The aim of our work was to study the epidemiological and clinical aspects of acute thoracic syndrome in children with sickle cell disease hospitalized in the paediatric department of the Gabriel Touré University. Materials and methods: We conducted a retrospective study over six (06) years, from January 1, 2017 to October 31, 2022, based on the records of children under 16 years of age with sickle cell disease confirmed by haemoglobin electrophoresis and hospitalized for acute thoracic syndrome in the paediatric department of the UH-GT. Results: The frequency of hospitalization was 5.46%, the average age was 6.2 years, with a male predominance (sex ratio: 4.6). Nearly half of (studie subject?) (47.8%) had a history of vaso-occlusive crises. Chest pain was the main reason of consultation (61.5%). Hyperthermia, tachypnoea and hypoxia were present in 43.6%, 4.4% and 76.9% respectively. Pulmonary signs were dominated by respiratory distress (92.3%), with the homozygous form (SS) being the most common (92.3%). Bilateral basal opacities were found on frontal chest X-ray in 46.2% of patients. All patients were rehydrated. The mean duration of treatment was 9.1 days, with extremes of 2 and 31 days. Mortality rate was 2.6%, related to the degree of hypoxia (P= 0.001). Conclusion: Acute thoracic syndrome is a frequent and serious acute complication of sickle cell disease. Any chest pain associated with respiratory signs and poor oxygen saturation should call for the diagnosis Acute thoracic syndrome.

Introduction: Birth trauma in newborns is the result of difficult deliveries. Despite improvements in pregnancy monitoring and the standardization of delivery care, injuries in neonates during delivery remain a major concern in neonatology. Methodology: Study conducted from January 1, 2014 to December 31, 2018, was a retrospective, cross-sectional, analytical study. The purpose was to determine the frequency of obstetric trauma in newborns at CHU Gabriel TOURE, to analyze the different types of injuries observed and to assess risk factors. All newborns admitted to neonatology for injuries were included. Results: Thirty-nine neonates were included (n=39). The sex ratio was 1.29 (M= 22; F=17). Hospital frequency was 1.9 ‰. The majority of patients were admitted within the first 24h (n=35; 90%). The majority of mothers were aged between 20 and 34, (i.e.76.8 %). Multiparous women represented 38% of the mothers. No pregnancy follow-up had been carried out in 23.1% of mothers. Deliveries by vaginal route accounted for 82.1%. Caesarean section accounted for 18%. Transverse fetal presentation was the most frequent reason for Caesarean section, representing 57%. Instrumental delivery was performed in 23.1% of deliveries. Cupping was utilized in 18%. Perinatal anoxia accounted for 59% of newborns. Trauma in newborns was as follows: Serosanguineous bump (n= 6; 15%), Skull skin injury (n=5; 13%), Brachial plexus nerve palsy (n=13; 33%), Femur fracture (n=12; 31%). Trauma to the skull and face accounted for 25.6%. Twelve patients (31%) received treatment with a posterior splint. Twenty percent of neonates had polytraumatism. Instrumental birth was a significant factor in neonatal craniofacial trauma (p = 0.0001). Macrosomia was a risk factor for brachial plexus palsy (p= 0.03). Breech positioning was a factor in the occurrence of lower leg fractures (p=0.001). The mortality rate was 33.3% (n=13). Perinatal asphyxia was the main cause of death (n= 23; 59%). Conclusion: Newborn birth trauma remains a major concern in neonatology in our country. Enhanced monitoring of pregnancy and delivery will reduce the morbidity and mortality associated with this disorder.

Macrosomia is a concern in the daily practice of the neonatologist. The aim of this work was to investigate the sociodemographic, clinical and survival aspects of macrosomic neonates. It was a retrospective and descriptive study ran from 01/01/2017 to 31/12/2019. Were included, all macrosomic neonates hospitalized in neonatology service during the study period. Fortysix macrosomic newborns were included, accounting for a hospital frequency of 0.71%. The predominant maternal age group was 20-29 years. Pregnancy was monitored in 73.9% of cases. Gestational diabetes represented 30.4% of cases. Pregnancy term was not specified in 43.5% of cases, and was exceeded in 6.5%. The main complications recorded were a serosanguineous bump observed in 41.3% of cases, clavicle fracture in 10.9%, cephalohaematoma in 6.5%, humerus fracture and obstetric brachial plexus palsy in 2.2% each (Figure 1). Hypoglycemia was observed in 39.1% of patients, 13% of whom died. Newborns were hospitalized for perinatal anoxia in 52.2% of cases, followed by neonatal infection in 47.8% and respiratory distress in 41.3% (Figure 2). At least a quarter of newborns (26.1%) were resuscitated at birth. The average hospital stay was 5.39 ± 2.902 days, with extremes ranging from one to twelve days.

