Le sous-sol du Mali regorge de matières premières : or, zinc, manganèse faisant l'objet d'exploitation artisanale et industrielle. Les travailleurs dans ces zones sont exposés aux poussières des minerais exploités. La mise en valeur de ces minerais à des conséquences très graves, sur l'appareil respiratoire des ouvriers. Un apport de l'exploration fonctionnelle respiratoire dans la surveillance de la santé de ces travailleurs a été évalué à travers cette étude. Il s'agit d'une étude transversale descriptive réalisée à partir des données spirométriques des travailleurs d'une mine de la région ouest du Mali. L'objectif est d'étudier les aspects fonctionnels respiratoires chez les travailleurs exposés à la poussière minérale au Mali. Sur 197 travailleurs, 104 ont réalisé une spirométrie soit, 53 %. La moyenne d'âge est de 36 ans avec une prédominance masculine. Dans notre étude, 37,5 % des sujets avaient un syndrome de petites voies aériennes (SPVA). La consommation du tabac et la durée du niveau d'exposition étaient les principaux facteurs de risques des troubles respiratoires chez les exploitants de la mine. Les risques de pathologies respiratoires liées à l'exposition à la poussière des minerais sont une réalité dans l'industrie minière extractive au Mali. La réalisation d'exploration fonctionnelle respiratoire sur les sites miniers s'avère nécessaire en vue de dépister précocement les atteintes respiratoires.

Tuberous Sclerosis Complex (TSC) is a multi-organ genetic disorder characterized by numerous hamartomas found in several organs, including the brain, heart, skin, eyes, kidneys, lungs, and liver. The responsible genes are TSC1 and TSC2, encoding hamartin and tuberin, respectively. The hamartin-tuberin complex inhibits the mammalian target of rapamycin pathway, which controls cell growth and proliferation. Variations in the distribution, number, size, and location of lesions lead to variations in the clinical syndrome, even among family members. Most features of Tuberous Sclerosis Complex become evident only in childhood, after the age of 3, limiting their usefulness for early diagnosis. Identifying patients at risk of severe manifestations is crucial. We report a case of Tuberous Sclerosis Complex inaugurated by epilepsy. It is a 10-year-old girl, a student, who came for consultation for a black spot on her left cheek evolving continuously for seven years. Two months later, this spot, asymptomatic solid lesions appeared on her face, gradually increasing in size and number. In her medical history, she has had convulsive seizures since the age of three, occurring at least five times a year, confirmed by an electroencephalogram. There is an oblong-shaped skin plaque measuring approximately 7x3 cm, erythematous, on the left cheek. Additionally, there are multiple normochromic angiofibromas affecting the nasal pyramid, nasolabial folds, and cheeks. The rest of the dermatological examination is unremarkable. The diagnosis of Tuberous Sclerosis Complex was made. In the presence or absence of cutaneous lesions, when faced with epilepsy in young children, we must always consider Tuberous Sclerosis Complex before ruling out other causes.

