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Background: Genetic factors play an important role in prostate cancer (PCa) susceptibility.Objective: To discover common genetic variants contributing to the risk of PCa in men of African ancestry.Design, setting, and participants: We conducted a meta-analysis of ten genome-wide association studies consisting of 19378 cases and 61620 controls of African ancestry.Outcome measurements and statistical analysis: Common genotyped and imputed variants were tested for their association with PCa risk. Novel susceptibility loci were identified and incorporated into a multiancestry polygenic risk score (PRS). The PRS was evaluated for associations with PCa risk and disease aggressiveness.Results and limitations: Nine novel susceptibility loci for PCa were identified, of which seven were only found or substantially more common in men of African ancestry, including an African-specific stop-gain variant in the prostate-specific gene anoctamin 7 (ANO7). A multiancestry PRS of 278 risk variants conferred strong associations with PCa risk in African ancestry studies (odds ratios [ORs] >3 and >5 for men in the top PRS decile and percentile, respectively). More importantly, compared with men in the 40-60% PRS category, men in the top PRS decile had a significantly higher risk of aggressive PCa (OR = 1.23, 95% confidence interval = 1.10-1.38, p = 4.4 × 10-4).Conclusions: This study demonstrates the importance of large-scale genetic studies in men of African ancestry for a better understanding of PCa susceptibility in this high-risk population and suggests a potential clinical utility of PRS in differentiating between the risks of developing aggressive and nonaggressive disease in men of African ancestry.Patient summary: In this large genetic study in men of African ancestry, we discovered nine novel prostate cancer (PCa) risk variants. We also showed that a multiancestry polygenic risk score was effective in stratifying PCa risk, and was able to differentiate risk of aggressive and nonaggressive disease.

Background In Senegal, psychological violence remains a taboo subject insofar as it often arises in the closed circle of family life. It has a highly negative impact on the health of pregnant women. The objective of this work was to study the epidemiological profile of female victims of psychological violence before and after birth in the Sedhiou region. Method An observational, cross-sectional and analytical study was carried out from December 4, 2018 to April 4, 2019. The study population consisted of all the women received for postnatal consultation in one of the referral health structures in the Sedhiou region. Data were collected using a survey form and a questionnaire administered to the women having met the inclusion criteria. The data were entered using CS Pro software and subsequently analyzed using R 3.4.4 software. Results The mean age of the women was 25.4 ± 7.8 (14–43 years). A total of 222 women (55.5 %) had suffered psychological violence during the prepartum period. Isolated psychological violence represented 44.3 % of the surveyed population, while psychological violence associated with sexual or physical violence represented 8.0 % and 5.4 % of the respondent population, respectively. The factors associated with psychological violence during the prepartum period were pursuit of a professional activity [ORaj = 4.7 (1.3–17.0)], high educational status [ORaj = 7.0 (4.2–11.5)] and performance of fewer than 3 antenatal consultations (ANC) [ORaj = 2.2 (1.2–4.0)]. Maternal, fetal and neonatal complications were more frequent among victims of psychological violence (P Conclusion Psychological violence among pregnant women has a negative impact on the health of the mother and the newborn. This state of affairs should induce health care providers to increase popular awareness of its detrimental effects. Communication efforts aimed at behavioral change will need to be combined during prenatal consultations with strengthened screening for violence, the objective being to achieve improved care.

West Africa is influenced by northeasterly winds flowing from the Sahara Desert, which transports large quantities of dust into the Sahel by discrete episodic dust events during winter and spring seasons. We investigate the role of horizontal grid spacing in simulating the Particulate Matter with a mass median diameter of less than 10 μm ( P M 10 ) concentrations over West Africa during January through March of 2012 with horizontal grid spacings of 18, 50 and 100 km using the Weather Research and Forecasting model with GOCART (WRF-CHEM). The results are compared to the ground measurements of P M 10 in Dakar, Senegal and three AMMA transect sites in Senegal, Mali, and Niger. In general, the 50 km simulations produced the smallest biases in P M 10 concentrations, while the largest negative biases are found for 100 km grid spacing during the period especially for Bodele sources. Further, the largest negative biases are found for the eastern Sahel region in Niger at Banizoumbou. We suggest that forecasts or long-term simulations of dust should occur at grid spacing less than 100 km.

