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Ce mémoire interroge les médias et parcours sonores en tant que médiation du territoire. Cette recherche s‘élabore, dans un premier temps, à partir d‘une réflexion théorique sur l‘écoute et la marche puis, dans un deuxième temps, à partir de l‘analyse de dispositifs médiatiques numériques sonores permettant l‘émergence de représentations territoriales. Les parcours sonores proposent une mise en récit du territoire grâce à une lecture culturelle, patrimoniale et poétique ; ils créent ainsi du ré-enchantement et offrent une expérience touristique augmentée. Cette propension des parcours sonores à jouer sur les imaginaires permet des développements intéressants dans le cadre des nouveaux enjeux des territoires. Aussi proposons-nous, in fine, une application de cette recherche, à la croisée de la culture et du tourisme, sous la forme d‘un projet culturel et citoyen de valorisation d‘un territoire métropolitain par les médias sonores.

International audience; Objective: To review studies conducted on the costs of dementia in low- and middle-income countries (LMICs), describe their methodology and summarize costsestimates.Methods: We conducted a systematic review, searching in bibliographic databases in health, economics and social sciences, and main grey literature resources. Publications were evaluated by two independent investigators, conflict discussed, and the final decision taken by a third investigator. We included all studies presenting costs of any aspect of dementia care.Results: Overall, 6,843 title and abstract, then 74 full texts articles evaluated. Finally, 15 single studies were included. Those were from only 9 out of the 156 LMICs: China (6); Brazil (2); and one from Argentina, Colombia, Iran, Peru, Romania, Thailand and Turkey. No study was from Africa. Studies focused mainly on Alzheimer’s disease. Studies investigated all three categories of cost-of-illness i.e., medical, social and informal care costs, but items, data collection and definitions in each category were highly variable. Dementia costs tend to increase with the severity of the disease with greater medical costs in the mild stage and higher social and informal care costs in the moderate and severe stages. Costs estimates varied widely: from $327.4 to $1,266.3 for annual medical costs, from $112.4 to $5,575.0 for social costs; and costs from $324.0 to $10,031.1 for informal care. Overall, dementia care cost up to $19,101 per year for a single patient, usually at the charge of families.Conclusion: Limited studies have been conducted on dementia costs in LMICs, with none so far in Africa. It appears urgent to provide accurate evidence of the disease burden in the region to guide public health policies.

International audience; BackgroundCaregivers encounter difficulties differentiating fear and pain experienced by children and tend to interpret what children may feel, often resulting in inadequate pain management. While many pain self-assessment scales are available, there is no validated self-assessment fear scale for children.Methods: The aim of this prospective study was to validate, in children aged 4 to 12 years, the psychometric properties of our scale. In a first part, in a school setting, five exercises were given to 484 children in order to validate the expression of fear, grade the intensity of the faces, the ability to discriminate the faces and the equality of the intervals. The scale's reproducibility was studied by assessing the children's fear in everyday situations at two different time points.In a second part, in a hospital setting, the aim was to test the scale's feasibility. Sixty children admitted to one emergency care department self-assessed their fear with the Scary Scale.FindingsThe expression of fear was validated by 57.64% (p < 0.0001) of the children in comparison with three other emotions (pain, surprise, sadness).The 7–9 year-olds validated the other properties (gradation, discrimination, equality, reproducibility). The 4–6 year-olds failed to validate the gradation exercise, but succeeded with the others.In the hospital, 95% of children self-assessed their fear using the scale.DiscussionOur self-assessment fear scale was validated in children aged 7–12 years specifically and was readily feasible in the hospital. We recommend its use in that age group in every care situation triggering fear.Trial registration: clinicaltrials.gov Identifier: NCT02675504.

International audience; Importance: Several studies conducted worldwide (mostly in Western countries) highlighted the negative effects of problematic internet use, particularly among adolescents aged 12 to 17, including depression, impulsivity, aggression, and social fear and avoidance. In Lebanon, literature on the prevalence and impact of problematic internet use among adolescents is limited.Objective: This study aim was to study the association between problematic internet use and depression, impulsivity, anger, aggression and social phobia among Lebanese adolescents.Methods: A cross-sectional study was performed on 1103 young adolescents (14-17 years), recruited from October 2017 till April 2018. The Internet Addiction Test (IAT) was used to evaluate the level of problematic internet use. Data were analyzed using the MANCOVA analysis. The main independent variable of interest was the IAT, while the dependent variables included the psychological scales.Results: The multivariate analysis taking the psychological scales as the dependent variables and the problematic internet use (IAT score) as an independent variable, showed that problematic internet use was associated with higher depression, impulsivity, aggression, anger, hostility and social anxiety.Interpretation: Problematic internet use has become an important health issue that should not be overlooked, particularly because of the increased use of the internet by adolescents. Educational programs on early exposure to the internet should be developed.

