Bone marrow aplasia is a rare and serious hematologic disorder. Although benign, it is a hematologic disorder whose prognosis can be poor and whose spontaneous development can be fatal. Treatment is long, difficult and costly. In developing countries, the mortality rate is high due to the difficulties of therapeutic management, both supportive and specific. We conducted a retrospective study of 92 cases of AM identified in the Pediatric Hematology and Oncology Department of the 20 Août University Hospital in Casablanca over a 10-year period (January 2010-January 2020). In this work, we present an overview of the situation and highlight the difficulties encountered in the management of AM in the Pediatric Hematology and Oncology Department of the University Hospital of Casablanca. In our study, the mean age was 19 years, ranging from 3 months to 29 years, with a peak in the 15-20 age group. The sex ratio (M/F) was 2.06, with a male predominance of 67%. In our series, only 35% of patients had complete bone marrow failure. An anemic syndrome was present in 92% of patients, and hemorrhagic and infectious syndromes were present in 70% and 41% of patients, respectively. The median time from diagnosis to treatment was 82 days. According to the Camitta score, 31% of our patients had mild AM, 41% had severe AM, and 28% had very severe AM. After etiologic evaluation, we concluded that 90% of the patients had idiopathic bone marrow aplasia, 2% had constitutional bone marrow aplasia, and 8% of the patients were suspected to have secondary bone marrow aplasia: post-hepatitis (3 cases), toxic (2 cases), drug-induced (1 case), and aplastic PNH (1 case). Mortality in the first three months after diagnosis was 21%. Sixty-nine percent of our patients received specific treatment: 28 were treated with cyclosporin (CIS) alone as first-line therapy, 20 received a combination of antilymphocyte serum (ALS) and cyclosporin, 2 received hematopoietic stem cell transplantation (HSCT), while 3 were treated with androgens alone. The overall response rate was 30% with CIS, 42% with ALS+CIS and 100% with HSCT. In our study, the overall death rate was 44%, while the one-year survival rate was 40%. It is important to note that septic shock was the leading cause of death (53% of deaths), followed by hemorrhagic shock (24%). This highlights the lack of hemodynamic resuscitation and symptomatic treatment. Our multivariate study defined the following risk factors as predictive of worse survival: age greater than 16 years (RR: 3.28; CI: 1.29-8.33; P=0.012), PNN less than 200 or very severe bone marrow aplasia (RR: 3.01; 1.1-8.08; P=0.028), and failure to receive any specific treatment (RR: 4.07; 1.77-9.35; P=0.0003). The high overall mortality in our series was due to several factors: inaccessibility to effective therapies, delayed diagnosis, failure to initiate specific treatment, inadequate symptomatic treatment, and geographical and financial inaccessibility.

OBJECTIVE: In Canada, regional evaluations of screening practices for chronic kidney disease (CKD) among people with diabetes highlight areas for improvement; however, national estimates are notably absent. Estimates of CKD incidence often discount the expected decline in estimated glomerular filtration rate (eGFR) associated with age; age-adaptive thresholds may help account for this. We describe the frequency of screening and diagnosis of CKD among adults with diabetes from a nationally representative primary care cohort.
METHODS: In this retrospective cohort study, we used electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network. We followed adult patients (≥18 years of age) with diabetes without CKD at baseline for 5 years starting in 2014. We determined the frequency of urine albumin-to-creatinine ratio (uACr) and/or eGFR testing over time. We identified incident CKD diagnoses based on eGFR measurements using fixed-threshold and age-adaptive definitions and quantified the incidence proportion and rate.
RESULTS: We analyzed records from 37,604 patients with diabetes. Only 13% of patients had yearly eGFR and uACr testing for CKD, although roughly 60% had non-yearly use of both tests in 5 years. eGFR testing was performed more frequently than uACr testing (94.1% vs 76.6% having testing over follow-up). We found increased incidence proportions (14.6% vs 6.0%) and rates (33.1 vs 13.4 diagnoses per 1,000 person years) of CKD using the fixed-threshold compared with age-adaptive definition.
CONCLUSIONS: Our study presents the first national understanding of screening practices for CKD among people with diabetes in Canada. Specifically, increased use of uACr testing should be encouraged for early detection of changes in kidney function.