Il termine idrocefalo indica una situazione di eccesso di liquido cerebrospinale (LCS) nei ventricoli cerebrali, diversa rispetto alla dilatazione passiva dei ventricoli. Dietro alla sua apparente semplicita, questo termine racchiude delle entita molto eterogenee. Idrocefali molto diversi possono, cosi, essere distinti in base all’eta dei pazienti (idrocefalo del bambino/idrocefalo dell’adulto), al loro meccanismo (difetto di assorbimento, disturbi della circolazione del LCS o, piu raramente, produzione in eccesso), all’esistenza o meno di un ostacolo al flusso del LCS (idrocefalo comunicante o non comunicante) e, infine, in base alle loro modalita di installazione (idrocefalo acuto/idrocefalo cronico). Il nostro obiettivo, qui, e di descrivere le diverse forme cliniche di idrocefalo nei bambini e negli adulti e la loro fisiopatologia. Definiremo, poi, gli esami complementari a nostra disposizione: imaging, biomarcatori, ma anche puntura lombare ed esplorazione idrodinamica del LCS. Vedremo che l’idrocefalo a pressione normale, o idrocefalo cronico degli adulti, e un’entita molto particolare, che solleva problemi specifici di diagnosi e di decisione terapeutica. Infine, descriveremo i trattamenti, soprattutto chirurgici, a nostra disposizione, le loro indicazioni e i loro risultati, sottolineando la necessita di mantenere a lungo termine il follow-up clinico dei pazienti operati.

A B S T R A C T African farmers are increasingly adopting sustainable agricultural practices including use of native shrub intercropping approaches. In one village of Senegal (near Thies) it was reported that farmers planted mango (Mangifera indica) seedlings within the canopies of a native shrub (Piliostigma reticulatum). Anecdotal information and qualitative observations suggested that the presence of P. reticulatum promoted soil quality and a competitive advantage for establishing mango plantations. We hypothesized that soil chemical and microbial properties of mango rhizosphere soil growing in the presence of P. reticulatum would be significantly improved over soils associated with mango growing outside the influence of P. reticulatum. The results showed that mango-shrub interplanting significantly lowered pH, and increased arbuscular mycorrhizal fungi (AMF) colonization of mango roots, enzyme activities, and microbial biomass compared to mango alone. Phylogenetic analyses by PCR-denaturing gradient gel electrophoresis (DGGE) showed that community structures of fungi, bacteria, and bacterial genes responsible for denitrification (nirK) of the soil from the rooting zone of the mango-shrub intercropping system were distinct from all other soil outside the influence of P. reticulatum. It is concluded that P. reticulatum enhances soil biological functioning and that there is a synergistic effect of intercropping mango with the native shrub, P. reticulatum, in soil quality with a more diverse community, greater AMF infection rates, and greater potential to perform decomposition and mineralize nutrients.

In this paper we prove the existence of insensitizing controls, having one vanishing component, for the local L 2 -norm of the solutions of the Navier–Stokes system. This problem can be recast as a null controllability problem for a nonlinear cascade system. We first prove a controllability result, with controls having one vanishing component, for a linear problem. Then, by means of an inverse mapping theorem, we deduce the controllability for the cascade system.

Apport du decapsuleur de poignet dans le traitement des raideurs severes en flexion du poignet. Les sequelles de traumatismes du membre superieur sont frequentes dans nos regions a cause d’un deficit de structures de soins et d’une certaine negligence de la population. Nous avons mene une etude prospective de janvier a aout 2018 chez 9 hommes et 8 femmes âges en moyenne de 22 ans. Les etiologies etaient representees par un syndrome de Volkmann (n = 5), une retraction des flechisseurs (n = 5), une fracture de l’extremite distale du radius (n = 3), une bride cicatricielle (n = 2). Vu en moyenne a 7 mois du traumatisme [3–18 mois], le flessum du poignet etait de 45° en moyenne [35–90°]. L’orthese etait realisee en materiau thermo-formable de 2 ou 2,4 mm. Elle etait placee en position dorso-palmaire, prenant la paume de la main et le dos de l’avant-bras. Le poignet etait maintenu au maximum de l’amplitude permise par le flessum retranche de 5 degres. L’orthese etait remoulee au fur a mesure de la recuperation des amplitudes. Elle etait portee de facon quasi permanente pour les flessums a arret dur, et pour 6 heures par jour chez les autres. Les patients etaient revus 2 fois par semaine. Apres une recuperation jugee stable, le port devenait nocturne pour une duree de 2 mois. Les patients ont ete suivis durant une periode 4 mois en moyenne [2,5–6 mois]. Nous avons realise en moyenne 15 remodelages [8 et 20]. Nous avons obtenu un gain d’extension de 34° en moyenne [10–60°]. De facon analytique 25° pour les syndromes de volkmann, 30° pour les fractures de l’extremite distale du radius et 35° pour les cas de retraction des flechisseurs, 55° pour les cicatrices retractiles. A ce jour, les resultats sont stables apres le port nocturne de l’orthese. Orthese de choix dans les cas de flessum de poignet raide a tres raide, leger et peu encombrant, le « decapsuleur » de poignet semble apporter une solution simple, pratique et efficace dans la recuperation des flessums invalidants de poignet.

