Background Typhoid fever incidence and complications, including intestinal perforation, have declined significantly in high-income countries, with mortality rates \1%. However, an estimated 10.9 million cases still occur annually, most in low-and middle-income countries. With the availability of a new typhoid conjugate vaccine licensed for children and recommended by the World Health Organization, understanding severe complications, including associated mortality rates, is essential to inform country-level decisions on introduction of this vaccine. This scoping review summarizes over 20 years of the literature on typhoid intestinal perforation in sub-Saharan Africa. Methods We searched EMBASE, PubMed, Medline, and Cochrane databases for studies reporting mortality rates due to typhoid intestinal perforation in children, under 18 years old, in sub-Saharan Africa published from January 1995 through June 2019. Results Twenty-four papers from six countries were included. Reported mortality rates ranged from 4.6-75%, with 16 of the 24 studies between 11 and 30%. Thirteen papers included postoperative morbidity rates, ranging from 16-100%. The most documented complications included surgical site infections, intra-abdominal abscesses, and enterocutaneous fistulas. High mortality rates can be attributed to late presentation to tertiary centers, sepsis and electrolyte abnormalities requiring preoperative resuscitation, prolonged perforation-to-surgery interval, and lack of access to critical care or an intensive care unit postoperatively. Conclusions Current estimates of mortality related to typhoid intestinal perforation among children in sub-Saharan Africa remain unacceptably high. Prevention of typhoid fever is essential to reduce mortality, with the ultimate goal of a comprehensive approach that utilizes vaccination, improvements in water, sanitation, and hygiene, and greater access to surgical care.

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Antibiotics remains an issue in intensive care units (ICUs), because of its overuse and the emergence of bacterial resistance. The objective of the study was to evaluate the prescription of antibiotics in ICUs at university teaching and the regional hospitals in Mali. PATIENTS AND METHODS: It was a cross sectorial retrospective and multicentric study over six months. The inclusion criteria were, all the patients hospitalized in ICUs at least for 48 hours with antibiotic treatment. We also included the cost of the daily consumption of antibiotics. The Microsoft excel was used for data entry and the data analysis was done with the software Epi info version 3.5.2. RESULTS: Five hundred sixty-and-six (566) patient les responded to the inclusion criteria. The antibiotics prescription rate was 43.3%. The mean age of the patients was 36.8 ± 20.7. The women were more represented (59.7%). The monotherapy (60.6%) was the most common concept use. The third-generation cephalosporin (3GC) was used in monotherapy (27.7%). The average volume of consumption of antibiotics in monotherapy was the highest. The analysis of the data showed that the volume consumption of antibiotics was different according to grade of the prescribers which was respectively 98972.3 for anaesthesia & intensive care residents and 74990.7 for anaesthetist-intensivist. The treatment was reviewed during the rst 48 hours (99.8%) and was readapted in 106 of the patients (18.7%). We mainly increased the doses of antibiotics 77.4%. The average duration of the treatment was 5.2 ± 3.7 (days). CONCLUSION: The use of antibiotics remains high and uncontrol in intensive care units in Mali, which could be explain by the limited blood culture testing and insufcient of qualied human resource in some of the regional hospitals.

Objective:To study the etiologies, therapeutic and prognosis factors of coma in the elderly in the Department of Anesthesia and Intensive Care of Gabriel TOURE Teaching Hospital, Mali.Materials and Methods:This was a prospective descriptive study of all cases of coma in the elderly, registered from February 1, 2008 to January 31, 2009 at the Department of Anesthesiology CHU Gabriel Touré, Bamako.Results:During the study period, 564 patients were admitted to the intensive care unit (ICU) in which 174 (30.85%) were older people. We collected 100 subjects with impaired consciousness, the object of our study, which represented 17.73% of all admissions in the Department of Anesthesiology during the study period and 57.47% of all admissions of older people; 66% of our subjects were male. Hypertensive patients accounted for 60% of cases. In 46% of cases, it was a coma from cardiovascular causes and in 28% of cases; it was a coma of metabolic origin. The diagnoses made in the wake of the care of the elderly in ICU were predominantly stroke (46%) and electrolyte disturbances (13%). The coma was sudden onset in 58% of cases, including 28 cases of stroke whether 48.27%. The prognosis was marked by a fatality with 51% of deaths in our sample.Conclusion:The prognosis improvement of the elderly in coma through to the introduction of proxy measures.