International audience; The invertebrate Galleria mellonella has increasingly and widely been used in the last few years to study complex host-microbe interactions. Aspergillus fumigatus is one of the most pathogenic fungi causing life-threatening diseases in humans and animals. Galleria mellonella larvae has been proven as a reliable model for the analysis of pathogenesis and virulence factors, enable to screen a large number of A. fumigatus strains. This review describes the different uses of G. mellonella to study A. fumigatus and provides a comparison of the different protocols to trace fungal pathogenicity. The review also includes a summary of the diverse mutants tested in G. mellonella, and their respective contribution to A. fumigatus virulence. Previous investigations indicated that G. mellonella should be considered as an interesting tool even though a mammalian model may be required to complete and verify initial data.

International audience; Objective: Epilepsy is a major neurological disorder that requires long-term medical treatment. Once epilepsy is diagnosed, people with epilepsy face many difficulties in accessing treatment (treatment gap). Our objective was to assess the situation regarding the availability, price, affordability, and quality of anti-seizure medication (ASM), which are major determinants of access to treatment. Method: A cross-sectional study was performed in provincial/district hospitals and private pharmacies in urban and rural areas in Cambodia. Data on ASM availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest-paid government employee must work to purchase a monthly treatment. Samples of ASM were collected, and the quality of ASM was assessed through Medicine Quality Assessment Reporting Guidelines. Results: Out of 138 outlets visited, only 72 outlets (52.2% [95% CI 43.5-60.7]) had at least one ASM available. Phenobarbital 100 mg was the most available (35.5%), followed by carbamazepine 200 mg (21.7%), phenobarbital 50 mg (11.6%), sodium valproate 500 mg (9.4%), and phenytoin 100 mg (9.4%). In provincial/district hospitals, ASM was provided free of charge. In private pharmacies, affordability for phenobarbital 50 mg and 100 mg was the best, with 0.6 and 0.5 days, respectively, compared to phenytoin 100 mg (1.8 days), and other ASM. No counterfeit ASM was found in this study. Phenytoin sample presented the worst quality (33.0%) compared to carbamazepine (27.8%), and other ASM. Significance: A lack of access to affordable and effective ASM due to low availability and poor quality of ASM was identified. Our research highlights the need for future policy efforts to ensure the quality of ASM and improve their availability. This can be achieved by involving the calculation of their annual needs for these drugs and increasing the national production of ASM.