Apport de la cravate belge adaptee a l’utilisation de ressources limitees. La cravate belge est une orthese qui aide a gagner ou a recuperer des amplitudes articulaires en pronation et en supination. Le Senegal, dans le domaine de la reeducation du membre superieur, cherche a diversifier et a ameliorer ses moyens de prestations. Nous avons mene une etude prospective de mai a septembre 2018 chez 10 patients (4 de sexe masculin et 6 de sexe feminin) âges en moyenne de 18,8 ans [3–45 ans]. Les etiologies etaient representees par des sequelles traumatiques de fracture de l’avant-bras (n = 9), du coude (n = 1). La pronation etait en moyenne de 57,17° (40–70°] et la supination 25,74° [−40° a 50°] avec un degre de mobilite de 82,85 [20–130°]. Les patients ont ete vus a 3,3 mois [3 et 6 mois] de leur traumatisme. Nous avons realise un dispositif compose d’une orthese du poignet sur laquelle est accrochee par l’intermediaire d’un velcro une echarpe de jersey (la cravate) dont le sens de l’enroulement permet d’induire une pronation ou une supination selon la demande. Le port du dispositif est diurne a une frequence de 2 heures avec des intervalles de repos de 3 heures. Les patients sont revus 3 fois par semaine. Les patients ont ete suivis durant une periode 3 mois en moyenne [2–4 mois]. Nous avons obtenu les amplitudes suivantes, pronation 78,33° en moyenne [60–90°], supination 48,33° [−40° a 90°], avec un degre de mobilite de 126,66 [40–180°]. Cet appareil a donne des resultats qui satisfaisants chez des patients qui souffraient de deficit en pronation, en supination ou les deux en meme temps. Une regression de la douleur aussi est notee lors de la mobilisation articulaire de ces derniers.

Background In sub-Saharan Africa, problems of access to relevant and high-quality facility-based statistics hinder the assessment of safe motherhood programs. The objective of this study was to assess the quality of data collected in referral hospitals in Mali and Senegal after the routine information system (RIS) was strengthened. Methods This was a multicenter observational study conducted during the pre-intervention period of a randomized controlled trial (trial QUARITE). The RIS was strengthened based on technical, organizational and behavioral factors. We included all women who gave birth in the 46 referral hospitals from October 1, 2007 to October 30, 2008. The completeness, completion and accuracy rates were monitored every 3 months in each hospital. The cost of investment needed to strengthen the existing RIS was also determined. Results The mean completeness rate ranged from 94 to 97% depending on the study period. The completion and accuracy rates increased during the study period from 72% and 79% to 87% and 93%, respectively (significant differences). The average investment per hospital was less than 1% of state subsidies for public hospitals. Conclusion Strengthening the existing information system has set up an economically and technologically appropriate system for monitoring maternal and perinatal health in Senegal and Mali. We encourage policy makers and researchers from countries with limited resources to invest in RIS to improve and monitor the performance of health systems.

Background Maternal mortality is still too high in sub-Saharan Africa, particularly in referral hospitals. Solutions exist but their implementation is a great issue in the poor-resources settings. The objective of this study is to assess the effect of the organization of obstetric care services on maternal mortality in referral hospitals in Mali. Methods This is a multicentric observational survey in 22 referral hospitals. Clinical data on 42,929 women delivering in the 22 hospitals within the 2007 to 2008 study period were collected. Organization evaluation was based on explicit criteria defined by an expert committee. The effect of the organization on in-hospital mortality adjusted on individual and institutional characteristics was estimated using multi-level logistic regression models. Results The results show that an optimal organization of obstetric care services based on eight explicit criteria reduced in-hospital maternal mortality by 41% compared with women delivering in a referral hospital with sub-optimal organization defined as non-compliance with at least one of the eight criteria (ORa = 0.59; 95% CI = 0.34–0.92). Furthermore, local policies that improved financial access to emergency obstetric care had a significant impact on maternal outcome. Conclusion Criteria for optimal organization include the management of labor and childbirth by qualified personnel, an organization of human resources that allows timely management of obstetric emergencies, routine use of partography for all patients and availability of guidelines for the management of complications. These conditions could be easily implemented in the context of Mali to reduce in-hospital maternal mortality.

