Profil Evolutif et Comorbidités des Troubles Fonctionnels Intestinaux (TFI) Persistants au CHU de Conakry

Introduction : Les troubles fonctionnels digestifs (TFI) ou syndrome de l’intestin irritable représentent un véritable problème de santé publique. Si cette affection n’engage pas le pronostic vital, elle altère significativement et de façon chronique la qualité de vie des malades. L’étiologie est mal connue et de nombreux facteurs sont impliqués. Méthodes : Il s’agissait d’une étude transversale descriptive à recueil prospectif de données réalisée en consultation externe du service d’hépato-gastroentérologie de l’hôpital national Donka du CHU de Conakry allant du 1er Janvier 2019 au 31 Décembre 2020 chez les patients souffrants de TFI et répondant aux critères de Rome IV. Résultats : Trois cent quatre-vingt-dix-huit cas de SII sur 1309 patients soit une prévalence de 30,40%. On notait une prédominance féminine avec un sex ratio de 0,92. L’âge moyen de nos patients était de 49 ans avec des extrêmes de 10 et 88 ans. Les tranches d’âge de 25-34 ans et 35-44 ans étaient les plus représentées avec des fréquences respectives de 24,52% et 22,07%. Les principaux signes cliniques étaient des douleurs abdominales (92,28%), de la constipation dans 84,41%, ballonnement abdominal 28,39% et diverses manifestations extradigestives : insomnie dans 32,08%, de céphalées dans 30,55% des cas, de la fibromyalgie 22,91%. Les principaux facteurs déclenchants étaient : les facteurs psychologiques 32,08% et alimentaires (tubercules 14,13%, haricot 6,11%, le diner tardif et ou copieux 4,2% et les boissons gazeuses 3,44%). Le retentissement socioprofessionnel des TFI était dominé par l’absentéisme dans 82,78% des cas, le retard au travail dans 20%. Les comorbidités digestives les plus fréquentes étaient : le RGO, la dyspepsie, le dolichocôlon ainsi que leur association. Conclusion  Le SII est un problème de santé publique qui altère la qualité de vie des personnes atteintes. Les douleurs abdominales, la constipation et le ballonnement abdominal en constituent la triade symptomatique. Le stress est un facteur déclenchant de la symptomatologie. L’association du SII avec des comorbidités digestives et extra-digestives est fréquente. Introduction : Functional digestive disorders (TFI) or irritable bowel syndrome represent a real public health problem. Although this condition is not life-threatening, it significantly and chronically alters the quality of life of patients. The etiology is poorly understood and many factors are involved. Methods : This was a descriptive cross-sectional study with prospective data collection carried out in outpatient consultation of the hepato-gastroenterology department of the Donka national hospital of the Conakry University Hospital from January 1, 2019 to December 31, 2020 in patients suffering from TFI and meeting the Rome IV criteria. Results: Three hundred and ninety-eight cases of IBS out of 1309 patients, representing a prevalence of 30.40%. There was a female predominance with a sex ratio of 0.92. The average age of our patients was 49 years with extremes of 10 and 88 years. The age groups of 25-34 and 35-44 were the most represented with respective frequencies of 24.52% and 22.07%. The main clinical signs were abdominal pain (92.28%), constipation in 84.41%, abdominal bloating in 28.39% and various extradigestive manifestations: insomnia in 32.08%, headache in 30.55% of cases. cases, fibromyalgia 22.91%. The main triggering factors were: psychological factors 32.08% and dietary factors (tubers 14.13%, beans 6.11%, late or heavy dinner 4.2% and soft drinks 3.44%). The socio-professional impact of TFIs was dominated by absenteeism in 82.78% of cases, lateness for work in 20%. The most common digestive comorbidities were: GERD, dyspepsia, dolichocolon and their combination. Conclusion IBS is a public health problem that impairs the quality of life of those affected. Abdominal pain, constipation and abdominal bloating constitute the symptomatic triad. Stress is a triggering factor for the symptoms. The association of IBS with digestive and extra-digestive comorbidities is common

Profil Evolutif et Comorbidités des Troubles Fonctionnels Intestinaux (TFI) Persistants au CHU de Conakry

