Traumatisme cranien penetrant non projectile par des clous: un cas inhabituel

Introduction: Les traumatismes crâniens pénétrants par des clous sont rares. Ils s’observent souvent dans le contexte d’auto-mutilation chez des personnes avec affection psychiatrique. Les cas secondaires à une agression physique par l’implantation intracrânienne de clous sont exceptionnels. Nous rapportons ici le cas clinique d’un jeune patient victime d’agression par une foule.Patient et méthode: Le patient de 29 ans a été amené aux urgences après avoir subi des coups et blessures volontaires d’une foule en colère. Au plan clinique, on notait des céphalées et des paresthésies à la main gauche ainsi que la présence de 2 corps métalliques implantés en région pariétale droite. La tomodensitométrie (TDM) crânio-cérébrale a mis en évidence une paire de clous intra-crânienne.Résultat: Le patient a été opéré en urgence. Nous avons extrait deux clous intracrâniens de 8 cm chacun. Le patient a bénéficié d’une prévention antitétanique, anti épileptique et d’une antibioprophylaxie. Les suites opératoires ont été simples. Le patient a récupéré de son trouble sensitif et n’a pas présenté de complications vasculaires et infectieuses. Ce cas particulier soulève la problématique de l’absence de protocole standardisé pour l’exploration radiologique et le traitement chirurgical des traumatismes crâniens pénétrant par des clous.Conclusion: Le score de Glasgow initial est un facteur pronostic important en cas de traumatisme crânien pénétrant par des clous. La gravité est fonction du siège de l’atteinte cérébrale et des lésions vasculaires endocrâniennes associées. L’angioscanner et/ou l’artériographie cérébrale sont déterminants dans la recherche de blessureMots clés: Agression, Clou, Plaie crânio-cérébrale, Traumatisme crânienEnglish Title: An unusual case of penetrating head injury by nailsEnglish AbstractIntroduction: Non-projectile penetrating head trauma by nails is rare. They are seen more often in the context of self-injury in psychiatric patients. The cases secondary to physical aggression by the intracranial implantation of nails by a person are rare.We report a particular clinical case of a young patient assulted by a crowd of people.Patient and method: A 29-year-old male patient is brought to the emergency room after being assaulted by a crowd of angry people. On clinical examination there were headaches and paresthesia in the left hand; also the presence of 2 metallic bodies implanted in parietal right area. The brain CT-scan shows an intra cranial pair of nails.Result: The patient was operated on urgently. We extracted two intracranial nails of 8 cm each. The patient benefited from tetanus prevention, anti-epileptic and prophylactic antibiotics. The postoperative course was simple. The patient recovered from his sensory disorder and did not develop vascular nor infectious complications. This particular case raises the problem of the lack of a standardized protocol for the radiological exploration and surgical treatment of penetrating head trauma by nails.Conclusion: The initial Glasgow score is an important prognostic factor for penetrating head trauma by nails. The severity of the clinical signs is a function of the location of the cerebral involvement and associated intracranial vascular lesions. CT angiography and / or cerebral arteriography are critical in the search for vascular injury. The most serious complications are infections and intracranial vascular lesions.Keywords: Aggression; head trauma; Nai

Ethnopharmacological survey of six medicinal plants from Mali, West-Africa

An ethnopharmacological survey was carried out to collect information about the use of six medicinal plants in the regions around Siby and Dioila, Mali. The plants investigated were Biopyhtum petersianum, Cola cordifolia, Combretum molle, Opilia celtidifolia, Parkia biglobosa and Ximenia americana

Ethnopharmacological uses of Erythrina senegalensis: a comparison of three areas in Mali, and a link between traditional knowledge and modern biological science

