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Objective To assess the association of lumbar bone marrow adipose tissue fat fraction (BMAT-FF) and paraspinal muscle proton density fat fraction (PDFF) and their interplay with intervertebral disc degeneration (IVDD). Methods In this retrospective cross-sectional study based on a prospective population-based cohort, BMAT-FF and PDFF of asymptomatic individuals were calculated based on 3T-MRI dual-echo and multi-echo Dixon VIBE sequences. IVDD was assessed at motion segments L1 to L5 and dichotomized based on Pfirrmann grade ≥ 4 and/or presence of other severe degenerative changes or spinal abnormalities at least at one segment. Pearson’s correlation coefficients were calculated for BMAT-FF and PDFF. Univariable and multivariable logistic regression models for IVDD were calculated. Results Among 335 participants (mean age: 56.2 ± 9.0 years, 43.3% female), the average BMI was 27.7 ± 4.5 kg/m2 and the prevalence of IVDD was high (69.9%). BMAT-FF and PDFF were significantly correlated (r = 0.31–0.34; p < 0.001). The risk for IVDD increased with higher PDFF (OR = 1.45; CI 1.03, 2.04) and BMAT-FF (OR = 1.56; CI 1.16, 2.11). Pairwise combinations of PDFF and BMAT-FF quartiles revealed a lower risk for IVDD in individuals in the lowest BMAT-FF and PDFF quartile (OR = 0.21; CI 0.1, 0.48). Individuals in the highest BMAT-FF and PDFF quartile showed an increased risk for IVDD (OR = 5.12; CI 1.17, 22.34) Conclusion Lumbar BMAT-FF and paraspinal muscle PDFF are correlated and represent both independent and additive risk factors for IVDD. Quantitative MRI measurements of paraspinal myosteatosis and vertebral bone marrow fatty infiltration may serve as imaging biomarkers to assess the individual risk for IVDD. Key Points • Fat composition of the lumbar vertebral bone marrow is positively correlated with paraspinal skeletal muscle fat. • Higher fat-fractions of lumbar vertebral bone marrow and paraspinal muscle are both independent as well as additive risk factors for intervertebral disc degeneration. • Quantitative magnetic resonance imaging measurements of bone marrow and paraspinal muscle may serve as imaging biomarkers for intervertebral disc degeneration.

Objectives Low bone mineral density (BMD) was recently identified as a novel risk factor for patients with hepatocellular carcinoma (HCC). In this multicenter study, we aimed to validate the role of BMD as a prognostic factor for patients with HCC undergoing transarterial chemoembolization (TACE). Methods This retrospective multicenter trial included 908 treatment-naïve patients with HCC who were undergoing TACE as a first-line treatment, at six tertiary care centers, between 2010 and 2020. BMD was assessed by measuring the mean Hounsfield units (HUs) in the midvertebral core of the 11th thoracic vertebra, on contrast-enhanced computer tomography performed before treatment. We assessed the influence of BMD on median overall survival (OS) and performed multivariate analysis including established estimates for survival. Results The median BMD was 145 HU (IQR, 115–175 HU). Patients with a high BMD (≥ 114 HU) had a median OS of 22.2 months, while patients with a low BMD (< 114 HU) had a lower median OS of only 16.2 months (p < .001). Besides albumin, bilirubin, tumor number, and tumor diameter, BMD remained an independent prognostic factor in multivariate analysis. Conclusions BMD is an independent predictive factor for survival in elderly patients with HCC undergoing TACE. The integration of BMD into novel scoring systems could potentially improve survival prediction and clinical decision-making. Key Points • Bone mineral density can be easily assessed in routinely acquired pre-interventional computed tomography scans. • Bone mineral density is an independent predictive factor for survival in elderly patients with HCC undergoing TACE. • Thus, bone mineral density is a novel imaging biomarker for prognosis prediction in elderly patients with HCC undergoing TACE.

Introduction Managing child abuse and neglect in pediatric emergency departments (PEDs) is difficult because of the complexity of screening and the prolonged care process. This study's main objective was to measure the child protection activity in a PED. Methods A retrospective, single-center study was conducted in the PED of the Lille University Hospital from 16 September∫2017 to 11 February 2019. All patients who required a social evaluation by the PED staff were included. Children admitted at first to the PED but for whom social management was exclusively performed by other units were not included. The whole population was analyzed first and then by type of abuse. The primary endpoint was the rate of patients who needed social management in the PED. The length of stay in the PED, the number of reports for investigation by child protective services, and reports to a judge were secondary assessment criteria. Results The study involved 245 patients (median age, 5 years; interquartile range [IQR], 2–13; boys, 49%), accounting for 0.6% of the PED visits. The main reasons for visiting the PED were somatic complaints (31%), sexual assault (23%), and behavioral disorders (20%). The median length of care in the PED was 5 h (IQR, 3–13). Thirty-three percent of the patients were monitored in the short-stay unit of the PED; 78% returned home. The main social measures taken were reports to child protective services (34%) and reports to a judge (24%); 51% of the patients required further actions by the PED physician after discharge. Conclusion Management of child abuse in the PED is important and time-consuming. A hospital team specialized in child protection is essential for the initial care and monitoring of child victims.

Background The impact of body compositions on surgical results is controversially discussed. This study examined whether visceral obesity, sarcopenia or sarcopenic obesity influence the outcome after hepatic resections of synchronous colorectal liver metastases. Methods Ninety-four consecutive patients with primary hepatic resections of synchronous colorectal metastases were identified from a single center database between January 2013 and August 2018. Patient characteristics and 30-day morbidity were retrospectively analyzed. Body fat and skeletal muscle were calculated by planimetry from single-slice CT images at the level of L3. Results Fifty-nine patients (62.8%) underwent minor hepatectomies, and 35 patients underwent major resections (37.2%). Postoperative complications occurred in 60 patients (62.8%) including 35 patients with major complications (Clavien–Dindo grade III–V). The mortality was nil at 30 days and 2.1% at 90 days. The body mass index showed no influence on postoperative outcomes (p = 1.0). Visceral obesity was found in 66 patients (70.2%) and was significantly associated with overall and major complication rates (p = .002, p = .012, respectively). Sarcopenia was observed in 34 patients (36.2%) without a significant impact on morbidity (p = .461), however, with longer hospital stay. Sarcopenic obesity was found in 18 patients (19.1%) and was significantly associated with postoperative complications (p = .014). Visceral obesity, sarcopenia and sarcopenic obesity were all identified as significant risk factors for overall postoperative complications. Conclusion Visceral obesity, sarcopenic obesity and sarcopenia are independent risk factors for overall complications after resections of CRLM. Early recognition of extremes in body compositions could prompt to perioperative interventions and thus improve postoperative outcomes.