Introduction: The objective was to study chronic pathologies associated with severe acute malnutrition in children aged 6 to 59 months hospitalized at URENI. Methodology: This was a retrospective, descriptive and analytical study running from January 1 to December 31, 2017. Results: During the study period 352 children were hospitalized for severe acute malnutrition at the URENI of the CSREF CV. Among them, 18 presented a chronic pathology, i.e. a frequency of 5.11%. The male gender was predominant, i.e. 61.1% with a sex ratio of 1.57. The 12-24 month age group represented 50% of cases. Thirty-three percent of children had a history of neonatal resuscitation and 16.7% were formerly premature babies. Marasmus was of the severe acute malnutrition type the most represented, i.e. 77.8% of the cases. The association of malnutrition with HIV infection and Cerebral Palsy (CP) were accounted for 27.8% each. More than half of the patients (55.6%) stayed between 15 - 21 days in the structure. Conclusion: HIV infection and cerebral palsy constitute the chronic pathologies most associated with severe acute malnutrition in children at the Csref of commune V.

Introduction: Upper GI endoscopy is a method of visual exploration of the upper part of the digestive tract using an optical tube fitted with a lighting system called an endoscope or fiberscope. In Mali, very few data are available on digestive endoscopy in children. The aim of our study was to demonstrate the role of endoscopy in the diagnosis of digestive pathologies in the pediatric department of Gabriel Toure hospital. Material and Methods: we conducted a retrospective study from January 2017 to December 2019 of children aged 0 to 15 years who had undergone upper GI endoscopy. Results: during our study period, 52 cases of digestive endoscopy were recorded out of 24326 children hospitalized in the Department of Pediatrics at Gabriel Touré hospital, representing a frequency of occurrence of 0.21%. The sex ratio was 0.92. 40.4% of our patients underwent endoscopy before 24 hours. Lesions were located in the esophagus in 28.8% of cases. Only 11.5% of children underwent biopsy, and the death rate was 3.8%. Conclusion: Digestive endoscopy is now a routine technique in paediatric gastrology, and represents a reliable diagnostic tool, provided that it is performed by an endoscopist trained in children and that the equipment is suitable

Introduction: Respiratory distress in children is a frequent emergency in daily practice. The aim was to describe the clinical and therapeutic characteristics of respiratory distress in young children aged 6 to 59 months admitted to the paediatric emergency department of CSREF CV. Methods: This was a prospective cross-sectional study conducted over a 12-month period from 01 August 2022 to 31 July 2023. Data were collected using an individual survey form. S0PSS 23.0 software was used for data entry and analysis. Results: During the study period, 881 hospital admissions were recorded, including 82 cases of respiratory distress, i.e. a frequency of 9.31%. Females were more prevalent (57.3%). The most common age group was 6-12 months (46.34%). The month with the highest number of admissions was September (15.85%). Dyspnoea was the most common reason for consultation (31.06%) and hospitalisation (68.29%). Intercostal indrawing was the most common sign of respiratory difficulty (49.02%). Pneumonia was the most common pulmonary cause (54.88%). The majority of patients were hospitalised for 1 to 5 days (47.56%). Almost a third of patients received antibiotic treatment (27.80%). Conclusion : Early management of respiratory distress can reduce the length of hospital stay and improve vital prognosis.