Introduction: 41 millions de décès sont liés aux maladies chroniques (MC), dont 31 millions surviennent annuellement dans les pays à faibles et moyens niveaux de revenus notamment en Afrique. Ces décès sont liés à la faible démographie médicale et aux difficultés d’accès aux soins. Face à ces problèmes majeurs de santé publique, le Conseil international des infirmières recommande de développer la prise en charge des MC par les infirmiers du fait de leurs compétences cliniques et expertises. Pourtant, leur rôle n’est pas clarifié, aucune revue systématique exhaustive n’existait sur le sujet. Objectifs: Fournir une description exhaustive du rôle des infirmiers, identifier les ressources, problèmes et lacunes auxquels les infirmiers sont confrontés dans la gestion des MC en Afrique. Méthodes: Une revue systématique en double aveugle a été réalisée interrogeant Medline, Web of science, Embase, CINALH, PyschInfo et Google Scholar, sans restriction de date ou de langue de publication. Une analyse de la qualité des publications a été réalisée. Résultats : 2120 articles étaient éligibles, 432 articles ont été lus en intégralité. Résultats: Les résultats préliminaires montrent que les stratégies développées et le rôle des infirmiers dans les MC se rapprochent du rôle des infirmiers en pratique avancée (IPA). En effet, des stratégies de glissement de tâches sont notamment mises en œuvre pour palier la désertification médicale faisant évoluer les rôles des infirmiers vers ceux des infirmiers en pratique avancée. Des éléments tels qu’une supervision, des formations régulières et la mise à disposition de moyens matériels sont identifiés comme des éléments clés pour réussir ces stratégies de glissement de tâche. Discussion et conclusion: Reconnaitre, structurer et réglementer l’implantation d’infirmiers aux compétences élargies telle que des IPA, notamment en Afrique, serait une solution avantageuse pour faire face aux enjeux de santé concernant la prise en charge des MC. Introduction: 41 millions de décès sont liés aux maladies chroniques (MC), dont 31 millions surviennent annuellement dans les pays à faibles et moyens niveaux de revenus notamment en Afrique. Ces décès sont liés à la faible démographie médicale et aux difficultés d’accès aux soins. Face à ces problèmes majeurs de santé publique, le Conseil international des infirmières recommande de développer la prise en charge des MC par les infirmiers du fait de leurs compétences cliniques et expertises. Pourtant, leur rôle n’est pas clarifié, aucune revue systématique exhaustive n’existait sur le sujet. Objectifs: Fournir une description exhaustive du rôle des infirmiers, identifier les ressources, problèmes et lacunes auxquels les infirmiers sont confrontés dans la gestion des MC en Afrique. Méthodes: Une revue systématique en double aveugle a été réalisée interrogeant Medline, Web of science, Embase, CINALH, PyschInfo et Google Scholar, sans restriction de date ou de langue de publication. Une analyse de la qualité des publications a été réalisée. Résultats : 2120 articles étaient éligibles, 432 articles ont été lus en intégralité. Résultats: Les résultats préliminaires montrent que les stratégies développées et le rôle des infirmiers dans les MC se rapprochent du rôle des infirmiers en pratique avancée (IPA). En effet, des stratégies de glissement de tâches sont notamment mises en œuvre pour palier la désertification médicale faisant évoluer les rôles des infirmiers vers ceux des infirmiers en pratique avancée. Des éléments tels qu’une supervision, des formations régulières et la mise à disposition de moyens matériels sont identifiés comme des éléments clés pour réussir ces stratégies de glissement de tâche. Discussion et conclusion: Reconnaitre, structurer et réglementer l’implantation d’infirmiers aux compétences élargies telle que des IPA, notamment en Afrique, serait une solution avantageuse pour faire face aux enjeux de santé concernant la prise en charge des MC.

International audience; Introduction : Les maladies chroniques (MC), tuent 31 millions de personnes chaque année dans les pays à faibles et moyens revenus (PRFI). Ces décès surviennent notamment en Afrique, en lien avec la faible démographie médicale et les difficultés d’accès aux soins. Le Conseil international des infirmières recommande de développer la prise en charge des MC par les infirmiers du fait de leurs compétences cliniques et de leur expertise déjà existante dans la prise en charge des maladies transmissibles. Implanter des Infirmiers en pratique avancée (IPA) en Afrique et notamment au Gabon permettrait comme les définitions et modèles internationaux le suggèrent d’améliorer l’accès et la qualité des soins, promouvoir une approche centrée sur les personnes, diminuer les coûts pour les usagers mais aussi de favoriser des parcours de soins innovants et un maillage territorial étendu. Afin de préparer cette implantation et d’adapter la formation aux besoins spécifiques des PRFI et du Gabon, il s’avère nécessaire d’identifier les besoins et enjeux liés à celle-ci. Méthode : étude mixte d’évaluation des besoins liés à l’implantation des IPA basée sur le modèle PEPPA développé par Bryant-Lukosius et DiCenso en 2004. Elle comprend des questionnaires et des focus group réalisés avec les différentes parties prenantes (infirmiers, enseignants, étudiants infirmiers, médecins…). Résultats : étude en cours, les résultats seront présentés lors du congrès. Discussion- conclusion : les résultats permettront d’alimenter la construction du programme de formation d’IPA qui est en cours de développement au sein de la faculté de sciences infirmières de Libreville.