Introduction : Les troubles fonctionnels digestifs (TFI) ou syndrome de l’intestin irritable représentent un véritable problème de santé publique. Si cette affection n’engage pas le pronostic vital, elle altère significativement et de façon chronique la qualité de vie des malades. L’étiologie est mal connue et de nombreux facteurs sont impliqués. Méthodes : Il s’agissait d’une étude transversale descriptive à recueil prospectif de données réalisée en consultation externe du service d’hépato-gastroentérologie de l’hôpital national Donka du CHU de Conakry allant du 1er Janvier 2019 au 31 Décembre 2020 chez les patients souffrants de TFI et répondant aux critères de Rome IV. Résultats : Trois cent quatre-vingt-dix-huit cas de SII sur 1309 patients soit une prévalence de 30,40%. On notait une prédominance féminine avec un sex ratio de 0,92. L’âge moyen de nos patients était de 49 ans avec des extrêmes de 10 et 88 ans. Les tranches d’âge de 25-34 ans et 35-44 ans étaient les plus représentées avec des fréquences respectives de 24,52% et 22,07%. Les principaux signes cliniques étaient des douleurs abdominales (92,28%), de la constipation dans 84,41%, ballonnement abdominal 28,39% et diverses manifestations extradigestives : insomnie dans 32,08%, de céphalées dans 30,55% des cas, de la fibromyalgie 22,91%. Les principaux facteurs déclenchants étaient : les facteurs psychologiques 32,08% et alimentaires (tubercules 14,13%, haricot 6,11%, le diner tardif et ou copieux 4,2% et les boissons gazeuses 3,44%). Le retentissement socioprofessionnel des TFI était dominé par l’absentéisme dans 82,78% des cas, le retard au travail dans 20%. Les comorbidités digestives les plus fréquentes étaient : le RGO, la dyspepsie, le dolichocôlon ainsi que leur association. Conclusion  Le SII est un problème de santé publique qui altère la qualité de vie des personnes atteintes. Les douleurs abdominales, la constipation et le ballonnement abdominal en constituent la triade symptomatique. Le stress est un facteur déclenchant de la symptomatologie. L’association du SII avec des comorbidités digestives et extra-digestives est fréquente. Introduction : Functional digestive disorders (TFI) or irritable bowel syndrome represent a real public health problem. Although this condition is not life-threatening, it significantly and chronically alters the quality of life of patients. The etiology is poorly understood and many factors are involved. Methods : This was a descriptive cross-sectional study with prospective data collection carried out in outpatient consultation of the hepato-gastroenterology department of the Donka national hospital of the Conakry University Hospital from January 1, 2019 to December 31, 2020 in patients suffering from TFI and meeting the Rome IV criteria. Results: Three hundred and ninety-eight cases of IBS out of 1309 patients, representing a prevalence of 30.40%. There was a female predominance with a sex ratio of 0.92. The average age of our patients was 49 years with extremes of 10 and 88 years. The age groups of 25-34 and 35-44 were the most represented with respective frequencies of 24.52% and 22.07%. The main clinical signs were abdominal pain (92.28%), constipation in 84.41%, abdominal bloating in 28.39% and various extradigestive manifestations: insomnia in 32.08%, headache in 30.55% of cases. cases, fibromyalgia 22.91%. The main triggering factors were: psychological factors 32.08% and dietary factors (tubers 14.13%, beans 6.11%, late or heavy dinner 4.2% and soft drinks 3.44%). The socio-professional impact of TFIs was dominated by absenteeism in 82.78% of cases, lateness for work in 20%. The most common digestive comorbidities were: GERD, dyspepsia, dolichocolon and their combination. Conclusion IBS is a public health problem that impairs the quality of life of those affected. Abdominal pain, constipation and abdominal bloating constitute the symptomatic triad. Stress is a triggering factor for the symptoms. The association of IBS with digestive and extra-digestive comorbidities is common

Profil Epidémiologique des Troubles Fonctionnels Intestinaux (TFI) Persistants au CHU de Conakry