Background:Matrix-associated autologous chondrocyte implantation (MACI) with autologous bone grafting (ABG) is an effective surgical treatment for osteochondral defects. Quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as noninvasive biomarkers to assess the biochemical composition of cartilage repair tissue.Purpose:To evaluate the association of quantitative MRI parameters of cartilage repair tissue and subchondral bone marrow with magnetic resonance morphologic and clinical outcomes after MACI with ABG of the knee.Study Design:Case series; Level of evidence, 4.Methods:Qualitative and quantitative 3 T MRI of the knee was performed in 21 patients (16 male) at 2.5 years after MACI with ABG at the medial (18/21) or lateral (3/21) femoral condyle for the treatment of osteochondral defects. Morphologic MRI sequences were assessed using MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 scores. T2 relaxation time measurements for the assessment of cartilage repair tissue (CRT2) were obtained. Single-voxel magnetic resonance spectroscopy was performed in underlying subchondral bone marrow (BM) and at both central femoral condyles. The presence of pain and Tegner scores were noted. Statistical analyses included Student t tests, correlation analyses, and multivariate regression models.Results:The mean defect size was 4.9 ± 1.9 cm2. At a follow-up of 2.5 ± 0.3 years, 9 of 21 patients were asymptomatic. Perfect defect filling was achieved in 66.7% (14/21) of patients. MOCART 2.0 scores (74.1 ± 18.4) did not indicate pain (68.3 ± 19.0 [pain] vs 81.7 ± 15.4 [no pain]; P = .102). However, knee pain was present in 85.7% (6/7) of patients with deep bony defects (odds ratio, 8.0; P = .078). Relative CRT2 was higher in hypertrophic cartilage repair tissue than in repair tissue with normal filling (1.54 ± 0.42 vs 1.13 ± 0.21, respectively; P = .022). The underlying BM edema–like lesion (BMEL) volume was larger in patients with underfilling compared with patients with perfect defect filling (1.87 ± 1.32 vs 0.31 ± 0.51 cm3, respectively; P = .002). Patients with severe pain showed a higher BMEL volume (1.2 ± 1.3 vs 0.2 ± 0.4 cm3, respectively; P = .046) and had a higher BM water fraction (26.0% ± 12.3% vs 8.6% ± 8.1%, respectively; P = .026) than did patients without pain.Conclusion:Qualitative and quantitative MRI parameters including the presence of subchondral defects, CRT2, BMEL volume, and BM water fraction were correlated with cartilage repair tissue quality and clinical symptoms. Therefore, the integrity of subchondral bone was associated with outcomes after osteochondral transplantation.

les abcès du cerveau à pyogènes (AC) sont une infection relativement rare et de diagnostic parfois difficile en raison de l'absence de signes cliniques ou biologique spécifiques. Un abcès cérébral provoquant des troubles neurologiques a été diagnostiqué chez une hémodialysée chronique. L'examen clinique trouve des céphalées et vomissements dans un contexte de déficit moteur hémi corporel droit. Chez qui l'examen neurologique retrouve un syndrome d'hypertension intracrânienne, un syndrome pyramidal d'installation progressive puis un syndrome infectieux ; faisant évoquer un processus expansif intracrânien (infectieux ou tumoral). L'intervention neurochirurgicale, décidée à partir des résultats de l'imagerie par résonnance magnétique, a confirmé l'abcès en peropératoire qui a été ponctionné et drainé. L'antibiothérapie associait la ceftazidime, le métronidazole et la gentamicine par voie parentérale. L'évolution a été marquée par la persistance des troubles neurologiques.

Tubal ligation is a surgical sterilization procedure that provides permanent and reliable contraception to women. Tubal obstruction is a method of permanent birth control that can be performed after mini-laparotomy under local anesthesia. Objective: To determine the outcome of tubal sterilizations by mini-laparotomy under local anesthesia performed in clients who underwent the surgical operation in the Maternity Ward of Ignace Deen National Hospital. Patients and Methods: The Gynecology and Obstetrics Department of Ignace Deen National Hospital was used as the place for the study. The study involved all the women seeking voluntary surgical contraception. This was a retrospective study of a descriptive type carried out from January 1, 2017 to December 31, 2018. A consent form was filled out and signed by spouses after an interview and a systematically carried out pre-operative clinical and para-clinical assessment. Results: During the study period, 56 tubal ligations were performed i.e. 4.72 percent of all family planning methods. The recruiting for the surgical contraception involved clients whose typical profile is that of women with an average age of 35, mostly housewives (35.71%), major multiparous (69.63%) with 6 living children on average. Married women made up the bulk of the recruiting i.e. 96.44%. Unmarried women made much more use of other methods. Indications of personal convenience were the most frequently encountered common reason. Among medical causes, high blood pressure concerned the majority of cases: 38% of the indications. Surgical contraception in between was more practiced than the post-partum one. The recorded complication was the parietal hematoma due to a lack of hemostasis and it accounted for 1.79% of cases. The progress was uncomplicated in 98.68% of cases. Forty couples (71.42%) expressed their feelings of satisfaction against only 6 cases of regret (10.71%). Conclusion: The surgical contraception has become a requirement for modern couples. Tubal ligation by mini-laparotomy is a simple operation and a harmless method of contraception that allows clients to use permanent contraception. Carried out on an outpatient basis, incidents and accidents are rare and may have psychological repercussions that are difficult to assess. The technical mastery of the gesture helps to minimize these incidents.

Low bone mineral density (BMD) was recently identified as a novel risk factor for patients with hepatocellular carcinoma (HCC). In this multicenter study, we aimed to validate the role of BMD as a prognostic factor for patients with HCC undergoing transarterial chemoembolization (TACE).This retrospective multicenter trial included 908 treatment-naïve patients with HCC who were undergoing TACE as a first-line treatment, at six tertiary care centers, between 2010 and 2020. BMD was assessed by measuring the mean Hounsfield units (HUs) in the midvertebral core of the 11The median BMD was 145 HU (IQR, 115-175 HU). Patients with a high BMD (≥ 114 HU) had a median OS of 22.2 months, while patients with a low BMD (114 HU) had a lower median OS of only 16.2 months (p.001). Besides albumin, bilirubin, tumor number, and tumor diameter, BMD remained an independent prognostic factor in multivariate analysis.BMD is an independent predictive factor for survival in elderly patients with HCC undergoing TACE. The integration of BMD into novel scoring systems could potentially improve survival prediction and clinical decision-making.• Bone mineral density can be easily assessed in routinely acquired pre-interventional computed tomography scans. • Bone mineral density is an independent predictive factor for survival in elderly patients with HCC undergoing TACE. • Thus, bone mineral density is a novel imaging biomarker for prognosis prediction in elderly patients with HCC undergoing TACE.

