Métastase orbitaire d’un ostéosarcome fémoral : à propos d’un cas: Orbital metastasis of a femoral osteosarcoma: case report

L’ostéosarcome est une tumeur maligne, les métastases peuvent être multiples et la localisation orbitaire est rare. Nous rapportons le cas d’un garçon de 9 ans qui présentait à l’examen physique une masse orbitaire, frontale et du genou gauche associés à un amaigrissement général. Les examens d’imagerie médicale à savoir la tomodensitométrie, la scintigraphie osseuse et l’imagerie par résonnance magnétique avaient mis en évidence plusieurs masses de localisation multiple notamment orbitaire. L’examen de la pièce opératoire avait mis en évidence un ostéosarcome. La prise en charge était pluridisciplinaire. L’évolution sous chimiothérapie a été défavorable. Osteosarcoma is a malignant tumor in which metastases may be multiple and orbital localization rare. We report the case of a 9-yearold boy who presented on physical examination an orbital, frontal and left knee mass associated with a general weight loss. Medical imaging examinations, namely computed tomography, bone scintigraphy and magnetic resonance imaging, had revealed several masses of multiple locations including orbital. Histopathological examination of the surgical specimen revealed osteosarcoma. The management was multidisciplinary. The course with chemotherapy was unfavorable

Implementation of active management of the third period of childbirth for the prevention of immediate post-partum bleeding in four regional maternity hospitals of Conakry, Guinea

Background: The objective of this study was to determine the frequency, skills level of health care service providers; to identify complications and difficulties related to the implementation of AMTPC/GATPA.Methods: It was about prospective study, descriptive of 6 months (1st March to 31st August 2014) carried out in the maternity hospitals of Faranah, Kindia, Mamou and Nzérékoré. It concerned the parturient women who had recently given birth and the personnel that carried out AMTPC/GATPA in these hospitals.Results: During the study period of 1,254 out of 1,305 births had benefited of AMTPC/GATPA, a frequency of 96.1%. The midwives were the most represented personnel in the implementation of GATPA (44.1%). In 46.4% of the cases, the health care service providers acquired this competence from the initial training. The release was obtained in the first trial in 64.9% cases. The duration of implementation of GATPA was less than 5 minutes in 72.6% cases. The different stages were respected in 91.5% cases. Complications were dominated by retention of placental fragments (10.2%). Lack of oxytocin was the main difficulty (36.6%).Conclusions: The sustainability of this achievement would depend on the systematic and correct implementation of AMTPC/GATPA at all childbirth attendants and the effective management of oxytocin

Obstetrical complications among adolescent girls at the maternity ward of Ignace Deen National Hospital

Background: The objective of this study was to highlight obstetrical complications that occurred among adolescent girls who delivered at the ward and to identify factors associated with the occurrence of such complications.Methods: This was a prospective study of descriptive and analytical type extending over a period of one year from September 1, 2016 to August 31, 2017 carried out at the maternity ward of Ignace Deen National Hospital at Conakry Teaching Hospital (CHU). It covered a continuous series of 1034 deliveries among adolescent girls.Results: The frequency of childbirth among adolescent girls was 16.7%. The main complications identified were dystocia, severe preeclampsia, eclampsia, retroplacental hematoma, placenta previa, uterine rupture, severe anemia, postpartum hemorrhage and puerperal endometritis. These complications occurred among adolescent girls aged 18 to 19, christian, skin and pelvic bones secondary school or university students. Factors associated with such complications were the marital status (p=0.010), the gestational age (p=0.012), the number of prenatal consultations (p=0.001), the place of prenatal consultation (p=0.001), the reason for admission (p=0.000) and the mode of admission (p=0.000).Conclusions: Childbirth among adolescent girls is frequent in this context; complications are numerous but they are preventable in the vast majority of cases

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

Consequences of female genital mutilation on maternal and perinatal health outcomes in the European context. The case of France.