Introduction : Les troubles fonctionnels Intestinaux (TFI) ou syndrome de l’intestin irritable représentent un véritable problème de santé publique. Si cette affection n’engage pas le pronostic vital, elle altère significativement et de façon chronique la qualité de vie des malades. L’étiologie est mal connue et de nombreux facteurs sont impliqués. Méthodes : Il s’agissait d’une étude transversale descriptive à recueil prospectif de données réalisée en consultation externe du service d’hépato-gastroentérologie de l’hôpital national Donka du CHU de Conakry pour une durée de 2 ans. Résultats : Trois cent quatre-vingt-dix-huit cas de TFI sur 1309 patients avaient été recensé soit une prévalence de 30,40%. On notait une prédominance féminine avec un sex ratio de 0,92. L’âge moyen de nos patients était de 49 ans avec des extrêmes de 10 et 88 ans. Les tranches d’âge de 25-34 ans et 35-44 ans étaient les plus représentées avec des fréquences respectives de 24,52% et 22,07%. Les principaux signes cliniques étaient des douleurs abdominales (92,28%), de la constipation dans 84,41%, ballonnement abdominal 28,39% et diverses manifestations extradigestives : insomnie dans 32,08%, de céphalées dans 30,55% des cas, de la fibromyalgie 22,91%. Les principaux facteurs déclenchants étaient : les facteurs psychologiques 32,08% et alimentaires (tubercules 14,13%, haricot 6,11%, le dîner tardif et ou copieux 4,2% et les boissons gazeuses 3,44%). Le retentissement socioprofessionnel des TFI était dominé par l’absentéisme dans 82,78% des cas, le retard au travail dans 20%. Les comorbidités digestives les plus fréquentes étaient : le reflux gastro œsophagien (RGO), la dyspepsie, le dolichocôlon ainsi que leur association. Les examens  complémentaires morphologiques étaient représentés par (une échographie abdominale et pelvienne a été réalisée chez 50,11% de nos patients et elle objectivait une aérocolie dans 45% des cas ;un scanner abdominopelvien  fait dans 3,56% des cas, examen sans anomalie ; une ano-recto-sigmoïdoscopie dans 17,80% des cas et une ; coloscopie dans 4,98% des cas, toutes normales ; une fibroscopie oeso-gastroduodénale chez  25% de nos patients et était normale ;un lavement baryté double contraste 11,20%. Conclusion : Le TFI est un problème de santé publique qui altère la qualité de vie des personnes atteintes. Les douleurs abdominales, la constipation et le ballonnement abdominal en constituent la triade symptomatique. Le stress est un facteur déclenchant de la symptomatologie. L’association du SII avec des comorbidités digestives et extra-digestives est fréquente. Les examens complémentaires morphologique ont des conséquences financières difficiles dans la majorité des cas chez nos patients.   Introduction : Functional digestive disorders (TFI) or irritable bowel syndrome represent a real public health problem. Although this condition is not life-threatening, it significantly and chronically alters the quality of life of patients. The etiology is poorly understood and many factors are involved. Methods : This was a descriptive cross-sectional study with prospective data collection carried out in the outpatient clinic of the hepato-gastroenterology department of the Donka National Hospital of the Conakry University Hospital for a period of 2 years. Results : Three hundred and ninety-eight cases of TFI out of 1309 patients were identified, representing a prevalence of 30.40%. There was a female predominance with a sex ratio of 0.92. The average age of our patients was 49 years with extremes of 10 and 88 years. The age groups of 25-34 and 35-44 were the most represented with respective frequencies of 24.52% and 22.07%. The main clinical signs were abdominal pain (92.28%), constipation in 84.41%, abdominal bloating in 28.39%, and various extra digestive manifestations: insomnia in 32.08%, headache in 30.55% of cases. cases, fibromyalgia 22.91%. The main triggering factors were: psychological factors 32.08% and dietary factors (tubers 14.13%, beans 6.11%, late or heavy dinner 4.2% and soft drinks 3.44%). The socio-professional impact of TFIs was dominated by absenteeism in 82.78% of cases, and lateness for work in 20%. The most frequent digestive comorbidities were: gastroesophageal reflux disease (GERD), dyspepsia, dolichocolon and their association. Additional morphological examinations were represented by (an abdominal and pelvic ultrasound was carried out in 50.11% of our patients and it revealed aerocolia in 45% of cases; an abdominopelvic scan was performed in 3.56% of cases, examination without abnormality; an anorecto-sigmoidoscopy in 17.80% of cases and the colonoscopy in 4.98% of cases, all normal; an esophagogastroduodenal fibroscopy in 25% of our patients and was normal; a double contrast barium enema 11 .20%. Conclusion: TFI is a public health problem that impairs the quality of life of those affected. Abdominal pain, constipation, and abdominal bloating constitute the symptomatic triad. Stress is a triggering factor for the symptoms. The association of IBS with digestive and extra-digestive comorbidities is common. Additional morphological examinations have difficult financial consequences in the majority of cases among our patients

