 46.7% of chronic renal failure with P = 0.000251. No cases of glomerular nephropathy were found in patients over 60 years of age.The most common causes were represented by nephrotoxic drugs injuries; infectious; high blood pressure and diabetes. The most observed aggravating factors are herbal medicine, urinary tract infections, renal hypoperfusion and unbalanced hypertension.

CONCLUSION

kidney disease is not uncommon in the emergency room at Hospital Fousseyni Daou of Kayes. The most common causes are nephrotoxic drugs, hypertension and diabetes.

[Acute renal failure due to covid-19: about the two cases in Mali]

The kidney is one of the target of Covid-19. Damage may present itself as acute renal failure (5-35% of patients), hematuria (30-40%) and/or proteinuria (40-65%). We report the first couple cases of acute renal failure due to Covid-19 in Mali : a 63years old woman and a 60years old man, both black and diabetics. The circumstances of discovery of renal failure were oliguria in both cases and total macroscopic hematuria for the man.

CONCLUSION

The kidney damages become more and more frequent during Covid-19 infection. We suggest that they should be systematically investigated as soon as the diagnosis of this infection is made.

[Epidemiological, clinical profile and outcomes of chronic hemodialysis patients in the Nephrology and Hemodialysis Department of the CHU du Point "G"]

AIM

Hemodialysis is the only method of renal replacement in Mali. Purpose of this work: to study the evolution of chronic hemodialysis.

PATIENTS AND METHODS

In a retrospective study, we used the medical charts of 150 patients. The studied parameters were the epidemiology and clinic profile of patients, the risk factors, the quality and the impact of the benefits on the survival. The data were analyzed on SPSS 12.0 for Windows with p <0.05 as the significance value.

RESULTS

The mean age was 40.45 years (15 years and 77 years). Patients have a low income in 60%. The hemoglobin level was less than 9 g/l in 63.3%. Kidney vascular disease was the most frequent causes in 42%. Hyperphosphataemia was found in 38.6%. The lipid balance was disturbed in 73.9%. A central catheter was used directly in 78.7%. The mortality rate was of 37.3%. The death was due to hypertrophic cardiomyopathy in 35.5% (p = 0.002). Low hemoglobin (p = 0.0002), central catheterization (p=0.008), cardiovascular complications (p= 0.007) and hemodialysis duration (p = 0.00001) are the risk factors for high mortality.

CONCLUSION

The duration of life in hemodialysis remains linked to the complications of renal damage and early management.

[Erectile Dysfunction In Chronic Hemodyalized Patients, Clinical And Epidemiological Aspects In Nephrologic Department Of Point "G" Hospital Teaching Center]

Erectile dysfunction is a common pathology in the general population. The frequency of these erectile disorders is increased in some particular populations such as patients with renal impairment in which it is estimated between 50% and 70% depending on the stage of renal failure.

AIMS

Our study aims to study erectile dysfunction in chronic hemodialyzed male patients.

METHOD

This is a descriptive prospective study carried out during the period from April 3 to August 31, 2017 having covered 65 chronic hemodialyzed patients for more than 12 months.

RESULT

In our study the prevalence of DE was 70.8% and moderate in 13.8%, severe in 30.8%, mild in 26.2%. Testosteronemia was normal in 83.1% of cases and significantly lower in patients with sexual disorders p = 0.030. Libido disorders were observed in 57% of our patients and significantly related to a decrease in testosteronemia p = 0.001. Vascular nephropathy was the most common etiology, i.e. 50.8% of cases followed by chronic Glomerulonephritis 24.6% and in 13.8% of cases no underlying etiology was found.

[Mortality in the hemodialysis unit of the Gavardo hospital in sebenikoro]

INTRODUCTION

Chronic kidney disease (CKD)is a serious public health problem in Africa with regard to mortality associated with it. According to global hospital data, CKD is involved in 4-22% of deaths in tropical Africa. In Mali, epidemiological studies are infrequent.Thus, this work is under taken with the objective of studying the epidemiological aspects and the factors associated with the mortality of hemodialysis patients in the hemodialysis unit of the Mali Gavardo Hospital (HMG) in Sébenikoro.

