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Objectif : Identifier les antibiotiques utilisés et évaluer notre pratique en médecine humanitaire. Patients et Méthode : Etude prospective de 30 jours. La saisie et l’analyse des données ont été faites par Windows 8, Epi info 3.5.3 fr et le khi² pour le test statistique. Résultats : Soixante-trois (63) patients répondaient aux critères. L’âge moyen était de 33,3 ± 18, 5 ans. Les femmes rurales prédominaient. Les urgences représentaient 65,1% des cas. L’indication de l'antibioprophylaxie était Gynéco-obstétricale dans 63, 5% suivie de la chirurgie viscérale dans 20,6%, de l’urologie dans 11,1% et de la traumatologie dans 4,8%. Les patients étaient ASA I dans 69,8%. La classe d’Altémeier était II dans 81%. Une antibioprophylaxie a été faite dans 88,9%. Les β lactamines en monothérapie ont été les plus utilisées dans 84,1% suivies de l’association β lactamine-imidazole dans 9,5%, de l’association β lactamine-aminoside dans 1,6% et les quinolones dans 1,6%. Le délai entre l’administration de l’antibiotique et l’induction anesthésique était de : 6 ± 2,4 minutes. L’antibiotique a été administré entre 25 et 40 minutes avant l’incision chirurgicale. Une complication infectieuse a été observée dans 11, 1%. L’évolution était favorable dans 98,4%.Conclusion : Même en situation de crise sanitaire, l’utilisation de l’antibiotique au bloc opératoire doit répondre à des critères dont l’écologie microbienne et le site opératoire sont déterminants.

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A case of abdominal pregnancy with live fetus at term was diagnosed in a patient living in the rural area of N'Djamena and who had nofollow-up. The laparotomy made it possible to extract a healthy child without any defect. The maternal prognosis was marked by anemia related to cataclysmic hemorrhaging during surgery. [ABSTRACT FROM AUTHOR]

Located in the heart of sub-Saharan Africa, between latitudes 10 deg. and 25 deg. N, Mali has a land area of 1.204 million km2. The population is presently estimated to be 12 million with a percapita energy consumption of 227 ktoe per inhabitant per year. Wood fuel still represents 90% of the total energy consumed. Mali does nothave any economically exploitable petroleum deposits, but it receives an average solar insolation of 6.3 kW h/m2/day. The review of the potential and problems of solar photovoltaic (PV) technology in Mali shows that high ambient temperatures affecting the performance of PV systems, high cost of installed PV systems, poor after saleservice and passive participation of local communities in implementation of the programmes remain the main constraints and challenges. Itis recommended that given Mali's meagre conventional energy resources, research should be intensified on low cost technology that minimises the effect of high temperatures on the performance of PV systems. Efforts should be made to avoid duplication of unsuccessful experiences, improve coordination of activities in this area and promote private sector participation. [ABSTRACT FROM AUTHOR]

Background: Treatment methods for mandibular condylar fractures in children can be broadly divided into closed treatment and open treatment (open reduction and internal fixation). The aim of the study is to evaluate the feasibility of removing the fracture fragments when treating intracapsular condylar fractures in children., Material and Methods: A retrospective study was performed in patients aged ≤12 years with intracapsular condylar fractures treated with removal of the fracture fragments from June 2010 through June 2018. The preoperative and postoperative data of physical complaints, facial asymmetry, maximal interincisal distance, occlusal relationship and radiographic examinations were extracted from the patients' records. The collected preoperative and postoperative data were analysed., Results: Thirteen intracapsular condylar fractures in nine cases were subjected to fracture fragments removal. In these patients, clinical and radiographic results at different follow-up periods displayed normal occlusion and satisfactory bone healing. New condyles were found to be regenerated, in the cases with follow-up period longer than 3 months., Conclusions: Removal of fracture fragments proves to be effective in delivering satisfactory clinical results and permitting ongoing condyle remodelling and regeneration.