Introduction: The aim of this study was to describe the epidemiological and clinical aspects of low-lying ARF in children aged 1 month to 14 years seen in the emergency department of the Nianankoro Fomba Ségou Hospital. Methodology: We included for this prospective descriptive study all children aged 1 month to 14 years of both sexes, seen in consultation at the pediatric emergency department, presenting with low-onset ARF, from January to December 2020. Results: The frequency of low ARF was 6.5%. More than half the patients were aged between 3 months and 2 years. Males predominated. The most frequent reason for consultation was fever. The most common diagnosis was bronchitis (63.23%). 78.6% of patients had moderate anemia and hyperleukocytosis. An opacity was found in 66.67 of the radiographs taken. Amoxicillin was the antibiotic of choice. Hospital mortality was 3.59%. Conclusion: ARIs are frequent in emergency consultations.

Introduction: Malnutrition is a major public health problem in several countries around the world. The aim of this study was to determine the impact of risk factors for the occurrence of types of malnutrition in children aged 6 to 59 months at the URENI of the CSRéf in Commune V. Method and Materials: Sampling was exhaustive; the sample size was 73 children. Results: The female sex was the most represented (55%), the most represented age group was 12 to 24 months (49.31%) and the majority of the children were not vaccinated. The mothers ranged in age from 20 to 34 years (64.38%), and were mostly uneducated, housewives (89.04%) and multiparous (64.4%). The most common form of SAM was marasmus (72.60%) and malaria was the most common pathology associated with severe acute malnutrition (54.8%). Risk factors for malnutrition included poverty (38%), food insecurity (20.5%), disease (13.7%) and poor diet (13.7%). A statistically significant link was found between the risk factors and the type of severe acute malnutrition. Conclusion: SAM is common in the Commune V CSREF, and the risk factors for its occurrence remain dominated by poverty.

When access to peripheral veins is delayed or impossible, intraosseous access must be rapidly considered. The aim of our study was to determine the epidemiological, clinical and therapeutic characteristics of children who have benefited from intraosseous access, as well as the practical details of its implementation. Materials and methods: It was a prospective study, on the assessment of aspects of intraosseous access in the management of pediatric emergencies. Children under 15 years of age who received this procedure were included. The study was performed over a 14-month period from March 2018 to April 2019 at the pediatric emergencies of Gabriel Touré hospital. Results: Twenty-two patients were included. The sex ratio was 2.14. The mean age was 9 months (2 months-36 months). Dehydration complicated by shock represented 45.5% of treated diseases. All intraosseous access points were placed in the proximal tibia. Manual insertion was used in all cases. The most frequent early complication was deperfusion (13.6%). Difficulty with peripheral venous access was the main indication (77.3%). The procedure was performed by a physician in 91% of cases, with a success rate of 86.4%. Vascular filling was the most common treatment used by this route, accounting for 82% of cases. Conclusion: Intraosseous device insertion has saved children in life-threatening emergencies. The main factors limiting the insertion of the intraosseous device in our study were high cost of devices and lack of appropriate training about veins access in case of pediatric emergencies.

was statistically significant (p=0.047).Conclusion: Pneumonia remains the most common complication of measles.The major challenge is to reach the WHO target of 95% immunization coverage.

The practice of excision in girls poses a significant risk to their health. The objective of this study was to determine the immediate acute complications associated with this practice.PATIENTS AND METHODS:This was a retrospective descriptive study over a period of 15 months including all girls aged 0-15 years hospitalized for acute complications related to excision within 7 days of the practice in the pediatric department of the University Hospital Gabriel Toure.RESULTS:We collected 17 patient files. The median consultation time was 43 h. The main reason for consultation was post-excision bleeding in 76.4% of the cases. Pallor associated with respiratory distress was found in almost all cases. On admission, four girls (23.5%) were comatose and five girls (29.4%) showed signs of shock. The reasons for hospitalization were hemorrhage associated with post-excisional sepsis (52.9%), complicated shock anemia (23.5%), and severe post-excision anemia (23.5%). The average hemoglobin level was 5.5 g/dL; there was severe anemia in 94.1% of the girls (Hb <7g/dl). All the girls received blood transfusions with red blood cell concentrate. The other treatments received were local care (100%), administration of analgesics (100%), antibiotic therapy (82.4%), and oxygen therapy (41.2%). The outcome was unfavorable in two patients (11.8% deaths).CONCLUSION:This study shows the seriousness of the immediate complications associated with the practice of excision.

