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Introduction: Breast cancer results from an anarchic malignant proliferation of abnormal cells of the mammary gland and is the first most common cancer in women in developed countries with 50,000 new cases estimated in 2008. The aim of our work was to describe the socio-demographic characteristics of the patents, to determine the different sites and the frequency of metastases and to describe the scanographic and histological aspects in the diagnosis of extension; therapy and assessment. Materials and Methods: Our study was a descriptive retrospective over a period of 12 months from January 2020 to December 2020 at the radiology and medical imaging department of CHUME Luxembourg. It concerned all patients with histologically confirmed breast cancer who had undergone a CT scan before treatment, during treatment or during therapeutic follow-up. The examinations were carried out by a HITACHI SUPRIA 16 BARRETTES brand CT scanner installed in 2015. Results: During the period of our study, the frequency of breast cancer was 10.7% (130 cases) out of 1204 scans carried out with a female predominance of 98%, an average age of 52 years and extremes of 12 at 90 years old. The main metastases found on computed tomography were: lung (59%), followed by lymph node (66%), bone (51%), liver (29%) and brain (2%) metastases. The association of lung, lymph node, liver and bone metastasis represented 27% of the most frequent associations. As for the histological aspect, the infiltrating carcinoma of the non-specific grade II SBR and TNM type was the most frequent. Conclusion: The scanner and the anatomopathology have a capital contribution in the diagnosis and the search for secondary localizations for a good management of the neo of the breast.

Methylenetetrahydrofolate reductase (MTHFR) plays a major role in the metabolism of folates and homocysteine, which in turn can affect gene expression and ultimately promote the development of breast cancer. Thus, mutations in the MTHFR gene could influence homocysteine, methionine, and S-adenosylmethionine levels and, indirectly, nucleotide levels. Imbalance in methionine and S-adenosylmethionine synthesis affects protein synthesis and methylation. These changes, which affect gene expression, may ultimately promote the development of breast cancer. We therefore hypothesized that such mutations could also play an important role in the occurrence and pathogenesis of breast cancer in a Malian population. In this study, we used the PCR-RFLP technique to identify the different genotypic profiles of the C677T MTHFR polymorphism in 127 breast cancer women and 160 healthy controls. The genotypic distribution of the C677T polymorphism in breast cancer cases was 88.2% for CC, 11.0% for CT, and 0.8% for TT. Healthy controls showed a similar distribution with 90.6% for CC, 8.8% for CT, and 0.6% for TT. We found no statistical association between the C677T polymorphism and breast cancer risk for the codominant models CT and TT p > 0.05 . The same trend was observed when the analysis was extended to other genetic models, including dominant (p = 0.50), recessive (p = 0.87), and additive (p = 0.50) models. The C677T polymorphism of MTHFR gene did not influence the risk of breast cancer in the Malian samples.

Information on the onset and cessation of rainy seasons is an important prerequisite for planning the sowing of crops in West Africa. A late onset, but also too early cessation of a rainy season, has a direct impact on plant growth and thus on the crop yield in the region. However, onset and cessation dates of rainy seasons can change under future climatic conditions. Therefore, this information is key for stakeholders and decision-makers to mainstream climate change into agricultural activities and policies for better adaptation in the region.To obtain information on the onset and cessation of rainy seasons on a regional scale under future climate change, Regional Climate Models (RCMs) are applied to dynamically downscale global climate projections generated by Earth System Models (ESMs). Therefore, regional climate projections provide more detailed information due to the higher spatial resolution compared to the climate projections generated by ESMs.The study will show initial results on the onset and cessation of rainy seasons in West Africa under two emission scenarios using the Representative Concentration Pathways (RCPs) 2.6 and 8.5 for the end of the century (2071-2100 vs. 1981-2010). The regional climate projections are taken from the Coordinated Output for Regional Evaluations (CORE) embedded in the WCRP Coordinated Regional Climate Downscaling Experiment (CORDEX) for Africa with a spatial resolution of about 25 km. In this initiative, three different RCMs (REMO2015, RegCM4-7, and CCLM5-0-15) were applied to perform the downscaling process.