Profil des Maladies Rhumatismales du Sujet Age en Guinee

Aim: To determine the respective share of the different rheumatic conditions observed in the elderly person who was hospitalized in the rheumatology department of the CHU Ignace Deen. Patients and methods: This was a cross-sectional study of patients aged 60 or aver seen in consultation or hospitalized in the rheumatology department during the period from October 2016 to April 2018. Rheumatic diseases have been diagnosed according to the criteria. Results: 1502 patients were examined during the study period; there were 521 patients aged ago 60 years and overs; of whom 351(23, 36%) had at least one rheumatologic diagnostic. There was a predominance of women (216; 61, 54%). The average age of diagnostic were 67, 63 ± 6, 71 years (extremes de 60 to 93 years). The average delay in diagnostic was 3, 91 ± 4, 21 years (extremes de 1 month to 51 years). High blood pressure (142; 40,45%) and diabetes (40; 11,39%) were the main comorbidities. Degenerative pathology (295; 84, 04%) was the most common with low pain (112; 31,90%) as a leader. There were 45 cases (12,82%) of chronic inflammatory rheumatism; rheumatoid arthritis (19; 5,41%) was the most common, followed by spondyloartritis (8; 2,27%). Osteopathies (36 ; 10,25%); periarticular and syndromes (20 ; 5,69%), microcristal arthropathies (24 ; 6,83%), infectious pathology (8; 2,27%) and tumoral pathology (9; 2,56%)were the other diseases found. Conclusion: Degenerative pathology and chronic inflammatory rheumatism were the most common. The expected balance of sex ratio in RA at this age was rather in favor of female predominance. Prospective cohort studies would provide a better understanding of this question.Objectifs: Déterminer le profil épidémiologique des maladies rhumatismales des personnes âgées au service de rhumatologie de l’hôpital National Ignace Deen de Conakry. Patients et méthodes: Il s'est agi d'une étude transversale portant sur des patients âgés d'au moins 60 ans vus en consultation ou hospitalisés dans le service de rhumatologie pendant la période d’octobre 2016 à Avril 2018. Les maladies rhumatismales ont été diagnostiquées selon les critères en vigueur. Résultats: Des 1502 malades examinés, 351 (23,36%) étaient âgés d’au moins 60 ans. Il y avait une prédominance féminine (216 ; 61,54%). L’âge moyen était de 67,63 ± 6,71 ans (extrêmes de 60 et 93 ans). Le délai moyen de diagnostic était de 3,91 ± 4,21 ans (extrêmes de 1 mois et 51 ans). L’hypertension artérielle (142; 40,45%) et le diabète (40; 11,39%) étaient les principales comorbidités. La pathologie dégénérative (295 ; 84,04 %) était la plus fréquente avec une prédominance de la lombalgie commune (112; 31,90 %). Il y avait 45 cas (12,82%) de rhumatisme inflammatoire chronique : la polyarthrite rhumatoïde (PR) (19 cas ; 5,41%) était le plus fréquent, suivie des spondyloarthrites (8; 2,27%). Les ostéopathies (36 ; 10,25%), la pathologie péri-articulaire et les syndromes canalaires (20; 5,69%), les arthropathies microcristallines (24 ; 6,83%), la pathologie infectieuse (8 ; 2,27 %) et la pathologie tumorale (9 ; 2,56 %) étaient les autres maladies retrouvées. Conclusion: La pathologie dégénérative et les rhumatismes inflammatoires chroniques étaient les plus fréquents. L’équilibre attendu du sex-ratio dans la PR à cet âge était plutôt en faveur d’une prédominance féminine. Des études de cohortes prospectives permettraient de mieux comprendre cette question