METHOD

We conducted a descriptive retrospective cross-sectionalstudy of the hemodialysis unit of the HMG in Sébenikoro. Data were collected over a 12-month period from January to December 2017. Included were records of all hemodialysis patients for chronic renal failure who died, of either sex and anyage.

RESULTS

A total of 52 patients were dialysed during the study period among whom 12 died or a mortality rate of 23%. The average age of the patients was 59.16 years with extremes of 39 and 71 years. Patients aged 60 and over accounted for 58.3% of cases. There was a male predominance with a sex ratio M / F: 2. In terms of chronic diseases, 83.3% of patients were hypertensive, 50% diabetic, and 16.66% hadhepatitis C. Compared to the initial nephropathies : glomerular nephropathy: 58.3%, vascular nephropathy: 25.0%, undetermined nephropathy: 16.7%. For the management of anemia, 100% ofour patients received EPO and iron injection. Regarding the management of hemodialysis, 83.3% had an AVF as a vascular approach and 16.7% had a central venous catheter as a vascular approach. The patients were all regular at their hemodialysis session with a rhythm of two sessions of 04H of time per session and per week. The causes of death were dominated by cardiovascular pathologies: 5 cases, 41.7%, infectious diseases: 4 cases, 33.3%, indeterminate pathologies: 3 cases or 25%. Deaths occurred in 58.3% of cases before one year of dialysis and 41.7% after one year of hemodialysis treatment.

CONCLUSION

The mortality rate of hemodialysis patients is high in Mali, especially in the HMG of Sébénikoro. Cardiovascular causes have an important role in the mortality of hemodialysis patients, but other causes such as infections are not to be over looked.

[Spontaneous acute subdural hematoma of the chronic hemodialysis patient, a case study and review of the literature]

INTRODUCTION

The appearance of spontaneous subdural hematoma (SSDH) is a rare phenomenon in chronic hemodialysis and is burdened with significant morbidity and mortality. It's prevalence remains low in Sub-Saharan Africa, is 0.43%. We report a case of SSDH in a young hemodialysis patient with favorable outcome after medico-surgical management.

CLINICAL OBSERVATION

This is a 35-year-old patient who has been hemodialysed since June 2016 for chronic renal insufficiency of hypertensive origin. He was admitted on 18 July 2018 in the nephrology department of CHU Point G for intense headaches in a context of dysarthria. They associate themselves with speech disorders, photo-phonophobia, uncontrollable nausea and vomiting. It does not report any notion of head trauma. The physical examination noted dysarthria, a right pyramidal syndrome made of right Babinsky sign, right arm deficit at 4/5, and right hemicorporeal hyperkinesia. He weighed 62 kg for 165 cm, the blood pressure was 187 / 110 mmHg. The patient had clinical signs of extracellular dehydration. Non-injected cerebral CT showed an acute left sub-dural hematoma with peri-lesional cerebral hypodensity. Surgical evacuation of the hematoma through a trephine hole is performed under local anesthesia. The postoperative course was simple. His hemodialysis sessions were done without heparin from diagnosis until 23 days post operatively.

CONCLUSION

Spontaneous subdural hematoma is multifactorial and rare in the dialysis patient. Despite high morbidity and mortality, hemodialysis should not refute surgical management of subdural hematoma.

[Pregnancy In Chronic Hemodialysis, Case Study]

For a long time, pregnancy in chronic hemodialysis was considered medically contraindicated, because of the many maternal complications that it could cause. Its management is as heavy for the medical teams (nephrologist, obstetrician and neonatologist) as for the patient herself. We report here a case of pregnancy in a dialysis patient observed at the Madeleine clinic in Dakar, Senegal. This pregnancy is the first described with a birth of a living child having a normal birth weight without abnormal malformative thanks to the multidisciplinary follow-up nephrologist, obstetrician and neonatologist), the intensification of dialysis care, the correction of anemia, control of blood pressure and improvement of the mother status nutritional.