Resume Position du probleme Les infections associees aux soins sont source de morbi-mortalite importante en neonatologie. L’objectif etait de decrire l’epidemiologie des infections associees aux soins en neonatologie en termes de frequence, de facteurs associes et de pronostic. Methodes La recherche a ete realisee sur les bases de donnees PubMed, Scopus et Web of Science. Ont ete incluses les etudes observationnelles chez les nouveau-nes qui ont developpe des infections survenues au-dela de 48 h apres l’hospitalisation, portant sur la prevalence ou l’incidence ou la mortalite. La mesure des effets globaux a ete calculee via le modele a effet aleatoire. Les biais de publication ont ete analyses par les funnel plot et le test d’Egger. Le logiciel de meta-analyse R Studio V1.2 a ete utilise pour l’analyse statistique. Resultats Parmi 137 articles retrouves, dix articles ont ete inclus. Ils concernaient surtout le Maroc, la Tunisie et l’Algerie. L’incidence globale etait de 10 % (IC95 % [4 %-18 %]) et la mortalite globale de 49 % (IC95 % [33 %-66 %]). L’heterogeneite etait significativement elevee entre les etudes avec des taux respectifs de 98 % et 90 %. Conclusion Il apparait necessaire de mener des etudes multicentriques ainsi que des etudes sur le systeme de surveillance, les attitudes et pratiques des agents de santes impliques dans les soins pour apprehender plus les realites de l’infection associee aux soins dans les services de la neonatologie au grand Maghreb.

L’utilisation des fertilisants chimiques dans l’agriculture s’est fortement accentuée ce dernier temps au Mali. En effet l’apport régulier du diammonium phosphate (DAP) peut influencer la mobilité du zinc, car les phosphates fixent cet élément. L’étude a pour but d’évaluer l’impact de l’utilisation de ce fertilisant phosphaté sur la disponibilité du zinc. Ainsi pour la caractérisation, l’échantillon est analysé par plusieurs méthodes physico-chimiques : la diffraction des rayons X et la microscopie électronique à balayage. Des essais d’absorption ont été réalisés avec cinq pots numérotés (P0, P1, P2, P3, P4) contenant chacun 1 kg d’échantillon auxquels a été ajouté respectivement 0 ; 2 ; 4 ; 8 et 10 g du fertilisant. D’autres essais ont été conduits avec 3 g d’échantillons prélevés dans le pot P4, auxquels ont été appliqué respectivement 150 ppm, 300 ppm, 450 ppm et 600 ppm de zinc. Il ressort de ce travail que la quantité de Zn retenu est proportionnelle à celle du DAP et que la limite (rétention en 21 jours) = 499,9993 ppm > limite (rétention en 15 jours) = 499,9991 ppm > limite (rétention en 7 jours) = 499,9990 ppm > limite (rétention en 1 jour) = 499,9980 ppm. Cette étude a montré que le diammonium phosphate retient le zinc et influence donc sa biodisponibilité.Mots clés : Sol rizicole, Pana au Mali, rétention du zinc, impact de l’utilisation, Diammonium phosphate. English Title: Estimate the impact of phosphate diammonium usage on the availability of zinc in a rice producing soil in Mali The use of chemical fertilizers in agriculture has highly increased this last time in Mali. In fact the regular contribution of DAP can influence the mobility of zinc, because the phosphate fix this element. The object of this study is to estimate the impact of this phosphate fertilizer on the availability of zinc. So for the characterization, the sample is analysed through several physico-chemical methods: the X rays diffraction and the sweeping electronic microscopy. Some absorbing tests have been carried out with five numbered pots (P0, P1, P2, P3, P4) containing each 1 kg of sample to which has been added respectively 0; 2; 4; 8 and 10 g of the fertilizer. Other tests have conducted with 3 g samples removed from the pot P4, to which has been applied respectively 150 ppm, 300 ppm, 450 ppm and 600 ppm of zinc. As a result of the work the quantity of zinc retained is proportional to the one of DAP and the limit (retention in 21 days) = 499.9993 ppm > limit (retention in 15 days) = 499.9991 ppm > limit (retention in 7 days) = 499.9990 ppm > limit (retention in 1 day) = 499.9980 ppm. This study has shown that the phosphate diammonium retains the zinc and influences in this case its bioavailability.Keywords: Rice producing soil, Pana in Mali, zinc retention, the impact of the usage, phosphate diammonium.