Les perforations typhiques restent une cause fré-quente de péritonite dans les pays en développement. Nos objectifs ont été de déterminer la fréquence hospitalière, de décrire les signes cliniques et paracliniques, d'analyser les suites opératoires. Nous avons réalisé une étude rétrospective qui a porté sur une période de dix ans (janvier 1999-décembre 2008) dans les services de chirurgie générale et pédiatrique du CHU Gabriel-Touré. Elle a porté sur tous les malades opérés pour péritonite par perforation typhique. Nous avons colligé 385 perforations typhiques, soit 32,5 % des péritonites toute cause confondue. C'était 136 femmes (35,4 %) et 249 hommes (64,6 %), l'âge moyen a été de 15,2 ± 11,6 ans (2-65 ans). Deux cent cinquante patients (64,93 %) avaient entre 2 et 15 ans, 64 malades (16,62 %) avaient déjà été traités pour fièvre typhoïde. Le séjour hospitalier a duré en moyenne 18,4 jours (ET = 6,5). La radiographie de l'abdomen sans préparation réalisée chez 221 avait une sensibilité de 70,59 %, la sensibilité du Widal a été de 82 %. Les organes perforés étaient les suivants : iléon 367 (95,32 %) ; côlon 9 (2,34 %) et vésicule biliaire 9 (2,34 %). L'excision-suture a été réalisée 273 fois, 44 résections-anastomoses en un temps, 54 iléostomies, neuf cholécystectomies et cinq hémi-colectomies droites avec iléostomies. La mortalité a été de 8,33 % et la morbidité de 21,56 % (61 abcès de parois, huit fistules digestives, sept péritonites postopératoires, sept évis-cérations postopératoires). Les suites n'ont pas été influencées par la technique opératoire. Conclusion : Il est nécessaire de mettre en place une méthode efficace de prévention de la fièvre typhoïde. Mots clés Péritonite · Fièvre typhoïde · MaliAbstract The typhoid perforations remain a frequent cause of peritonitis in the developing countries. The aims of this study were to determine the frequency of hospital visit, describe the clinical and paraclinical signs, and analyze the complications after surgery, during 10 years (January 1999-December 2008, in the service of general and pediatric surgery at the GabrielTouré teaching hospital. The study involved all the patients operated for peritonitis due to typhoid perforation (385 cases, i.e., 32.5% of all peritonitis). There were 136 women (35.4%) and 249 men (64.6%), and the mean age was 15.2 ± 11.6 years (2-65 years). Two hundred and fifty patients (64.93%) were between 2 and 15 years, and 64 patients (16.62%) had been treated already for typhoid fever. The average of hospital stay was 18.4 days (DS = 6.5). The radiography of the abdomen without preparation was carried out in 221 patients and had a sensitivity of 70.59%; the sensitivity of Widal was 82%. The perforated bodies were the following: ileum 367 (95.32%), colon 9 (2.34%), and gall bladder 9 (2.34%). The excision closure was carried out 273 times, 44 resections with anastomosis in first time, 54 ileostomies, 9 cholecystectomies, and 5 right colectomies with ileostomies. Mortality was 8.33%, and the morbidity was 21.56% (61 wound infections, 8 ...

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During a prospective study conducted at the rehabilitation Center of the physically handicapped persons and at the mother-child Hospital in Bamako, the authors report 50 cases of neuromuscular complications of the quinine intramuscular injection in the child. The scan revealed muscular calcifications in 37 cases (740%), abscesses, in 7 cases (14%) and muscular inflammations in 6 cases (12%). Xray of the affected limb was not systematic: it has been performed in four children in the case of a subjacent bone involment. It showed calcifications in two cases. If muscular abscess is easily diagnosed by clinical exam it is not the case for calcifications. The scan allows to set up a precise mapping of the muscular lesions, to determine their type and size. It also helps the clinicians in their therapeutic attitude. Medical treatment associated with rehabilitation has been carried out in 40 patients (80%) and surgery in 10 patients (20%).

Intestinal volvulus on mesenteric cysticum lymphangioma (CL) is rare in children. The clinical picture is not very suggestive. We report a case of intestinal volvulus on CL in a 7-year-old girl after an abdominal trauma. Resection and anastomosis were made. The confirmation diagnosis was done by anatomopathological examination. Early diagnosis of intra-abdominal CL will allow avoiding complication.