[Prevalent Of Echocardiography Anomaly In Chronic Hemodialysis Patients At The Point G Hospital]

INTRODUCTION

Cardiovascular abnormalities are frequent and often early, severe and masked in patients with renal impairment. These cardiovascular complications are the main causes of death in hemodialysis patients. The diagnosis of these cardiovascular anomalies by cardiac ultrasound allows the individualization of patients at high cardiovascular risk. We conducted this study to evaluate the echo-cardiographic aspects of chronic hemodialysis in the nephrology and hemodialysis department of the G-Point CHU.

METHODS

This is a retrospective study of chronic renal failure patients who have undergone extra-renal treatment for 6 months or more from January 1, 2011 to December 31, 2012. Results: During this study, 83 files were retained The sex ratio was 1.51 in favor of men. The average age of patients was 48 years old. HTA (59%) and tobacco (43.3%) remain the dominant risk factors. Vascular nephropathy was the leading cause of CKD, 44.6%. Echo-cardiac abnormalities are dominated by cavitary dilatation (78.3%), LVH (41%), cardiac dysfunction (83.2%), valvular lesion (30.1%), and pericarditis (22,9%). The cardiovascular complications were LVH (41%), hypertension (25.3%) and dilated cardiomyopathy (9.7%). The evolution was favorable for 73.5% of the patients, the mortality represented 8.4% with various complication (18.1%).

[Depression To The Chronic Hemodialysis Of the University Hospital OF Point G (Bamako-Mali)]

OBJECTIVE

Determine prevalence of the depression in a population of patients chronic hemodialysis. Look for the associated sociodemographic, clinical and biological factors.

METHOD

It was a transverse study. She concerned the at least 18-years-old patients, followed in the center of Hemodialysis of the CHU at the rate of 2 - 3 sessions a week. The patients having agreed, were in dialysis at least for 3 months and benefited from an individual interview through an index card of investigation based of Hamilton's scale French version in 17 items.

RESULTS

On a sample of 107 patients, the average age was 43, 24 ± 14 years old with extremes between 20 and 75 years. The average duration in dialysis was of ±40, 37 36, 5 months with extremes between 4 and 144 months. Prevalence of the depression was 88 %. The depression was light in 78, 5 %, moderated in 6,5% and severe in 3 %. The anemia was present at 94 patient's among whom 76 had a light depression.

CONCLUSION

We observed that prevalence of the depression remains high to the chronic hemodialysis.

[Role Of Emigration In The Spread Of HIV Infection In The Region Of Kayes, Mali]

AIM

To determine the impact of emigration on HIV transmission in the Kayes region.

PATIENTS AND METHODS

It was a cross-sectional study conducted in 2007 in the Fousseyni DAOU Hospital of Kayes. A total of 109 subjects were included - all participants were over 14 years old and were diagnosed as HIV positive. The variables studied were knowledge, attitudes and behaviors regarding HIV/AIDS, the notion of traveling outside of Mali and emigration. Pearson Chi² and Fisher test were used for a bivariate analysis.

RESULTS

The female/male sex ratio was of 2.51. In this data pool, 32.3% (10/31) of men were emigrants. More than a third 37.2% (29/78) of women had an emigrant as a sexual partner. There was no significant difference in the levels of knowledge regarding HIV between emigrants and those who never went abroad. The likelihood of having had relations with a sex worker in the preceding 12 months was nine times higher for an emigrant than to a non-emigrant [OR=9.13, CI 95% (2.20 - 37.84)].

An emigrant was five times more likely to have at least two sexual partners [OR=5.11, CI 95% (1.37-18.94)].