Knowledge, attitudes and practices (KAP) of mothers/caregivers on infant and young child feeding are key factors for optimal nutritional status, health and growth of the children. A community-based, cross-sectional descriptive study was conducted duringJanuary 2017 to assess the knowledge, attitudes and practices on infant and young child feeding (IYCF) of mothers/ caregivers who lived in peri-urban areas of Bobo-Dioulasso, Burkina-Faso. This study was carried out before a nutrition education-based interventionand included 245 mothers/ caregivers that were randomly selected in the peri-urban communities of Bobo-Dioulasso. A semi-structured interviewer-administered questionnaire developed based on Food and Agriculture Organization knowledge, attitudes and practices assessment method was used to collect KAP and socio-economic data. Analyses were performed using SPSS version 20. For this study, authorization was obtained from the regional directorate of health of the Hauts-Bassins region. Verbal consent was obtained after the participants had been informed about the study objectives. Among the 245 study participants, 55.1% were aged less than 30 years. More than 3 out of 4 mothers/caregivers (76.3%) were Muslim and 59.2% of them were illiterate. Almost all mothers/caregivers (98.8%) had adequate knowledge for breastfeeding and 87.9% of them knew about exclusive breast feeding up to 6 months. In addition, 91.8% of mothers/caregivers reported that they gave colostrum at birth. Furthermore, 67.5% of the mothers started breastfeeding within one hour after delivery. Based on mothers/caregivers’ report on complementary foods consumed by 6-59 months children in the previous 24h before the interview, cereals were the most reported consumed food group (89.8%) followed by meat and fish products (28.6%). This study found that mothers/caregivers had adequate knowledge about IYCF in general. However,mothers/caregivers’ practice of complementary feeding was inappropriate. Cereals were the food group consumed by most of children aged 6-59 months raising the needs for interventions, such as cooking demonstrations during postnatal visits in health facilities, to improve complementary feeding in this population. Key words: IYCF, knowledge, attitude, and practices; low income countries; Burkina Faso

In this paper, we are devoted to study the existence and local attractivity of solutions for a class of integro-differential equations.Under the situation that the nonlinear term satisfy Carathéodory conditions and a noncompactness measure condition, we establish some existence and local attractivity of mild solutions by utilizing Mönch fixed point theorem, Kuratowski measure of noncompactness and resolvent operator theory in the sense of Grimmer.Our investigations will be situated in the Banach space of real functions which are defined, continuous, and bounded on the right-hand real half axis 𝕉+. Moreover an example is given to illustrate our outcomes.

Agriculture in West Africa is highly dependent on rainfall during the rainy seasons. Therefore, modifications in rainy season characteristics due to recent and future climate change have a direct impact on crop yields and production in the region. Consequently, stakeholders and decision-makers need reliable regional climate change information on rainy seasons in order to develop appropriate adaptation measures.Regional Climate Models (RCMs) can provide information on climate change at high temporal and spatial resolution through dynamic downscaling of climate projections generated by Earth System Models (ESMs). In order to assess the performance of RCMs in simulating rainy seasons and their characteristics such as onset and cessation, length and total sum of rainfall, a thorough evaluation of RCMs is required.The current study evaluates the performance of three different RCMs (REMO2015, RegCM4-7 and CCLM5-0-15) in simulating rainy seasons in West Africa using gridded observational data sets. For the assessment, we will use the ERA-INTERIM driven simulations of the RCMs from the Coordinated Output for Regional Evaluations (CORE) embedded in the WCRP Coordinated Regional Climate Downscaling Experiment (CORDEX) for Africa with a spatial resolution of about 25 km.

Introduction The determination of the groups at risk of death at admission in patients with bacterial infection in the ICU is important. Several prognostic factors have already been identified, however the neutrophil/lymphocyte ratio (NLR) has the advantage of being common and inexpensive. Objective To determine the threshold value of NLR to determine the group at risk of 15-day mortality and the overall survival of patients according to this threshold. Methods This was a retrospective cohort conducted in the intensive care unit of the Ibn Rochd University Hospital in Casablanca over a period of 2 years (January 2019 - January 2021), among hospitalized patients with bacterial infection, acquired or nosocomial. The sample size was calculated a priori and multivariate statistical analyses (multiple logistic regression, Youden index and Kaplan Meier survival estimation and Log Rank) were performed using Rstudio software. The significance level was less than 5%. Results A total of 200 patients were included in the study, 136 patients were alive at 15 days, there were no differences in age between the two groups. Factors associated with patient mortality at 15 days were: gender, use of vasoactive drugs, use of mechanical ventilation, type of sepsis, site of infection, SOFA score (p < 0.000), Apache score (p = 0.009) and NLR at admission (p = 0.001). The cut-off value for NLR was 15.07 with a mean discriminant value of 64.1%. The difference in median overall survival of patients in the two groups according to the threshold value was statistically significant 22 +/- 1.9 days and 11 +/-1.12 days (p = 0.042). Conclusions The NLR appears to be a prognostic factor for 15-day mortality. The knowledge of prognostic factors and threshold values of these indicators allow the prediction of at-risk groups in order to best adapt their management. Key messages The use of common and inexpensive biological prognostic markers are a reliable alternative to identify at-risk patients to optimize their management in developing countries. The RNL is a good biological prognostic markers of mortality of patients infected in ICU.