L'évolution de la BPCO est émaillée d'exacerbations qui peuvent être prévenues et nécessiter un traitement spécifique et parfois une hospitalisation [1]. Sa prévalence mondiale oscille autour de 12 % de la population générale et elle est responsable de 3 millions de décès après les maladies cardiovasculaires [2]. Le masseur-kinésithérapeute a alors toute sa place dans la prise en charge globale du patient du début à la fin [3]. Le but est d'évaluer la fonction respiratoire des patients suivi pour BPCO avant et après les séances de kinésithérapie. Étude prospective, descriptive et observationnelle qui s'est déroulé du 1er janvier 2022 au 31 décembre 2022. La présente étude s'est déroulée à la polyclinique de l'amitié de Bamako et a inclus les patients suivis pour BPCO ayant bénéficié des séances de kinésithérapie. L'échantillonnage a été exhaustif incluant tous les patients qui ont répondu aux critères d'inclusions durant la période d'étude. Tous les patients ont bénéficié d'une spirométrie et d'un TM6 avant et après les séances de kinésithérapie. L'âge moyen de nos patients était de 62,23 ± 7,35 ans. Le sex-ratio était de 14, soit 28 hommes (93,30 %) et 2 femmes (6,70 %). On notait le tabagisme actif chez 93,30 % (n = 28) des patients dont la moitié était sevrée et 20 % de nos patients avaient un antécédent de tuberculose. Les motifs de consultation étaient dominés par la toux, la dyspnée et l'expectoration dans 96,70, 93,30 et 76,70 % des cas. L'examen pleuropulmonaire mettait en évidence un syndrome de condensation pulmonaire dans 60 % des cas (n = 18). La biologie mettait en évidence un syndrome inflammatoire biologique chez 63,30 % des patients (n = 19). La TDM thoracique retrouvait des images d'emphysème pulmonaire dans 73,30 % des cas (n = 22). Majoritairement nos patients avaient un TVO non réversible dans 87 % (n = 26) et TV mixte dans 13 % (n = 4) des cas. Le VEMS moyen avant et après les séances de kinésithérapie était de 58,53 % (±16,46 %) et de 62,07 % (±16,17). La distance moyenne parcourue au cours du TM6 avant et après la kinésithérapie était de 338,90 ± 138, 10 m et de 445,43 ± 139,63 m. Le traitement de font a été administré chez 26 patients (86,70 %) et tous les patients avaient bénéficié des séances de kinésithérapie et des séances d'ETP. Le taux d'hospitalisation était de 23,30 % (n = 7) et la durée moyenne d'hospitalisation était de 9,86 jours avec des extrêmes de 2 et 21. Aucun de nos patients n'a été hospitalisé au cours du suivi médical et pendant la kinésithérapie et ils maîtrisaient tous l'aérosolthérapie. Nous avons constaté une augmentation du VEMS chez la majorité de nos patients et une augmentation de la distance parcourue au cours du TM6. La kinésithérapie améliore les symptômes de la BPCO et réduit les risques d'hospitalisation. Elle permet d'améliorer la qualité de vie des patients en leur permettant de mener de façon plus ou moins autonome les actes de la vie quotidienne. Le VEMS et la distance parcourue en 6 min étaient améliorées chez nos patients.

Progressive erythrokeratodermia (PEK) is a rare génodermatose associated with disorders of keratinization. Mutations are found in genes encoding connexins 31 and 30.3 mapped to chromosome 1 p34-35. This disease is characterized by fixed hyperkeratotic plaques and transient erythematous plaques. Approximately 50% of affected individuals develop palmoplantar keratoderma. Connexins are components of gap junctions, which are intercellular channels present in almost all tissues, including the skin. A 15-year-old Guinean female, a seamstress, presented with asymptomatic black patches on her feet that had been evolving continuously for 5 years, initially starting on the feet and spreading elsewhere, gradually increasing in size with a transient tingling sensation. Previous treatment involved topical phytotherapy. She had no significant medical history, no similar skin conditions in the family, and no history of consanguinity between her parents. On examination, erythematous and keratotic plaques of variable shapes and sizes were noted on the backs of the hands, the posterior surfaces of the forearms, both knees, the lower thirds of the legs, and the backs of the feet, giving a sock-like appearance to the latter location. The complete blood count, lipid profile, and fasting blood glucose were normal. Histopathology was not performed. The diagnosis of progressive erythrokeratodermia of Gottron was considered based on the age of onset, clinical characteristics, and location of the lesions. The patient was prescribed topical keratolytics, oral Acitretin 10 mg, and psychotherapy for both the patient and her parents. It often constitutes an entity encountered in a syndromic context, highlighting the necessity for surveillance.