OBJECTIVE: Information on bladder cancer (BC) according to the risk scoring for recurrence or progression in a general population is scarce despite its clinical relevance. The objective was to describe the characteristics of incident BC in a general population, with a focus on the initial management of high-risk non-muscle invasive BC (HR-NMIBC).
METHODS: BC incident in 2011-2012 recorded in a population-based cancer registry were studied. Data was extracted from medical files. NMIBC were classified according to potential risk for recurrence/progression. Individual and tumor characteristics of incident BC were described. Incidence, initial management and survival (12/31/2021) of HR-NMIBC were assessed.
RESULTS: Among 538 BC cases, 380 were NMIBC [119 low (22.1%), 163 intermediate (30.3%), 98 high (18.2%) risk] and 147 (27.3%) were MIBC. HR-NMIBC diagnostic and therapeutic management [imaging, re-TUR, multidisciplinary team meetings (MDT) assessment, specific treatment] revealed discrepancies with guidelines recommendations. Seventy-two out of 98 cases were assessed in an MDT with a median time from diagnosis of 18days [first quartile: 12-third quartile: 32]. Globally, treatment agreed with MDT decisions. Intravesical instillation was the most common treatment (n=56) but 27 HR-NMIBC did not receive specific treatment after TUR. Five and 10years overall survival was 52% [42-63] and 41% [31-51], respectively. Five years net survival was 63% [47-75].
CONCLUSIONS: Despite National cancer plans aiming to improve care giving and despite the severity of HR-NMIBC, guideline-recommended patterns of care were underused in this region. This may deserve attention to identify obstacles to guideline adoption to try to improve BC patient care and survival.
METHODS:

The CARMEN-France registry is a prospective, multicenter registry in France including adult patients with a new diagnosis of immune thrombocytopenia or of autoimmune immune hemolytic anemia (2402 patients included in December 31, 2023). The recording of clinical, biological and treatment data allows detailed epidemiological and pharmacoepidemiological real-world studies. This review summarizes the CARMEN-France registry protocol, gives examples of studies conducted in the registry, and indicates future directions such as inclusion of patient reported outcomes, linkage with the French national health insurance database and linkage with other registries in Europe.

OBJECTIVE: This article aims to describe the causes of ophthalmological disqualification from the military services detected during specialist consultations conducted at Army Training Hospitals.
METHODS: This observational, cross-sectional, multicenter study retrospectively included individuals deemed as \"unfit for military service\" due to eye diseases identified during the specialist consultation conducted at 3 ATHs between January 2020 and December 2021. The data collected included age, medical and surgical history, reasons for ophthalmological disqualification, uncorrected distance visual acuity, best corrected distance visual acuity and cycloplegic refraction.
RESULTS: Over this period, 133 subjects (98 men and 35 women) were included. Thirty-eight candidates (28.6%) were declared unfit due to a refractive error beyond the required limits, including 30 myopic subjects in excess of -10 diopters (D) and 8 hypermetropic subjects over +8 D. Twenty-five candidates (18.8%) were unfit under the age of 21 years due to corneal refractive surgery performed before the required age. Four subjects (3.0%) were unfit due to phakic intraocular lenses. Degenerative conditions were observed in 23 subjects (17.3%), including 21 patients with severe keratoconus. Other causes of incapacity were linked to oculo-orbital trauma in 11 subjects (8.3%), moderate or severe amblyopia in 7 patients (5.3%), congenital causes in 7 subjects (5.3%), inflammatory or infectious diseases in 7 candidates (5.3%), hereditary causes in 6 subjects (4.5%) and undetermined visual dysfunctions in 4 subjects (3.0%).
CONCLUSIONS: The three main causes of ophthalmological disqualification were high ametropia, refractive surgery performed before the required age and keratoconus.