Background Rational drug prescribing is essential to ensure good disease management and avoid the emergence of drug resistance. However, the decision to prescribe a drug is not only based on the medical knowledge of physicians, but other factors may also influence this decision. We conducted this study to determine the factors that may influence drug prescribing in general practice in Casablanca. Methods A cross-sectional study was conducted in Casablanca (Moulay Rachid and Sidi Bernoussi prefectures) from January to April 2019 among general practitioners in the public and private sectors. The survey was based on the response to a self-administered questionnaire designed and pre-tested by epidemiology laboratory of the Faculty of Medicine and Pharmacy of Casablanca. In addition to a descriptive analysis of the results, a logistic regression analysis was performed to evaluate the factors that could be associated with drug prescription. Results Among 191 general practitioners practicing in the prefectures of Moulay Rachid and Sidi Bernoussi 140 agreed to participate in our study, among which 101 (72.1%) prescribed on average more than two drugs per consultation. In addition to patient-related characteristic: enrolment in medical coverage (OR = 0.1 [0.1; 0.9] if 25-50% of patients had medical coverage), long-term illnesses (OR = 1.73 [1.57; 1.90]); the independent factors associated with this doctor-related prescription were age (OR = 0.23 [0.1; 0.7] over 55 vs. under 40 years), sector of activity (OR = 22.8 [7.4; 70.0] private sector vs public sector), professional seniority (OR = 0.1 [0.01; 0.8] if seniority more than 5 years), and consultation duration (OR = 1.1 [1.09; 1.2]). Conclusions In addition to seniority, duration of consultations, and sector of activity, patient characteristics influence GPs' drug prescription. Key messages The decision to prescribe a drug is influenced by the length of time the GP has been in practice, the duration of consultations and the sector in which he/she works. Patient characteristics influence GPs' drug prescribing.

Introduction Schizophrenia is a psychiatric condition in which patient adherence is a key issue in its management. Objectives To estimate the prevalence and determine the factors associated with medication adherence in patients with schizophrenia. Methods This was a cross-sectional study conducted at the psychiatry department of the CHU IBN Rochd of Casablanca among schizophrenic patients followed from May 2019 to January 2020. The sample size was calculated apriori and the measurement of therapeutic compliance and Insight (patients' perception of the disorders related to their pathology) was made thanks to the Medication Adherence Rating Scale (MARS) and the Birchwood insight scale (BIS) respectively. Socio-demographic data and data on the management of schizophrenia were also collected. Statistical analyses were performed with RStudio software and the multivariate analysis method of logistic regression was used. The threshold of significance was set at 5%. Results A total of 370 were collected, the median age was 31 years and the most represented class was the over 28 years (26.25%). The female gender represented 28% and the majority was single (72%). Substance abuse was 68.8%, 46% were on dual therapy and 43.2% of patients were on regular follow-up. The prevalence of therapeutic compliance was 25.6% and 30.3% were aware of their pathology. The determinants of medication adherence in the schizophrenic patients included in the final model were: regularity of follow-up (p < 0.001), insight (p < 0.001), number of medications (p = 0.011), history of substance use (p = 0.008), place of residence (p = 0.082). Conclusions Therapeutic compliance was low, the knowledge of the factors associated with therapeutic compliance in schizophrenia allows us to put forward hypotheses in order to improve the management of patients. Key messages Patient adherence to treatment is important in the management of Schizophrenia. Therapeutic compliance is poor.