Objective The GERONTACCESS trial evaluated the utility and cost-effectiveness of a gerontological telemedicine (TLM) programme for preventing unplanned hospitalisation of residents living in nursing homes (NHs) in regions lacking medical facilities and/or qualified medical providers (“medical deserts”). Design GERONTACCESS was a 12-month, multicentre, prospective cluster-randomised trial conducted in NHs. The intervention group underwent TLM assessments every 3 months. The control group received the usual care. In both groups, comprehensive on-site assessments were conducted at baseline and the final visit. Care requirements were documented throughout the study. Setting and participants NH residents aged ≥ 60 years with multiple chronic diseases. Methods The study outcomes were the proportion of patients who experienced avoidable and unplanned hospitalisation, and the incremental cost savings per quality-adjusted life years from baseline to the 12-month follow-up. Results Of the 426 randomised participants (mean ± standard deviation age, 87.2 ± 7.6 years; 311 [73.0%] women), 23.4% in the intervention group and 32.5% in the control group experienced unplanned hospitalisation (odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.43 to 0.97; p = 0.034). Each avoided hospitalisation in the intervention group saved $US 3,846. Conclusions and implications The results of GERONTACCESS revealed that our gerontological, preventative TLM program significantly reduced unplanned hospitalisations. This innovative intervention limited disease progression and promoted a healthy lifestyle among NH residents. Trial registration Clinicaltrials.gov, NCT02816177, registered June 28, 2016.

International audience

International audience; Like much of the developing world, sub-Saharan Africa (SSA) is facing a major challenge. This challenge is due to noncommunicable diseases (NCDs) whose rates are rising dramatically in SSA. Two conditions that frequently coexist head the list of NCDs as either established disease entities or risk factors for NCDs. These are hypertension and diabetes. Hypertension is the foremost cardiovascular condition. The objective of this scoping review is to examine peer-reviewed publications for the period 2009–2019 related to the detection and management of hypertension in SSA. We seek to define the issues confronted in managing hypertension in SSA, what measures have been implemented and evaluated, and what barriers and facilitators have been found. By mapping the complex, heterogeneous literature, we aim to identify the key concepts that underpin a major public health issue in SSA. The central question that this review addresses is how to control hypertension in SSA.

Background Hyperglycemia leads to serious damage to the body, especially the blood vessels and nerves. This study aimed to determine the prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019. Materials and methods This was a cross-sectional, descriptive and analytical study, nested in the Tanvè Health Study (TAHES) cohort. It covered all residents of the villages of Tanvè and Dékanmey, aged 25 years and above, and having given their written consent. Data were collected in the households during the fourth annual monitoring visit in 2019 using the WHO STEPS Wise approach. Hyperglycemia was defined as a fasting capillary blood glucose value ≥ 110 mg/dL. Data were analyzed with R Studio software version 3.5.1. Results A total of 1331 subjects were included in the study with a 60% female predominance and a sex ratio (male/female) of 0.7. The median age was 40 years (Q1 = 32 years; Q3 = 53 years) with a range of 25 and 98 years. The prevalence of hyperglycemia was 4.6%. In multivariate analysis, advanced age (AOR = 1.03; 95%CI = 1.02–1.73; p = 0.004), male sex (AOR = 2.93; 95%CI = 1.49–5.84; p = 0.023), monthly income> 105,000 FCFA (AOR = 2.63; 95%CI = 1.24–5.63; p = 0.030), abdominal obesity (AOR = 2.80; 95%CI = 1.29–6.16; p = 0.007, and obesity (AOR = 1.68; 95%CI = 0.75–3.59; p = 0.004) were statistically associated with hyperglycemia. Conclusion The prevalence of hyperglycemia is not negligible in rural areas in Benin. Our study found that older age, male gender, high income, abdominal obesity, and obesity are determining factors in its occurrence.

International audience; Objective: We aimed to assess hepatitis B vaccination coverage (vaccine coverage) among preschool children in Libreville, Gabon, and determine associated factors.Methods: A cross-sectional study was done evaluating hepatitis B vaccination records, by cluster random sampling of children aged 4 months to 5 years from 5 medical centres.Results: Of the 500 children (243 males) included, we found a hepatitis B vaccine coverage of 78.6% (95% CI 75% to 82.2%). Factors significantly associated with vaccine coverage included parental confidence in the vaccine (OR=2.2;95% CI 1.4-5.5), the number of children at home lower than the median (aOR=1.6; 95% CI ; 1.3-3.7). and working mothers/fathers.Conclusion: Hepatitis B vaccine coverage in Libreville is lower than WHO objectives. Healthcare providers have a crucial role in building up confidence among parents.

