[Importance of psychological support for patients with Covid-19 treated at the University Hospital Center (CHU) Hôpital du Mali]

INTRODUCTION

the disease linked to Covid-19 is a SARS-CoV-2 pneumonia with strong clinical expression and highly lethal which has shaken the world since November 2019, to the detriment of certain determinants of health, in particular the psychosocial aspect. In this work, we are proposed to study the importance of psychological support for patients during the Covid-19 pandemic admitted to the treatment center of the CHU Hôpital du Mali.

METHOD

this was a cross-sectional study, a prospective recruitment including 50 patients admitted to hospital from April to May 2020.

RESULTS

in the cohort, 30% of patients had a notion of recent travel. Eighty percent (80%) of patients did not follow preventive measures before testing. Sixty percent (60%) of patients were asymptomatic at the time of screening. We found that 80% of the patients had not received any psychological preparation. 78% of the patients did not believe in the existence of the disease. At discharge, 38% of patients were depressed, 10% were in denial of the disease. Regarding the quality of care, 84% of patients were satisfied with the quality. We found that patients who had not received psychological preparation were eight times more likely to have depression, compared to patients who had received it, with a correlation coefficient (r) = 0.810 and a level of significance p < 0.001. OR which excludes 1.

CONCLUSION

this study confirms the low importance given to the psychological preparation of patients with Covid-19 in our structure. However, we believe that good psychological preparation could help improve the quality of patient care.

[Dysthyroidism in children and adolescents at the Mali hospital]

INTRODUCTION

Dysthyroidism (hyperthyroidism or hypothyroidism) in children and adolescents is much rarer than in adults. The purpose of our study was to study the epidemiological, clinical, paraclinical, etiological and etiological aspects and to specify the therapeutic and evolutionary modalities of this condition.

METHOD

This was a five-year descriptive, retrospective and prospective study of children and adolescents under 18 years of age with dysthyroidism.

RESULTS

We collected 90 children and adolescents with dysthyroidism (hyperthyroidism 77.8% (n=70) and hypothyroidism 22.2% (n=20). For hyperthyroidism (n=70): the average age was 13.07 years and the sex ratio was 0.16. The family history of dysthyroidism was found in 24.3% (n=17). Clinical manifestations were dominated by tachycardia 88.57% (n=62), weight loss 87.14% (n=61), vibrating pulse 87.14% (n=61) and palpitation 81.42% (n=57). Bilateral exophthalmos was present in 70% of patients (n=49) with palpebral retraction in 51.42% (n=56). Goitre was present in 54 patients (77.1%). It was diffuse in 62.9% (n=44) and nodular in 12.9% (n=9). Basedow's disease represented the first etiology with 84.3% (n=59), followed by toxic multinodular goitre12, 9% (n=9). Sixty-eight patients (97.1%) received medical treatment with synthetic antithyroid drugs. Clinical remission was achieved in 64.3% (n=45) and 54.3% of patients were in biological euthyroidism at 6 months follow-up. For hypothyroidism (n=20): the average age was 10.70 years and the sex ratio was 0.53. Six family cases of hypothyroidism and three cases of family goitre were found. The clinical picture was dominated by signs of hypo metabolism at hypersomnia type 95% (n=19) and anorexia 75% (n=15). The skin was dry in 60% (n=12). A staturo-weight delay in 65% (n=13), behavioural disorders in 55% (n=11), weight gain in 40% (n=8) and puberty delay in 10% (n=2). Goitre was nodular in 25% (n=5) with cervical adenopathy present in 15% (n=3). Hashimoto's thyroiditis accounted for 45% (n=9) of etiologies followed by iodine deficiency disorders in 15% (n=3) and iatrogenic causes (2 cases of thyroidectomy). All patients were started on hormone replacement therapy for life. Five patients with large multinodular goiter received total thyroidectomy in addition to medical treatment. Euthyroidism was observed in 55% (n=11) of patients at 6 months follow-up.

CONCLUSION

Dysthyroidism in children and adolescents exists in our health facilities. Its management is deficient because of the technical and financial platform. Our public health decision-makers must help implement a screening strategy to facilitate faster diagnosis and treatment.

[Epidemiological And Clinical Aspects Of Obesity In The Medicine And Endocrinology Service Of Mali Hospital]

INTRODUCTION

Lifestyle changes have played an important role in increasing the prevalence of obesity. The objectives were to describe the epidemiological, clinical and progressive aspects of obesity in patients of the Mali hospital.

PATIENTS AND METHOD

this is a descriptive study with retrospective collection of data from the medical records of patients hospitalized in the Medicine and Endocrinology department. Our patients benefited from weight gain, height, waist measurement and hip measurement with calculation of the body mass index.

RESULTS

the study concerned 90 obese patients out of 1515 hospitalized (5.94% of frequency). The mean age was 42 ± 5 with extremes 10 and 74. The sex ratio was 0.38. Obesity was mixed: 75.4% of men, 60% of woman; Android in 36% of men, 18% of women and the only child aged 10 had morbid obesity. The reason for hospitalization was complications of obesity in 13.30%. The psychological reactions collected were: anxiety 54.40%, indifference 40% and shame 5.60%. There were 68.90% complications including 37.80% cardio metabolic (hypertension associated in 51.10%). The lipid assessment carried out showed hyper LDLdemia: 70%; HDL hypoemia: 67.80%, hyper triglyceridaemia: 66.70%. Our patients received dietary and dietary advice. No drug or surgical treatment has been initiated despite the indication. We recorded 3.30% of deaths.