RESUMELa drepanocytose pose un probleme de sante publique au Mali. Elle concerne principalement les enfants et les adolescents. L’objectif de notre travail etait de decrire les profils epidemiologiques, cliniques et hematologiques de la drepanocytose dans une cohorte d’enfants suivis au service de pediatrie de l’hopital de Sikasso. Patient et Methodes. Il s’est agit d’une etude prospective transversale. Etaient inclus les enfants drepanocytaires confirmes a l’electrophorese de l’hemoglobine âges de 0 a 15 ans du 1er Janvier au 31 Decembre 2019. Resultats. Nous avons collige 72 dossiers de drepanocytaires (29 filles et 43 garcons). L’âge moyen etait 29,5mois. Il y avait une diversite ethnique avec une predominance de peulhs 36,1% suivi de senoufos 27,7% et les bambaras 18,1%. L’âge moyen des enfants a la premiere crise etait de 35,5mois. Les circonstances de decouverte etaient dominees par les douleurs abdominales 41,7% ; les douleurs osteo-articulaires 27,8% et le syndrome pieds-main 8,3%. Les signes cliniques a l’admission etaient predominer par La pâleur 62,5% ; l’ictere 29,1% et la splenomegalie 13,8%. Le type de complication qu’avait presente les enfants etait domine par la crise vaso-occlusives 56,2% suivi de l’infection 25% et de l’anemie aigue 12,5%. La forme homozygote SS etait dominante dans 57%. A l’hemogramme l'anemie etait retrouvee chez tous les enfants et elle etait normo chrome normocytaire dans plus de la moitie des cas (76,4%) et regenerative dans 69,4%. Conclusion : Le depistage neonatal de la drepanocytose pourrait ameliorer le diagnostic et favoriser une prise en charge precoce dans la region. ABSTRACTIntroduction. Sickle cell disease poses a public health problem in Mali. It mainly concerns children and adolescents. The objective of our work was to describe the epidemiological, clinical and hematological profiles of sickle cell disease in a cohort of children followed in the pediatric department of the Sikasso hospital. Patient and Methods. This is a cross-sectional prospective study. Included were children with sickle cell disease confirmed by hemoglobin electrophoresis aged 0 to 15 years from January 1 to December 31, 2019. Results. We collected 72 sickle cell disease files (29 girls and 43 boys). The average age was 29.5 months. There was significant ethnic diversity with a predominance of 36.1% Fulani followed by 27.7% Senoufos and 18.1% Bambaras. The average age of the children at the first attack was 35.5 months. The circumstances of discovery were dominated by abdominal pain 41.7%; osteoarticular pain 27.8% and hand-foot syndrome 8.3%. Clinical signs on admission were predominantly Pallor 62.5%; jaundice 29.1% and splenomegaly 13.8%. The type of complication presented by the children was dominated by vaso-occlusive crisis 56.2% followed by infection 25% and acute anemia 12.5%. The homozygous form SS was dominant in 57%. On the blood count, anemia was found in all children and it was normochromium, normocytic in more than half of the cases (76.4%) and regenerative in 69.4%. Conclusion. Newborn screening for sickle cell disease could improve diagnosis and promote early management in the region.

The growing emergency of infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) secreting the Panton-Valentine toxin (PVL) has become a serious health problem with epidemic proportions. These bacteria are responsible of severe skin and soft tissue infections, with frequently necrotic lesions, and severe necrotizing pneumonias. Besides adequate antibiotic treatment, surgical drainage and incision of the skin lesions are important. It is therefore essential to respect elementary hygiene rules in order to prevent the acquisition and transmission of CA-MRSA.

