Uric acid-lowering effects of sodium-glucose cotransporter 2 inhibitors for preventing cardiovascular events and mortality: A systematic review and meta-analysis

BACKGROUND

To evaluate the effect of a 1 mg/dl reduction in uric acid (UA) on cardiovascular events and mortality in patients treated with sodium-glucose cotransporter 2 (SGLT2) inhibitors.

RESEARCH DESIGN AND METHODS

We performed a systematic review of the MEDLINE and EMBASE databases searched up to 30 June 2023 (PROSPERO, CRD42022355479) to identify large-scale SGLT2 inhibitor trials. Random-effects meta-analyses were used to pool the estimates.

RESULTS

In total, five SGLT2 inhibitor trials (31 535 patients, 54% with heart failure) were analysed. Over a median follow-up of 2.2 years, the mean reduction in UA was -0.79 mg/dl (95% confidence interval (CI), -1.03 to -0.54). Every 1 mg/dl reduction in UA was associated with a significantly lower risk of a composite of cardiovascular death and hospitalization for heart failure [hazard ratio, 0.64 (95% CI, 0.46-0.88)] and hospitalization for heart failure (0.68; 95% CI, 0.62-0.74), with a similar risk of mortality.

CONCLUSIONS

SGLT2 inhibitors reduced UA levels and cardiovascular events independently of heart failure status.

Genetic Structure and TALome Analysis Highlight a High Level of Diversity in Burkinabe Xanthomonas Oryzae pv. oryzae Populations

Bacterial Leaf Blight of rice (BLB) caused by Xanthomonas oryzae pv. oryzae (Xoo) is a major threat for food security in many rice growing countries including Burkina Faso, where the disease was first reported in the 1980's. In line with the intensification of rice cultivation in West-Africa, BLB incidence has been rising for the last 15 years. West-African strains of Xoo differ from their Asian counterparts as they (i) are genetically distant, (ii) belong to new races and, (iii) contain reduced repertoires of Transcription Activator Like (TAL) effector genes. In order to investigate the evolutionary dynamics of Xoo populations in Burkina Faso, 177 strains were collected from 2003 to 2018 in three regions where BLB is occurring. Multilocus VNTR Analysis (MLVA-14) targeting 10 polymorphic loci discriminated 24 haplotypes and showed that Xoo populations were structured according to their geographical localization and year of collection. Considering their major role in Xoo pathogenicity, we assessed the TAL effector repertoires of the 177 strains upon RFLP-based profiling. Surprisingly, an important diversity was revealed with up to eight different RFLP patterns. Finally, comparing neutral vs. tal effector gene diversity allowed to suggest scenarios underlying the evolutionary dynamics of Xoo populations in Burkina Faso, which is key to rationally guide the deployment of durably resistant rice varieties against BLB in the country.

Novel angular velocity estimation technique for plasma filaments

Magnetic field aligned filaments such as blobs and edge localized mode filaments carry significant amounts of heat and particles to the plasma facing components and they decrease their lifetime. The dynamics of these filaments determine at least a part of the heat and particle loads. These dynamics can be characterized by their translation and rotation. In this paper, we present an analysis method novel for fusion plasmas, which can estimate the angular velocity of the filaments on frame-by-frame time resolution. After pre-processing, the frames are two-dimensional (2D) Fourier-transformed, then the resulting 2D Fourier magnitude spectra are transformed to log-polar coordinates, and finally the 2D cross-correlation coefficient function (CCCF) is calculated between the consecutive frames. The displacement of the CCCF's peak along the angular coordinate estimates the angle of rotation of the most intense structure in the frame. The proposed angular velocity estimation method is tested and validated for its accuracy and robustness by applying it to rotating Gaussian-structures. The method is also applied to gas-puff imaging measurements of filaments in National Spherical Torus Experiment plasmas.