Background Improving the quality of life of patients is a key concern in public health. In the context of improving therapeutic compliance, quality of life of patients undergoing anti-tuberculosis treatment, and prevention of antibiotic resistance, we conducted this systematic review to support risk minimization actions. Methods A literature review of risk management strategies targeting adverse drug reactions to anti-tuberculosis drugs was conducted, including published observational studies. Two independent reviewers identified studies through Medline, Scopus, and Web of Science. The methodological quality of the included studies was assessed using criteria defined by the Newcastle Ottawa Scale. Results Seven studies were included in this review, which identified four risk management strategies (psychological intervention, reduction of drug dose with or without prescription of adjunctive medications, change of medication, permanent or temporary discontinuation of medication). The strategies adopted were dependent on the nature and severity of the adverse events. All drugs responsible for serious adverse events were changed or discontinued. Three studies had a moderate risk of methodological bias. Conclusions Strategies to minimize the risk of adverse drug reactions and improve adherence to therapy have a strong potential to improve adherence to therapy, improve patient quality of life, and reduce antibiotic resistance. However, high-level evidence on the effectiveness of strategies to minimize the risk of adverse events is limited. Key messages Strategies to manage the risk of adverse drug reactions have a strong potential benefit for TB patients on treatment; and improve adherence to treatment. High-level evidence on the effectiveness of strategies to minimize the risk of adverse events is limited.

Background Congenital digestive malformations are a leading cause of infant mortality and morbidity. There are currently no reliable estimates of the number of children born with these malformations and the diversity of the underlying causes requires a range of preventive approaches. Thus, to estimate the prevalence and mortality of these pathologies and to determine the interest of prenatal diagnosis in Casablanca, we initiated this study. Methods This was a cross-sectional study conducted at the Ibn Rochd University Hospital in Casablanca from January 1, 2016, to December 31, 2019, among newborns with congenital digestive malformations diagnosed by a specialist in visceral and digestive surgery. Data related to pregnancy, delivery, and time of diagnosis were collected through the medical record and complemented by clinical and surgical data from the hospitalization registry. In addition to the descriptive analysis of the results, the statistical analysis included Log Rank tests and the Cox method. Results Among 33853 live births 140 cases (56 Esophageal Atresia, 12 Diaphragmatic Hernia, 29 Laporoschisis, 20 Neonatal Occlusion, and 23 Omphalocele) of neonatal digestive malformation (4,13/1000 live births) had been diagnosed, 19.3% (27/140) of which were diagnosed during the antenatal period with an estimated mortality of 2.86/1000 (96/33853) live births and a mean survival time of 9.14±0.92 days. There was no statistically significant association between the time of diagnosis (prenatal vs postnatal) of the disease and the risk of mortality (Log Rank test p = 0.781), and the differences in the association between prenatal diagnosis and infant mortality in the five neonatal digestive malformations were not statistically significant. Conclusions These results imply that survival may no longer be the most relevant outcome, or the best criterion, for assessing the impact of prenatal diagnosis on the outcome of neonatal digestive malformations. Key messages The prevalence and mortality of children with neonatal GI defects is high. Survival may be the most relevant outcome to assess the impact of prenatal diagnosis on the outcome of neonatal GI defects.

Background To evaluate the prevalence of anxiety and depressive disorders in facial trauma patients admitted to the Ibn ROCHD University Hospital of Casablanca, we initiated this study. Indeed, facial trauma is damage that can have serious repercussions on the mental health of patients. However, there is little data in Morocco. Methods This was a cross-sectional study conducted at the Ibn Rochd University Hospital in Casablanca from January to April 2019 among facial trauma patients without a history of anxiety and depressive disorders, admitted to the Maxillofacial Surgery Department within 72 hours of the trauma. The patients' socio-demographic and clinical data were collected through a questionnaire, and then the Hospital Anxiety and Depression Scale (HADS) was applied to assess depression and anxiety. In addition to a descriptive analysis of the results, a multinomial regression analysis was performed to assess factors that might be associated with depression and anxiety. Results Among 50 facial trauma patients admitted to the Ibn Rochd University Hospital in Casablanca and included in our study, 11 had symptoms of anxiety (22%) and 12 had symptoms of depression (24%) according to the HADS classification. The mean HADS anxiety and depression subscale scores of the patients were 7.32±4.17 and 6.32±5.10, respectively. Although gender (OR = 2.28 [0.35; 5.70] females), marital status (OR = 3.30 [0.70; 12.70] singles), occupation (OR = 2.66 [0.58; 12.18] not employed), and circumstances of occurrence (OR = 3.66 [0.35; 15.70] public roads) increased the risk of anxiety in patients without anxiety (HADS score≤7); none of these factors was statistically associated with either anxiety or depression. Conclusions This cross-sectional study showed that the prevalence of anxiety and depression in victims of facial trauma is very high in Casablanca. Key messages The prevalence of anxiety and depression among facial trauma victims is very high. Gender, marital status, occupation, and circumstances of occurrence non-significantly increase the risk of anxiety and depression.