CONCLUSION

This study showed that emigration is an important factor regarding the spread of HIV in the region of Kayes Mali. Sensitization of the candidates to emigration must be reinforced.

[Cerebral toxoplasmosis during AIDS in the infectious diseases department of Point-G Teaching Hospital, Bamako, Mali]

Cerebral toxoplasmosis is common opportunistic infections of central nervous system in AIDS. It occurs most often in case of severe immunosuppression. The aim of this study is to investigate the general characteristics of cerebral toxoplasmosis during HIV infection and AIDS in hospital area in Bamako. It is a retrospective study of 5 years (form January 2001 to December 2005), conducted in the infectious diseases department of Point G Teaching Hospital of Bamako. It concerned all patients infected with HIV, hospitalized for cerebral toxoplasmosis. The diagnosis of cerebral toxoplasmosis was based on clinical, C T and therapeutic arguments. A total of 745 patients investigated, 26 met cerebral toxoplasmosis diagnostic criteria (14 men and 12 women). The rate of cerebral toxoplasmosis in the study population was 3.5%. The average age was 38.1 years (18-58 years). Focused neurological deficit (73.07%), intracranial hypertension signs (69.20%), meningeal syndrome (15.40%), seizures (57.69%) and consciousness disorders (30.80%) were the clinical characteristics. Hypodensity with or without peripheral enhancement images (93.75%) were found on CT. The average rate of CD4 T cells was 98.7cells/mm3 (5-473 cells/mm3). Oropharyngeal candidiasis in 61.53% of cases, intestinal cryptosporidiosis (11.53%), herpes zoster (3.84%) and Pott's disease (3.84%) were the opportunistic infections associated. Cotrimoxazole was used in 88.46% of patients and 3 patients (11.54%) received the standard treatment (Sulfadiazine-Pyrimethamine). Antitoxoplasmic treatment led to a clinical improvement in 84.61% and 4 deaths (15.39%). were recorded. The technical platform for etiological diagnosis of toxoplasmosis is not available at the Point-G Teaching Hospital, so in case of encephalitis signs in a HIV positive patient, CT should be urgently perform and a treatment trial must begin without delay.

[Study of the quality of life of hemodialysis patients at the University Hospital of Point G (CHU) in Bamako- the study of 30 cases]

AIMS

To assess the social and psychological state development of our patients six months after their dialysis treatment.

PATIENTS AND METHODS

It was about a prospective study within January to June 2006. The data collection was conducted on personal search records and a questionnaire "Choice Health Experience Questionnaire" (CHEQ). The CHEQ self managed assessed the mental health, the physical health, the sexual and social functioning, the concept of sleeping disorders, familial life, leisure's and education's level. The typing was done on Epi Info 6,0 and the analyse on SPSS10.

RESULTS

They where 20 men and 10 women or a ratio sex of 2. The average age was 40.36 years ±13.08. Twenty three patients (76.7%) were satisfied of their life in general. Four patients (13.3%) were depressed, two had sleeping disorders. Fifteen men (75%) had erection disorders.

CONCLUSION

Our patients' quality of life in iterative haemodialysis remains satisfactory. A better care taking of the anaemia is necessary because it plays an important role in the erection disorders.

[Prevalence and risk factors of hepatitis C virus infection in chronic hemodialysis patients at the University Hospital of Point G, Bamako, Mali]

The objective of this prospective study conducted in November 2008, was to determine the prevalence and the factors associated with Hepatitis C Virus (HCV) infection in chronic hemodialysis patients. The study was carried out in the hemodialysis unit of the university teaching hospital of Point G. Serum samples were tested for anti-HCV antibody, anti-HIV antibody and HBs Ag using enzyme immunoassay methods (ELISA) at the laboratory of immunology of the National Blood Transfusion Service of Bamako. The following parameters were assessed: initial nephropathy, duration of the dialysis, history of blood transfusion, number of blood units transfused since the beginning of the dialysis, history of nosocomial exposure. A total of 66 patients were enrolled. The mean age of the patients was 42,27±14, 8 years, with a male to female sex-ratio of 1,44. Anti-HCV antibodies were found in 13 chronic hemodialysis patients, leading to a prevalence of 19,7%. A significant association was found between the bearing of HCV and the duration of the dialysis. These results indicate that hepatitis C is frequent in the chronic hemodialysis patients of the university teaching hospital of Point G, and that the duration of dialysis constitutes the main factor associated with the contamination by the HCV.