Introduction: Darier and Ferrant dermatofibrosarcoma is a rare malignant cutaneous mesenchymal tumour, representing less than 0.1% of malignant tumours and less than 5% of soft tissue sarcomas in adults. The aim of this study was to describe the evolutionary profile of cases of dermato fibrosarcoma of Darier et Ferrant reported in the dermato-venereology department of the National Centre for Disease Control (CNAM). Patients and methods: This was a descriptive cross-sectional study conducted in the dermatology department of the National Centre for Disease Control Support between 1991 and 2016, a period of 25 years. Was included, all patient with a histologically confirmed dermatofibrosarcoma notified in the registers of the CNAM histology laboratory or in the patient's medical file during the study period. Results: In total we collected 23 cases out of 5520 biopsied patients, i.e. a proportion of 0.41%. Males represented 60.8% with an average age of 40 years. The lesions were simple nodular in 12 of the 23 patients (52.2%), multi-nodular in 7 of the 23 patients (30.4%), nodulo-ulcerous and in patches in 4 of the 23 patients (17.4%). The lesions were located on the trunk in 60.8% of cases (image 1), on the head in 21.7% of cases and on the limbs in 17.5% of cases. The mean size of the lesions was 10×8cm with extremes of 3cm×3cm to 25cm×20cm. Management was exclusively surgical. Conclusion: DFSP is a rare tumour with a slow evolution, characterised by its rare metastasis but above all by its strong tendency to recurrence. The diagnosis is often evoked clinically and confirmed by histological study. The treatment of DFSP is surgical based on a large and deep lesion removal. Clinical monitoring allows early detection of recurrence, which is frequent in this disease.

Background: Psoriasis is a chronic recurrent inflammatory dermatosis occurring in genetically predisposed individuals. Its dramatic nature of the lesions, successive flare-ups, and skin discomfort may affect the quality of life of patients and result in a depressive tendency. Objective: To assess the impact of psoriasis on the quality of life of patients and the relationship between disease severity and quality of life. Methods: A descriptive cross-sectional study was carried out in Bamako from September 3, 2018 to August 30, 2019. The Dermatology Life Quality Index (DLQI) and Psoriasis Area Severity Index (PASI) were used to assess quality of life and factors of disease severity. Inclusion was based on clinical and histopathologic criteria. Questionable cases were excluded from the study. Results: A total of 106 cases of psoriasis were identified out of 24,000 consultations, i.e., a hospital frequency of 0.44%. Of these cases, 54 were included. Males accounted for 70% of the cases, and the average age was 37. The distribution of the social repercussions of the disease was as follows: disability (68.52%), non-participation in ceremonies (20.37%), stigmatization (18.52%), isolation (12.96%), work stoppage (11.11%), and non-sharing of meals (9.26%). However, the reception by caregivers was satisfactory in 96.30% of cases, and 85% of patients scored ≤ 10 on DLQI, suggesting that they had good quality of life. Among the patients with psoriasis, 35.04%, 12.96%, and 50.00% had mild, moderate, and severe disease, respectively. Conclusion: Quality of life is multifactorial and has no direct association with the severity of psoriasis. Dermatologists must take into account the dimensions of symptoms and psychological state when managing patients with psoriasis.