Introduction The electronic cigarette is an electronic device containing or not nicotine that produces vapours that are inhaled by users, thus mimicking the use of conventional cigarettes. These devices nevertheless contain components that are harmful to health. They have become particularly popular in recent years, especially among young people. Objective To estimate the frequency of e-cigarette use among medical students and to describe perceptions and practices of e-cigarette use. Methods This was a descriptive cross-sectional study conducted from August 2020 to March 2021 among medical students at the Faculty of Medicine and Pharmacy in Casablanca. The data were collected through a selfadministered, pre-tested, online questionnaire. The sample size was calculated a priori and statistical analyses were carried out using RStudio software. Results A total of 491 students were collected with a mean age of 21.03+/- 2.35 years, 66% were female, 51.9% were undergraduates and 20.6% were first year students. The frequency of e-cigarette use was 20.2%, and smoking was 20.8%. Of the 99 e-cigarette users, 75.75% had used e-cigarettes in the past 12 months. More than 21.9% of e-cigarette users used it daily, the most frequent reasons for use were curiosity (88.6%) and imitation (58.4%). Regarding perceptions, 22.1% felt more or less informed about the risks of e-cigarettes, 54.8% agreed that e-cigarettes are an effective way to quit smoking and 29.5% thought they would be more effective than nicotine replacement therapies. Conclusions The frequency of e-cigarette use is high among future doctors despite their knowledge of the health effects of its use. Preventive measures should be implemented to improve the health of students. Key messages Medical student are a subgroup particulary vulnarable to e-cigarette use. The perceptions of medical students, future health care providers, are heterogeneous.

Introduction Eating disorders (EDs) are multifactorial in origin. Medical students are a special population because they are particularly young and exposed to stress, workload and the experience of illness in the field. Objective To determine the prevalence of EDs and associated factors among medical students Methods This was a cross-sectional study conducted from November to December 2020 among medical students at the Faculty of Medicine and Pharmacy in Casablanca. Data were collected using a hetero questionnaire distributed online. The presence of EDs was measured using the SCOFF (Stick, Control, One stone, Fat, Food) scale and anxiety and depression were measured using the HAD (Hamilton Anxiety and Depression) scale. The sample size was calculated a priori and multivariate statistical analyses such as logistic regression were performed. The α threshold was set at 5%. Results A total of 315 students participated in the study, the mean age was 21.01+/- 2.5 years, the majority were female (68.7%), and undergraduates represented 61.7% of the sample. The incidence of EDs was 39.9%. Regarding BMI (Body Mass Index). In terms of BMI, 65.5% had a normal BMI, anxiety and depressive symptoms were absent in 48.4% and 72.2% of cases respectively. Factors associated with EDS were: use of weight control (OR: 7.14 [1.72- 32.519], p = 0.00), BMI (OR: 1.142 [1.06-1.22], p = 0.000) and anxiety symptoms (OR: 3.51 [51.98-6.23], p = 0.000). Conclusions The frequency of eating disorders is high among medical students. The knowledge of the potentially associated factors allows us to generate hypotheses in order to define the axes of prevention of these disorders. Key messages Eating disorders are a health problem among medical students. Eating disorders are multifactorial in origin.