System-on-chip approach microwave imaging reflectometer on DIII-D tokamak

System-on-chip millimeter wave integrated circuit technology is used on the two-dimensional millimeter-wave imaging reflectometer (MIR) upgrade for density fluctuation imaging on the DIII-D tokamak fusion plasma. Customized CMOS chips have been successfully developed for the transmitter module and receiver module array, covering the 55-75 GHz working band. The transmitter module has the capability of simultaneously launching eight tunable probe frequencies (>0 dBm output power each). The receiver enclosure contains 12 receiver modules in two vertical lines. The quasi-optical local oscillator coupling of previous MIR systems has been replaced with an internal active frequency multiplier chain for improved local oscillator power delivery and flexible installation in a narrow space together with improved shielding against electromagnetic interference. The 55-75 GHz low noise amplifier, used between the receiver antenna and the first-stage mixer, significantly improves module sensitivity and suppresses electronics noise. The receiver module has a 20 dB gain improvement compared with the mini-lens approach and better than -75 dBm sensitivity, and its electronics noise temperature has been reduced from 55 000 K down to 11 200 K. The V-band MIR system is developed for co-located multi-field investigation of MHD-scale fluctuations in the pedestal region with W-band electron cyclotron emission imaging on DIII-D tokamak.

Diagnosing the pedestal magnetic field and magnetohydrodynamics radial structure with pedestal-scrape of layer electron cyclotron emission radiation inversion in H-mode plasma (invited)

Forward modeling is used to interpret inversion patterns of the pedestal-Scrape of Layer (SOL) Electron Cyclotron Emission (ECE) in DIII-D H-mode experiments. The modeling not only significantly improves the ECE data interpretation quality but also leads to the potential measurements of (1) the magnetic field strength |B| at the separatrix, (2) the pedestal |B| evolution during an inter-Edge Localized Mode (ELM) period, and (3) the pedestal Magnetohydrodynamics (MHD) radial structure. The ECE shine-through effect leads to three types of pedestal-SOL radiation inversions that are discussed in this paper. The first type of inversion is the non-monotonic T_e,rad profile with respect to the major radius. Using the ECE frequency at the minimum T_e,rad, the inversion can be applied to measure the magnetic field |B| at the separatrix and calibrate the mapping of the ECE channels with respect to the separatrix. The second type of inversion refers to the opposite phase between the radiation fluctuations δT_e,rad at the pedestal and SOL. This δT_e,rad phase inversion is sensitive to density and temperature fluctuations at the pedestal foot and, thus, can be used to qualitatively measure the MHD radial structure. The third type of inversion appears when the pedestal and SOL T_e,rad evolve in an opposite trend, which can be used to infer the pedestal |B| field change during an inter-ELM period. The bandwidth effect on measuring δT_e,rad due to pedestal MHD is also investigated in the radiation modeling.

A 2020 baseline assessment for the monitoring of the End TB indicator of catastrophic costs in Burkina Faso

BACKGROUND Prior assessment of the economic burden of TB showed high risk of catastrophic costs in Burkina Faso. A decade later, the National TB Programme conducted the first national patient cost survey, establishing a baseline for future policymaking.METHODS A national TB patient cost survey was conducted early 2020. Following WHO methods, a structured questionnaire was administered to 465 patients (20 clusters) to report on the direct and indirect costs of TB, household income and coping strategies adopted by the TB-affected families. The share of households facing catastrophic costs was assessed. Multiple logistic regression was performed to identify factors associated with catastrophic costs due to TB.RESULTS One in two (54.4%) TB-affected households in Burkina Faso faced catastrophic costs, resulting in major improvements over the past decade. On average, households incurred in US$962.64 per episode of care (respectively US$741.7, US$122.3 and US$98.6 for indirect, direct medical and non-medical costs), leaving substantial costs requiring mitigation strategies (39.8%). Major risk factors were associated with hospitalisation and wealth-related variables. Job loss, food insecurity and other social consequences were also experienced.CONCLUSION Despite progress, reducing the End TB indicator of catastrophic costs remains central to policymaking to ensure effective financial protection in Burkina Faso.

[Anatomical and Junctional results of total hip prosthesesat Kati University Hospital]

INTRODUCTION

Hip prosthetic surgery is a commonly performed procedure in orthopedic trauma. It has changed the prognosis of traumatic, degenerative and inflammatory hip diseases.