Malnutrition is a major public health problem in Mali, along with the country’s political and security instability. We initiated this work with the objective of determining the frequency as well as the risk factors favoring the occurrence of malnutrition in children aged 6 - 59 months hospitalized in the pediatrics department of the Gabriel Touré University Hospital in Bamako, country reference service to identify potential interventions to plan. A cross-sectional study was carried out over a period of 4 months. A bivariate logistic regression analysis allowed us to identify risk factors with degree of significance if p 0.05. During the study period, 2888 children were hospitalized, including 348 aged 6 to 59 months, or a frequency of 12.04%. One in two children was malnourished, i.e. a frequency of 50%. It more frequently affected infants aged between 6 and 23 months with a frequency of 33.7%, with a hospital frequency of growth retardation which was 23% including 14.7% of severe form. The emaciation was 27% of which 18.7% were severe form. The underweight was 42.2% with 31% in severe form. We found the diet inequality in all malnourished and non-malnourished children. A bivariate analysis showed that children with an out-of-school mother have a 2.4-fold risk of being malnourished (OR = 2.425; CI = 1.9 - 4.2; p 0.03). Also children from households with no stable income (non-salaried father) have twice the risk of children from a household with stable income (OR = 2.120; IC = 1.1 - 4.1; p 0.002). Finally, inappropriate nutrients (early introduction of food and early weaning) have been strongly associated with the occurrence of malnutrition. The prevalence of malnutrition reflects the way children eat. Emphasis should be placed on nutritional education and financial stability in households.

RESUMELes troubles moteurs de l’œsophage sont rares et les donnees populationnelles en Afrique subsaharienne sont inexistantes. Le diagnostic et la prise en charge sont en pleine revolution du fait de l’apparition de la manometrie haute revolution (MHR) et des techniques therapeutiques innovantes. Dans un contexte de ressources limites ou la manometrie fait defaut, les examens classiques comme l’endoscopie et le TOGD, restent utiles pour le diagnostic. Nous rapportons deux cas cliniques fortuitement colliges en deux semaines d’intervalle dans notre pratique quotidienne. Le traitement endoscopique de choix propose a ete refuse par les patients, nous contraignant a adopter un traitement medicamenteux. ABSTRACTMotor disorders of the esophagus are rare and population data in sub-Saharan Africa are lacking. Diagnosis and treatment are undergoing a revolution due to the emergence of high-revolution manometry and innovative therapeutic techniques. In a context of limited resources where manometry is lacking, conventional examinations such as endoscopy and TOGD remain useful for diagnosis. We report two accidentally collected clinical cases within two weeks of our daily practice. The first choice endoscopic treatment proposed was refused by the patients, forcing us to adopt a drug treatment.

La cryptococcose neuroméningée (CNM) est une mycose cosmopolite grave, affectant généralement les sujets ayant un déficit de l’immunité cellulaire surtout les séropositifs au virus de l'immunodéficience humaine (VIH).Nous rapportons l’observation d’un cas chez une fille de 7 ans, admise pour altération de l’état général, trouble de la conscience (Glasgow à 8/15), syndrome méningé (raideur de la nuque, signe de Kernig et de Brudzinski) et tétraplégie prédominant à gauche. La tomodensitométrie (TDM) cérébrale avait mis en évidence une dilatation de l’ensemble des cavités ventriculaires avec hypodensité périventriculaire cérébrale.La ponction lombaire (PL) avait ramené un liquide cérébrospinal (LCS) clair. L’analyse du LCS avait permis de retrouver une méningite pléiocytaire, hyperprotéinorachique, hypoglycorachique et un Cryptococcusneoformans. Un traitement antifungique associant amphotéricine B et fluconazole avait été instauré.La patiente avait aussi subit un drainage chirurgical de l’hydrocéphalie. Après 12 semaines d’hospitalisation, le décès était survenu dans un contexte d’altération de l’état général, de convulsions à répétition et de coma profond. La cryptococcose neuroméningée pose un sérieux problème de diagnostic et de traitement chez l’enfant immunocompétent à cause de l’insuffisance des moyens d’investigation et de traitement.