Introduction : Le district de Banamba a enregistré un taux de morbidité de malnutrition de 13% lié à la malnutrition. Cette étude avait pour objectif d'identifier les facteurs déterminants de la survenue de la malnutrition aiguë sévère avec complication chez les enfants âgés de moins de cinq dans le district sanitaire de Banamba au Mali. Méthodologie : il s'agissait d'une étude transversale rétrospective déroulée en octobre 2019. Les données du 01er janvier 2014 au 31 décembre 2018 ont été collectées. L'analyse a été faite avec Epi info 7.2 et Excel 2013 avec réalisation du test Exact Fisher et présentation des rapports de prévalences en plus des résultats descriptifs. Résultats : Nous avons enregistré au total 171 cas de malnutrition dont 10 cas (5,85%) de kwashiorkor et 161 cas (94,15%) de marasme. La quasi- totalité (93,57%) provenait du milieu rural. Le sex-ratio était de 1,04. Plus de la moitié (56,72%) avait entre 6 à 23 mois. Presque toutes les mères étaient mariées (94,15%) et ménagères (95,32%). Peu d'entre elles (8,19%) étaient scolarisées. Le sevrage précoce a été beaucoup pratiqué avec 94,15%. L'admission à l'Unité de Récupération et d'Education Nutritionnelle Intensive (URENI) a été spontanée pour la grande majorité soit 96,91%. L'allaitement n'était pas exclusif presque toutes les femmes avec 99,42%. Aucune association significative n'a été trouvée entre les facteurs et la malnutrition aiguë sévère avec complication. Conclusion: Notre étude a concerné 171 enfants malnutris avec complication. Les facteurs sexe masculin, lieu de résidence rurale, profession ménagère et mères non scolarisées étaient majoritaire mais n'étaient pas associés à la survenue des formes cliniques de la malnutrition avec complication.

Introduction : Au Mali, de 2015 à 2018, on a recensé 2611 cas de morsures de chiens dont 6 cas de rage humaine confirmés. Durant la même période, les cas de morsures de chiens à Sikasso, s'élèvent à 236 et est en constante augmentation d'année en année. Les objectifs étaient de décrire les cas de morsures en personne, Caractériser les lésions des morsures et apprécier la prise en charge des cas. Méthodologie : Nous avons mené une étude descriptive portant sur les dossiers des sujets mordus par chiens de janvier 2017 à octobre 2019 dans le District Sanitaire de Sikasso. Résultats : Les consultants recensés au nombre de 196 en majorité de sexe masculin (64 %), avaient un âge moyen de 14 ans. Seuls 31/196, soit 15,81 % des chiens étaient vaccinés. Les fesses ont été le site privilégié des morsures de chiens avec 39,80%. Le schéma vaccinal à 5 doses avec lavage de la plaie représentait 52,52%. Parmi les 196 consultants recensés, 15,62 % avaient abandonné le traitement vaccinal. Les chiens mis en observation étaient 41,34% et un grand nombre abattu soit 38,26%. La classification finale des cas fait état de trois (3) cas de rage canine et aucun cas de rage humaine. Conclusion La lutte contre la rage doit mettre l'accent le traitement post exposition précoce, la vaccination des animaux ainsi que sur la sensibilisation de la population vis-à-vis du risque de rage.

A recent randomized controlled trial, the WANECAM (West African Network for Clinical Trials of Antimalarial Drugs) trial, conducted at seven centers in West Africa, found that artemether-lumefantrine, artesunate-amodiaquine, pyronaridine-artesunate, and dihydroartemisinin-piperaquine all displayed good efficacy. However, artemether-lumefantrine was associated with a shorter interval between clinical episodes than the other regimens. In a further comparison of these therapies, we identified cases of persisting submicroscopic parasitemia by quantitative PCR (qPCR) at 72 h posttreatment among WANECAM participants from 5 sites in Mali and Burkina Faso, and we compared treatment outcomes for this group to those with complete parasite clearance by 72 h. Among 552 evaluable patients, 17.7% had qPCR-detectable parasitemia at 72 h during their first treatment episode. This proportion varied among sites, reflecting differences in malaria transmission intensity, but did not differ among pooled drug treatment groups. However, patients who received artemether-lumefantrine and were qPCR positive at 72 h were significantly more likely to have microscopically detectable recurrent Plasmodium falciparum parasitemia by day 42 than those receiving other regimens and experienced, on average, a shorter interval before the next clinical episode. Haplotypes of pfcrt and pfmdr1 were also evaluated in persisting parasites. These data identify a possible threat to the parasitological efficacy of artemether-lumefantrine in West Africa, over a decade since it was first introduced on a large scale.

