Etude épidémiologique, clinique et thérapeutique des hydrocèles dans trois districts sanitaires de la région de Sikasso/Mali: Epidemiological, Clinical and Therapeutic Study of Hydroceles in Three Health Districts in the Sikasso Region / Mali

Context and objective. Hydrocele is one of the most common urogenital manifestations of lymphatic filariasis. It is a common cause of enlarged scrotum in the tropics. This study aims to describe the epidemiological, clinical and therapeutic aspects of hydroceles. Methods. This cross-sectional descriptive study of hydroceles in three endemic filarial Sikasso areas in Mali was conducted from November 2017 to December 2018. The variables studied were: frequency of hydrocele, age of patients, duration of evolution, type of anesthesia, surgical technique, volume, operative time and postoperative results. Results. Three hundred fifty-eight patients were operated on in fourteen months. The frequency of hydrocele‘s surgery was 31%. Their average age was 47.1 years old (extremes 4 months and 94 years). The duration of evolution was 10.7 years (extremes 6 months and 21 years). The right side was the most affected with 44.1% followed by the left side with 31.3%. Hydrocele was bilateral in 19%. Local anesthesia (with xylocaine 2%) was used in 88%. All patients underwent a successful vaginal resection. Conclusion. The hydrocele remains a common urological pathology in these endemic areas. The diagnosis is made after a long period of evolution of the disease. Treatment in outpatient surgery is undertaken using local anesthesia. These hydrocele management campaigns should be encouraged to treat the maximum number of patients. Contexte et objectif. L’hydrocèle constitue l’une des manifestations urogénitales les plus fréquentes de la filariose lymphatique. Elle est une cause fréquente de grosse bourse dans les régions tropicales. L’objectif de cette étude est de décrire les aspects épidémiologiques, cliniques et thérapeutiques des hydrocèles. Méthodes. Il s’agissait d’une étude transversale et descriptive sur les hydrocèles, réalisée entre novembre 2017 et décembre 2018 ; dans trois zones endémiques filariennes dans la région de SIKASSO au Mali. Les variables étudiées étaient : la fréquence de l’hydrocèle, l’âge des patients, la durée d’évolution, le type d’anesthésie, la technique chirurgicale, le volume, le temps opératoire et les résultats postopératoires. Résultats. Trois cent cinquante-huit patients ont été opérés en quatorze mois. L’intervention de l’hydrocèle rendait compte de 31% des activités chirurgicales. Leur âge moyen était de 47,1 ans (extrêmes 4 mois et 94 ans). La durée d’évolution était de 10,7 ans (extrêmes de 6 mois et 21 ans). Le testicule droit était le plus touché (44,1 %) suivi du côté gauche (31,3%). L’hydrocèle était bilatérale dans 19 %. L’anesthésie locale à la xylocaïne 2 % a été réalisée dans 88%. La résection vaginale a été réalisée chez tous les patients avec succès. Conclusion. L’hydrocèle reste une pathologie urologique fréquente en zone d’endémie filarienne. Le diagnostic se fait après une longue durée d’évolution de la maladie. Le traitement en chirurgie ambulatoire réalisée sous anesthésie locale a montré des résultats satisfaisants. Ces campagnes de prise en charge de l’hydrocèle sont à encourager pour pouvoir traiter le maximum de patients

Apport des moyens endoscopiques dans la dilatation des sténoses caustiques de l’oesophage