Mammalian parenting is an unusually demanding commitment. How has the reward system been co-opted to ensure parental care? Previous work has implicated the lateral habenula (LHb), an epithalamic nucleus, as a potential intersection of parenting behavior and reward. Here, we examine the role of the LHb in the maternal behavior of naturally parturient primiparous mouse dams. We show that kainic acid lesions of the LHb induced a severe maternal neglect phenotype in dams toward their biological pups. Next, we demonstrate that chronic chemogenetic inactivation of the LHb using inhibitory DREADDs impaired acquisition and performance of various maternal behaviors, such as pup retrieval and nesting. We present a random intercept model suggesting LHb inactivation prevents the acquisition of pup retrieval, a novel maternal behavior in primiparous mouse dams, and decreases nest building performance, an already-established behavior, in primiparous mouse dams. Lastly, we examine the spatial histology of kainic acid-treated dams with a random intercept model, which suggests the role of LHb in maternal behavior may be preferentially localized at the posterior aspect of this structure. Together, these findings serve to establish the LHb as required for maternal behavior in the mouse dam, thereby complementing previous findings implicating the LHb in parental behavior using pup-sensitized virgin female mice., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 Benedict et al.)

As the Universal Health Insurance Plan (RAMU) is gradually being implemented in Mali, community-based health insurance (CBHI) -considered one of the pillars of this programme- must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale than before, moving from municipalities to circles (departments). A mixed-method study was carried out in the Mopti region to assess the acceptability of this innovation among CBHI elected representatives. In April 2021, 118 questionnaires were administered to CBHI elected representatives, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon et al. (2017) developed an approach outlining seven dimensions of acceptability (attitude, burden, values, coherence, opportunity costs, perceived efficiency, and personal effectiveness), which was used as a conceptual model for data analysis. The results obtained by factor analysis indicate that more than half of individuals (58%) reported above-average acceptability. Elected representatives feel well supported in their activities by the Technical Union of Malian Mutuality (TUM), the umbrella organisation of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected representatives note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. The new CBHI is highly advantageous for the population in terms of content, financial, and geographical access. Professionalisation is an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected representatives are concerned about the sustainability of this CBHI and rely on the State and its partners to assume responsibility. The TUM will play an essential role in continuing its support and fulfiling its functions as a delegated management organisation within the framework of the RAMU., (© 2024 The Author(s). The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

Determining the maturity of cocoa pods early is not just about guaranteeing harvest quality and optimizing yield. It is also about efficient resource management. Rapid identification of the stage of maturity helps avoid losses linked to a premature or late harvest, improving productivity. Early determination of cocoa pod maturity ensures both the quality and quantity of the harvest, as immature or overripe pods cannot produce premium cocoa beans. Our innovative research harnesses artificial intelligence and computer vision technologies to revolutionize the cocoa industry, offering precise and advanced tools for accurately assessing cocoa pod maturity. Providing an objective and rapid assessment enables farmers to make informed decisions about the optimal time to harvest, helping to maximize the yield of their plantations. Furthermore, by automating this process, these technologies reduce the margins for human error and improve the management of agricultural resources. With this in mind, our study proposes to exploit a computer vision method based on the GLCM (gray level co-occurrence matrix) algorithm to extract the characteristics of images in the RGB (red, green, blue) and LAB (luminance, axis between red and green, axis between yellow and blue) color spaces. This approach allows for in-depth image analysis, which is essential for capturing the nuances of cocoa pod maturity. Next, we apply classification algorithms to identify the best performers. These algorithms are then combined via stacking and voting techniques, allowing our model to be optimized by taking advantage of the strengths of each method, thus guaranteeing more robust and precise results. The results demonstrated that the combination of algorithms produced superior performance, especially in the LAB color space, where voting scored 98.49% and stacking 98.71%. In comparison, in the RGB color space, voting scored 96.59% and stacking 97.06%. These results surpass those generally reported in the literature, showing the increased effectiveness of combined approaches in improving the accuracy of classification models. This highlights the importance of exploring ensemble techniques to maximize performance in complex contexts such as cocoa pod maturity classification.

Telecommunications offers an alternative or supplement to community-based interventions as a means of extending healthcare services and improving health outcomes in remote settings but can fail to reach target communities and achieve the desired impact if barriers to access are not overcome. We conducted seven focus group discussions and 26 interviews with community health workers, community leaders, and female members of the public who declared that they had or had not previously accessed free audio health messages provided via a mobile platform in two rural communities of Mali, Koulikoro and Bougouni. A content analysis showed that participants accessed and trusted health information from a range of sources, including radio, telephone and television, as well as town criers, local relays and community health centres. Barriers to access faced by women included economic factors, lack of network or electricity, and social factors such as illiteracy, cultural restrictions and being unaware of mobile communication. Through analysis and interpretation of the participants' responses, we have made recommendations for future campaigns for the dissemination of health-related information for women in remote settings., (© 2024. The Author(s).)