METHODS: This was a cross-sectional and descriptive study with retrospective collection conducted from 1 January 2020 to 31 December 2021 in Kisangani on HIV-infected patients. Sociodemographic, clinical and therapeutic data of patients were recorded and analyzed.
RESULTS: A total of 124 patients were identified, 71% of whom were females. The majority were aged 26-35, female and unemployed. Provider-initiated testing and counselling was the most common circumstance of discovery of HIV diagnosis (56.4%). Weight loss (48.4%), fever (40.3%) and cough (37.9%) were the main clinical manifestations found in patients. At the time of the discovery of HIV infection, the majority of patients were in category C at stage III of the disease according to the 1993 CDC classification. The most frequently encountered antecedents were sexually transmitted infections (22.6%) and tuberculosis (14.5%). HIV infection mainly affects young adults, females, married, unemployed, urban residents, secondary school and who consult health facilities at the advanced stage of the disease.
CONCLUSIONS: Public awareness (targeting especially youth) and early use of screening could improve this situation.
UNASSIGNED: Il s\'est agi d\'une étude une étude transversale et descriptive à collecte rétrospective menée du 1er janvier 2020 au 31 décembre 2021 à Kisangani portant sur les patients infectés par le VIH. Les données sociodémographiques, cliniques et thérapeutiques des patients ont été enregistrées et analysées.
UNASSIGNED: Au total 124 patients ont été identifiés, dont 71% des sujets de sexe féminin. La majorité était âgée de 26-35 ans, de sexe féminin et sans emploi. Le dépistage et le conseil initié par le prestataire était la circonstance de découverte la plus fréquente du diagnostic de l\'infection à VIH (56,4%). L\'amaigrissement (48,4%), la fièvre (40,3%) et la toux (37,9%), étaient les principales manifestations cliniques retrouvées chez les patients. Lors la découverte de l\'infection par le VIH, la majorité des patients était dans la catégorie C au stade III de la maladie selon la classification de CDC de 1993. Les antécédents les plus fréquemment rencontrés étaient les infections sexuellement transmissibles (22,6%) et la tuberculose (14,5%). L\'infection par le VIH affecte principalement des adultes jeunes, de sexe féminin, mariés, sans profession, résidents en milieu urbain, de niveau d\'étude secondaire et qui consultent les formations sanitaires au stade avancé de la maladie.
CONCLUSIONS: La sensibilisation de la population (ciblant surtout les jeunes) et le recours précoce au dépistage pourraient améliorer cette situation.

BACKGROUND: Musculoskeletal disorders are the most common occupational disease in the world. They constitute a major health problem.
METHODS: A cross-sectional study was carried out over a period of three months involving the secretaries of the Yopougon University Hospital. The data were collected using a questionnaire inspired by the National Research and Security Institute (INRS) questionnaire.
RESULTS: The study found an exclusively female population with an average age of 40.6 years ± 8.6, mostly overweight or obese (71%). Almost half of the secretaries had more than ten years of seniority in the post (44.7%) and the absence of an ergonomic chair was noted in 84% of cases. In this population of 38 secretaries, the prevalence of MSDs was 89.5% with pain as the main symptom (89.5%). The preferred locations for MSDs were the dorsolumbar spine (78.9%) and the cervical spine (57.9%). The study showed a predominance of MSDs in the following populations: overweight secretaries (63.1%); more than ten years in the post (39.6%); poor working posture (68.4%); the use of a non-ergonomic seat (81.6%).
CONCLUSIONS: Musculoskeletal disorders are common among secretaries. They are associated with many factors. It is imperative to implement preventive measures to reduce their risk of occurrence.
BACKGROUND: Les troubles musculo-squelettiques (TMS) représentent la maladie professionnelle la plus courante dans le monde. Ils constituent un problème majeur de santé.
UNASSIGNED: Une étude transversale a été conduite sur une durée de trois mois ayant concernée les secrétaires du Centre Hospitalier et Universitaire(CHU) de Yopougon. Les données ont été recueillies à l\'aide d\'un questionnaire inspiré du questionnaire de l\'Institut National de Recherche et de Sécurité (INRS).
UNASSIGNED: L\'étude a mis en évidence une population exclusivement féminine avec un âge moyen de 40.6 ans ± 8,6, en majorité en surpoids ou obèse (71%). Près de la moitié des secrétaires avaient plus de dix ans d\'ancienneté au poste (44,7 %) et l\'on a noté l\'absence de siège ergonomique dans 84 % des cas. Dans cette population de 38 secrétaires, La prévalence des TMS était de 89,5 % avec la douleur comme symptôme principal (89,5 %). Les localisations préférentielles des TMS étaient le rachis dorsolombaire (78,9 %) et le rachis cervical (57,9 %). L\'étude a montré une prédominance des TMS dans les populations suivantes : les secrétaires en surcharge pondérale (63,1 %) ; une ancienneté au poste de plus de dix ans (39,6 %) ; une mauvaise posture de travail (68,4 %) ; l\'utilisation d\'un siège non ergonomique (81,6 %).
CONCLUSIONS: Les troubles musculo-squelettiques sont fréquents chez les secrétaires. Ils sont associés à de nombreux facteurs. Il est impératif de mettre en application les mesures préventives afin de réduire leur risque de survenue.