Introduction: The aim of this work was to present the contribution of the endoscopy in the management of esophageal dilatation for caustic esophageal stenosis (CES). Methods: This was a descriptive and prospective study in the thoracic surgery department at the Hospital of Mali. A total of 46 cases of CES is recorded and divided into 4 groups according to the topography of the esophageal lesions. For the different methods of dilatation the number of performed endoscopic support was determined to understand the contribution of endoscopic means in the success of dilatation for CES. The outcome, complications and mortality in the two methods were compared. Results: Fibroscopy was used in 41.30% of patients with Savary Guillard dilators and in 47.82% of patients with Lerut dilators. Video laryngoscopy was used in 58.69% of patients who underwent dilatation with Lerut dilators. The passage of the guide wire was performed in 39.13% under video laryngoscopy and 58.68% under fibroscopy. In comparison of the two methods, there is a significant difference in the occurrence of complications (p = 0.04075), general anesthesia (p = 0.02287), accessibility (p = 0.04805) and mortality (p = 0.00402). Conclusion: The CES is a serious disease and under evaluated in Mali. The endoscopies contribute significantly to the success of esophageal dilatation for caustic stenosis in the different methods we used.Keywords: Esophagus, caustic stenosis, dilatation, endoscopicPan African Medical Journal 2016; 2

Space-time clustering of childhood malaria at the household level: a dynamic cohort in a Mali village

BACKGROUND: Spatial and temporal heterogeneities in the risk of malaria have led the WHO to recommend fine-scale stratification of the epidemiological situation, making it possible to set up actions and clinical or basic researches targeting high-risk zones. Before initiating such studies it is necessary to define local patterns of malaria transmission and infection (in time and in space) in order to facilitate selection of the appropriate study population and the intervention allocation. The aim of this study was to identify, spatially and temporally, high-risk zones of malaria, at the household level (resolution of 1 to 3 m). METHODS: This study took place in a Malian village with hyperendemic seasonal transmission as part of Mali-Tulane Tropical Medicine Research Center (NIAID/NIH). The study design was a dynamic cohort (22 surveys, from June 1996 to June 2001) on about 1300 children (<12 years) distributed between 173 households localized by GPS. We used the computed parasitological data to analyzed levels of Plasmodium falciparum, P. malariae and P. ovale infection and P. falciparum gametocyte carriage by means of time series and Kulldorff's scan statistic for space-time cluster detection. RESULTS: The time series analysis determined that malaria parasitemia (primarily P. falciparum) was persistently present throughout the population with the expected seasonal variability pattern and a downward temporal trend. We identified six high-risk clusters of P. falciparum infection, some of which persisted despite an overall tendency towards a decrease in risk. The first high-risk cluster of P. falciparum infection (rate ratio = 14.161) was detected from September 1996 to October 1996, in the north of the village. CONCLUSION: This study showed that, although infection proportions tended to decrease, high-risk zones persisted in the village particularly near temporal backwaters. Analysis of this heterogeneity at the household scale by GIS methods lead to target preventive actions more accurately on the high-risk zones identified. This mapping of malaria risk makes it possible to orient control programs, treating the high-risk zones identified as a matter of priority, and to improve the planning of intervention trials or research studies on malaria

Assessment of the Physico-Chemical Conformity of an Antiseptic Solution: Case of Polyvidone - Iodine 10%

Introduction: Antiseptics have been used for many years in human and veterinary medicine. Over the years, the lengthening of surgical procedures in human surgery and the increasingly frequent use of inert material has increased the risk of infections. This was why skin antisepsis has become very important in the prevention of infections of the surgical wound and resulting complications. In Mali, at the Gabriel Touré University Hospital, the most prescribed family of antiseptics was the halogenated ones, in particular 10% povidone iodine for wound and surgical site antisepsis. This study was aimed to control the quality of 10% povidone iodine used in the hospital. Methodology: We conducted at the Medicines Quality Control Service of the National Health Laboratory of Mali (LNS) a retrospective analytical study on the quality control of 10% povidone iodine. We obtained 10% povidone iodine samples from the Pharmacie Populaire du Mali (PPM). We analyzed 48 batches of samples in regards of visual inspection, average volume, titrimetry, colorimetric test and pH control. Results: All 48 analyzed batches were compliant, i.e. contained the active ingredient and could be used in health facilities or at home as an antiseptic. Conclusion: All analyzed batches of 10% povidone iodine samples did not show any cases of inconsistency and therefore could be used in the management of wound dressings. Future Direction: Use other analytical methods like HPLC to test the quality control of povidone and other types of antiseptics. Keywords: antiseptic, povidone-iodine 10%, compliance, quality contro