Purpose: The purpose of this study was to retrospectively evaluate the feasibility of 2-point fixation using absorbable plates by the transoral approach in the management of the zygomatic complex (ZMC) fractures., Methods: Twenty-five patients (15 male and 10 female, age range 16 y to 55 y) with Knight and North Group Ⅲ zygomatic fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using absorbable plates placed at the zygomaticomaxillary buttress and infraorbital rim. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mouth opening, facial asymmetry, diplopia, and paresthesia., Results: Postoperatively, all patients achieved uneventful healing; facial symmetry and wound healing were achieved, along with sensory recovery involving the infraorbital nerve. Complications such as sensory disturbances, infection, diplopia, malunion, and nonunion were not encountered in these patients., Conclusions: Two-point fixation using absorbable plates by transoral approach can provide sufficient stabilization for Knight and North Group III zygomatic fractures., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Introduction: The Health and Social Development Program of the Mopti Region (PADSS2) project, launched in Mali's Mopti region, targeted Universal Health Coverage (UHC). The project addressed demand-side barriers by offering an additional subsidy to household contributions, complementing existing State support (component 1). Component 2 focused on supply-side improvements, enhancing quality and coverage. Component 3 strengthened central and decentralised capacity for planning, supervision and UHC reflection, integrating gender mainstreaming. The study assessed the impact of the project on maternal and child healthcare use and explored how rising terrorist activities might affect these health outcomes., Methods: The impact of the intervention on assisted births, prenatal care and curative consultations for children under 5 was analysed from January 2016 to December 2021. This was done using an interrupted time series analysis, incorporating a comparison group and spline regression., Results: C1 increased assisted deliveries by 0.39% (95% CI 0.20 to 0.58] and C2 by 1.52% (95% CI 1.36 to 1.68). C1-enhanced first and fourth antenatal visits by 1.37% (95% CI 1.28 to 1.47) and 2.07% (95% CI 1.86 to 2.28), respectively, while C2 decreased them by 0.53% and 1.16% (95% CI -1.34 to -0.99). For child visits under 5, C1 and C2 showed increases of 0.32% (95% CI 0.20 to 0.43) and 1.36% (95% CI 1.27 to 1.46), respectively. In areas with terrorist attacks, child visits decreased significantly by 24.69% to 39.86% compared with unexposed areas., Conclusion: The intervention had a limited impact on maternal and child health, falling short of expectations for a health system initiative. Understanding the varied effects of terrorism on healthcare is key to devising strategies that protect the most vulnerable in the system., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Purpose of Review: Purpose of the review is to address management and prevention of urolithiasis in elderly patients examining the dynamic interplay between general measures, dietary adjustments, lifestyle modifications, and targeted pharmacological and/ or surgical interventions. The goal is to provide understanding of the evolving strategies required for effective urolithiasis prevention in the geriatric population., Recent Findings: Age-specific diagnostic considerations are necessary because urolithiasis in the elderly population is characterized by bigger stones, greater peri-operative risks, and heightened symptom severity. When comorbidities are present, conservative treatments - especially analgesia - provide difficulties. Surgical procedures prove to be safe and effective, with complication rates and practical application comparable to younger cohorts. Prevention approaches that include lifestyle changes and the investigation of novel pharmaceutical options such as sodium-dependent glucose co-transporter 2 (SGLT-2)-inhibitors are promising in the management of urolithiasis in the elderly population., Summary: Our review offers a thorough investigation of urolithiasis in the elderly population, elucidating distinct clinical manifestations, complex diagnostic issues, and treatment implications. The safety and effectiveness of ureteroscopy in older patients, as well as the possible prophylactic function of SGLT-2-I, offer crucial insights for clinicians. Subsequent studies are necessary to enhance age-specific therapies, addressing the distinct obstacles presented by urolithiasis in the elderly population within this rapidly growing demographic., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Mammalian parenting is an unusually demanding commitment. How did evolution co-opt the reward system to ensure parental care? Previous work has implicated the lateral habenula (LHb), an epithalamic nucleus, as a potential intersection of parenting behavior and reward. Here, we examine the role of the LHb in the maternal behavior of naturally parturient mouse dams. We show that kainic acid lesions of the LHb induced a severe maternal neglect phenotype in dams towards their biological pups. Next, we demonstrate that through chronic chemogenetic inactivation of the LHb using DREADDs impaired acquisition and performance of various maternal behaviors, such as pup retrieval and nesting. We present a random intercepts model suggesting LHb-inactivation prevents the acquisition of the novel pup retrieval maternal behavior and decreases nest building performance, an already-established behavior, in primiparous mouse dams. Lastly, we examine the spatial histology of kainic-acid treated dams with a random intercepts model, which suggests that the role of LHb in maternal behavior may be preferentially localized at the posterior aspect of this structure. Together, these findings serve to establish the LHb as required for maternal behavior in the mouse dam, thereby complementing previous findings implicating the LHb in parental behavior using pup-sensitized virgin female mice., Competing Interests: Conflict of Interest Authors report no conflicts of interest.

