Aspects Épidémiologiques, Cliniques Et Histologiques Du Cancer De L’estomac Au CHU Gabriel Touré de Bamako (Mali)

Introduction : Le cancer de l’estomac constitue un véritable problème de santé publique. Certaines études ont porté sur les aspects épidémiologiques et anatomo-cliniques de cette affection. Nous avons voulu actualiser les données sur l’épidémiologie et la sémiologie du cancer de l’estomac. Méthodologie : Etude transversale du 07 mai 2017 au 7 juin 2018 à Bamako au Mali. Étaient inclus, les sujets des deux sexes âgés d’au moins 18 ans chez lesquels le diagnostic de cancer de l’estomac était retenu sur l’aspect endoscopique et confirmé à l’histologie. Résultats : Cent cinquante-neuf cas de cancers digestifs ont été recensés dont 37 cas de cancer de l’estomac (23.3%). L’âge moyen était de 59,5 ans ±13,5 ans. Le sex-ratio était de 1,3. Parmi ces patients, 64,9% des provenaient du milieu rural, 89,2% utilisaient la conservation naturelle des aliments, et 86,4% consommaient du poisson fumé. Une consommation de potasse dans les repas était retrouvée chez 83,7% ; 21,6 % ne consommaient pas de fruits et légumes. Une consommation de tabac a été retrouvée chez 21,6% des patients. La consommation d’alcool a été retrouvée chez 8,1% des patients. Les principaux symptômes étaient l’épigastralgie, l’amaigrissement et les vomissements respectivement dans 34% ; 34% et 33% des cas. Les lésions ulcéro-bourgeonnantes étaient plus retrouvées chez 67,6% des patients. La localisation antrale était retrouvée chez 51,35% des patients. L’adénocarcinome a été le type histologique le plus retrouvé dans 91,89% des cas. Conclusion : Le cancer de l’estomac est une affection relativement fréquente, diagnostiquée à un stade tardif. Le rôle permissif des facteurs nutritionnels et le mode de vie sont déterminants dans la genèse de ces cancers.   Introduction: Stomach cancer is a real public health problem. Some studies have focused on the epidemiological and anatomo-clinical aspects of this condition. We wanted to update the data on the epidemiology and semiology of stomach cancer. Methodology: Cross-sectional study from 07 May 2017 to 7 June 2018 in Bamako, Mali. Included were subjects of both sexes aged at least 18 years in whom the diagnosis of stomach cancer was retained on the endoscopic aspect and confirmed at histology. Results: One hundred and fifty-nine cases of digestive cancer have been identified, including 37 cases of stomach cancer (23.3%). The average age was 59.5 years ±13.5 years. The sex ratio was 1.3. Of these patients, 64.9% came from rural areas, 89.2% used natural food preservation, and 86.4% consumed smoked fish. Potash consumption in meals was found in 83.7%; 21.6% did not consume fruits and vegetables. Tobacco use was found in 21.6% of patients. Alcohol consumption was found in 8.1% of patients. The main symptoms were epigastralgia, weight loss and vomiting respectively in 34%; 34% and 33% of cases. Ulcerative budding lesions were more found in 67.6% of patients. Antral localization was found in 51.35% of patients. Adenocarcinoma was the most common histological type found in 91.89% of cases. Bottom Line: Stomach cancer is a relatively common. Conclusion: diagnosed at a late stage. The permissive role of nutritional factors and lifestyle are decisive in the genesis of these cancers

Carbapenem-producing Enterobacteriaceae in mothers and newborns in southeast Gabon, 2022