International audience; BackgroundDiabetes is a chronic disease characterized by hyperglycemia that can be responsible for blindness, heart attacks, strokes, kidney failure and amputations. In 2014, about 415 million people were estimated to live with diabetes, which represents 8•5% of global population. The prevalence of diabetes will keep rising in the years to come, particularly in low-and middle-income countries (LMICs).Methods5 databases (Medline, Google Scholar, Web of Science, Cochrane Library, and Scopus) were searched for studies about intervention programs on type 2 diabetes in LMICs from 2009 to 2019. This research was made according to PRISMA recommendations.Results74 studies were included, of which 42 had quantitative results (HbA1c level). Most of these interventions were educational programs that took place in Asia (69%) and in Upper-Middle-Income Countries (77%). A monthly decrease of glycated hemoglobin level (HbA1c) by 0•156% was found in patients who had the intervention compared to the patients of the control group.ConclusionInterventional programs on diabetes in LMICs had a positive effect on glycemic control. Further studies are necessary in order to improve knowledge on other criteria such as cost-efficiency ratio. These studies shall be less focused on Asian countries and also put forward Low-Income Countries (LICs) in order to have a global vision in LMIC

The annual meeting of the European Association of Cardiovascular Imaging, EuroEcho 2019, was held in Vienna, Austria, in December 2019. In this article, we present a summary of the ‘Highlights’ session.

Background Discovery of new Toxoplasma gondii serotyping epitopes is important due to reports showing the influence of genotype on the severity of toxoplasmosis. In Turkey, genotypes belonging to type II, type III and Africa 1 lineages were mainly detected. The present study focused on to find out epitopes with high discriminative capacity to serotype these genotypes using well characterized strains isolated from Turkey. Methods To meet this objective, GRA6 and GRA7 genes were sequenced from strains belonging to the type II, III and Africa 1 lineages, and B cell epitopes inside these sequences were predicted by Bcepred and additional docking analysis was performed with B cell receptor. Based on these analyses, 22 peptides harboring lineage specific epitopes were synthesized. Then, the serotyping potency of these peptides was tested using peptide ELISA and well categorized serum samples collected from stray cats infected with genotypes of the different lineages type II (n:9), III (n:1) and Africa 1 (n:1). As a result of peptide-ELISA, a serotyping schema was constructed with peptides that show high discriminative capacity and this assay was validated by sera collected from humans after an outbreak (n:30) and mother/newborn pair sera (n:3). Later, the validated serotyping schema was used to serotype a larger group of human (n:38) and cat (n:24) sera. Results Among 22 peptides, GRA6II/c, GRA7III/d, and GRA6 Africa 1/b epitopes have shown discriminative capacity. During the validation of peptide-ELISA, the serotype of toxoplasmosis outbreak and mother/newborn cases were detected to be serotype II. Moreover, the analyses in a larger group showed that serotype II was prevalent in humans and stray cats. Conclusions Overall, the results showed that the serotyping schema could be successfully used to serotype T. gondii infections caused by type II, III and Africa 1 genotype., Izmir Katip Celebi Scientific Research Projects Coordination Unit [2018-ONAPTIPF-0006], This study was supported by a project given by the Izmir Katip Celebi Scientific Research Projects Coordination Unit (Project number: 2018-ONAPTIPF-0006) to AAG.

Background While malaria morbidity and mortality have declined since 2000, viral central nervous system infections appear to be an important, underestimated cause of coma in malaria-endemic Eastern Africa. We aimed to describe the etiology of non-traumatic comas in young children in Benin, as well as their management and early outcomes, and to identify factors associated with death. Methods From March to November 2018, we enrolled all HIV-negative children aged between 2 and 6 years, with a Blantyre Coma Score ≤ 2, in this prospective observational study. Children were screened for malaria severity signs and assessed using a systematic diagnostic protocol, including blood cultures, malaria diagnostics, and cerebrospinal fluid analysis using multiplex PCR. To determine factors associated with death, univariate and multivariate analyses were performed. Results From 3244 admissions, 84 children were included: malaria was diagnosed in 78, eight of whom had a viral or bacterial co-infection. Six children had a non-malarial infection or no identified cause. The mortality rate was 29.8% (25/84), with 20 children dying in the first 24 h. Co-infected children appeared to have a poorer prognosis. Of the 76 children who consulted a healthcare professional before admission, only 5 were prescribed adequate antimalarial oral therapy. Predictors of early death were jaundice or increased bilirubin [odd ratio (OR)= 8.6; 95% confidential interval (CI): 2.03–36.1] and lactate > 5 mmol/L (OR = 5.1; 95% CI: 1.49–17.30). Antibiotic use before admission (OR = 0.1; 95% CI: 0.02–0.85) and vaccination against yellow fever (OR = 0.2, 95% CI: 0.05–0.79) protected against mortality. Conclusions Infections were found in all children who died, and cerebral malaria was by far the most common cause of non-traumatic coma. Missed opportunities to receive early effective antimalarial treatment were common. Other central nervous system infections must be considered in their management. Some factors that proved to be protective against early death were unexpected.