OBJECTIVE

The aim of this work was to evaluate the functional and anatomical results of a series of total hip replacements in our department in the short and medium term and to compare them with the literature.

PATIENTS AND METHODS

This was a retrospective descriptive and analytical study of a series of 96 total hip replacements performed at the University Hospital of Kati, from January 2019 to December 2021. Functional discomfort was assessed in all patients before and after surgery. The prostheses used were of the Aston, AK, Surgival, Evolutus and Sharma types. The anatomical results were assessed by radiological criteria and the functional results by Postel Merle d'Aubigné criteria.

RESULTS

In our study, 96 hips were operated on by total prosthesis in 91 patients, including five bilateral cases. The patients were 49 men and 42 women. The average age was 46.9 years. Coxarthrosis associated with necrosis of the femoral head was the most frequent indication for arthroplasty (n=51), followed by femoral neck fracture (n=26). The inclination of the cup was anatomical in 73.3% of cases. The mean femoral offset was 44.1 mm with extremes of 26 and 59 mm. Cup anteversion was normal in 79.4% of cases. The mean preoperative PMA score increased from 5.2 (0 and 15) to 16.9 (4 and 18) late postoperatively. Our results were satisfactory in 89% of cases.

CONCLUSION

Total hip arthroplasty allows, in the vast majority of cases, to recover indolence and perfect functionality of the hip.

Covid-19 à Mayotte : profil épidémiologique d’une année de crise

Introduction

Le 13/03/20, Mayotte déclare son premier cas de Covid-19. Le contexte socio-économique précaire rend inconcevable l’application des recommandations de prévention. Bien que la moitié de la population ait moins de 18 ans ; chez les adultes, la prévalence des facteurs de risque de formes graves fait redouter une saturation de l’unique hôpital de l’île : 38 % d’HTA, 12 % de diabète tandis que l’IMC moyen est de 26,9 kg/m².

Matériels et méthodes

Afin de comprendre la dynamique et la sévérité du Covid-19 à Mayotte, plusieurs dispositifs de surveillance ont été mis en place. Ce travail décrit l’évolution épidémique du 9/03/20 au 14/03/21 en distinguant deux vagues différentes du fait de l’émergence de variants: 2020 (9/03/20-31/12/20) versus 2021 (01/01/21-14/03/21).

Résultats

L’épidémie a débuté en mars 2020 avec un pic en mai (taux d’incidence (TI) de 133/100000 hbts). L’âge médian des cas était de 36 ans et la plupart d’entre eux était sans activité professionnelle. Le TI a diminué pour passer début juillet, sous le seuil d’alerte, suggérant une accalmie durant l’hiver austral. Cette première vague s’est avérée relativement peu sévère avec un maximum de cas hospitalisés en S21 : 51 patients hospitalisés dont 11 en réanimation. La circulation virale a continué sans impact sanitaire majeur jusqu’en décembre 2020 où l’Afrique du Sud a signalé l’émergence du variant 501Y.V2. Quelques semaines après les Comores, Mayotte enregistrait une dégradation rapide et intense de la situation: doublement du TI, triplement du taux de positivité Sars-Cov-2 (TP) entre mi-décembre et mi-janvier, y compris chez les 0-14 ans. En S6-2021, le TI a atteint un pic (894/100000 hbts) tout comme le TP culminant à 28 %. Deux enquêtes flash en février ont montré la part majoritaire d’un variant avec la mutation 501Y, représentant 87 % (150/172) des échantillons analysés par criblage. Les indicateurs hospitaliers témoignaient de la sévérité de cette nouvelle vague avec un pic atteint en S18-2021 : 148 patients hospitalisés dont 27 en réanimation, majoritairement des formes oxygéno-requérentes. En 2021, 149 cas ont été admis en réanimation contre 104 en 2020 (sex ratio H/F = 1,9). Parmi les patients présentant une forme pulmonaire, le profil des cas admis en réanimation en 2021 a changé par rapport à 2020 : ils étaient significativement plus jeunes (57 vs 62 ans) et présentaient un profil de comorbidités différent. Au total, en un an, 18899 cas ont été confirmés biologiquement et 253 patients admis en réanimation: ils correspondaient à 203 cas de formes pulmonaires, 46 cas de portage asymptomatique et 14 cas de syndrome inflammatoire multi-systématique associé à une infection par le Sars-Cov-2. En 2021, 88 patients sont décédés contre 55 en 2020; âges médians respectifs de 73 et 64 ans.