This paper describes ethnopharmacological knowledge on the uses of Erythrina senegalensis DC (Fabaceae) in traditional medicine in three different areas (Dioila, Kolokani and Koutiala) in Mali. Data were collected using interviews of traditional healers selected randomly. The main reported diseases for which E. senegalensis was used by the traditional healers were amenorrhea, malaria, jaundice, infections, abortion, wound, and body pain (chest pain, back pain, abdominal pain etc). The fidelity level (which estimates the agreement of traditional healers on the same area about a reported use of the plant) was calculated to compare the results from the three areas. Certain differences were noticed, the most striking was the fact that amenorrhea was the most reported disease in Dioila and Kolokani with 21% of agreement for both areas, while this use was not reported in Koutiala at all. Similarities existed between the three areas on the use of the plant against malaria and infections, although with different degree of agreement among the healers. We also report the results of a literature survey on compounds isolated from the plant and their biological activities. A comparison of these results with the ethnopharmacological information from Mali and other countries showed that some of the traditional indications in Mali are scientifically supported by the literature. For instance, the use of E. senegalensis against infectious diseases (bilharzias, schistosomiasis, pneumonia etc.) is sustained by several antibacterial and antifungal compounds isolated from different parts of the plant. The comparison also showed that pharmacologists have not fully investigated all the possible bioactivities that healers ascribe to this plant

Devenir de l’hématome sous-dural chronique associé à l’alcool : analyse rétrospective d’une série des cas: Outcome of chronic subdural hematoma associated with alcohol: a retrospective case series analysis

Context & objective. Although chronic subduralhaematoma (CSDH) associated with alcoholism isrelatively common in extreme ages (children andelderly subjects), postoperative data are fragmentary. The aim of the present study was todescribe the postoperative outcome of CSDHassociated with chronic alcoholism. Methods.Retrospective study involved a series of cases withCSDH and chronic alcoholics. Parameters ofinterest included sociodemographic data, andpostoperative outcome (immediate, 1 year and 2years). Results. A total of 11 records of chronicalcoholic CSDH patients were collected. Theirmean age was 59 years (all male). The meanduration of the disease was 4 weeks. Threepatients were classified as MARKWALDER I andtwo as MARKWALDER IV. The haematoma wasbilateral in 3 cases. Eight patients were operatedon under local anesthesia. Seven patients had animmediate postoperative complication including 4cases of acute rebleeding. At one-year follow-up,4 cases of recurrence were recorded. At 2-yearfollow-up, 5 cases of post-therapeutic sequelaeand 3 cases of complete recovery were recorded.Conclusion. The management of chronic subduralhaematoma in chronic alcoholics is complex. Therisks of recurrence and postoperative sequelae arenot negligible. Contexte et objectif. Le risque et les conséquences de la grossesse des adolescentes restent peu documentés dans les pays d’Afrique subsaharienne. L’objectif de l’étude était de déterminer le devenir périnatal des nouveau-nés de mères adolescentes. Méthodes. Il s’agissait d’une étude transversale incluant les nouveau-nés des mères adolescentes (âgés de ≤ 18 ans), entre les 1er septembre 2018 et 03 avril 2019, à l’hôpital de Ziguinchor. Etaient exclus, les enfants nés à domicile et les nouveau-nés dont le dossier obstétrico-néonatal était incomplet. Les paramètres d’intérêt englobaient les données épidémiologiques, sociodémographiques, obstétricales et périnatales. Résultats. Au total, il y a eu 170 naissances pour une population de 166 adolescentes dont 162 grossesses mono fœtales et 4 grossesses gémellaires. Les mort-nés étaient au nombre de 7 et les naissances vivantes au nombre de 163. L’âge moyen des adolescentes était de 17 ans [13 – 18], 56% d’entre eux n’avaient pas réalisé les 4 consultations prénatales requises. L’hypertension artérielle, l’éclampsie étaient les pathologies obstétricales les plus représentées (27,1%). Le sex-ratio des nouveau-nés était de 1,2. L’âge gestationnel moyen était de 35,2 semaines d’aménorrhée [32 - 43,5] et le poids de naissance moyen était de 2788 grammes [1300 - 4400]. Quatre-vingt-neuf nouveau-nés étaient hospitalisés, soit un taux de 52,4%. Les principales pathologies néonatales étaient l’asphyxie périnatale (n = 41) ; le petit poids de naissance (n=41) ; l’infection néonatale (n=36). La durée moyenne d’hospitalisation était de 5,5 jours [3 - 16]. Conclusion. Les nouveau-nés de mère adolescente à Ziguinchor présentent des risques de prématurité, d’hypotrophie, d’asphyxie périnatale et d’infection, tandis que leur mère, l’hypertension artérielle