Summary: Sister Mary Joseph nodule is a metastatic localization with a generally abdominal-pelvic origin and secondary to a primary adenocarcinoma in 90% of cases. We report an observation of Sister Mary Joseph nodule revealing a primary adenocarcinoma of the colon in a young adult with multiple pathologies. Observation: A 57-year-old patient, followed for hepatitis B, HIV1+, and benefiting from a therapeutic regimen (Tenofovir+Lamivudine+Dolutegravir) since 2019 and later a hyperthyroidism of incidental discovery. For one year he has had a firm nodular ulceration measuring 07 cm in its longest axis, with a reddish-pink appearance and whitish deposits, a haemorrhagic ooze on contact, and located at the umbilicus. Also, a tongue laden with whitish coatings that are easily removed with a tongue depressor and the inner surface of the cheeks and palate are erythematous. Bilateral exophthalmos abolished vocal vibrations in both lung bases; two hard left inguinal adenopathies adhering to the deep plane, painless, 3 cm in diameter each. He also described episodes of alternating constipation and diarrhoea accompanied by abdominal pain, coughing, physical asthenia and weight loss (40% loss in 2 years). Anatomopathology of a fragment of the nodule revealed a well-differentiated adenocarcinoma whose tumour cells were of colorectal origin and expressed CK20 and CK8/18. Colonoscopy revealed a multilobed polyploid tumour of the ascending colon and histology concluded that it was a liberkuhnian adenocarcinoma. A chest CT scan revealed pulmonary and abdominal-pelvic metastases and the diagnosis of a Sister Mary Joseph nodule revealing a colonic and metastatic adenocarcinoma was made. The patient was referred to the oncology department for palliative care after the surgical opinion. Conclusion: The nodule of Sister Marie Joseph is a cutaneous metastasis revealing a cancer of the abdominopelvic sphere. This rare and characteristic tumour deserves to be known by practitioners .......

Introduction: necrotizing fasciitis (FN) is a medico-surgical emergency that often involves the vital prognosis. Despite its rarity in children, necrotizing fasciitis is complicated by septic shock in 74 cases out of 100 and it is a serious infection, fatal in about 30% of cases. The aim of this work was to study the risk factors for necrotizing fasciitis in children. Methodology: This was a case-control study interesting children aged 0-15 years seen in dermatological consultation and included in accordance with the objectives of the study for a given period from January 1, 2020 to December 30, 2021. Diagnosis of necrotizing fasciitis was based on clinical and histological. Results: During the study period, 2501 children were seen in dermatological consultation, of which 20 had necrotizing fasciitis, ie a hospital frequency of 0.80%. These twenty cases of necrotizing fasciitis were matched with 20 controls by age, sex, hospital, date of admission. The age of children with necrotizing fasciitis ranged between 3 and 15 years, and the average age was 11.7 years. Preschool children (3-5 years old) accounted for 5%, school-age children (6-10 years old) accounted for 25% and adolescents accounted for 70%. The cases were divided into 11 boys (55%) and 9 girls (45%), the sex ratio was 1.22. The average duration of evolution of necrotizing fasciitis in children was 7.6 days with extremes ranging from 3 to 12 days. Conclusion: Many factors in our study were associated with the occurrence of necrotizing fasciitis in children, led by NSAIDs, traditional medications and traumatic wounds. In view of these results obtained in our study carried out under unfavorable conditions, it is necessary that cohort studies be carried out in order to confirm our results.

Introduction: Infertility can have serious psychological and social repercussions on the life of a couple. Hysterosalpingography and laparoscopy are necessary exams for the exploration of tubal infertility. The aim of this study was to determine the concordance between these two exams in our daily practice. Patients and Methods: Our study was retrospective, cross-sectional, descriptive and comparative. It took place from January 2020 to August 2022 at the 'GRACE' medical clinic. Data were collected using a survey form and obtained from the patients' records, hysterosalpingography results and operative reports. Data were analyzed with SPSS version 20.0 software. Results: A total of 33 patients met our inclusion criteria. They had a mean age of 29.61+/-6.11 years with a minimum age of 18 years and a maximum of 42 years. Pelvic adhesions were the most common lesions found at laparoscopy. Hysterosalpingography was more specific (Sp=83.33%) than sensitive (Se=60%) in the diagnosis of proximal tubal obstructions. The sensitivity of hysterosalpingography was higher (Se=72.22%) than its specificity (Sp=20%) in the diagnosis of distal tubal obstructions. The concordance rate between the two exams (kappa) was 44% in the diagnosis of proximal tubal obstructions and 8.1% in the case of distal tubal obstructions. Conclusion: Our results corroborate those of the literature. Rather than substituting one for the other, hysterosalpingography and laparoscopy remain complementary examinations in the diagnosis of tubal infertility.