Recours a la Médecine Traditionnelle chez les Rhumatisants en Guinée

Aim: To determine the frequency and pattern of use of traditional medicine in rheumatic patients at Ignace Deen National Hospital in Conakry, Guinea. Patients and methods: Descriptive cross-sectional study in the rheumatology department of HNID between January and March 2018 Results: Of the 108 patients interviewed, 40 had used traditional medicine (37.03%). There was a female predominance (21 women, 52.5%) with a sex ratio of 0.90. The mean age of the patients was 44.75 ± 17.24 years. Rheumatoid arthritis and knee osteoarthritis were the main rheumatic diseases observed with 41.86% and 16.27% respectively. The diagnostic delay was 6.54 ± 1.25 years. The nature of the treatment used was dominated by taking a decoction (57.50%) and the reason for using traditional treatment was to relieve pain (85%). The oral route was the main mode of use of traditional treatment (67.5%). More than half of the patients (52.50%) were not satisfied with the outcome of traditional treatment received and did not know the name of the treatment used in their vernacular language. In 47.50% of cases they thought that traditional treatment had adverse effects and had possible interactions with modern drug therapy. Conclusion: More than a third of rheumatology consulting patients use traditional medicine even though they believe it has side effects. This phenomenon leads to a delay in consultation with the rheumatologist, hence the need for better communication between the different actors.Objectif : Déterminer la fréquence et le profil de l’utilisation de la médecine traditionnelle chez les patients souffrant de rhumatisme à l'hôpital national Ignace Deen de Conakry (Guinée). Patients et méthodes : Etude transversale de type descriptif dans le service de rhumatologie de l'HNID entre janvier et mars 2018. Résultats : Sur 108 patients interrogés, 40 avaient eu recours à la médecine traditionnelle soit 37,03 %. On notait une prédominance féminine (21 femmes ; 52,5 %) avec un sexe ratio de 0,90 H/F. L’âge moyen des patients était de 44,75 ± 17,24 ans. La polyarthrite rhumatoïde et la gonarthrose étaient les principales affections rhumatologiques observées avec respectivement 41,86% et 16,27%. Le délai diagnostique était de 6,54 ±1,25 ans. La nature du traitement utilisé était dominée par la prise de décoction (57,50%) et le motif d’utilisation du traitement était de soulager la douleur (85%). La voie orale était le principal mode d’utilisation (67,5%). Plus de la moitié des patients (52,50%) n’étaient pas satisfaits du résultat du traitement traditionnel reçu et ne connaissaient pas le nom du traitement utilisé dans leur langue vernaculaire. Ils pensaient dans 47,50% des cas que le traitement traditionnel entrainait des effets indésirables et avait de possibles interactions avec le traitement médicamenteux moderne. Conclusion : Plus du tiers des patients consultant en rhumatologie ont recours à la médecine traditionnelle même s’ils croient qu’elle a des effets indésirables. Ce phénomène entraîne un retard à la consultation chez le rhumatologue, d’où la nécessité d’une meilleure communication entre les différents acteurs

Framing the future of the COVID-19 response operations in 2022 in the WHO African region

With the evolving epidemiological parameters of COVID-19 in Africa, the response actions and lessons learnt during the pandemic's past two years, SARS-COV 2 will certainly continue to circulate in African countries in 2022 and beyond. As countries in the African continent need to be more prepared and plan to 'live with the virus' for the upcoming two years and after and at the same time mitigate risks by protecting the future most vulnerable and those responsible for maintaining essential services, WHO AFRO is anticipating four interim scenarios of the evolution of the pandemic in 2022 and beyond in the region. In preparation for the rollout of response actions given the predicted scenarios, WHO AFRO has identified ten strategic orientations and areas of focus for supporting member states and partners in responding to the COVID-19 pandemic in Africa in 2022 and beyond. WHO analysed trends of the transmissions since the first case in the African continent and reviewed lessons learnt over the past months. Establishing a core and agile team solely dedicated to the COVID-19 response at the WHO AFRO, the emergency hubs, and WCOs will improve the effectiveness of the response and address identified challenges. The team will collaborate with the various clusters of the regional office, and other units and subunits in the WCOs supported with good epidemics intelligence. COVID-19 pandemic has afflicted global humanity at unprecedented levels. Two years later and while starting the third year of the COVID-19 response, we now need to change and adapt our strategies, tools and approaches in responding timely and effectively to the pandemic in Africa and save more lives

Quantifying the value of viral genomics when inferring who infected whom in the 2014–16 Ebola virus outbreak in Guinea