Objective: Postmortem examination of the essential tremor cerebellum has revealed a variety of pathological changes centered in and around Purkinje cells. Studies have predominantly focused on cerebellar neuronal connections. Bergmann glial morphology has not yet been studied in essential tremor. Among their many roles, Bergmann glia in the cerebellar cortex ensheath Purkinje cell synapses and provide neuroprotection. Specifically, the complex radial processes and lateral appendages of Bergmann glia are structural domains that modulate Purkinje cell synaptic transmission. In this study, we investigate whether Bergmann glia morphology is altered in the essential tremor cerebellum., Methods: We applied the Golgi-Kopsch method and used computerized three-dimensional cell reconstruction to visualize Bergmann glia in the postmortem cerebellum of 34 cases and 17 controls. We quantified morphology of terminal structures (number of terminations and lateral appendage density) and morphology of radial processes (total process length, branch length, branch order, and branch volume) in each glial cell. We quantified number of branches and volume as well., Results: Essential tremor cases had a 31.9% decrease in process terminations and a 35.7% decrease in lateral appendage density in Bergmann glia. Total process length and branch length did not differ between essential tremor cases and controls. We found also a reduction in number of secondary and tertiary branches and tertiary branches volume., Interpretation: These findings suggest that Bergmann glia in essential tremor cases have more alterations in their terminal structures, with a relative preservation of radial processes, and highlight a potential role for these astrocytes in the disease pathophysiology., (© 2023 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)

The quality of cocoa beans is crucial in influencing the taste, aroma, and texture of chocolate and consumer satisfaction. High-quality cocoa beans are valued on the international market, benefiting Ivorian producers. Our study uses advanced techniques to evaluate and classify cocoa beans by analyzing spectral measurements, integrating machine learning algorithms, and optimizing parameters through genetic algorithms. The results highlight the critical importance of parameter optimization for optimal performance. Logistic regression, support vector machines (SVM), and random forest algorithms demonstrate a consistent performance. XGBoost shows improvements in the second generation, followed by a slight decrease in the fifth. On the other hand, the performance of AdaBoost is not satisfactory in generations two and five. The results are presented on three levels: first, using all parameters reveals that logistic regression obtains the best performance with a precision of 83.78%. Then, the results of the parameters selected in the second generation still show the logistic regression with the best precision of 84.71%. Finally, the results of the parameters chosen in the second generation place random forest in the lead with a score of 74.12%.

Introduction: While real-time reverse transcription PCR (RT-PCR) is the recommended laboratory method to diagnose severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection, its use in resource limited settings can be difficult to maintain due to high testing demand and shortage of reagents. The aim of this study was to evaluate the performances of Realy Tech™ and Standard Q™ in comparison to RT-PCR in a relatively low COVID-19 prevalence setting, Mali., Methods: We conducted a cross-sectional study between January and April 2021 in Bamako and Kati regions to evaluate both rapid tests during a large SARS-CoV-2 prevalence study in Mali., Results: Of the 390 samples tested, the sensitivity and specificity of Realy Tech™ and Standard Q™ were 57.1% (95%CI: 44.1-69.2), 95.8% (95%CI: 93.1-97.5); 61.9% (95%CI: 46.8-75.0), and 94.1% (95%CI: 89.5-96.8) respectively. Using RT-PCR, the global prevalence of SARS-CoV-2 was 14.4% (56/390). In both rapid antigen tests, the performance was better when used in suspected patients compared to positive patients under treatment. Moreover, higher viral loads equivalent to Ct < 25 were associated with better detection rates., Conclusion: While waiting for more complete data, these preliminary studies suggest that Realy Tech™ and Standard Q™ should not be used alone for COVID-19 diagnosis in Mali., Competing Interests: The funding sources of this study had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. All authors reported no conflicts., (© 2023 Fatimata D et al.)