Objective: to evaluate the effect of clinical pharmacy interventions on the unplanned rehospitalisation rates of elderly people admitted following a fall to the emergency medical treatment for the elderly unit (médecine d'urgence de la personne âgée [MUPA]) in a teaching hospital.Design and measures: this was a longitudinal, comparative pilot study. Patients aged at least 75 who were admitted to the MUPA unit following a fall, who had at least two chronic diseases, and who were being treated with two or more medications were included between 1 February 2018 and 30 June 2018 and were followed for 90 days. The main outcomes were the unplanned rehospitalisation rate at Limoges Teaching Hospital within the 90 days (primary outcome), 30 days and 72 h. The estimated cost-saving was also assessed.Results: 252 patients were included. The mean age was 88.4 ± 5.8 years and the average baseline number of medications was 8.3 ± 3.4. In total, 158 pharmaceutical interventions were performed, reflecting an acceptance rate of 94.9%. We found a significant reduction in the rate of unplanned rehospitalisations at 90 days (OR = 0.45 (0.26-0.79) P = 0.005). These results were also consistent at 30 days (P = 0.035) and 72 h (P = 0.041). We found a cost-saving of €37770 related to 21 avoided rehospitalisations.Conclusions: our results strongly emphasise the positive effects of clinical pharmacy services on the prevention of unplanned rehospitalisations of elderly patients admitted following a fall.

CONTEXTELa SPPB est un test fréquemment utilisé en pratique clinique pour évaluer les performances physiques chez la personne âgée.OBJECTIFSExplorant la relation entre la SPPB et l’index de SOF dans une population d’Afrique subsaharienne, nous nous sommes intéressés à la relation qui existe entre la SPPB et l’index de SOF (Study of Osteoporotic Fractures), instrument de dépistage de la fragilité physique.METHODESLes données sont issues d’une enquête transversale réalisée au Cameroun. L’index SOF (noté de 0 à 3) était évalué par 3 critères (perte de poids involontaire, incapacité à faire cinq lever de chaise, faible niveau d'énergie) et la SPPB (noté de 0 à 12) a été évaluée par 3 sous-tests (test d'équilibre, test des levers de chaise et test de la vitesse de marche). La fragilité était définie pour un index SOF > 0 ou pour un score SPPB < 9. Le coefficient de corrélation de Pearson, le coefficient de Kappa, la courbe ROC ont permis d’étudier la relation entre ces deux tests. Une analyse en composante principale (ACP) a été réalisée pour évaluer la part de chaque sous-test de la SPPB dans la relation avec la SOF.RESULTATSSur les 403 personnes incluses (49,6% de femmes) âgées en moyenne de 67,1 ans (±6,2), 35,7 % et 47,9% étaient respectivement fragiles selon SOF et la SPPB. Le coefficient de corrélation entre la SPPB et la SOF était de -0,71 (p< 0,001) tandis que le coefficient de concordance kappa était de 0,60 [IC95% : 0,51 – 0,66], p

Introduction. Les envenimations par morsure de serpent constituent un problème de santé publique dans les pays en développement. Les complications neurovasculaires sont rares. Nous rapportons deux cas d’hémorragies cérébrales au Centre hospitalier universitaire Sourô Sanou de Bobo-Dioulasso compliquant une envenimation.Description clinique. La première patiente était âgée de 60 ans avec une gingivorragie et une altération de la conscience. La seconde, âgée de 50 ans, présentait une hémorragie digestive et une hémiplégie droite. La tomodensitométrie (TDM) cérébrale a trouvé des saignements cérébro-méningés chez nos deux patientes. Elles ont reçu de l’antivenin polyvalent Afrique de Vins Bioproducts Ltd ainsi qu’un traitement symptomatique. L’évolution a été favorable sur le plan vital mais avec des séquelles à type de tétraparésie chez la première patiente et d’hémiparésie chez la seconde. Discussion – Conclusion. Les hémorragies cérébrales sont des complications rares des envenimations par morsure de serpent. Cependant, elles sont responsables d’une morbi-mortalité élevée dans notre contexte.

Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.

CONTEXTELa sarcopénie est fréquente chez les personnes âgées. De récents travaux suggèrent que la déficience visuelle (DV) est associée aux déficiences physiques dont la sarcopénie chez les personnes âgées. Or, la sarcopénie augmente le risque de dépendance et de décès prématuré dans cette population. En Afrique subsaharienne (ASS) très peu de données existent sur ce sujet.OBJECTIFSLa présente étude avait pour objectif d’étudier la relation entre la DV et la sarcopénie chez les personnes âgées au Cameroun.METHODESIl s’agissait d’une enquête transversale réalisée à Douala en 2019 chez des personnes âgées de 55 ans et plus qui sont membres d’une mutuelle de santé. La sarcopénie a été évaluée à l'aide du test SPPB (Short Physical Performance Battery) noté de 0 à 12 et composé de trois sous-tests: le test d'équilibre, le test des levers de chaise et le test de la vitesse de marche.Le diagnostic de sarcopénie était posé pour un score au test SPPB < 9. La DV quant à elle était auto-déclarée. Des analyses de régressions logistique et linéaire ont été utilisées pour explorer la relation d’intérêt.RESULTATSAu total 403 personnes (50,4% d’hommes) âgées en moyenne de 67,1 (±6,2) ans ont été inclues dans nos analyses. Sur cet échantillon, 356 (88,3%) ont déclaré avoir une DV et la prévalence de la sarcopénie était de 47,9 % [IC95% : 43,0 - 52,7]. Après ajustement sur plusieurs facteurs dont l’âge, le sexe, l’état civil, le niveau scolaire, le statut cognitif, l’hypertension et le diabète ; la DV était significativement associée à la sarcopénie (OR : 2,66 [IC95% : 1,29 - 5,48]). Parmi les sous-tests de la SPPB, seul le lever de chaise était négativement associé à la DV (?=-0,45 [IC95% : -0,82,-0,07]).ConclusionCette première étude issue d’une population d’ASS sur la relation entre DV et la sarcopénie confirme l’influence de la DV dans l’altération du bien-être physique chez la personne âgée. Elle suggère que la DV peut être utilisée comme un indicateur précoce dans le repérage de la sarcopénie chez les personnes âgées en ASS

BackgroundsAging has been clearly associated with visual and physical performance. Alteration of visual function is associated with negative health outcome such as cognitive decline, disability, loss of mobility.ObjectivesTo determine the relationship between visual impairment (VI) and physical frailty (using the SOF index and SPPB).MethodsData from the Douala Study of Aging, an observational, cross-sectional study. Visual impairment was self-reported. Physical frailty was assessed using the SOF index and the SPPB test. Considering the SOF index, participants meeting one or more criteria (unintentional weight loss, inability to do five chair stands, low energy level) were classified as pre-frail/frail. The SPPB is consisting of three sub-tests : test of balance, chair stands test and gait speed test (range between 0 to 12). Participants with SPPB test score > 9 were classified as fit. Descriptive statistics and linear regression analyses were used to determine the relationship between VI and physical frailty.ResultsThe study sample consisted of 406 patients aged 55 years or older, among whom 49.80 % were female. The mean age of participants was 67.0 (+/- 6.4) years. A total of 359 (88.4 %) have self-reported VI. Considering both test (SOF and SPPB), the prevalence of frailty/pre-frailty was 40 %. After adjustments, the VI was significantly associated with physical frailty (OR :2.88 IC95 % 1.23 - 6.79, P

International audience; Aim: To study the knowledge, attitudes and practices regarding mental health amongst health professionals at the end of their curriculum in Burkina Faso.Design: A descriptive and cross-sectional study was adopted.Methods: A simple random sampling was used to select 420 health students in Burkina Faso. Self-administered questionnaires on sociodemographic profile, knowledge, attitudes and practices about mental health were distributed.Results: The response rate to the questionnaires was 93%. Our study sample included 391 students amongst whom 35% (138/391) were nurse students, 32% (125/391) medical students, 26% (100/391) midwife students and 7% (28/391) were pharmacy students. A quarter of our sample had completed an internship in psychiatry.Medical students’ average knowledge, attitudes and practices in mental health were significantly higher than that of other students. Medical students had more time dedicated to mental health lectures and more opportunities for a mental health internship, unlike nurse students.