[Tuberculosis in chronic hemodialysis patients at the Teaching Hospital of Point G (CHU) in Bamako]

AIMS

To determine the frequency and the diagnostic difficulties of tuberculosis of haemodialysis patients.

PATIENTS AND METHODS

The study was about a retrospective analyse of patients haemodialysis records treated for tuberculosis within January 2003 to April 2006. The tuberculosis check-up contained a questioning, a meticulous clinic examination, thorax radiography, a tuberculosis intra dermoreaction (IDR) and the search of Koch Bacillus (BK) in biological liquids.

RESULTS

Tuberculosis was identified to 15.52% of haemodialysis patients (10/95). The average age of our patients was from 44.3 years, with a ratio sex of 2.5 in favour of men. Tuberculosis infection happened on average 27.4 months after the beginning of the haemodialysis. We found out 50% of extra pulmonary tuberculosis (three peritoneales and two pleurales); and 50% of pulmonary tuberculosis. The IDR was positive in two cases (2/6). The search of BK didn't succeed. We reported three deaths.

CONCLUSION

The effect of tuberculosis to chronic haemodialysis patients is very high. The diagnostic is sometimes difficult and is based only on specific therapeutic test.

[Frequency of red blood cell alloimmunization in polytransfused patients at the university teaching hospital of Point G, Bamako, Mali]

This prospective study conducted within 9 months period aimed to determine the frequency of red cell alloimmunization among polytransfused patients of the medical Hematology and oncology ward, and the unit of hemodialysis of the Nephrology ward at the Point-G hospital. Irregular red blood cell antibody screening and identification were performed by gel-filtration method using indirect antiglobulin test and enzymatic treated cells. We did not use saline medium. A total of 78 patients were included in this study. The mean age of the patients was 36.78±14.73 years (range: 11 and 77 years). The sex ratio was of 1.11 in favour of the women. The mean blood units transfused were 12.21±9.99 units (range: 4 and 45 units). The Rhesus phenotypes Dccee, DccEe and DCcee were most predominant, with the respective frequencies of 67.9, 15.4 and 10.3%. Kell antigen was found at a frequency of 1.28%. The total rate of red cell alloimmunization was 10.3%. There was no significant difference between the two wards. All the screened agglutinins were warm antibodies belonging to the Rhesus system: anti-E (7.7%), anti-C (1.3%) and anti-D (1.3%). Only Anti-E was present among hematologic patients. We did not find a significant link between the sex, the age, the number of blood units transfused and the positivity of the antibody screening. We conclude that the frequency of post-transfusional alloimmunization is high among polytransfused patients in Mali. A systematic antibody screening among these patients and the selection of red cells with known Rhesus/Kell phenotypes would allow an optimal blood transfusion safety.

[Kidney sicknesses associated with gene of the drepanocytose in the Department of Nephrology and Haemodialysis of the CHU of Point G]

PURPOSE

To assess renal features joint to gene of the drepanocytose.

PATIENTS AND METHODS

It concerned a descriptive transversal study from June 1995 to January 2004. Were included drepanocytose patients admitted hospital or seeing for consulting having one of the features: haematuria, proteinuria, leucocyturia, positive aeroculture, urea increasing and/ or of blood creatinine. The analysis and data capture were conducted on SPSS 11.0. The statistic text was the Khi square with a threshold of signification p<0.05.