Transmission trees can be established through detailed contact histories, statistical or phylogenetic inference, or a combination of methods. Each approach has its limitations, and the extent to which they succeed in revealing a 'true' transmission history remains unclear. In this study, we compared the transmission trees obtained through contact tracing investigations and various inference methods to identify the contribution and value of each approach. We studied eighty-six sequenced cases reported in Guinea between March and November 2015. Contact tracing investigations classified these cases into eight independent transmission chains. We inferred the transmission history from the genetic sequences of the cases (phylogenetic approach), their onset date (epidemiological approach), and a combination of both (combined approach). The inferred transmission trees were then compared to those from the contact tracing investigations. Inference methods using individual data sources (i.e. the phylogenetic analysis and the epidemiological approach) were insufficiently informative to accurately reconstruct the transmission trees and the direction of transmission. The combined approach was able to identify a reduced pool of infectors for each case and highlight likely connections among chains classified as independent by the contact tracing investigations. Overall, the transmissions identified by the contact tracing investigations agreed with the evolutionary history of the viral genomes, even though some cases appeared to be misclassified. Therefore, collecting genetic sequences during outbreak is key to supplement the information contained in contact tracing investigations. Although none of the methods we used could identify one unique infector per case, the combined approach highlighted the added value of mixing epidemiological and genetic information to reconstruct who infected whom

Determinants of Transmission Risk During the Late Stage of the West African Ebola Epidemic.

Understanding risk factors for Ebola transmission is key for effective prediction and design of interventions. We used data on 860 cases in 129 chains of transmission from the latter half of the 2013-2016 Ebola epidemic in Guinea. Using negative binomial regression, we determined characteristics associated with the number of secondary cases resulting from each infected individual. We found that attending an Ebola treatment unit was associated with a 38% decrease in secondary cases (incidence rate ratio (IRR) = 0.62, 95% confidence interval (CI): 0.38, 0.99) among individuals that did not survive. Unsafe burial was associated with a higher number of secondary cases (IRR = 1.82, 95% CI: 1.10, 3.02). The average number of secondary cases was higher for the first generation of a transmission chain (mean = 1.77) compared with subsequent generations (mean = 0.70). Children were least likely to transmit (IRR = 0.35, 95% CI: 0.21, 0.57) compared with adults, whereas older adults were associated with higher numbers of secondary cases. Men were less likely to transmit than women (IRR = 0.71, 95% CI: 0.55, 0.93). This detailed surveillance data set provided an invaluable insight into transmission routes and risks. Our analysis highlights the key role that age, receiving treatment, and safe burial played in the spread of EVD

Effective Project Management of a Pan-African Cancer Research Network : Men of African Descent and Carcinoma of the Prostate (MADCaP)

CITATION: Odiaka, E. 2018. Effective Project Management of a Pan-African Cancer Research Network : Men of African Descent and Carcinoma of the Prostate (MADCaP). Journal of Global Oncology, 4:1-12, doi:10.1200/JGO.18.00062.The original publication is available at https://ascopubs.orgPurpose Health research in low- and middle-income countries can generate novel scientific knowledge and improve clinical care, fostering population health improvements to prevent premature death. Project management is a critical part of the success of this research, applying knowledge, skills, tools, and techniques to accomplish required goals. Here, we describe the development and implementation of tools to support a multifaceted study of prostate cancer in Africa, focusing on building strategic and operational capacity. Methods Applying a learning organizational framework, we developed and implemented a project management toolkit (PMT) that includes a management process flowchart, a cyclical centerspecific schedule of activities, periodic reporting and communication, and center-specific monitoring and evaluation metrics. Results The PMT was successfully deployed during year one of the project with effective component implementation occurring through periodic cycles of dissemination and feedback to local center project managers. A specific evaluation was conducted 1 year after study initiation to obtain enrollment data, evaluate individual quality control management plans, and undertake risk log assessments and follow-up. Pilot data obtained identified areas in which centers required mentoring, strengthening, and capacity development. Strategies were implemented to improve project goals and operational capacity through local problem solving, conducting quality control checks and following compliancy with study aims. Moving forward, centers will perform quarterly evaluations and initiate strengthening measures as required. Conclusion The PMT has fostered the development of both strategic and operational capacity across project centers. Investment in project management resources is essential to ensuring high-quality, impactful health research in low- and middle-income countries.https://ascopubs.org/doi/abs/10.1200/JGO.18.00062Publisher's versio