Les mutilations génitales féminines (MGF) sont un ensemble de pratiques corporelles répandues dans plusieurs régions du monde et affectant des millions de filles et de femmes. Malgré les campagnes de prévention, les MGF persistent dans les régions où elles sont traditionnellement pratiquées ainsi que dans certaines régions d'immigration tels qu'en Europe, et particulièrement en France. L'existence de séquelles systématiques des MGF, telles que les complications obstétricales, a fait l'objet de nombreux débats au cours des dernières décennies. Face aux évolutions spatio-temporelles des MGF, la production de connaissances biomédicales sur leurs conséquences lors de la grossesse et à l’accouchement est au cœur de notre réflexion qui se décline en trois axes. Axe 1 : Trois revues de la littérature suggèrent que les risques obstétricaux liés aux MGF sont principalement attribués à la cicatrisation résultant de la procédure. Toutefois, la robustesse méthodologique de ces synthèses est discutable et ne permet pas de discerner l'effet lié aux MGF de celui lié au contexte d’accouchement. Nous avons actualisé ces connaissances en Europe et en Afrique par une revue systématique de la littérature et une méta-analyse à l'échelle de 111 558 femmes, en tenant compte du contexte d’accouchement. Notre étude suggère l’existence de risques de complications maternelles (hémorragies) ainsi qu’une fréquence accrue d’interventions obstétricales (épisiotomie, césarienne) chez les femmes concernées. Cependant, ces risques varient selon la méthodologie des études, le pays d’accouchement (pays à haut revenus versus pays à faible revenus) et les caractéristiques individuelles des femmes (parité). Nos résultats contribuent à l’élaboration d’un cadre référentiel en soulignant l’importance de la prise en compte du contexte d’accouchement. Axe 2 : En France, l’enquête Excision et Handicap (ExH) menée auprès de 2882 femmes montre que certains risques de santé sont plus importants chez les femmes ayant subi une MGF, mais l’estimation des risques obstétricaux n’avait pas été approfondie. A partir du cadre référentiel proposé dans la méta- analyse, nous avons étudié les risques de complications maternelles et périnatales associées aux MGF, en tenant compte des caractéristiques sociodémographiques des femmes, de leur histoire génésique et de leurs conditions d’accouchement. Nos résultats montrent un risque accru de déchirures périnéales chez les femmes accouchant avec une forme de MGF, y compris en France, suggérant l’insuffisance d’interventions obstétricales visant à prévenir ces complications. Notre étude confirme aussi l’importance de tenir compte de facteurs de risques liés au contexte d’accouchement. Axe 3 : L’Organisation Mondiale de la Santé classe les MGF en quatre catégories selon l’étendue anatomique des dommages causés. Bien que cette classification présente plusieurs utilités dans l’évaluation du risque de survenue de complications obstétricales liées aux MGF, elle présente aussi des limites. A partir des données de l’enquête ExH, nous avons exploré ces limites en étudiant l’effet de la typologie anatomique des MGF et celui du vécu des séquelles psychologiques et physiques liées aux MGF sur la survenue de complications maternelles et périnatales. Nos analyses restreintes aux types I et II majoritairement représentés, n'ont pas montré de différences significatives entre ces deux formes. Cependant, elles indiquent une association entre l'expérience des MGF et la survenue d'épisiotomie et d'hémorragie du post-partum. Le risque d’épisiotomie était particulièrement accru lorsque les femmes cumulaient des problèmes de santé liés aux MGF et des souvenirs traumatisants ou douloureux. Des recherches supplémentaires sont nécessaires pour explorer les avantages d’interventions obstétricales telles que l’épisiotomie qui n'est pas sans risques propres en termes de lésions engendrées pouvant s'étendre sur la période post-partum.Female genital mutilations (FGM) represent widespread bodily practices affecting millions of girls and women in various regions of the world. Despite prevention campaigns, FGM persists in regions where it is traditionally practiced, as well as in immigration regions such as Europe, and particularly in France. The health sequalae of FGM, such as obstetric complications, have been a subject of extensive debate in recent decades. Considering the spatial- temporal changes in FGM practices, an re- examination of the biomedical knowledge of the consequences of FGM during pregnancy and childbirth is at the core of our research, divided into three main axes. Axis 1: Three literature reviews suggest that obstetric risks associated with FGM are primarily attributed to the scarring resulting from the procedure. However, the methodological robustness of these studies is debatable and does not allow a distinction between the effect of FGM itself and the childbirth context. We updated these previous reviews across Europe and Africa through a systematic literature review and meta-analysis among 111,558 women, taking into account childbirth context. Our study reveals the existence of maternal complication risks (hemorrhage) and elevated obstetric interventions (episiotomy, cesarean section) among affected women. However, these risks varied depending on the study methodology, the place of delivery (high income countries versus low income countries) and women’s characteristics (parity). Our findings contribute to the development of a framework which highlights the importance of considering childbirth context. Axis 2: In France, the Excision and Handicap (ExH) survey involving 2,882 women, reported elevated health risks associated with FGM, but the estimation of obstetric risks has not been thoroughly investigated. Therefore, using the proposed framework explored in Axis 1, we evaluated the maternal and perinatal risks associated with FGM, while accounting for women’s sociodemographic characteristics, their reproductive history and childbirth context.. Our results indicate an increased risk of perineal tears associated with FGM, even among women delivering in France, suggesting the inadequacy of obstetric interventions aimed at preventing these complications. Our study also confirmed the importance of adjusting for risk factors related to the childbirth context. Axis 3: The World Health Organization classifies FGM into four categories based on the anatomical extent of the damage caused. While this classification has several utilities in evaluating the risk of obstetric complications related to FGM, it also has limitations. Using ExH survey data, we explored these limitations by studying the effect of the anatomical typology of FGM and the experience of psychological and physical sequelae related to FGM on the occurrence of maternal and perinatal complications. Our analyses, focusing predominantly on types I and II, showed no significant differences between these two forms. However, they indicate an association between the experience of FGM and the occurrence of episiotomy and postpartum hemorrhage. The risk of episiotomy was particularly increased when women experienced health issues related to FGM alongside traumatic or painful memories. Further research is required to explore the benefits of obstetric interventions, such as episiotomy, which also carries inherent risks in terms of resulting lesions that may extend into the postpartum period

La lutte contre les mutilations sexuelles féminines en France

Longtemps essentialisées dans des représentations stéréotypées dans les espaces publics, les femmes issues de l’immigration paraissaient invisibles dans la mobilisation contre les mutilations sexuelles féminines en France. Pourtant, depuis des décennies, elles multiplient des actions de prévention au sein d’associations qui prennent en compte la spécificité de l’expérience migratoire dans la promotion des droits et de la santé des femmes et des filles. Leurs actions tentent ainsi de s’adapter au profil de chaque survivante de MSF afin de proposer un accompagnement spécifique