Ethnopharmacological survey of different uses of seven medicinal plants from Mali, (West Africa) in the regions Doila, Kolokani and Siby

An ethnopharmacological survey was carried out to collect information on the use of seven medicinal plants in rural areas in the nearby regions of Bamako, Mali. The plants were Opilia celtidifolia, Anthocleista djalonensis, Erythrina senegalensis, Heliotropium indicum, Trichilia emetica, Piliostigma thonningii and Cochlospermum tinctorium About 50 medical indications were reported for the use of these plants in traditional medicine. The most frequent ailments reported were malaria, abdominal pain and dermatitis. The highest number of usages was reported for the treatment of malaria (22%). The majority of the remedies were prepared from freshly collected plant material from the wild and from a single species only. They were mainly taken orally, but some applications were prepared with a mixture of plants or ingredients such as honey, sugar, salt, ginger and pepper. Decoction of the leaves was the main form of preparation (65%) and leaf powder was mostly used for the preparation of infusions (13%). The part of the plants most frequently used was the leaves. There was a high degree of informant consensus for the species and their medicinal indications between the healers interviewed. The results of this study showed that people are still dependent on medicinal plants in these rural areas of Mali

Etude ethnobotanique des plantes alimentaires utilisées en période de soudure dans les régions Sud du Mali

La période de soudure est celle pendant laquelle les stocks de céréales sont épuisés et les prochaines récoltes ne sont pas encore prêtes. Au Mali (Afrique de l’Ouest), elle varie d’août à septembre. Pendant cette période, les communautés locales utilisent les plantes sauvages comme aliment. L’objectif de la présente étude était de recenser les plantes sauvages alimentaires consommées dans les régions Sud du Mali (Kayes, Koulikoro, Sikasso et Ségou) pendant cette période. Des enquêtes ethnobotaniques utilisant les méthodes du focus group, d’enquête individuelle et d’interviews semi-structurées ont été menées. Au total, 454 personnes dont 338 hommes et 116 femmes soit respectivement 74,4% et 25,6% ont été interrogées. Les jeunes (15 - 30 ans), cultivateurs et Bambara étaient les plus nombreux. 87 plantes alimentaires appartenant à 44 familles ont été identifiées; les fruits de 56 plantes (62,2%), les feuilles de 43 plantes (47,8%) et les graines de 10 plantes (11,5%) sont consommées comme aliments pendant les périodes de soudure. Parkia biglobosa, Adansonia digitata et Vitellaria paradoxa sont les plantes les plus utilisées soit seules ou dans des plats comme additifs. Certaines de ces plantes servent également comme médicament et comme source de revenus pour les communautés locales.© 2016 International Formulae Group. All rights reserved.Mots clés: Plantes sauvages alimentaires, enquête ethnobotanique, période de soudure, Sud-MaliEnglish Title: Ethnobotanical study of food plants used in the period of soldering in the southern regions of MaliEnglish AbstractThe lean period is the one during which grain stocks are depleted and the next harvest is not yet ready. In Mali (West Africa), it varies from August to September. During this period, local communities use wild plants as food. The objective of this study was to identify wild food plants consumed in the southern regions of Mali (Kayes, Koulikoro, Segou and Sikasso) during this period. Ethnobotanical surveys using focus group methods, individual survey and semi-structured interviews were conducted. A Total of 454 respondents including 338 (74.4%) men and 116 (25.6%) women were interviewed. Yong farmers (15-30 years) from Bambara ethic group were the most numerous. 87 food plants belonging to 44 families have been identified; the fruit of 56 (62.2%) plants, the leaves of 43 (47.8%), and the seeds of 10 plants (11.5%) were consumed as food during lean periods. Parkia biglobosa, Adansonia digitata and Vitellaria paradoxa are the most used plants either alone or in dishes such as additives. Some of these plants are also used as a medicine and as a source of income for local communities.© 2016 International Formulae Group. All rights reserved.Keywords: wild food plants, ethnobotany survey, lean period, South Mal