Introduction Infections caused by carbapenemase-producing Enterobacteriaceae (CPE) pose a significant threat, leading to severe morbidity and mortality among newborns. Methods This study, conducted at Franceville hospital's maternity and neonatology wards from February 22nd to June 20th, 2022, investigated the prevalence of CPE in 197 parturients and 203 newborns. Rectal swabs were taken from parturients before delivery and from newborns 30 minutes after birth. Blood culture samples were collected if signs of infection were observed in newborns during a 28-day follow-up. A total of 152 environmental samples were obtained, comprising 18 from sinks, 14 from incubators, 27 from cradles, 39 from maternal beds, 14 from tables and desks, four from the two baby scales and 36 from bedside furniture. Results None of the 203 newborns were found to be CPE carriers 30 minutes after delivery. CPE carriage was found in 4.6% of mothers. When comparing colonized and uncolonized parturients, well-established risk factors for CPE carriage, such as recent hospitalization and antibiotic therapy, were more frequently observed among CPE carriers (33.3 vs 10.6% for hospitalization in the past 15 days; 55.5 vs 30.3% for hospitalization during pregnancy, and 55.5 vs 35.1% for antibiotic therapy during pregnancy). Notably, the prevalence of treatment with amoxicillin and clavulanic acid was 44.4% in CPE carriers compared to 17.0% in non-carriers. The incidence density of CPE-associated bloodstream infection was 0.49 per 100 newborns, accounting for a fatal case of CPE-associated bacteremia identified in one of the 203 newborns. Seven environmental samples returned positive for CPE (5 sinks and two pieces of furniture). Whole genome sequencing, performed on the 25 CPE isolates, revealed isolates carrying blaNDM-7 (n=10), blaNDM-5 (n=3), blaOXA181 (n=10), blaOXA48 (n=2) or blaOXA244 (n=1), along with genetic traits associated with the ability to cause severe and difficult-to-treat infections in newborns. Core genome comparison revealed nine CPE belonging to three international high-risk clones: E. coli ST410 (four mothers and a sink), two E. coli ST167 (a mother and a piece of furniture), and K. pneumoniae ST307 (a sink and a piece of furniture), with highly similar genetic backgrounds shared by maternal and environmental isolates, suggesting maternal contamination originating from the environment. Discussion Our study reveals key findings may guide the implementation of infection control measures to prevent nosocomial infections in newborns: the prevalence of CPE carriage in one out of 20 parturients, an infection occurring in one out of 400 newborns, substantial contamination of the care environment, clinical and environmental CPE isolates possessing genetic traits associated with the ability to cause severe and challenging infections, and clonal relationships between clinical and environmental isolates suggesting CPE spread within the wards, likely contributing to the acquisition and colonization of CPE by parturients during pregnancy.</p

Image_1_Carbapenem-producing Enterobacteriaceae in mothers and newborns in southeast Gabon, 2022.jpeg

IntroductionInfections caused by carbapenemase-producing Enterobacteriaceae (CPE) pose a significant threat, leading to severe morbidity and mortality among newborns.MethodsThis study, conducted at Franceville hospital's maternity and neonatology wards from February 22nd to June 20th, 2022, investigated the prevalence of CPE in 197 parturients and 203 newborns. Rectal swabs were taken from parturients before delivery and from newborns 30 minutes after birth. Blood culture samples were collected if signs of infection were observed in newborns during a 28-day follow-up. A total of 152 environmental samples were obtained, comprising 18 from sinks, 14 from incubators, 27 from cradles, 39 from maternal beds, 14 from tables and desks, four from the two baby scales and 36 from bedside furniture.ResultsNone of the 203 newborns were found to be CPE carriers 30 minutes after delivery. CPE carriage was found in 4.6% of mothers. When comparing colonized and uncolonized parturients, well-established risk factors for CPE carriage, such as recent hospitalization and antibiotic therapy, were more frequently observed among CPE carriers (33.3 vs 10.6% for hospitalization in the past 15 days; 55.5 vs 30.3% for hospitalization during pregnancy, and 55.5 vs 35.1% for antibiotic therapy during pregnancy). Notably, the prevalence of treatment with amoxicillin and clavulanic acid was 44.4% in CPE carriers compared to 17.0% in non-carriers. The incidence density of CPE-associated bloodstream infection was 0.49 per 100 newborns, accounting for a fatal case of CPE-associated bacteremia identified in one of the 203 newborns. Seven environmental samples returned positive for CPE (5 sinks and two pieces of furniture). Whole genome sequencing, performed on the 25 CPE isolates, revealed isolates carrying blaNDM-7 (n=10), blaNDM-5 (n=3), blaOXA181 (n=10), blaOXA48 (n=2) or blaOXA244 (n=1), along with genetic traits associated with the ability to cause severe and difficult-to-treat infections in newborns. Core genome comparison revealed nine CPE belonging to three international high-risk clones: E. coli ST410 (four mothers and a sink), two E. coli ST167 (a mother and a piece of furniture), and K. pneumoniae ST307 (a sink and a piece of furniture), with highly similar genetic backgrounds shared by maternal and environmental isolates, suggesting maternal contamination originating from the environment.DiscussionOur study reveals key findings may guide the implementation of infection control measures to prevent nosocomial infections in newborns: the prevalence of CPE carriage in one out of 20 parturients, an infection occurring in one out of 400 newborns, substantial contamination of the care environment, clinical and environmental CPE isolates possessing genetic traits associated with the ability to cause severe and challenging infections, and clonal relationships between clinical and environmental isolates suggesting CPE spread within the wards, likely contributing to the acquisition and colonization of CPE by parturients during pregnancy.</p