Las fistulas vesicovaginales (FVV) son una complicacion infrecuente de una histerectomia o de una cesarea y su tratamiento esta descrito en varios tratados de ginecologia o urologia. En los paises en vias de desarrollo, las FVV son secundarias a una lesion isquemica en una distocia fetopelvica, a causa de un largo periodo entre el inicio del trabajo de parto y la realizacion de una cesarea. Esto provoca consecuencias desastrosas en terminos de lesiones fisicas y morales. En este articulo se describen la etiopatogenia y el tratamiento quirurgico de las fistulas obstetricas (FO), que representan la mayoria de las FVV. Asimismo, se exponen las demas formas de FVV. La exploracion vaginal es fundamental y debe permitir establecer una clasificacion predictiva de la FVV respecto a la dificultad que encontrara el cirujano y al pronostico. La via de acceso baja esta indicada en el tratamiento de la mayoria de las FO y permite tecnicas de cirugia reconstructiva, como los colgajos de interposicion y de sosten. Es necesario emplear tecnicas apropiadas para anticipar el riesgo de recidiva y de una posible incontinencia de esfuerzo residual, sobre todo si el cuello vesical y la uretra estan implicados en el proceso de formacion de la FVV. La suspension del cuello vesical de la fascia endopelvica o arco tendinoso es la clave de la continencia tras la reparacion de las grandes destrucciones tisulares. Las FO con laceracion del cuello uterino (fistulas yuxtacervicales) se tratan mejor por via mixta para completar la separacion vesicouterina y garantizar la hermeticidad de la reparacion. Las fistulas altas tras histerectomia son de facil acceso con laparoscopia convencional o robotizada. Las complicaciones de esta cirugia son el fracaso de la reparacion y la incontinencia de esfuerzo residual, que resultan frustrantes tanto para la paciente, que tiene grandes expectativas en estas situaciones, como para el cirujano. Las reintervenciones en caso de recidiva se efectuan en un tejido aun mas cicatrizal que en las FVV denominadas «de primera mano». En este articulo se describe tambien un modelo de tratamiento global de la FO en condiciones rurales (el modelo de Tanguieta en Benin).

Resume Une etude retrospective a ete conduite de janvier 2000 a decembre 2003 pour evaluer la resistance de Mycobacterium tuberculosis aux antituberculeux et ses consequences sur le resultat du traitement. Deux cent deux dossiers-patients sont etudies (âge moyen : 36 ans ; sex-ratio : 1,7). La tuberculose est pulmonaire (85,7 %) ou extrapulmonaire (14,3 %). Le statut VIH est negatif (71,3 %), positif (10,8 %) ou inconnu (17,9 %). Le taux global de guerison est de 60,7 % (61,4 % chez les VIH− ; 46,1 % chez les VIH+), celui des echecs therapeutiques est de 2,7 % (1,1 % chez les VIH− ; 15,4 % chez les VIH+), celui des deces dus a la tuberculose est de 6,3 % (2,3 % chez les VIH− ; 23,1 % chez les VIH+), et le taux des patients perdus de vue est de 30,3 % (35,2 % chez les VIH− ; 14,2 % chez les VIH+). Une hepatotoxicite survenant au cours du traitement est observee dans 14,3 % des cas (guerison : 56,2 % ; echec : 6,2 % ; perdus de vue : 18,8 %). Quatre-vingt-quatre pourcent des patients n’ont jamais recu de traitement antituberculeux (groupe A) versus 15,8 % de patients ayant deja recu un ou plusieurs medicaments antituberculeux (groupe B). Les taux de resistance a l’isoniazide sont de 6,4 % (A) et de 12,5 % (B), a la rifampicine de 1,7 % (A) et 12,5 % (B), a l’ethambutol de 0,5 % (A) et 0 % (B), a la streptomycine de 24,1 % (A) et de 46,8 % (B). Le pourcentage de souches multiresistantes est de 1 % chez les patients non traites auparavant et de 11 % chez ceux ayant deja recu un traitement antituberculeux. Lorsque les patients sont porteurs d’une souche sensible au traitement administre, le taux de guerison est de 64,2 % versus 46,7 % chez les patients dont la souche est resistante a au moins un des traitements administres.

Si definisce «idrocefalo» un disturbo dell’idrodinamica del liquor la cui risultante e una dilatazione attiva delle cavita ventricolari e, spesso, degli spazi subaracnoidei. Entro tale termine, apparentemente banale, vengono compresi e confusi concetti fisiopatologici ancora oggetto di discussione e, in particolare, i concetti di «idrocefalo a pressione normale» e di «idrocefalo cronico dell’adulto». Si tratta di una patologia frequente in ambito neurologico e neurochirurgico; si manifesta a qualsiasi eta e le cause che lo sostengono sono varie, anche se le cause prevalenti sono quelle neoplastiche, infettive e malformative. La diagnosi e prima di tutto clinica. La valutazione diagnostica si basa sulle tecniche di imaging, ma anche sulla valutazione idrodinamica. Il trattamento dell’idrocefalo e esclusivamente chirurgico. Le diverse tecniche, largamente praticate, hanno dimostrato la loro efficacia nella gestione dell’idrocefalo.