Conclusion

Le confinement de février 2021 s’est suivi d’une inversion de la tendance épidémique. Fin mars, l’épidémie se poursuit avec un TI de 63/100000 hbts. Alors que moins de 5000 personnes ont été vaccinées à deux doses, la vigilance est de mise pour ce territoire vulnérable.

Novel 2D velocity estimation method for large transient events in plasmas

Dynamics of fast transient events are challenging to be analyzed with high time resolution. Such events can occur in fusion plasmas such as the filaments during edge-localized modes (ELMs). In this paper, we present a robust method-the spatial displacement estimation-for estimating the displacements of structures with fast dynamics from high spatial and time resolution imaging diagnostics [e.g., gas-puff imaging (GPI)] with sampling time temporal resolution. First, a background suppression method is shown, which suppresses the slowly time-evolving and spatially non-uniform background in the signal. In the second step, a two-dimensional polynomial trend subtraction method is presented to tackle the remaining polynomial order trend in the signal. After performing these pre-processing steps, the spatial displacement of the propagating structure is estimated from the two-dimensional spatial cross-correlation coefficient function calculated between consecutive frames. The method is tested for its robustness and accuracy by simulated Gaussian events and spatially displaced random noise. An example application of the method is presented on propagating ELM filaments measured by the GPI system on the National Spherical Torus Experiment spherical tokamak.

Initial operation and data processing on a system for real-time evaluation of Thomson scattering signals on the Large Helical Device

A scalable system for real-time analysis of electron temperature and density based on signals from the Thomson scattering diagnostic, initially developed for and installed on the NSTX-U experiment, was recently adapted for the Large Helical Device and operated for the first time during plasma discharges. During its initial operation run, it routinely recorded and processed signals for four spatial points at the laser repetition rate of 30 Hz, well within the system's rated capability for 60 Hz. We present examples of data collected from this initial run and describe subsequent adaptations to the analysis code to improve the fidelity of the temperature calculations.

System-on-chip upgrade of millimeter-wave imaging diagnostics for fusion plasma

Monolithic, millimeter wave "system-on-chip" technology has been employed in chip heterodyne radiometers in a newly developed Electron Cyclotron Emission Imaging (ECEI) system on the DIII-D tokamak for 2D electron temperature and fluctuation diagnostics. The system employs 20 horn-waveguide receiver modules each with customized W-band (75-110 GHz) monolithic microwave integrated circuit chips comprising a W-band low noise amplifier, a balanced mixer, a ×2 local oscillator (LO) frequency doubler, and two intermediate frequency amplifier stages in each module. Compared to previous quasi-optical ECEI arrays with Schottky mixer diodes mounted on planar antennas, the upgraded W-band array exhibits >30 dB additional gain and 20× improvement in noise temperature; an internal eight times multiplier chain is used to provide LO coupling, thereby eliminating the need for quasi-optical coupling. The horn-waveguide shielding housing avoids out-of-band noise interference on each module. The upgraded ECEI system plays an important role for absolute electron temperature and fluctuation measurements for edge and core region transport physics studies. An F-band receiver chip (up to 140 GHz) is under development for additional fusion facilities with a higher toroidal magnetic field. Visualization diagnostics provide multi-scale and multi-dimensional data in plasma profile evolution. A significant aspect of imaging measurement is focusing on artificial intelligence for science applications.

[Socio-Anthropological Determinants of the High Prevalence of Obstetric Fistula in Guinea]

Objective

The purpose of this study was to analyse the socio-anthropological determinants (representations, beliefs, practices and perceptions of health services) of the high prevalence of obstetric fistulas in Guinea.

Patients and methods

From January 15 to February 15, 2018, we carried out a qualitative study in three health centres (one urban and two rural). The study focused on biological mothers who attended the centres to get vaccinated their children. The data were collected by semi-structured individual interview.