To assess the association of lumbar bone marrow adipose tissue fat fraction (BMAT-FF) and paraspinal muscle proton density fat fraction (PDFF) and their interplay with intervertebral disc degeneration (IVDD).In this retrospective cross-sectional study based on a prospective population-based cohort, BMAT-FF and PDFF of asymptomatic individuals were calculated based on 3T-MRI dual-echo and multi-echo Dixon VIBE sequences. IVDD was assessed at motion segments L1 to L5 and dichotomized based on Pfirrmann grade ≥ 4 and/or presence of other severe degenerative changes or spinal abnormalities at least at one segment. Pearson's correlation coefficients were calculated for BMAT-FF and PDFF. Univariable and multivariable logistic regression models for IVDD were calculated.Among 335 participants (mean age: 56.2 ± 9.0 years, 43.3% female), the average BMI was 27.7 ± 4.5 kg/m• Fat composition of the lumbar vertebral bone marrow is positively correlated with paraspinal skeletal muscle fat. • Higher fat-fractions of lumbar vertebral bone marrow and paraspinal muscle are both independent as well as additive risk factors for intervertebral disc degeneration. • Quantitative magnetic resonance imaging measurements of bone marrow and paraspinal muscle may serve as imaging biomarkers for intervertebral disc degeneration.

ObjectivesRecently, several scoring systems for prognosis prediction based on tumor burden have been promoted for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). This multicenter study aimed to perform the first head-to-head comparison of three scoring systems.MethodsWe retrospectively enrolled 849 treatment-naïve patients with HCC undergoing TACE at six tertiary care centers between 2010 and 2020. The tumor burden score (TBS), the Six-and-Twelve score (SAT), and the Seven-Eleven criteria (SEC) were calculated based on the maximum lesion size and the number of tumor nodes. All scores were compared in univariate and multivariate regression analyses, adjusted for established risk factors.ResultsThe median overall survival (OS) times were 33.0, 18.3, and 12.8 months for patients with low, medium, and high TBS, respectively (pConclusionIn a direct head-to-head comparison, the SAT was superior to the TBS and SEC in survival stratification and predictive ability. Therefore, the SAT can be considered when estimating the tumor burden. However, all three scores showed only moderate predictive power. Therefore, tumor burden should only be one component among many in treatment decision making.

Social movements that involve a variety of individuals from various backgrounds, such as Black Lives Matter, have made social justice (SJ) a prominent factor when purchasing. Although clothing is an influential communication tool and identity construction mechanism, very little research has explored the relationship between dress and SJ activism. Using Identity theory, this study proposed a model of non-Blacks’ adoption of BLM apparel/accessories which included repurchase intention and need for uniqueness as a moderating factor. The model was verified using structural equation modeling for the data obtained from a sample of 405 non-Black participants who purchased BLM apparel/accessories in the past 12 months. The results show a positive relationship exists between SJ commitment and SJ social identity salience and identity salience positively influences SJ behavior. The study also validated that SJ behavior positively influences repurchase intention. The findings improve our understanding of the motivations of non-Black BLM supporters.

Objectives: The objectives of this work were to describe the socio-demographic, clinical and prognostic characteristics of forceps deliveries at the maternity ward of the Donka National Teaching Hospital of Conakry. Parturients and Method: This was a prospective and descriptive study of all forceps deliveries performed at the Donka National Hospital maternity ward over a 6-month period from April 1, 2018 to September 30, 2018. Results: We performed 90 fetal extractions by forceps on 3518 deliveries i.e. a frequency of 2.55%. The socio-demographic profile of the parturient women was that of a young primiparous woman with an average age of 21.20 years and a full-term pregnancy with an average gestational age of 39 weeks of amenorrhoea. Fore position varieties were the most frequent with, in order of frequency, the fore left occipito-iliac (61.3%) and the fore right occipito-iliac (22.22%). Posterior varieties accounted for 15.55% of cases. Clinical pelvimetry showed that 88.89% of parturients had a practicable pelvis, while 11.11% had a moderately narrow pelvis. Acute fetal suffering was the most common indication (55.56%), followed by maternal exhaustion (27.78%) and prolonged expulsion (16.67%). All forceps were performed by doctors. We noted 8 cases of forceps failure (8.88%) that required a cesarean section. Maternal complications were dominated by soft tissue lesions, including 7 cases of perineal tearing (7.77%); 4 cases of vaginal tearing (4.44%); 3 cases of cervical tearing (3.33%) and 2 cases of hemorrhage of delivery by uterine atony (2.22%). No cases of maternal death have been recorded. The majority of newborns had a normal birth weight (88.88%) and more than half of newborns (66.66%) had an Apgar score below 7 out of 10 at the first minute. By the fifth minute there was an improvement in Apgar’s score from an average of 5 to 8 out of 10. Five newborns died, or 5.55%. Conclusion: Forceps extractions are less and less practiced in our maternity wards. Their bad reputation has something to do with it, but this is not always justified, because complications are rare and minimal if the indications are well laid out and the operator experienced. It therefore seems important to reposition this instrument, which still retains its place in obstetrical practices.

Perineal trauma is a non-surgical solution of continuity of posterior perineal committing under the effect of a violent exertion during childbirth. It occurs at the time of disengagement, either from the head or the posterior shoulder. Objectives: To calculate the perinea trauma during childbirth, describe the socio demographic profile of the women in childbed, identify contributory effects and appreciate the maternal prognostic. Methodology: It was a prospective study, descriptive type of 6 months (from May 19 to November 20, 2014). It took place at the maternity ward of Donka National Hospital. It concerned all received parturient, women in bed of a single fetus in the unit and having had a perineum traumatism. The real ones were epidemiologic, therapeutic clinical and prognostic. Results: We have recorded 110 perinea traumatism cases over 3496 childbirth let say a frequency of 3%. The socio demographic profile of the woman who did perinea traumatism was a teenager (42.7%), professional occupation (29.1%), married (88.2%), schooled, secondary and Technical level (42.7%), primary (70%) having had more than 3 prenatal consultations (73.6%). Contributory effects were: prim parity, young age, instrumental extraction by obstetrical forceps and the fetal weight between 2500 to 3999 g. Surgical management was (100%). The following were simple in 88.2% cases versus 11. 8% of complications. Conclusion: The reduction of this frequency requests systematical practice and corrects recentered prenatal consultations and the respect of episiotomy indications.