RESULTS

The folders of 30 patients (18 m and 12 w) were collected. The average age was of 3104 years (5 and 64 years). The most hospitalization reasons encountered were the oedema syndrome (26.7%) and the overall haematuria (20%). The majority of the patients were heterozygote 93.33%. The kidney sicknesses encountered were: acute renal deficiency 40%, the macroscopic haematuria 20%, the nephritic syndrome 20%, chronic renal deficiency 13.4%, urinary infection 3.3% and microscopic haematuria 33%.

CONCLUSION

The sicklaneny's gene in Mali is associated to a renal morbidity. The increased frequency of drepanocytaria feature bearers must be confirmed by other studies in order to establish a strategic of treatment of this pathology.

[Clinical and biological evolution of nephrotic syndrome patients and corticotherapy]

AIMS

This study was aimed to follow clinical and biological data of patients presenting a nephrotic syndrom apparently primitiv, devided in two groups.

PATIENTS AND METHODS

The study was prospectiv including 50 patients hospitalized from January 1999 to January 2001. The first group received prednison tablets according to their body weight, and the second group received firstly a bolus of methyl prednisone to the cumulative dose of 20mg/kg divided on 3 days; relayed by the 20mg/day of prednison tablets. The Chi2 test was estimated (p<or=0.05)

RESULTS

The comparison of the age in the two groups was homogenous (p=0.37) and sex also (p=0.57). The ratio of these two parameters was 1.77 in favour of men. The nephrotic syndrom was pur by 38 patients (76%), and associated in 12 patients (24%). The evolution of body weight, dieresis, and proteinuria was significativ in the two groups (p<or=0.01). The blood pressure raised from 114/73 mmHg to 123/82 mmHg in the bolus group, and in the prednisone tablets group from 115/72 mmHg to 123/80 mmHg. The average hospitalisation was 5 weeks in first groups and 8 weeks in second before proteinuria disappeared in the urine.

CONCLUSION

We concluted that methylprednisolon contributed to a faster normalisation of proteinuria and shorter hospitalisation time.

[Clinical aspects, paraclinics and therapeutics of uro-genital tuberculosis]

OBJECTIVE

To specify the clinical, paraclinic and therapeutic aspects of urogenital tuberculosis in the services of Urology and Nephrology of the CHU of the Point G.

PATIENTS AND METHODS

From January 2005 to November 2006, six patients reached of urogenital tuberculosis were seen. The initial evaluation comprised an interrogation in the search of antecedents of urinary extra tuberculosis, a creatinemy, a urogenital echography and an intravenous urography. The research of the bacillus of Koch in the urines was made. A bacteriological examination cyto- of urines (ECBU) was carried out as well as the histological analysis of the fragment S biological and/or the part of exérèse.

RESULTS

The incidence of urogenital tuberculosis was 0.3%. compared to the consulted patients. The principal clinical demonstrations were the lumbar pain (83.33%), the hématurie (33.33%), the pollakiurie (33.33%) and the burns mictionnell be (16.67%). 50% of the patients presented a fever and 33.33% an asthenia. Three (50%) were presented with a renal insufficiency (average creatinemy: 866.7 micromol/l). The bacilluria was present in 50% of the cases. Echography had shown anomalies in 100% of the cases of which most frequent was the urétéro hydronéphrose (2 cases, are 33.33%). The positive diagnosis was related to the bacteriological data (3 times) and histological (3 times). The treatment consisted of a bacillar anti chemotherapy among all patients in association with the surgery (4 cases) and/or of the endo-urologic operations (1 case).

CONCLUSION

The diagnosis of urogenital tuberculosis remains difficult and often late in our context. A surgical or endo-urologic gesture is often necessary to preserve the renal function and to improve the quality of life.

