theses.fr - Philippe Cabre , Epid&miologie, ph¬ype et traitement des affections inflammatoires d&my&linisantes primitives du syst&me nerveux central aux Antilles fran&aises.
Uniquement les thèses soutenues
Uniquement les thèses soutenues accessibles en ligne
Epidémiologie, phénotype et traitement des affections inflammatoires démyélinisantes primitives du système nerveux central aux Antilles fran?aises.
Thèse de doctorat en Recherche clinique, innovation technologie santé publique
Sous la direction de
Soutenue le 04-06-2012
, dans le cadre de
Le président du jury était
Le jury était composé de
mots clés
Les pathologies inflammatoires démyélinisantes primitives du système nerveux central (SNC) sont dominées par deux entités : la sclérose en plaques (SEP) et la neuromyélite optique (NMO). Ces deux pathologies se différencient par : 1. leur phénotype, la NMO se caractérisant par une myélite extensive dans le plan transversal et longitudinal et peu de lésions encé 2. leur sévérité, le pronostic de la NMO étant moins bon que celui de la SEP ; 3. leur mécanisme immunologique, puisque l’immunité humorale domine nettement dans la NMO, cette pathologie répondant peu ou pas aux traitementshabituellement prescrits dans la SEP. Un anticorps sérique (IgG-NMO) a été retrouvé chez les patients atteints de NMO avec une sensibilité de 50-70% et une spécificité de 90-100%. Cet anticorps a pour cible le principal canal hydrique du SNC, l’aquaporine-4 (AQP4), qui se situe principalement sur les pieds astrocytaires jalonnant la barrière hémato-encéphalique. La SEP est relativement familière des neurologues car décrite sur le plan épidémiologique et dans son histoire naturelle depuis plus d’un siècle à travers de larges séries réalisées parfois en population générale. Son approche thérapeutique progresse suite à des essais contr?lés qui s’accumulent depuis maintenant près de 20 ans. Toutefois, la majorité des travaux ont été effectués chez les populations Caucasiennes en raison de sa plus grande fréquence dans ces populations. A l’inverse, la NMO garde encore un relatif mystère à cause de sa relative rareté, l’établissement très récent de critères diagnostiques et une physiopathologie très récemment éclaircie par la découverte de l’IgG-NMO qui a indiscutablement suscité un regain d’intérêt de cette affection. Ainsi, son incidence est quasiment inconnue de même que sa susceptibilité génétique. La progression du handicap de la NMO qu’il soit visuel ou moteur à l’évidence sévère, ne repose toujours pas sur des chiffres précis, la description des lésions neuroradiologiques reste encore très embryonnaire. Enfin, même s’il existe un consensus pour traiter énergiquement les poussées de NMO et les espacer, il n’existe quasiment aucune étude prospective.
Introduction: Aim of the study is to describe épidemiology, phenotype and treatment of demyelinating inflammatory diseases of the central nervous system (CNS) namely multiple sclerosis (MS) and neuromyelitis optica (NMO) in French West Indies.Epidemiology: MS emerged in the French West Indian (FWI) population with an incidence of 1.27/100 000 (CI 95%: 1.16-1.38) for the period
while incidence of NMO remained stable at 0.19/100,000 (CI 95%: 0.15-0.23). Both migration in Metropolitean France (MF) and decrease of sun exposure were risk factors for MS acquisition in FWI. Phenotype and treatment of NMO: NMO is a very rapidly disabling disease with median times to reach DSS 3, 6 and 8 of one year, 8 years and 22 years respectively. However, treatment by plasma exchanges were shown to reduce sequellae of NMO mitoxantrone and rituximab reduced significantly annualized relapse rate (ARR) from 1.7 to 0.29 (p&10-4) and from 1,34 to 0,56 (p=0.0005) respectively, improving dramatically natural course of NMO.Phenotype and treatment of MS: Absence of Migration in MF in MS patients was found to be the strongest independent predictive factor of disability progression to DSS 6 (hazard ratio, 2.59; p=0.0002); beside short time to DSS3 (p=0.005), later age at onset (p=0.005), and multi-symptomatic onset (p=0.03). Treatment of MS by interferon beta-1 had a moderate impact in MS while natalizimab proved to be highly effective by reducing drastically ARR and inflammatory parameters on magnetic resonance imaging. Conclusion: Spectrum of demyelinating inflammatory disorders of CNS has reversed in French West Indies with overrepresentation of MS. Agressive therapy is needed to improve prognosis of NMO. Rapidly increasing of its incidence makes MS a new public health problem in French West Indies.
Il est disponible au sein de la bibliothèque de l'établissement de soutenance.
Consulter en bibliothèque
La version de soutenance existeInternationalization Of Operations And Competitive Advantage By Commercial Banks In Kenya
JavaScript is disabled for your browser. Some features of this site may not work without it.
dc.contributor.authorAlokpo, Joy
dc.date.accessionedT10:19:48Z
dc.date.availableT10:19:48Z
dc.date.issued2016
dc.identifier.urihttp://hdl.handle.net/
dc.description.abstractThere has been an increase in the number of companies that have been operating outside their home countries. This has allowed them to gain attributes that banks in home countries only cannot acquire, giving most of them a certain competitive advantage. Kenyan banks following that trend have extended their operations to other countries in East Africa and this study determines whether that internationalization positively impacts their competitive advantage. The study which was a cross-sectional descriptive survey was done using 5 banks, namely, Equity, Kenya Commercial Bank ltd, Investment and Mortgage Bank ltd, the Cooperative Bank of Kenya ltd and the National Industrial Credit Bank ltd. This study found that KCB has internationalized more its operations with presence in 6 countries, having over 10 foreign branches, 10%-15% of foreign profit. It is followed by Equity with presence in 5 host countries, over 10 foreign branches and 10-15% of foreign profit. NIC is in 3 host countries, has 7 foreign branches and under 5% foreign profit. Lastly there was Cooperative bank which is in 2 host countries, has 4 foreign branches and under 5% of foreign profit. Using the Likert scale to analyze the data, it was found that the banks that have internationalized their operations the most, KCB and Equity Bank, have gained the most competitive advantage and the bank that have internationalized less like the Cooperative Bank of Kenya get the least competitive advantage from their internationalization. This was reflected in the other banks results as the more there was internationalization, the more there was competitive advantage. This implies a positive relationship between the extent of internationalization and the level of competitive advantage. A correlation analysis between the rank of banks according to their extent of internationalization and the rank of the banks according to the percentage of important advantages gained reveals a strong correlation. This means that the level of internationalization is important in gaining a better competitive advantage. It was also found that Cost leadership was the least advantage gained through internationalization while differentiation was the main. Internationalization is advantageous if the banks desire to gain competitive advantage through differentiation.en_US
dc.language.isoenen_US
dc.publisheruniversity of Nairobien_US
dc.rightsAttribution-NonCommercial-NoDerivs 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/us/*
dc.subjectCompetitive Advantage By Commercial Banks In Kenyaen_US
dc.titleInternationalization Of Operations And Competitive Advantage By Commercial Banks In Kenyaen_US
dc.typeThesisen_US
Files in this item
license_rdf
application/rdf+xml
Description:
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivs 3.0 United States
copyright&&&&
Search Repository
This Collection
copyright&&&&