Introduction: Innovations in surgical and anaesthetic techniques to provide a good maternal and child safety have made the cesarean section a routine intervention in obstetrics. However, its complications, especially the short or long term per and postoperative maternal ones, are not exceptional and can affect mothers’ vital prognosis. The objectives of this study were to describe the maternal per and postoperative complications encountered during the cesarean section. Patients and method: This is a prospective, descriptive and analytical study carried out at the maternity ward of Kankan Regional Hospital over a 6 month period from January 1, 2018 to June 30, 2018. Results: During this period, out of a total of 2229 deliveries, 319 caesarean sections were performed i.e. a rate of 12.51%. Complications concerned 111 patients (34.79%). The average age was 28 with extremes of 15 and 45. Non-medical transportation concerned 71.17% of our patients. The cesarean section was performed in emergency situations in 82.8% of cases. Indications were dominated by the fetopelvic disproportion. There was a statistically significant relationship between labour duration and the occurrence of complications. Intraoperative complications were dominated by bleeding (25.22% of all complications and 8.77% of total cesarean sections). Post-operative complications were dominated by parietal suppurations (94.49% of all complications and 34.79% of the total number of cesarean sections). In most cases, patients simultaneously developed several complications. Conclusion: The maternal complications of cesarean sections remain considerable. If the increase in the rate of caesarean sections has contributed to the improvement of the mother-fetal prognosis, the surgical procedure itself is not without complications, which encourages us to review its indications for a better management. Hemorrhagic and infectious complications were the most frequent. These results call for increased asepsis measures in our operation theaters to reduce infectious complications. The increase in Caesarean section rates over the years is faced with increased maternal morbidity in the short and long term. Its indications should be well thought out and should include the responsibility of an experienced obstetrician.

Objectives: To describe the socio-demographic aspects of transferred parturient women; To identify the means of transport used by the evacuated parturient women to the Donka maternity ward at the University Hospital of Conakry; To describe the difficulties met; And to assess maternal and fetal prognosis. Methodology: It consisted of a prospective study over a period of 6 months from 01/02 to 31/07/2018. All patients transferred to the maternity ward of the Donka National Hospital of Conakry University Hospital. Results: The frequency of obstetric transfers was 13.79%. The epidemiological profile was that of a parturient woman of an average age of 25.7 years, married, and housewife, unschooled, who was on her first pregnancy and from the city of Conakry. The average distance covered was 16 km with extremes of 3 and 50 km. The transfer to the referral maternity clinic was not medicalized in 94% of cases. The venous route was not taken in 96% of cases. The parturient was not escorted by a health worker in 98% of cases. Bleeding was the most frequent reason for evacuation, followed by acute fetal sufferings. The average number of prenatal consultation was 2 with extremes of 0 and 9. The average length of stay was 3.6 days with extremes of 1 and 28 days. The majority of transferred women had a full-term pregnancy. The Cesarean section was 79.4%. The Retro placental hematoma was the most common complication found and was 29.4%. The counter-reference was not made in 97.79%. We recorded 8 maternal deaths, for a lethality rate of 1.77%. Possible interventions to reduce the dramatic situation of obstetric evacuations require first of all the decentralization of health care structures capable of performing a cesarean section. This approach should aim to create medical centers with a surgical antenna in all municipalities. These decentralized units would reduce the delay in case management and thus, limit the number of complications.

Summary: Estimate the incidence of endometrial hyperplasia according to socio-demographic parameters and the type of lesions histological. Methodology: This was a retrospective, and 15-year descriptive study from January 1, 2000 to December 31, 2014 conducted at the Department of Anatomy and Pathological Cytology of the National Hospital Donka in collaboration with the obstetric gynecology departments of the Conakry University Hospital. Results: We collected 296 cases of malignant and benign endometrial hyperplasia in 15 years, accounting for 37% of all endometrial biopsy curettages examined. The age group 47 to 56 years was the most affected (81 cases) or 27, 36%. The mean age was 53.6 years with extremes of 27 and 83 years. Metrorrhagia was the main reason for consultation (206 cases), i.e. 69.59%. The suspicion of endometrial hyperplasia by physicians was the most frequently diagnosed circumstance (149 cases) or 50.33%. Biopsy curettage was the most frequently used method (176 cases), is 59.45%. Histological endometrial lesions of atypical complex adenomatous hyperplasia (79 cases) represented 26.69%. Benign behavior was most frequently observed in (235 cases) or 79.39%. Conclusion: Endometrial hyperplasia is an endometrial lesion whose atypical histological types represent the borderline lesions between benignity and malignancy.

Supplemental material, sj-pdf-1-ajs-10.1177_0363546520980134 for Quantitative 3-T Magnetic Resonance Imaging After Matrix-Associated Autologous Chondrocyte Implantation With Autologous Bone Grafting of the Knee: The Importance of Subchondral Bone Parameters by Matthias Jung, Dimitrios C. Karampinos, Christian Holwein, Joachim Suchowierski, Thierno D. Diallo, Alexandra S. Gersing, Fabian Bamberg, Frederic A. Baumann, Stefan Ruschke and Pia M. Jungmann in The American Journal of Sports Medicine

The lifespans of bridges have become very short in Guinea. They partially collapse, until they fall completely. To understand this scourge and provide some answers, we have conducted more than fifty surveys among neighboring populations and certain professional services (those in charge of studies: climatic; hydrological; agricultural and public works). One problem emerges in common: soil degradation. Lola (border town with the Ivory Coast) is said to have cut itself off from the rest of Guinea after heavy rain. Because? The bridge that linked it to the rest of the country would have collapsed after a complete degradation of its support: the ground. In Kérouané (another city in Guinea), landslides are permanent and cause certain bridges to collapse. The results of our surveys show that with the alternation of the seasons, these soils (lacking scientific and professional studies) undergo degradation and lose their initial states of stability. Our research work and their results support the need for a basic geotechnical study before the start of any project. This could prevent any probable socio-economic impact caused by soil degradation in the regions.