INTRODUCTION : Dans un pays où la radiothérapie n'est pas disponible, un plaidoyer basé sur la pertinence de la chirurgie + la radiothérapie adjuvante sur le contrôle locorégional et la survie des patients est nécessaire. Notre objectif était d’évaluer l'impact de la chirurgie et la radiothérapie sur le contrôle local et la survie par rapport à la chirurgie seule dans le cancer du sein. MATERIELS ET METHODES : Entre 2007 et 2016, 210 patients atteints de cancer du sein ont été revus rétrospectivement, dont 90 patients étaient traités par chirurgie et radiothérapie (groupe 1) et 120 patients par la chirurgie seule (groupe 2). Les facteurs pronostiques associés à la survie globale et au contrôle local ont été déterminés. RESULTATS : Il y avait plusieurs combinaisons de traitement, y compris la chirurgie associée à une chimiothérapie néoadjuvante, radiothérapie et la chimiothérapie adjuvante. Les résultats ont montré 88 (41,9%) cas de rechute, dont 31 (34,4 %) (groupe 1) et 57 (47,5%) (groupe 2) (p=0,046). La récidive était survenue après un délai moyen de 1,5 an dans le groupe 1 contre 0,66 an dans le groupe 2 (p=0,006). Les survies globales à cinq ans et spécifiques du cancer du sein étaient de 49,5% et 62,5%, respectivement. La survie à cinq ans était de 60,0% (groupe 1) et 40,0% (groupe 2) (p

Background The aim of this study was to determine the resistance of diarrheagenic Escherichia coli strains to β-lactams antibiotics and to perform the molecular characterization of Extended Spectrum β-lactamases (ESBL) and integrons genes. Methods This study was carried out from August 2013 to October 2015 and involved 31 DEC strains isolated from diarrheal stools samples collected from children less than five years of age. The identification and characterization of DEC strains was done through the standard biochemical tests those were confirmed using API 20E and Polymerase Chain Reaction (PCR). The determination of antimicrobial resistance was realized by the disk diffusion method then an amplification of the β-lactamase resistance genes and integrons by PCR was done. Results Out of the 419 E. coli strains identified, 31 isolates (7.4%) harbored the DEC virulence genes. From these DEC, 21 (67.7%) were ESBL-producing E. coli. Susceptibility to ESBL-producing E. coli showed that the majority of isolates were highly resistant to amoxicillin (77.4%), amoxicillin clavulanic acid (77.4%) and piperacillin (64.5%). The following antibiotic resistance genes and integron were identified from the 31 DEC isolates: blaTEM (6.5%), blaSHV (19.4%), blaOXA (38.7%) blaCTX−M (9.7%), Int1 (58.1%) and Int3 (19.4%). No class 2 integrons (Int2) was characterized. Conclusions Because of the high prevalence of multidrug-resistant ESBL organisms found in this study among pediatric patients, there is a need of stringent pediatric infection control measures.

Background: Artemether-lumefantrine is a highly effective artemisinin-based combination therapy that was adopted in Mali as first-line treatment for uncomplicated Plasmodium falciparum malaria. This study was designed to measure the efficacy of artemether-lumefantrine and to assess the selection of the P. falciparum chloroquine resistance transporter (pfcrt) and P. falciparum multi-drug resistance 1 (pfmdr1) genotypes that have been associated with drug resistance. Methods: A 28-day follow-up efficacy trial of artemether-lumefantrine was conducted in patients aged 6 months and older suffering from uncomplicated falciparum malaria in four different Malian areas during the 2009 malaria transmission season. The polymorphic genetic markers MSP2, MSP1, and Ca1 were used to distinguish between recrudescence and reinfection. Reinfection and recrudescence were then grouped as recurrent infections and analyzed together by PCR-restriction fragment length polymorphism (RFLP) to identify candidate markers for artemether-lumefantrine tolerance in the P. falciparum chloroquine resistance transporter (pfcrt) gene and the P. falciparum multi-drug resistance 1 (pfmdr1) gene. Results: Clinical outcomes in 326 patients (96.7%) were analyzed and the 28-day uncorrected adequate clinical and parasitological response (ACPR) rate was 73.9%. The total PCR-corrected 28-day ACPR was 97.2%. The pfcrt 76T and pfmdr1 86Y population prevalence decreased from 49.3% and 11.0% at baseline (n = 337) to 38.8% and 0% in patients with recurrent infection (n = 85), p = 0.001), respectively. Conclusion: Parasite populations exposed to artemether-lumefantrine in this study were selected toward chloroquine-sensitivity and showed a promising trend that may warrant future targeted reintroduction of chloroquine or/and amodiaquine.