CONCLUSION

The epidemiological and clinical description, diagnosis and evaluation of the repercussions of obesity are easy in our daily practice. However, care remains insufficient due to the inadequacy of the technical platform, the lack of financial means and the prejudices of our patients (ignorance of obesity as a disease).

[Management of Hyperprolactinemia at the Hôpital du Mali]

INTRODUCTION

Hyperprolactinemia, which is a supra-physiological secretion of prolactin, is the most common anterior pituitary disorder encountered in clinical practice. Its incidence and prevalence are poorly defined in Africa and the rest of the world. The objectives were to study the clinical, paraclinical, etiological and therapeutic aspects of hyperprolactinemia at the Mali hospital.

METHODOLOGY

This was a 5-year cross-sectional study. Data collection was retrospective (July 2011 to October 2015) and prospective (December 2015 to July 2016).

RESULTS

We collected 37 cases of hyperprolactinemia. The sex ratio was 0.85. The average age was 37.32 years with extremes ranging from 15 to 74 years. The clinical picture was dominated in women by amenorrhea (80%), galactorrhea (70%), headache (55%), hypofertility (50%), visual disorders (25%) and in men by decreased libido (64.7%), gynecomastia (47.1%), headache (47.1%), visual disorders (41.2%) and erection disorders (29.4%). Basal prolactinemia was greater than 100ng/ml in 45.9% of patients. Cerebral CT had objectified: 11 cases of macroadenomas and 5 cases of pituitary microadenomas. The main causes of hyperprolactinemia were: prolactin pituitary adenoma (43.24%); hypothyroidism (5.40%) and estrogen-progestin use in 5.40%. For treatment, 64.9% of patients were placed on cabergoline; 27% on bromocriptine and 8.10% on simple clinical and biological monitoring.

CONCLUSION

Hyperprolactinemia is a condition that exists in our health care facilities. Clinicians should consider this in the face of galactorrhea amenorrhea or decreased libido. It is also necessary to improve the technical platform for better care.

[Contribution of therapeutic education on the psychological level of diabetic patients in the medical department of the Hospital Mali 2018]

AIMS

The management of patients with diabetes is done with a focus on the "biological" component in relation to other determinants of health, namely the psychosocial aspect. This work aimed to study the contribution of therapeutic education to the psychological level of patients.

METHOD

a cross-sectional study, carried out in the medical department of the Mali Hospital during the first half of 2018, which concerned all 115 patients hospitalized during this period.

RESULTS

Among these patients, 52.20% were over 50 years old, with 52.2% female versus 47.8% male. Depression was found in 64.31% of patients, patients who never received a Therapeutic Education constituted 67.83%, the correlation was significant between the psychological level of the patient and his participation in a therapeutic education with a correlation coefficient r = 0.518 and a level p <0.001.

CONCLUSION

Educating a patient can help him cope with and manage his illness. However, this education is complex because it is a real training leading to a transfer of skills from the caregiver to the care.

[Status Of Markers Of Oxidative Stress At The Internal Medicine And Endocrinology Department Of The Mali Hospital]

Oxidative stress represents an imbalance between the endogenous antioxidant defenses and the production of pro-oxidant molecules. The present study describes oxidative stress markers (oxidant and antioxidant) metabolic disturbances in diabetic and non-diabetic patients at the Internal Medicine and Endocrinology ward of hospital of Mali.

MATERIALS AND METHODS

We conducted a descriptive case / control study involving 30 diabetic and 30 non-diabetic patients. Studied markers were Glutathione erythrocyte peroxidase (GPX), intra erythrocyte Superoxide dismutase (SOD), plasmatic uric acid, direct and total bilirubins, albumin and markers for diagnosis and monitoring of diabetes.

RESULTS

Non-diabetic patients (9%) had higher glutathione peroxidase levels compared diabetics (3%) (p = 0.005). An increase in superoxide dismutase was observed in 73.3% of diabetics versus 40% of nondiabetics (p = 0). The albumin, uric acid and bilirubin levels were identical in both populations. Glycated hemoglobin was significantly correlated with microangiopathies (p = 0.0058) and macro angiopathies( p=0,0007) in diabetics.

CONCLUSION

The study showed an increase in antioxidant defenses in diabetics by the elevation of superoxide dismutase and a relative normalization of glutathione peroxidase.

[Turner syndrome in the hôpital du Mali, a case]

Turner syndrome is a chromosomal aberration linked to the complete or partial absence of an X chromosome. Its prevalence is 1/2500 female newborns. We report a case in the department of internal medicine and endocrinology of the hospital of MALI. This was a 14-year old girl who consulted for stunting and puberty. She presented clinically a dysmorphic syndrome, TANNER stage1 secondary sexual characteristics, weight and height at -3 DS and a bone age estimated to 9½ years old on the X-ray of the hand. The hormonal assessment showed an elevation of FSH and LH and the genetic study showed an iso chromosome Xq. This result was part of a Turner syndrome with Xq iso chromosome.