[Using CT to diagnose brain tumors at the Point G Hospital in Mali]

The authors report 27 cases of cerebral tumours in 22 men and 5 women age 1 to 81. Clinical symptoms were dominated by cranial hypertension (59.3%), focal motor impairment involving cranial nerves (51.9%.) and seizures due to epilepsy (44.4%). The main tumors detected with CT scan include glyoma (.5 cases), craniopharyngioma (3 cases), adenoma (3 cases), medulloblastoma (3 cases), and metastasis (3 cases). The supra tentoriel was predominant (76.9%). Neurosurgery was performed in 6 patients and 21 cases received medical treatment. We fund 13 cases of death. In conclasion, cerebral tumours are very severe pathologies because of the high mortality associated with. CT scan has contributed to diagnose the lesions, show their topography and to determinte the histological nature. Neurosurgery is necessary for the treatment of these lesions.

[Association of urinary tract infections and HIV infection in an internal medicine ward of Hospital of Point G-Bamako-Mali]

We gathered 14 clinical observations of urinary track infections in AIDS patients in Internal Medicine wards from August 1, 1998 to July 31, 1999. Urinary track infection and HIV were both present in 1.75% of 797 hospitalized patients. The specific prevalence was 14.43% among AIDS patients. The sex ratio (female/male) was 1.33. The mean age of patients was 37.2 years with ranges between 25 years and 59 years. Urinary symptoms were discret. Urinary tract infection was primarily evidenced by urine leucocytes > 10(4) organism/ml and a bacteriuria > 10(5) colony-forming units/ml. The main pathogenswere Escherichia coli (42.85%), Klebsiella pneumoniae (28.57%), Colibacilles app. (21.42%) and Enterobacter cloacae (7.14%). All isolated germs were sensible to the gentamicin, to the amikacin, to the nalidixic acid, to the cefoxitine, to the ceftazidime to the cefotaxime and the ciprofloxacin. Cephalosporin of 3rd generation, aminoglycosides, and fluoroquinolone can be used like treatment of first line in urinary tract infection suspicion case in Bamako. Our patients were highly immunosuppressed with the majority of them being in class IV C of CDC of Atlanta (90%) and CD4 count constantly bellow 200 cells/mm3. The main opportunistic affections were non bacilar bacterial pneumopathies (28.57%), oesophagal mycosis (71.42%), the association of cerebral toxoplasmosis and pulmonary tuberculosis (35.71%). All urinary infections were cured by mean of 5 days of treatment. Very few recidivism was found (1 case).

[Clinical and bacteriological profiles of the urinary infections associated the VIH/AIDS in hospital area of Bamako, Mali]

The syndrome of immunodepression is the bed of multiple infections of which urinary infections. The goal of this study was to determine the aspects clinical and bacteriological urinary infections during the AIDS with the service of the infectious diseases of the hospital of the Point G of February 1, 2003 to June 30 2005. The diagnosis of the urinary infection was retained on the basis of bacteria number > or =10(4) bacteriury and or leucocytes count > or =10(5)/mm3. The prevalence of the urinary infection was estimated at 8.85%. The principal clinical aspects were a symptomatic pyelonephritis 73.5%, the leucocytiury 11.8%, the cystitis 8.8%, and acute prostatitis 5.9%. Escherichia coli was the most frequent bacterium (46.7%). The sensitivity of the germs was 91.7% with the aminosides, 90.9% with the fluoroquinolones, from 63.6 to 80% respectively with the cephalosporines of first and second generation. Resistance to ampicilline, chloramphenicol and sulfamides was about 72 and 80%. The systematic research of the urinary infection is necessary during the AIDS and the antibiotherapy of choice in first intention in absence of etiologic possibility of diagnosis should be the aminosides and or the fluoroquinolones.