Resume Position du probleme Le depistage neonatal de la drepanocytose s’impose en Afrique ou la maladie est plus frequente. L’electrophorese de l’hemoglobine permet ce depistage, mais son usage est limite par un cout eleve et des difficultes d’acces. Le test d’Emmel, plus abordable et techniquement plus accessible est souvent demande dans le bilan prenatal des gestantes en Afrique, pour reserver le depistage aux nouveau-nes issus de meres chez qui le test positif atteste la presence d’hemoglobine S. Cette etude se propose d’evaluer le nombre de naissances drepanocytaires non reperees dans le cadre d’une politique de depistage ciblant les seules naissances issues de meres chez qui le test d’Emmel serait positif. Methodes De 2010 a 2012, a Bamako, Mali, 2489 nouveau-nes ont fait l’objet d’un depistage systematique de la drepanocytose, au niveau du cordon ombilical ou du talon, par isoelectrofocalisation, completee au besoin par une chromatographie liquide haute performance. Ces nouveau-nes etaient issus de 2420 meres dont l’hemoglobinique a ete etudiee par isoelectrofocalisation. Les donnees ont ete enregistrees et traitees a l’aide du logiciel Excel dans sa version 14.0.0. Nous avons calcule la frequence du gene drepanocytaire chez les populations des meres et des nouveau-nes depistes ainsi que le nombre de nouveau-nes drepanocytaires nes de meres heterozygotes ou homozygotes C. Resultats Parmi les 2489 nouveau-nes, 16 etaient drepanocytaires majeurs dont 6 SS et 10 SC ; 198 avaient le trait drepanocytaire ; 139 etaient AC et 1 etait CC. Parmi les 10 drepanocytaires majeurs SC, 3 etaient nes de meres n’ayant pas le drepanocytaire S, mais porteuses du gene C de l’hemoglobine et chez lesquelles, un test d’Emmel aurait ete negatif. Conclusion Un depistage neonatal cible, base sur les resultats du test d’Emmel chez les femmes enceintes, meconnaitrait plus d’un drepanocytaire majeur sur six qui serait ainsi prive d’une prise en charge adaptee precoce. Des etudes de rapport cout/efficacite d’un depistage neonatal systematique de la drepanocytose doivent conduire a une meilleure strategie de depistage a adopter dans les contextes ou la mutation S coexiste avec d’autres mutants hemoglobiniques.

A 60-year-old Hispanic male presented to his primary care physician office with an asymptomatic, but palpable right anterior chest wall mass. Initial work up of the finding included a CT scan of the chest which revealed a non-calcified, solid right anterior chest wall mass with invasion of the anterior fifth rib and intercostal space. The patient was presented at multidisciplinary conference with the patient’s primary physician, a medical oncologist, radiologist, pathologist and oncologic surgeon in attendance. The decision was to perform surgical resection of the mass to treat this primary mesenchymal malignancy. The anterior aspect of the fifth rib and intercostal muscles were resected with negative margins. Pathology confirmed the mass to be a low-grade chondrosarcoma. Due to the low-grade nature, low metastatic potential and negative margins of the tumor, the decision was made not to pursue adjuvant chemotherapy or radiation therapy. The patient made full recovery.

Aim. To assess feasibility of integrating family planning counselling into mass screening for cervical cancer in Guinea. Methodology. This was a descriptive cross-sectional study conducted over a month in Guinea regional capital cities. The targeted population comprised women aged 15 to 49 years. Nearly 4000 women were expected for the screening campaigns that utilized VIA and VIL methods with confirmation of positive tests through biopsy. A local treatment was immediately performed when the patient was eligible. Results. Overall 5673 women aged 15 to 60 years were received, a surplus of 42% of the expected population. 92.3% of women were aged 15–49 years and 90.1% were 25–49 years. Long-acting methods were the most utilized (89.2% of family planning users). 154 precancerous and cancerous lesions were screened, a global positivity rate of 2.7%. Conclusion. Integration of counselling and family planning services provision during cervical cancer mass screening is a feasible strategy. A cost-effective analysis of this approach would help a better planning of future campaigns and its replication in other contexts.

Objective: This study was conducted to evaluate the role of colposcopy in the screening of cervical cancer at the UTH in Conakry. Material and Methods: We conducted a descriptive study on over a period of 18 months of from the 1 July 2004 to December 31, 2005 in the CHU of Conakry Any women aged from 25 to 65 years old who has agreed to the screening of cervical cancer by colposcopy was included. Statistical tests of sensitivity, specificity, and predictive values positive and negative were computed directly and compare among all participants. Results: During the study period, we included a total of 9339 women. For all precancerous and cancerous lesions, sensitivity and specificity were 93% and 64% respectively. With a positive predictive value of 46% and the negative predictive value of 90%, low and high grade precancerous lesions were found with: a sensitivity of 91%, the specificity of 64%. The positive predictive value of 37%, and the negative predictive value of 91% were estimed. Intra epithelial lesions (LIEBG) low-grade squamous sensitivity was 94%, specificity of 62%, the positive predictive value of 31%, the negative predictive value of 95%. For lesions intra epithelial highgrade squamous (LIEHG), the sensitivity was 85%, 10%, the positive predictive value of 74% specificity, negative predictive value of 95%. Conclusion: Colposcopy is a reference method of detection of precancerous lesions of the cervix to promote cancer.

Resume Introduction La retinopathie est une complication chronique a risque fonctionnel important chez le drepanocytaire, dont l’incidence est mal connue en Afrique subsaharienne, faute de depistage. Ce travail decrit les resultats d’un depistage systematique de la retinopathie drepanocytaire dans un centre de suivi des drepanocytaires au Mali. Methodes Tous les drepanocytaires âges de 10 ans et plus, suivis au centre, ont ete depistes entre 2010 et 2012 par un examen du fond d’œil complete si besoin par une angiographie. Les caracteristiques des patients porteurs d’une retinopathie ont ete comparees a celles de drepanocytaires sans retinopathie recrutes durant la meme periode et selectionnes au hasard. Resultats La retinopathie avait une prevalence globale de 8,8 % chez les 1604 drepanocytaires âges de 10 ans et plus et concernait 91/731 (12,4 %) drepanocytaires SC, 38/734 (5,2 %) SS, 5/53 (9,4 %) Sβ 0 thalassemiques et 8/86 (9,3 %) Sβ + thalassemiques. La forme proliferante de la retinopathie etait plus frequente chez les SC ( p 0 thalassemiques. Conclusion La retinopathie touche pres d’un patient drepanocytaire sur dix et sa prevalence est negativement associee au taux d’hemoglobine fœtale. L’efficience d’un depistage systematique de la retinopathie drepanocytaire doit etre etudiee en Afrique, ainsi que l’interet de la phlebotomie et de l’hydroxycarbamide en traitement preventif.