Sirenomelia is a rare form of caudal dysgenesis generally incompatible with life due to the severe renal malformations associated. In Africa, it is associated with mystico-religious considerations and witchcraft and sometimes exposes the family to a violent stigmatization. The transgressions of socio-cultural prohibitions by parents would be the cause of the occurrence of this malformation. Its etiology is still very controversial. We report the observation of a case born at the University Teaching Hospital ‘Pr BSS’ of Kati, this is the first Malian case reported in the literature.

OBJECTIVE:It was to take stock of the dermatological conditions managed within the hospital over a period of five years.PATIENTS AND METHODS:Retrospective and descriptive study performed from January 2015 to December 2019 at the Bamako Dermatology Hospital, based on the records of patients received in consultation.RESULTS:During the period, 6,322 new consultations were recorded. The mean age was 42 ± 12.5 years with extremes of two months and 82 years. The sex ratio was 0.6. The majority of our patients (76.1%) came directly from home. Socio-professionally, the patients were mainly peasants (45%), housewives (23.9%) and workers (12%). Among the 6,322 consultants, 27.1% were hospitalized. In terms of diagnosis, skin conditions were dominated by infections (56.1%), followed by allergies (15.4%); system diseases (12.0%); genetic dermatoses (7.5%) and tumor dermatoses (5.2%). The average length of hospital stay was 46 ± 18.7 days in adults and 21 ± 11.6 days in children.CONCLUSION:This study made it possible to identify the skin conditions subject to consultation in dermatology which are dominated by infections and allergies.

Introduction: Hypopharyngeal cancers are ubiquitous cancers. These are very lymphophilic cancers; cervical lymph node metastases are present in 60% to 80% of patients at the time of diagnosis. Alcohol and tobacco have been implicated in their genesis. Objective: To study the epidemiological, clinical and paraclinical aspects of hypopharyngeal cancer in the ENT department of the CHU Gabriel Toure. Patients and Methods: It is a retrospective and prospective quantitative study covering a period of 4 years from June 2014 to July 2018; all patients who presented with hypopharyngeal cancer were included. Results: Thirty-five (35) patients were collected during the study period. The mean age of the patients was 44 ± 14 years with extremes of 16 and 78 years. The sex ratio was 0.47. Dysphagia was the reason for consultation at 100%. The average consultation time was 14 months, with extremes of 3 to 26 months. Smoking intoxication was found in 13 patients. The piriform sinus was interested in 52%. More than half of the patients were received at the advanced stage (T3 - T4). The histology was dominated by the well-differentiated epidermal carcinoma (91%). Conclusion: Hypopharyngeal cancer is common and occurs at all ages. T3 - T4 tumors are bad factors, hence early diagnosis and appropriate management are important for improving the prognosis.

Long considered as orphan diseases because of their poorly estimated frequency. Genodermatoses are more and more encountered in the world. They have been reported in all ethnic groups, including African blacks. In Mali, ethnic diversity and the frequency of consanguineous marriage justify the interest of this study.

Xeroderma pigmentosum is related to a defect of the enzymes involved in repairing the oncogenic effects of ultraviolet exposure. The condition is found all over the world, in all ethnicities and races. This rare genodermatosis is often unknown in countries lacking specialist in dermatology. This scarcity and insufficiency of qualified personnel give rise to difficulties in diagnosing this pathology, especially in West Africa where XP is wrongly diagnosed for other pathologies. Objective: To share with colleagues the problem of diagnosis of Xeroderma pigmentosum in countries with insufficient number of dermatologist and poor technical platform. Observation: 21-year-old man, with no pathological history of dermatosis was seeking for medical consultation because of cutaneous dryness and photophobia. Previous visits at several health centers failed to diagnose the condition and no noticeable improvement was seen from given treatment. Verbal questioning found the notion of consanguinity (his father and his mother are cousins, and belong to the same Dogon group). Cutaneous pigmentary disorders were absent at birth but appeared at the age of 12 years. Physical examination highlighted photophobia in addition to specific clinical and paraclinical signs allowed to diagnose Xeroderma pigmentosum varying type. Conclusion: in West Africa, the challenge of diagnosis of Xeroderma pigmentosum is undoubtedly related to a lack of qualified personnel and technical means of diagnosis, which makes its frequency underestimated.