Resumen Los quistes epidermoides son lesiones congenitas benignas, de lento crecimiento, que representan el 1% de todos los tumores intracraneales. En un 25% tienen una localizacion intradiploica y excepcionalmente infratentorial. Presentamos un caso clinico poco frecuente de un quiste epidermoide intradiploico gigante infratentorial. El paciente consulto por una diplopia y un sindrome cerebeloso. La tomografia computarizada y la resonancia magnetica mostraron una lesion gigante litica extradural de la fosa posterior de 5,2 cm × 3,8 cm, con realce periferico con el contraste. Utilizamos un abordaje suboccipital retrosigmoideo para realizar una exeresis completa tumoral y una reseccion incompleta capsular, debido a la adherencia de esta al seno lateral. La evolucion posoperatoria fue favorable. Realizamos una revision bibliografica de la literatura y discusion de nuestro caso.

Resume A travers un cas clinique decrit au Senegal, les auteurs abordent les problemes que pose le comportement d'un psychopathe dans un cadre socioculturel africain. Ils montrent les difficultes d'appartenance et l'angoisse d'exclusion du groupe social. Les familles, pour ⪡reparer⪢ la deviance, font souvent recours aux soins traditionnels dans une grande discretion, avant de s'adresser a l'hopital. Elles parviennent neanmoins, avec l'aide d'une equipe specialisee, a trouver des ressources intrinseques leur permettant de gerer au mieux cette difficulte. La societe, s'auto-protegeant, privilegie le groupe social sur l'individu.

This paper describes the study of low pressure chemical vapour deposition of silicon from disilane (Si2H6) in a horizontal hot-wall furnace. Special attention is devoted to the kinetic phenomena, and in particular to the thickness distribution across the wafers and across the load. Examples are given, which show that acceptable uniformities can be obtained. A simulation of these processes is also presented. For that, a two-dimensional model taking into account, in every region of the furnace, mass transport, fluid dynamics and chemical reactions in the gas phase and on the solid surfaces has been used. In particular, it shows that the much lower deposition rate obtained when silane (Si2H4) is the source gas is due to a much lower silylene (SiH2) contribution. The SiH content measurements by Fourier transform IR spectroscopy show that, for similar deposition conditions (temperature and pressure), the SiH content of “SiH4 films” is much higher than that of “Si2H6 films”, thus confirming than the ultimate silicon precursor is different for the two gases. The study of the crystallization properties of the amorphous films made on SiO2 shows that they are dependent not only on the SiH content, but also on the deposition growth rate and pressure.

Introduction et objectifs L’evaluation des pratiques professionnelles (EPP) en milieu medical est une obligation ayant pour finalite, l’amelioration de la qualite des soins. Sa mise en pratique implique l’analyse des donnees cliniques et le suivi des resultats. Depuis plusieurs annees, le service de neurochirurgie du centre hospitalier de Limoges participe a la surveillance des infections du site operatoire (ISO). Ce travail s’est naturellement integre dans le cadre de l’EPP mise en place dans ce service depuis 2006. Materiels et methodes L’analyse semestrielle des dossiers des patients presentant des ISO a servi de base a cette EPP. La methodologie de la surveillance des ISO est largement inspiree du modele national propose par le R.A.I.S.I.N. (Reseau d’Alerte, d’Investigation et de Surveillance des Infections Nosocomiales). Resultats De mai 2002 a juin 2008 nous avons suivi une cohorte de 6 514 patients representant un total de 7 569 interventions dont plus de la moitie etaient rachidiennes ou intra rachidiennes. Le sexratio etait de 1,8 : 2 856 femmes (âge moyen de 55,7 ans) et 3 658 hommes (âge moyen de 53,4 ans). Le taux global des ISO durant cette periode est passe de 3,9 % a 1,8 %. Il est passe en dessous de 2 % a partir de 2006, avec une baisse plus nette pour les interventions crânio-encephaliques. Conclusion Meme si la baisse du taux des ISO n’est pas uniquement le fait de la mise en place de l’EPP, la discussion des dossiers au cours de ces reunions multidisciplinaires permet l’amelioration des pratiques et contribue a la formation continue des participants. Ces resultats nous confortent dans la poursuite et l’amelioration de ce travail.