Relever la distribution des differents genotypes du virus de l’hepatite B (VHB) et rechercher une relation entre le genotype et la severite de l’atteinte hepatique. Etude descriptive et analytique menee sur une periode de huit mois en consultation externe dans deux structures hospitalieres d’Abidjan en Cote-d’Ivoire, un pays d’Afrique de l’Ouest. Etaient inclus les patients porteurs chroniques de l’AgHBs suivis ayant realise le genotypage du VHB. Il y avait 33 patients (27 hommes, soit 81,8 %; sex-ratio = 4,5). L’âge moyen etait de 46 ± 12,4 ans (extremes: 25 et 77; âge median = 44 ans). L’infection virale B a ete decouverte de facon fortuite dans 24 cas (72,7 %). Le genotype E a ete majoritairement retrouve (27 cas, soit 81,8 %) suivi du genotype A (six cas, soit 18,2 %). L’AgHBe etait negatif chez 28 patients (84,9 %). Nous avons note cinq cas d’hepatite virale B (HVB) chronique a AgHBe positif, 14 cas d’HVB chronique a AgHBe negatif et 14 cas de portage chronique inactif du virus B. La severite de l’atteinte du foie n’etait pas influencee par le genotype viral. Les genotypes A et E etaient les deux genotypes retrouves avec une nette predominance du genotype E. La severite de l’hepatopathie chronique n’etait pas influencee par le genotype viral.

But Identifier les determinants maternels du petit poids pour l’âge gestationnel (PAG) afin de proposer des mesures preventives pour reduire la morbidite et la mortalite infantiles.

In Senegal, numerous initiatives exist to cultivate Jatropha curcas L. (JCL) trees as a multipurpose energy crop, including for fuel. Thus, research on this drought-resistant shrub has been predominately focused on biofuel production from its seeds, while its potential for carbon (C) sequestration, which could be valuable in sink projects (i.e., afforestation, reforestation) under the Clean Development Mechanism (CDM) of the Kyoto protocol, has been largely unstudied. This study was carried out in Senegal’s Peanut basin to develop allometric equations for estimating biomass of individual JCL shrubs, JCL plantations, and determining their respective C storage potential. We discovered a three-stage evolution of JCL biomass accumulation. A slow build-up stage (1–3 years), followed by a fast production of biomass (3–4 years), and a relatively slower stage where certain fractions-root and leaf biomass-reach a plateau (4–5 years). The ratio between belowground and aboveground biomass varies from 53% (1 year after planting) and 26% (5 year after planting), with an average of 41%. We developed allometric models that provide a reliable estimation of the different biomass fractions of JCL and according to tree age. The models revealed that the stocks of biomass and C become relatively important from the fifth year with a storage capacity of 5.07 kg per tree. Most of the biomass and organic C are stored in the aboveground fractions of trees, suggesting that JCL plantations may be valuable for C sink and CDM projects.

Introduction En France comme dans les pays du nord, la quasi totalite des enfants drepanocytaires atteint desormais l’age adulte, mais la mortalite infanto-juvenile liee a la drepanocytose est inconnue en Afrique, ou vivent pourtant 80 % des enfants atteints. L’absence de depistage neonatal et de registre de deces y rendent les etudes de mortalite liees a la drepanocytose tres difficiles. Patients et methodes Etude multicentrique au Burkina Faso, au Senegal, au Mali, en RDC et en Cote d’ivoire. Nous avons inclus des femmes en bonne sante ayant au moins un enfant drepanocytaire SS et des femmes temoins de phenotype AA (verifie par test rapide), toutes ayant eu au moins 3 enfants nes il y a plus de 5 ans (vivants ou decedes) et issues du meme milieu social. Durant un entretien mene par une professionnelle de sante etaient recueillies les caracteristiques socioeconomiques des familles (âge des parents et de leurs enfants, lieu d’habitation, niveau d’etude des parents, calcul de l’indice OMS multidimensionnel de pauvrete) et les donnees de mortalite infanto-juvenile (nombre d’enfants nes vivants, nombre d’enfants decedes, age de deces, drepanocytose (suspectee ou confirmee) ou non, circonstances et lieu de deces). Les taux de mortalite infanto-juvenile des familles drepanocytaires et temoins et leur intervalle de confiance, ont ete calcules par la methode de Kaplan Meier. Sachant que dans les familles avec un enfant drepanocytaire et des parents sains (heterozygotes AS), 25 % en moyenne des nouveaux-nes sont drepanocytaires, les taux de mortalite des enfants drepanocytaires ont ete estimes comme suit : (taux de mortalite des enfants des familles drepanocytaires × 4) - (taux de mortalite des enfants des familles temoins × 3). Un modele de Cox multivarie a ete utilise pour decrire les facteurs socio-economiques et geographiques associes a la mortalite. Resultats 2559 familles ont ete recrutees (1302 familles drepanocytaires et 1257 familles temoins) pour un total de 13199 enfants dont 1457 enfants decedes. Les caracteristiques sociodemographiques des familles etaient similaires dans les 2 groupes. L’âge moyen des enfants vivants etait de 15,5 (± 10,2) ans chez les familles temoins et 14,6 (± 9,1) ans chez les familles drepanocytaires (p = 0,001). La premiere circonstance de deces etait la fievre : 53 % et 58 % dans les familles temoins et drepanocytaires, respectivement. Dans les familles drepanocytaires 65 % des enfants decedes avant 5 ans avaient une suspicion de drepanocytose mais seulement la moitie avaient recu un diagnostic formel. L’estimation du taux de mortalite chez les enfants drepanocytaires etait de 8 % [IC 95 % : 7-8] avant l’âge de 1 an, 19 % [18-19] avant 5 ans et 27 % [25-28] avant 10 ans. La mortalite observee dans les familles temoins etait de 4 % [4-5], 7 % [6-8] et 7 % [7-8] a respectivement 1, 5 et 10 ans. Le risque relatif (RR) de mortalite liee a la drepanocytose augmentait avec l’âge : 2,0 avant 1 an, 2,7 avant 5 ans et 3,8 avant 10 ans. Toutefois, on observait de grandes disparites selon les pays. L’etude de survie multivariee a confirme que le fait d’appartenir a une famille drepanocytaire etait un facteur independant de mortalite avant 20 ans [HR 1,67(1,47-1,189), p Conclusion Dans cette etude retrospective nous avons estime a 19 % la mortalite infanto-juvenile (avant 5 ans) liee a la drepanocytose en Afrique sub-saharienne centrale et de l’ouest par une methode indirecte permettant de contourner l’absence depistage neonatal -et donc le sous-diagnostic de la maladie- d’une part, et l’absence de registre de mortalite national d’autre part. Cette mortalite est bien superieure a celle des enfants drepanocytaires vivant en Europe, ou plus de 90 % d’entre eux atteignent l’âge adulte, mais est a ponderer par la mortalite observee dans les familles sans drepanocytose qui est egalement elevee. Toutefois, ces taux de mortalite liee a la drepanocytose sont tres inferieurs a ceux rapportes dans la litterature ou il est considere que 90 % des enfants drepanocytaires nes en Afrique meurent avant l’âge de 5 ans. De toute evidence la survie des enfants drepanocytaire a bien evolue en Afrique, du moins dans les grandes villes. Nous avons egalement mis en evidence quelques facteurs de risques associe a la mortalite dans les familles, majoritairement socioeconomiques et non specifiques a la drepanocytose.