INTRODUCTION:Hemangiomas are regenerative benign vascular tumors of the child, which may be of interest to all organs, most often located on the skin. The aim of our study is to determine the prevalence of haemangiomas on black skin. It is a descriptive cross-sectional study that took place from November 2015 to August 2016 at CNAM, in the department of dermatology-leprology- Venereology of Mali.RESULTS:Of 14,810 patients seen in consultation, we received 17 cases of hemangioma, ie 0,11%. The average age was 5 months with extremes of 1 month and 60 months. Tuberous angiomas represent 82,35% of clinical forms, subcutaneous angiomas 11,76% and mixed angiomas 5,89%. In 4/17 of our patients there was an infectious complication, following an ulceration on the first day of the consultation. The average lesion size was 3,25cm with extreme 0.5cm and 8cm. The number of lesions per patient was 1 in 16 patients and 2 in 1 patient. In 10/17 patients the lesions were localized at the cephalic level, 3/17 at the trunk level, and 4/17 at the perineum.CONCLUSION:Infantile hemangioma is a poorly reported condition on black skin. The demands for care are motivated either by the character showing lesions or by ulcerative complications. Sensitization of populations and ongoing training of health workers are needed to detect hemangiomas.

Kaposi's disease in children with HIV is rarely reported in everyday practice. This is a case study of cutaneous Kaposi's disease revealing HIV in a 5-year-old child with polymorphic eruption of papules and nodules on the face, trunk, back, and limbs. Histopathological examination confirmed the diagnosis of Kaposi's disease. The child's HIV serology was positive with a CD4 count of 240/mm3, normochromic and normocytic anemia, and a hemoglobin level at 8.5 g/dl. It was found that the child, after early weaning from his HIV-negative mother, had repeatedly suckled his healthy grandmother, who had no skin lesions but was HIV1 positive. Both grandmother and child were referred for treatment in their locality. The case is noteworthy for the way in which the HIV1 virus infected the child during weaning and then being suckled by his grandmother. The child already had an initial dental flare that could have injured his grandmother. Thus, in our case, there is a contamination by HIV1 virus most likely from the grandmother and contamination by the HHV8 virus, source unidentified as a technical plateau was reached.

Le risque de survenue de carcinome épidermoïde chez les femmes utilisatrices de cosmétiques dépigmentants n’est pas connu. En Afrique subsaharienne, les premiers cas ont été rapportés à Dakar en 2010. Nous rapportons le premier cas au Mali. Madame AK, malienne de 30 ans a consulté en décembre 2014 pour une ulcération du cou évoluant depuis 5 ans. Le début était marqué par une petite érosion spontanée trainante secondairement ulcérée sans tendance à la guérison. Elle n’avait pas d’antécédents pathologiques particuliers. Depuis 10 ans, elle utilisait régulièrement des produits cosmétiques dépigmentants à base d’hydroquinone et de dermocorticoïdes. L’examen physique retrouvait une tumeur ulcéro-bourgeonnante de grande taille de la face latérale du cou. Il n’y avait pas d’adénopathie associée. Le reste de l’examen clinique était normal de même que le bilan biologique. L’examen histologique d’un fragment biopsique a confirmé le diagnostic de carcinome épidermoïde. Une exérèse large de la lésion était pratiquée suivie d’une récidive 7 mois plus tard. Ce qui a nécessité une reprise chirurgicale. Les suites opératoires étaient simples. La présence de lésion ulcérée trainante sur des zones photo-exposées chez une femme qui se dépigmente doit faire évoquer un carcinome épidermoïde et inciter à pratiquer une biopsie cutanée pour un examen histopathologique.