DataSheet_1_Carbapenem-producing Enterobacteriaceae in mothers and newborns in southeast Gabon, 2022.docx

IntroductionInfections caused by carbapenemase-producing Enterobacteriaceae (CPE) pose a significant threat, leading to severe morbidity and mortality among newborns.MethodsThis study, conducted at Franceville hospital's maternity and neonatology wards from February 22nd to June 20th, 2022, investigated the prevalence of CPE in 197 parturients and 203 newborns. Rectal swabs were taken from parturients before delivery and from newborns 30 minutes after birth. Blood culture samples were collected if signs of infection were observed in newborns during a 28-day follow-up. A total of 152 environmental samples were obtained, comprising 18 from sinks, 14 from incubators, 27 from cradles, 39 from maternal beds, 14 from tables and desks, four from the two baby scales and 36 from bedside furniture.ResultsNone of the 203 newborns were found to be CPE carriers 30 minutes after delivery. CPE carriage was found in 4.6% of mothers. When comparing colonized and uncolonized parturients, well-established risk factors for CPE carriage, such as recent hospitalization and antibiotic therapy, were more frequently observed among CPE carriers (33.3 vs 10.6% for hospitalization in the past 15 days; 55.5 vs 30.3% for hospitalization during pregnancy, and 55.5 vs 35.1% for antibiotic therapy during pregnancy). Notably, the prevalence of treatment with amoxicillin and clavulanic acid was 44.4% in CPE carriers compared to 17.0% in non-carriers. The incidence density of CPE-associated bloodstream infection was 0.49 per 100 newborns, accounting for a fatal case of CPE-associated bacteremia identified in one of the 203 newborns. Seven environmental samples returned positive for CPE (5 sinks and two pieces of furniture). Whole genome sequencing, performed on the 25 CPE isolates, revealed isolates carrying blaNDM-7 (n=10), blaNDM-5 (n=3), blaOXA181 (n=10), blaOXA48 (n=2) or blaOXA244 (n=1), along with genetic traits associated with the ability to cause severe and difficult-to-treat infections in newborns. Core genome comparison revealed nine CPE belonging to three international high-risk clones: E. coli ST410 (four mothers and a sink), two E. coli ST167 (a mother and a piece of furniture), and K. pneumoniae ST307 (a sink and a piece of furniture), with highly similar genetic backgrounds shared by maternal and environmental isolates, suggesting maternal contamination originating from the environment.DiscussionOur study reveals key findings may guide the implementation of infection control measures to prevent nosocomial infections in newborns: the prevalence of CPE carriage in one out of 20 parturients, an infection occurring in one out of 400 newborns, substantial contamination of the care environment, clinical and environmental CPE isolates possessing genetic traits associated with the ability to cause severe and challenging infections, and clonal relationships between clinical and environmental isolates suggesting CPE spread within the wards, likely contributing to the acquisition and colonization of CPE by parturients during pregnancy.</p

Le Mali contemporain

Le Mali contemporain ? Il est bien différent des images que les médias diffusent ! La société malienne a considérablement évolué depuis l'indépendance, les jeunes y sont beaucoup plus nombreux et mieux informés, les femmes plus actives. Mais les changements qui ont marqué notamment la gouvernance et la situation économique paraissent décalés au regard des nouvelles contraintes, attentes et exigences liées à ces mutations. Comment cette société, dans sa diversité, pense-t-elle et s'engage-t-elle dans la modernité ? Voilà le sujet de ce livre. Une cinquantaine de chercheurs en sciences sociales, dans le cadre d'une collaboration franco-malienne, ont travaillé sur le Mali contemporain dans la période qui a immédiatement précédé la crise (2007-2012). Ils se sont principalement intéressés à la vie politique dans les communes et quartiers, à la réalité de la décentralisation, à l'image que l'Etat en action donne de lui, au fait religieux dans ses manifestations et ses tendances lourdes, mais aussi aux divers aspects de la migration, et enfin et surtout à la place des jeunes dans la société. Le tableau qui se dégage de leurs observations est sans complaisance : faire évoluer positivement la situation actuelle de la société malienne est un défi pour les décideurs et l'ensemble de la population ; et pour y parvenir, il est impérieux d'ébranler les pesanteurs, blocages, et faux-fuyants qui ont conduit le pays au bord du gouffre