The infection by the virus of the hepatitis C can be associated with other infectious diseases, including the viral and bacterial infections of which the tuberculosis. The infection to Mycobacterium tuberculosis can remain latent during several years and show itself during a state of immunesuppression. The role of the antiviral treatment in the reactivation of the tuberculosis is debated. We bring back an observation of tubercular reactivation during dual therapy with pegylated interferon and ribavirin for a viral chronic hepatitis C. A virologique answer slow was obtained in the 40th week, as well as the reactivation of the tuberculosis. The tuberculosis was of ganglionic localization at our patient. The antituberculous treatment was established while maintaining the treatment. The evolution of the tuberculosis under treatment was favorable but for the VHC, we noted a virologique answer with premature relapse.

The objective of this study was to evaluate the impact of a rapid diagnostic test for influenza (the SofiaA retrospective, observational, cross-sectional study was conducted in the PED of the Lille University Hospital between 2013 and 2015. All patients under 18 years of age for whom influenza RDT was administered were included. Clinical data, management, and related hospitalizations were compared between positive and negative RDT groups. The length of stay in the PED (main outcome) and the number of additional tests (biological and radiographic tests) between the two groups were compared.A total of 238 tests were reported: 119 positive, 110 negative, nine invalid. The mean length of stay in the PED was significantly lower in the positive RDT group: 4.0h vs. 7.4h (P10This study showed a significant medical impact of the use of Sofia

Healthy Love is a brief, highly interactive, single-session, group-level HIV prevention intervention designed for African American women that is effective at reducing sex risk behaviors and increasing condom use and HIV testing among participants. The Centers for Disease Control and Prevention, through a contract, developed a user-friendly intervention package that would allow organizations to adopt and implement Healthy Love with fidelity.Training and implementation materials were developed to support original research protocols, and piloted and revised to conduct field-testing with case study agencies (CSAs). Three CSAs were selected to deliver the intervention over a 3-month period to test the utility of intervention materials and feasibility of implementation.All CSAs were able to successfully deliver 10 sessions with a total of 185 women ranging from 18 to 59 years of age. Successes and challenges encountered in training, preimplementation activities, and intervention delivery are described.Lessons learned from training, technical assistance, and process monitoring and evaluation informed final package revisions. Research to practice recommendations are shared as is guidance for future implementations of Healthy Love. The research to practice process used is a model approach for developing a comprehensive intervention package and will support the adoption of Healthy Love by other organizations.

L"objectif était de tester une méthode simple adaptée à un contexte de ressources limitées pour mesurer l"observance et identifier les motifs de non observance rencontrés dans le suivi des traitements antirétroviraux (ARV) en milieu décentralisé au Mali. Il s"agissait d"une étude transversale de juin 2006 à décembre 2008 chez des patients VIH suivis en consultation dans l"Unité de Soins et d"Accompagnements et de Conseils (USAC) de Koulikoro.. C"est ainsi que l"observance pour les ARV a été mesurée. Les patients ont été considérés comme observants si d"après le nombre de comprimés restants ils n"ont sauté aucune prise de leur traitement. L"étude a porté sur 250 patients. La tranche d"âge 30 à 34 ans était la plus représentée dans la série avec 17,6%. La majorité des patients était de sexe féminin soit 75,1%. La majorité de patients résidait dans la commune urbaine de Koulikoro soit 74,4%. Le schéma 2 Inhibiteurs Nucléosidiques de la Transcriptase Inverse (INTI) + 1Inhibiteur Non Nucleosidique de la Transcriptase Inverse (INNTI) était le plus prescrit soit 91,6%. Tous les patients étaient sous traitement ARV, avec 78% sous Triomune (Lamivudine + Stavudine + Nevirapine en combinaison fixe). Les patients qui ont fait un abandon (ou refus) de prendre le médicament étaient majoritaires avec 27,4%. L"observance était de 75,2%. L"indice global d"observance donne 188 patients (75,2%) comme observants et 62 patients (24,8%) comme non observants. L"observance thérapeutique dans l"étude est relativement bonne (75,2 % des patients). Cette étude montre que la mesure de l"observance est possible et faisable en utilisant le comptage des comprimés des patients en milieu décentralisé. Les causes d"inobservances étaient dominées par le refus (27,4%) ; l"oubli (24,2%) ; le voyage (16,1%) ; les effets indésirables des antirétroviraux de type allergique (12,9%). Notre étude a montré que 24,8% des patients ont été non observants en raison du refus,de l"oubli, du voyage et des effets indésirables. Les prestataires ou agents de santé avaient eu plusieurs astuces pour améliorer l"observance des patients telles que relier la prise du traitement à une activité quotidienne ou avant le petit déjeuner. Les associations des PVVIH œuvrent auprès des agents de santé afin de faire accepter aux nouveaux inclus leur statut et surtout le traitement ARV. Mots clés : VIH, Observance, ARV, Koulikoro.