BACKGROUND: This study aims to identify the epidemiological and occupational characteristics of patients with occupational asthma (OA) and to assess their clinical evolution and occupational outcomes.
METHODS: We carried out a descriptive epidemiological study over a period of five years (from 2012 to 2016) about the OA cases in the private sector reported in the Tunisian region of Zaghouan.
RESULTS: All in all, 165 OA cases were reported during the study period, representing an annual incidence of 733.3 cases per 1,000,000 workers in the private sector. Our study population was composed predominantly (85.5%) of women, whose mean age was 41.5±6.8years. More than three quarters of the affected persons were working in the automobile industry, and most illnesses (77%) were attributable to isocyanates. The mean time to onset of the respiratory symptoms was longer for low molecular weight agents (13.6±3.1years) compared to high molecular weight agents (12.0±3.9years) (P=0.0006). The majority of OA cases (66.7%) lost their jobs. Job loss was significantly more frequent among asthmatic women and workers with OA due to isocyanates. Among the 62 cases of OA for whom risk factors were eliminated, 45 nonetheless remained symptomatic.
CONCLUSIONS: Effective prevention strategies involving the various actors need to be implemented in work environments so as to reduce the frequency and the medico-legal repercussions of a disabling condition.

BACKGROUND: Infective endocarditis (IE) remains a serious disease with significant morbidity and mortality despite therapeutic advancements. The aim of our study was to determine the predictive factors of in-hospital mortality.
METHODS: A prospective comparative study over a period of 54 months was conducted, including all patients admitted for definite infective endocarditis, diagnosed according to the modified Duke criteria published in 2015 by the European Society of Cardiology.
RESULTS: Thirty-four patients were included. Drug addiction was the main risk factor for infective endocarditis (56%). Tricuspid valve involvement was predominant (50%). Staphylococcus aureus was the most commonly isolated pathogen (65%). In-hospital mortality rate was 47%. In multivariate analysis, predictive factors for mortality were acute heart failure (OR=7.4; p=0.026; 95% CI [1.2-44]) and cerebral embolic localization (OR=11.1; p=0.024; 95% CI [13-90]).
CONCLUSIONS: Cardiac and cerebral complications influence the prognosis of IE. Thus, close collaboration among multidisciplinary teams is necessary for improved diagnostic and therapeutic management.

OBJECTIVE: First Nations children face a greater risk of experiencing mental disorders than other children from the general population because of family and societal factors, yet there is little research examining their mental health. This study compares diagnosed mental disorders and suicidal behaviours of First Nations children living on-reserve and off-reserve to all other children living in Manitoba.
METHODS: The research team, which included First Nations and non-First Nations researchers, utilized population-based administrative data that linked de-identified individual-level records from the 2016 First Nations Research File to health and social information for children living in Manitoba. Adjusted rates and rate ratios of mental disorders and suicide behaviours were calculated using a generalized linear modelling approach to compare First Nations children (n = 40,574) and all other children (n = 197,109) and comparing First Nations children living on- and off-reserve.
RESULTS: Compared with all other children, First Nations children had a higher prevalence of schizophrenia (adjusted rate ratio (aRR): 4.42, 95% confidence interval (CI), 3.36 to 5.82), attention-deficit hyperactivity disorder (ADHD; aRR: 1.21, 95% CI, 1.09 to 1.33), substance use disorders (aRR: 5.19; 95% CI, 4.25 to 6.33), hospitalizations for suicide attempts (aRR: 6.96; 95% CI, 4.36 to 11.13) and suicide deaths (aRR: 10.63; 95% CI, 7.08 to 15.95). The prevalence of ADHD and mood/anxiety disorders was significantly higher for First Nations children living off-reserve compared with on-reserve; in contrast, hospitalization rates for suicide attempts were twice as high on-reserve than off-reserve. When the comparison cohort was restricted to only other children in low-income areas, a higher prevalence of almost all disorders remained for First Nations children.
CONCLUSIONS: Large disparities were found in mental health indicators between First Nations children and other children in Manitoba, demonstrating that considerable work is required to improve the mental well-being of First Nations children. Equitable access to culturally safe services is urgently needed and these services should be self-determined, planned, and implemented by First Nations people.