[Ultrasonographic aspects of urinary schistosomiasis in children of the Dogon plateau and the Niger office; impact of praziquantel treatment]

Urinary bilharziasis is a parasitic infection responsible for vesical, urethral and renal lesions. The authors demonstrate the importance of ambulatory echography on a large scale and describe various echographic lesions. Vesical attacks occurred in 27% of the wall irregularity, 44% of the masses and polyps. Pyelic and urethral abnormalities occurred in 16.6% and 29.9% of cases respectively at the baseline in 1991. These prevalence rates decreased after seven years, in 1998. The authors discuss the utility of chemotherapy with praziquantel and the necessity of a periodical mass treatment in the areas with high bilharziasis endemicity in Mali.

Retinopathy, hematuria, and diabetic nephropathy

We have retrospectively analyzed the incidence of diabetic nephropathy in 21 diabetic patients who underwent renal biopsy between 1985 and 1995 for microscopic hematuria and/or proteinuria >2.5 g/day without retinopathy. Diabetic nephropathy was observed in 13 of 21 patients (62%). 50% of our patients with diabetic nephropathy had hematuria, the incidence being higher in type I as compared with type II diabetic patients (30 vs. 20%). Diabetic nephropathy without retinopathy but with hematuria was noted in 5 of 13 patients, and diabetic nephropathy without retinopathy and hematuria was also noted in 5 of 13 patients. We suggest from our retrospective analysis that renal-retinal diabetic syndrome really exists.

Urinary tract morbidity due to Schistosoma haematobium infection in Mali

A total of 824 Malian villagers in a region endemic for Schistosoma (S.) haematobium were examined clinically, parasitologically and by abdominal ultrasound. Systematic schistosomicidal treatment had never been applied to this population. Prevalence of S. haematobium infection ranged from 77% in adolescents to 51% in adults older than 40 years. Intensity of infection was generally mild, 91% of all patients excreting less than 100 ova/10 ml urine. Bladder wall enlargement and irregularities, bladder masses, pseudopolyps and dilation of the upper urinary tract were found ultrasonographically in about one third of infected individuals. Bladder lesions were more frequent in children than in adults and correlated with the intensity of infection in younger age groups only. Hydronephrosis was rare (7 of 824) and never seen in uninfected individuals. Prevalence of urinary tract pathology dropped significantly with age (P < 0.001) and was lowest in patients older than 40 years. Logistical regression identified age and infection as independent parameters affecting the prevalence of urinary tract pathology (P < 0.001). We conclude that Schistosoma haematobium infection causes substantial morbidity in children and younger adults. The reduction of urinary tract morbidity with age despite a considerable prevalence of infection in older age groups suggests spontaneous resolution during adulthood in most cases.

Lack of ultrasonographic evidence for severe hepatosplenic morbidity in schistosomiasis mansoni in Mali

The inhabitants of four villages endemic for Schistosoma mansoni in central Mali (n = 1,106 of both sexes, age range 2-80 years) and of two nonendemic villages in another part of the country were examined parasitologically and ultrasonographically to establish the prevalence of periportal liver fibrosis (PF) and other features of hepatosplenic schistosomiasis. The prevalence of S. mansoni infection ranged from 36% to 93% in the endemic villages. A severe infection (> 400 eggs/g of stool) was found in 16% of the infected individuals. No case of grade III PF (echogenic bands usually > 10 mm in diameter around the central part and major branches of the portal vein and streak-like fibrous bands that extended into the periphery of the liver) and only eight cases of grade II PF (echogenic bands usually > 10 mm in diameter around the central part and major branches of the portal vein) were found; no other signs of severe hepatosplenic disease were encountered. However, grade I PF (echogenic bands usually > 4 mm in diameter that were best visible in the area of the portal vein bifurcation and gall bladder neck) was detected in 21% of all individuals, mainly in adults. In the nonendemic villages, the prevalence of grade I PF in adults was 9%. Generally, there was no significant correlation between the grade of PF and S. mansoni egg output. In one village with a high endemicity level, however, the prevalence of grade PF I increased with the intensity of infection. Morphometric data revealed no significant influence of S. mansoni infection on portal vein stem diameter and spleen size.(ABSTRACT TRUNCATED AT 250 WORDS)