RESUME Introduction. Le but de cette etude etait de reunir les donnees epidemiologiques et diagnostiques, et evaluer les modalites therapeutiques et evolutives de la perforation d’ulcere gastro-duodenal. Materiel et methode. Du 1er Octobre 2012 au 31 septembre 2013, nous avons effectue une etude prospective de type descriptif sur 30 patients admis au service de chirurgie generale de l’hopital de Kankan pour peritonite par perforation d’ulcere gastro-duodenal. Resultat. Au cours de cette etude nous avons pris en charge en urgence 30 patients pour Peritonite par perforation d’ulcere gastroduodenal soit 8,26% de tous les cas. La moyenne d’âge de nos patients etait de 43,16 ans avec des extremes de 15 et 74 ans. Nous avons note une predominance masculine avec un sex ratio H/F egal a 14. La couche socio professionnelle la plus touchee a ete les cultivateurs/Orpailleurs 20 cas, soit 66,66%. Les signes en faveur d’une peritonite par perforation d’ulcere gastro-duodenal ont ete domines par la douleur abdominale, la defense ou contracture abdominale soit 100% des cas. La suture simple a ete la technique operatoire la plus utilisee 24 cas soit 80%. Les suites operatoires ont ete simples chez 10 patients, soit 33, 33% et compliquees chez 12 patients. Nous avons enregistre 8 cas de deces soit 26,66%. La duree moyenne d’hospitalisation etait 12,83 jours avec des extremes de 1 et 40 jours. Conclusion. Les peritonites par perforation d’ulcere gastro- duodenal sont des affections graves pouvant mettre en jeu le pronostic vital. L’amelioration de ce pronostic depend essentiellement du diagnostic precoce de l’affection, des moyens de reanimation efficace et de la rapidite des gestes chirurgicaux. ABSTRACTIntroduction. The aim of this study was to report the clinical features, management and outcome of patients with peritonitis secondary to perforated gastroduodenal ulcer in our setting... Material and method. From October 1, 2012 to September 31, 2013, we carried out a prospective descriptive study on 30 patients admitted to the general surgery department of Kankan hospital for perforation of peptic ulcer. Result. During this study period, we treated as emergencies 30 patients for generalized acute peritonitis by perforation of peptic ulcer, i.e. 8.26% of all surgical emergencies.The average age of the patients was 43.16 years with extremes of 15 and 74 years. We noted a male predominance with a sex ratio M / F equal to 14. The socio-professional group most affected was the cultivators / Gold washers (20 cases, or 66.66%). The signs in favor of a peptic ulcer perforation were mainly abdominal pain, abdominal tenderness and contracture, i.e. 100% of the cases. Simple suturing was the most frequently used operating technique (24 cases, 80%). The postoperative course was simple in 10 patients (33, 33%) and there were complications in 12 patients. The mortality rate was 26.66% ( eight patients). The average length of hospital stay was 12.83 days with extremes of 1 and 40 days. Conclusion. Peritonitis due to gastric-duodenal ulcer perforation is a serious condition that can be life-threatening. The improvement of this prognosis depends essentially on the early diagnosis of the disease, the means of effective resuscitation and the speed of the surgical procedures.

Introduction: According to Mali’s National Immunization Center, the Haemophilus influenzae b (Hib) vaccine coverage rate was 90% in 2015. Our work aimed to study invasive bacterial infections due to Haemophilus influenzae type b in children aged 0 - 15 years hospitalized in the pediatrics department of the UH-GT. Method: We carried out a retrospective descriptive study from January 2017 to December 2018 (i.e. 2 years) among children aged 0 - 15 years and hospitalized for Haemophilus influenzae type b infection confirmed by culture (blood culture, Cerebro-spinal Fluid, and pleural and skin fluid). Results: Thirty-three cases of Hib infections were collected giving a frequency of 0.2% and the age group 3 months to 3 years was the most affected (72.73%). Children who received no vaccine accounted for 21.21%. The Cerebro-spinal Fluid culture and other samples (pleural and skin) identified the bacterium in 100% of cases, against 72.72% in the blood culture Meningitis was the most frequent pathology (78.79%) and the lethality was high (21.21%). Conclusion: Despite the introduction of the Hib vaccine in the routine immunization program in Mali, Hib infections remain with a high lethality linked to meningitis.

Pneumomediastinum is sometimes observed in adult patients but its occurrence in pediatric patients (especially infants) is very rare. We here report a 14-month-old male infant who had subcutaneous emphysema, pneumomediastinum, and importantly, pneumopericardium. He had no particular past histories. He abruptly had cough, fever, and eruption on the abdomen. Computed tomography and echocardiography revealed pneumomediastinum and pneumopericardium. Antibiotics, rest, and supportive therapy ameliorated the condition. We must be aware that pneumomediastinum, and importantly pneumopericardium, can be present in a pediatric patient with subcutaneous emphysema. The infant’s symptoms disappeared under strict monitoring of respiratory status, nasal oxygen therapy and antibiotic therapy.