Background: Onchocerciasis control activities in Mali began in 1975 with vector larviciding carried out by the Onchocerciasis Control Programme (OCP), followed by the distribution of ivermectin from 1998 until the closure of the OCP in 2002. At that time, epidemiological evaluations, using skin snip microscopy and O-150 pool screening PCR in black flies, indicated that the disease had been largely controlled as a public health problem. Ivermectin distribution was nevertheless continued after 2002 in 34 of the 75 health districts in Mali as these were known to still be meso- or hyper-endemic for onchocerciasis. In addition, the onchocerciasis sites known to be hypo-endemic for onchocerciasis benefited from the distribution of ivermectin treatment as part of the mass drug administration (MDA) program for lymphatic filariasis. Various entomological and epidemiological evaluations have now indicated that Mali may have achieved successful interruption of onchocerciasis transmission., Methods: A series of cross-sectional surveys to update vector breeding sites throughout the endemic areas, followed by a pre-stop ivermectin mass drug administration (Pre-stop MDA) survey, were undertaken in 2019-2020. Based on breeding site findings, historical epidemiological assessments, and vector collection site maps, 18 operational transmission zones (OTZ) were delineated within which a total of 104 first line villages were selected for evaluation. Dried blood spots (DBS) samples were collected from 10,400 children (5-9 years old) from these 104 first line villages and processed for the presence of OV16 antibody using a lab-based rapid diagnostic test., Results: Within the 544 Simulium damnosum s.l. breeding sites visited in all five endemic onchocerciasis endemic regions of Mali 18.01% (98/544) were seen to be active with the presence of at least one stage of S. damnosum. The overall prevalence of OV16 positive children was 0.45% (47/10,400). However, two hotspots were identified: 2.60% (13/500) seroprevalence in the OTZ number 5 in Kayes Region and 1.40% (7/500) in the OTZ number 1 of Sikasso Region., Conclusion: These data show that onchocerciasis prevalence in the five endemic regions has declined to levels that indicate that Stop-MDA surveys should be now carried out in most of the OTZ except for one in the Kayes Region. This latter site will need additional ivermectin treatment before reevaluation, and an OTZ in the Sikasso Region requires revaluation before possibly reinitiating MDA., Competing Interests: No competing interests, (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Introduction: The COVID-19 pandemic has exacerbated an already existing security crisis leading to massive population displacements that have been taking place since 2012., Purpose of Research: This study aims to explore the representations of internally displaced persons (IDPs) about the existence of COVID-19 and their knowledge about its signs, symptoms, modes of transmission and prevention measures., Methods: The study was qualitative and exploratory. Individual and group interviews were used to collect data from 52 IDPs in six sites in Bamako and Segou. All interviews were recorded and transcribed. Thematic content analysis and N-Vivo software were used., Results: The majority of IDPs believed in the existence of COVID-19 and had good knowledge of the signs, symptoms, modes of transmission and prevention measures against the disease. However, this was not sufficient for the adoption of public health measures. Among those who believed in its existence, some thought that it was a disease of the white and rich. Finally, a group of participants believed in conspiracy theories and claimed that the government and humanitarian organizations were only trying to make money through these campaigns., Conclusion: To our knowledge, this is the first study in Mali to explore IDPs’ beliefs and knowledge about COVID-19. These results could inform policies, strategies, and interventions to combat COVID-19 in IDP sites and in the general population.

Introduction: Improving Reproductive Maternal Newborn Child Adolescent Health Plus Nutrition (RMNCAH+N) indicators is a challenge for health systems, especially those in sub-Saharan Africa. The objective of this study was to identify barriers and facilitators to the use of RMNCAH+N services in areas with low indicators in Cote d’Ivoire., Methods: A qualitative case study was conducted in September 2021, with 76 beneficiaries of RMNCAH+N services in the health districts of Boundiali, Toulepleu and Tanda. Individual interviews (09) and focus groups (09) were conducted with community leaders/tradi-practitioners/midwives and pregnant women/ women of childbearing age/men who have or are responsible for a child under the age of 5, respectively. A thematic analysis was performed after coding the data in NVivo 12., Results: Barriers to utilization of RMNCAH+N services were unavailability of certain equipment/amenities, disrespectful care in some RMNCAH+N services, women’s lack of financial autonomy, lack of autonomy in decision making, and male healthcare providers. Facilitators identified were geographic accessibility, men’s involvement in the mother-child dyad’s health, and community awareness., Conclusion: Improving utilization of RMNCAH+N services requires the implementation of interventions that address these barriers and facilitators, such as raising community awareness of RMNCAH+N services and promoting respectful, patient-centered, humanized care among healthcare providers.