Les progrès du 5e objectif du millénaire pour le développement, globalement et les exemples d’application au Maghreb : quoi de neuf ?

The first part of this article examines the global progress towards target A of the fifth Millennium Development Goal (MDG5). The target is to reduce by three quarters the maternal mortality ratio between 1990 and 2015. This implies that most maternal deaths could be avoided. Recent sources are examined and the MMEIG data set is used for the comparison as being the one in use by the United Nations. Giving birth remains a risk process, particularly in Souhern Asia and sub-Saharan. In the second part data from Algeria, Lybia, Mauritania, Morocco and Tunisia, the five countries composing the Maghreb are examined. Four of these countries are in good progress and possibly on track. In Morocco a full process has been developed including emproved governance, accessibility and quality. This has included a full procedure of confidential enquiry into maternal health, including the five recommended steps of the process: enhanced identification, documentation, determination of causes, assessment of substandard care and recommendations based on the results of the four first steps. Maternal haemorrhage is the leading cause of death in that region.     

Plasmodium falciparum causing hemophagocytic syndrome after allogeneic blood stem cell transplantation

We describe a case of Plasmodium falciparum infection in a 25-year-old male patient with a myelodysplastic syndrome, who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) in September 2003. Conditioning regimen consisted of total body irradiation (10 Gy) and cyclophosphamide 60 mg/kg for 2 days. A dose of 4 x 10(6) CD34+ cells/kg was transfused. Engraftment was well documented on day 17 post-transplantation. Spiking fevers occurred on days 19 and 21, associated with a pancytopenia, hepatosplenomegaly and neurological signs. P. falciparum parasites were found on the peripheral blood smear (parasitemia = 23%). Marrow aspiration showed P. falciparum parasites and proliferation of mature histiocytes with hemophagocytosis. Quinine 10 mg/kg i.v. three times a day for 10 consecutive days was given. The fever subsided within 3 days, and pancytopenia vanished in 14 days. Parasitemia cleared in 6 days. The patient left the unit on day 46 with no further complications. The screening of donors showed that infection was acquired from two blood units (from a single donor) given 5 days before transplantation. We report the first case of profound hemophagocytosis in immunosuppressed patient with malaria of high parasitemia after a bone marrow transplant.     

Allogenic bone marrow transplantation complications. Part II

Bone marrow transplantation increase the chances of cure of many hematology and also neoplasms cancers. The procedure is however a cause of expected mortality and morbidity. The complications are represented by mucocutaneous, toxicity graft versus host disease, veno-occlusive disease and most importantly injections consequences all this complications needs to be prevented and treated considering the risk associated to the moderling immunosuppression.     

Bioclinical correlations in bony metastases. Results of a prospective study. 60 cases

Our objective is to compare clinical and biological presentation of patients with bone metastatic disease. PATIENTS AND METHODS: We collected prospectively 60 patients (adults and children) with proven bone metastasis. Tumors are mainly breast cancer (25/60) or nasopharyngeal carcinoma (8/60). All 8 children presented all with abdominal neuroblastoma. Bone lesions are lytic in 85% of cases. ALP and LDH seem to be sensitive markers for bone mestatasis with 75% and 80% pathologic rates. The highest rates have been observed in patients with multiple bones lesions (> 8) and painful metastases (more than 7 in the VAS). The median survival was 8 months (3 to 54). CONCLUSION: Even conventional, some biochemical markers as ALP and LDH remain useful in the diagnosis and prognosis in patients with proven bone metastasis.