Resume Introduction Les concentrations plasmatiques de la parathormone (PTH) et de l’acide urique (AU) s’elevent des que le debit de filtration glomerulaire (DFG) commence a diminuer au cours de la maladie renale chronique (MRC). L’objectif de cette etude etait d’evaluer l’association entre le DFG et l’augmentation de ces 2 parametres chez l’enfant. Patients et methodes Etude retrospective de 100 enfants âges de 5 a 18 ans ayant realise une exploration fonctionnelle renale (EFR), et qui presentaient une augmentation de la PTH ou de l’AU. Le DFG a ete mesure par la clairance de l’inuline (C In). Resultats Le DFG etait normal (> 90 mL/min/1,73 m2) chez 39 % des enfants, l’AU etait augmente chez 44 % et la PTH chez 75 % ; 29 % des enfants ayant une PTH elevee avaient un DFG normal. Une correlation inverse a ete observee entre l’AU et le DFG (r = −0,452, p ≤ 0,0001), et entre la PTH et le DFG (r = −0,226, p = 0,024). La meme relation negative a ete observee entre l’AU et la PTH (r = −0,266, p = 0,007), ainsi qu’entre l’AU et le taux de reabsorption du phosphore (TRPhosph) (r = −0,415, p Discussion L’hyperuricemie s’observait a tous les stades de la MRC, faisant discuter une atteinte tubulaire precoce infraclinique. L’augmentation precoce de la PTH dans cette cohorte semble en contradiction avec certaines etudes nord-americaines decrivant des concentrations de PTH normales en phase precoce de la MRC. Des etudes prospectives sont necessaires pour confirmer ces donnees et evaluer le role de l’AU dans la genese des anomalies minerales et osseuses de la MRC.

A study was conducted to determine the optimal level of nitrogen for a better performance of the virgin canes. The vegetal materiel is composed of the variety SP 70-1284. The materiel of laboratory is composed of an electric grinder ("Jeffco" food and fodder cutter grinder, model 265 B, set L 1710), a refractometer (Schmidt+Haensch, HARD-SW model, set 29129) and a polarimeter (Saccharomat Z, set 29305). The test was conducted with the variety SP 70-1284 as an experimental randomized complete block with 9 treatments, with 4 repetitions. The total doses of N of three contributions for the cycle of harvest (35, 70, 105, 140, 175, 210, 245, 280, 0 kg ha 1) correspond to the T1 treatments, T2, T3, T4, T5, T6, T7, T8 and T0. The T0 (14, 79 t s ha-1 ± 1, 03) recorded the weak quantity of sugar. The quantity raised of sugar has been observed on the T8 (16, 83 t s ha-1 ± 1, 09), T5 (16, 84 t s ha-1 ± 1,15) and T7 (16,94 t s ha-1 ± 1,12). The weak rate of the Brix has been revealed on the T2 (22, 05% ± 0, 84). The T4 (23, 15% ± 0, 77), T3 (23, 21% ± 0, 21), T8 (23, 43% ± 0, 62) recorded the strong rates of the Brix. The elevated Pol rate is gotten with the T8 (20, 90% ± 0, 55), the lowest with the T2 (19, 45% ± 0, 80). The weak rate of Wealth Hugo Simplifiee (RHS) is recorded on the T2 (12, 84% ± 0, 55), the T8 (13, 87% ± 0, 45) got the elevated rate. The dose of 280 kg N ha-1 corresponding to T8 appears to be effective and can be used for the profitability of the variety SP 70-1280 to the Agro Industrial Complex of the CST-Banda in Chad.

Mycobacterium abscessus is a common non tuberculous mycobacterium associated with diseases in patients with underlying conditions. The diagnosis is often missed in resource limited settings. We reported a case of M. abscessus in a patient with renal failure. A young female patient admitted at the hospital for kidney failure was diagnosed with malignant hypertension based on clinical and laboratory findings. Over the course of hospitalization, the patient presented hematuria and leukocyturia and the urine culture was positive for acid-fast bacilli. Empirically antituberculous treatment given to the patient was changed to clarithromycin after confirmation of M. abscessus by probe line hybridization assay. Favorable outcome was achieved with regression of symptoms and the decrease of the serum creatinine level. In patients with underlying conditions, differential diagnosis should be considered particularly in resource limited settings.

Le succès du traitement des morsures de serpent en milieu rural passe par l'implication des tradipraticiens de santé. Le but de cette étude effectué auprès des tradipraticiens de santé de Kolokani (Mali) était de répertorier les différentes plantes utilisées dans la prise en charge des morsures de serpents. Au total nous avons interviewé 21 tradipraticiens de santé (TPS). La majorité des TPS était des hommes (17/21) soit 80,95%. Plus de 71% (15/21) des enquêtés n'étaient pas alphabétisés. 69,91% (13/21) des TPS exerçaient leur profession depuis plus de 20 ans. La quasi-totalité des TPS enquêtés soit 95% (20/21) pouvait nous citer au moins un problème de santé dans la communauté. Pour la prise en charge des morsures de serpent, au total 16 plantes appartenant à 11 familles botaniques ont été identifiées. Les trois premières plantes les plus citées ont été : Securidaca longipedunculata Fres (Polygalaceae) Gardenia ternifolia…..(Rubiaceae) et Tamarindus indica L. (Ceasalpiniaceae). Les feuilles étaient utilisées majoritairement et le plus souvent sous forme de décocté pour boisson et poudre pour massage.

Resume La cancerologie est percue comme un probleme de sante secondaire dans les pays emergents, Pourtant, l'incidence annuelle des cancers y est en pleine croissance (environ 100 a 120/100 000 actuellement en Afrique subsaharienne). Cela peut s'expliquer par l'incidence elevee des pathologies infectieuses a risque oncogene (hepatites, VIH, Helicobacter, etc.) mais aussi par des politiques nationales et internationales de prevention encore trop reduites. Si cette tendance epidemiologique se poursuit, l'Afrique comptera en 2020 pres d'un million de nouveaux cas de cancers chaque annee. Si l'incidence augmente, la morbimortalite y est egalement importante. Cette constatation depasse la simple consequence d'un defaut de moyens. Le paysage socioculturel et les representations de la maladie font egalement partie integrante des causes de ce constat. Nous evoquerons dans cette tribune la situation de l'Afrique en citant l'exemple du Mali. Nous conclurons sur les apports qui peuvent etre faits a l'echelle individuelle au travers de l'exemple de l'association « OncoMali ».