Argemone mexicana decoction for the treatment of uncomplicated falciparum malaria

A prospective, dose-escalating, quasi-experimental clinical trial was conducted with a traditional healer using a decoction of Argemone mexicana for the treatment of malaria in Mali. The remedy was prescribed in three regimens: once daily for 3 days (Group A; n = 23); twice daily for 7 days (Group B; n = 40); and four times daily for the first 4 days followed by twice daily for 3 days (Group C; n = 17). Thus, 80 patients were included, of whom 80% were aged 2000/μl but no signs of severe malaria. The proportions of adequate clinical response (ACR) at Day 14 were 35%, 73% and 65% in Groups A, B and C, respectively (P = 0.011). At Day 14, overall proportions of ACR were lower in children aged 5 years (81%) (P = 0.027). Very few patients had complete parasite clearance, but at Day 14, 67% of patients with ACR had a parasitaemia <2000/μl. No patient needed referral for severe disease. Only minor side effects were observed. Further research should determine whether this local resource could represent a first-aid home treatment in remote area

Paragangliome nasopharynge avec extension a la base du crane: Une localisation inhabituelle des paragangliomes

Introduction : Le paragangliome est une rare tumeur neuroendocrine. La localisation nasopharyngée avec extension à la base du crâne est très rare.Présentation du cas : Il s‘agissait d‘une dame de 39 ans, prise en charge au service de neurochirurgie du CHU « Hôpital du Mali » pour un paragangliome nasopharyngé qui s‘étendait à la base du crâne. La patiente présentait une dyspnée d‘aggravation progressive associée à une épistaxis à répétition évoluant depuis 3 ans environ et une paralysie faciale périphérique gauche. Le scanner avait mis en évidence une masse volumineuse siégeant au niveau du nasopharynx obstruant partiellement les fosses nasales. La lésion était rehaussée après injection de produit de contraste. La patiente a eu une chirurgie d‘exérèse de la tumeur en 2 temps. L‘analyse anatomopathologique avec immunohistochimie a permis de confirmer le diagnostic de paragangliome. Une radiothérapie complémentaire a été réalisée sur le résidu tumoral. Les suites du traitement ont été satisfaisantes.Discussion : Les paragangliomes de la tête et du cou ne représentent que 0,6% des tumeurs de la tête et du cou et 3% de tous les&nbsp; paragangliomes. Le traitement repose sur la chirurgie. La radiothérapie est indiquée si la chirurgie n‘assure pas une résection complète.Conclusion : Les paragangliomes sont une entité à prendre en compte dans les tumeurs nasopharyngées et de la base du crâne. &nbsp; Englsih title: Nasopharyngeal paraganglioma with extension at the skull base: An unusual location of the paragangliomas Introduction: Paraganglioma is a rare neuroendocrine tumor. Nasopharyngeal localization with extension at the skull base is very rare.Case: A thirty-nine-year-old woman, was managed by the Neurosurgery Department of « Hôpital du Mali » for a nasopharyngeal paraganglioma that extended to the skull base. The patient had progressive dyspnea associated with repeated epistaxis for 3 years and left peripheral facial palsy. The CT scan showed a bulky mass sitting in the nasopharynx partially obstructing the nasal cavity. The lesion was enhanced after injection of contrast. The patient had surgery to remove the tumor in 2 steps. Histological analysis with&nbsp; immunohistochemistry confirmed the diagnosis. Complementary radiotherapy was performed on the tumor residue. The results of the treatment were satisfactory.Discussion: Head and neck paragangliomas represent only 0.6% of head and neck tumors and 3% of all paragangliomas. The treatment is based on surgery. Radiotherapy is indicated if the surgery does not provide complete resection.Conclusion: Paragangliomas are an entity to be considered in nasopharyngeal and skull base tumors