Results

None of the 42 respondents could link the occurrence of obstetric fistulas and obstructed labour. Participants at all three study sites believed that obstructed labour and obstetric fistula have a mystical origin. In Kissidougou, the respondents thought that obstructed labour and obstetric fistulas are caused either by soubaya, sorcery in Malinké or the evil spell korte in Malinké cast by an enemy, or the bad behaviour of the parturient which means either she practices adultery or if she behaves disrespectfully towards elders. In Dubréka, the respondents linked the occurrence of labour dystocia and obstetric fistula to witchcraft koromikhi in Sousou. In Labé, some respondents thought that obstructed labour and obstetric fistula are due to divine punishment in local dialect lette Allah when the woman does not respect her husband or has contracted the pregnancy out of the legal union. Others deemed that childbirth is difficult because of the narrowness of the delivery route in Fulani lawol ngol no faadhi in parturients who do not have sex during pregnancy or when the woman had not adequately had female circumcision, in local dialect o suuwaaki laabhi which means, part of the clitoris was left in place during the excision. The majority of respondents had a poor perception of health services (male staff, lack of privacy, poor hygiene, abuse). Several cultural practices (early wedlocks, genital mutilations, dietary restrictions, home deliveries) also induce obstetric fistulas.

Conclusion

Respondents' cultural beliefs and practices regarding childbirth limit women's attendance at maternity hospitals during childbirth and favour obstetric fistulas.

Integrated package of electron cyclotron emission imaging data processing and forward modeling in OMFIT

An Electron Cyclotron Emission Imaging (ECEI) data analysis module has been developed for the OMFIT platform to accommodate the needs of users at the DIII-D tokamak for physics applications. The user can easily access the ECEI spatial observation windows in the plasma that are calculated based on the automatically retrieved hardware setup and available DIII-D equilibria, perform spectral analysis, and obtain 2D electron temperature fluctuation images. The module provides a powerful data post-processing package for extracting important physics parameters from the 2D measurements, including the radial structure and poloidal mode number of Alfven eigenmodes, as well as the frequency-vs-wavenumber dispersion relationship of broadband MHD. The module propagates characterized synthetic fluctuations for the user, so one can perform forward modeling tasks with simple analytical fluctuations.

Prognostic value of longitudinal strain and ejection fraction in Friedreich's ataxia

BACKGROUND

Friedreich's ataxia (FA) is a rare autosomal recessive mitochondrial disease most commonly due to a triplet repeat expansion guanine-adenine-adenine (GAA) in the FXN gene. Cardiac disease is the major cause of death, patients with reduced left ventricular ejection fraction (LVEF) having the worse prognosis. Longitudinal strain (LS) appeared to be a better predictor of outcome than LVEF in different diseases. We compared the prognostic value of LS measured from the 4 chambers view to LVEF.

METHODS

From 2003 to 2017 consecutive patients with FA were included and LS analysis was retrospectively performed.

RESULTS

We studied 140 patients, with a median age of 34 (26-41) years (Q1-Q3) with age at onset of 14 (11-19) years and GAA repeats on the shorter allele of 600 (467-783) pb. Mean LS was 19.9 ± 5.0% and LVEF 64 ± 8%. After a mean follow-up of 7.4 ± 3.9 years, 14 patients died. In univariate Cox analysis, all-cause mortality was associated with: LS (HR 0.83; 95%CI, 0.75-0.91, p = 0.0002), LVEF (HR 0.30; 95%CI, 0.19-0.49, p < 0.0001), GAA repeats on the shorter allele (HR 1.29; 95%CI, 1.10-1.51, p = 0.002), age at onset (HR 0.87; 95%CI, 0.77-0.98, p = 0.018), LVSystolic Diameter (HR 1.17; 95%CI, 1.09-1.26, p < 0.0001), LVMass index (HR 1.02; 95%CI, 1.00-1.04, p = 0.027), and LVDiastolic Diameter (HR1.12; 95%CI, 1.01-1.23, p = 0.028). In multivariate analysis, LVEF was the only independent predictor of mortality (HR 0.41; 95%CI, 0.23-0.74, p = 0.0029).

CONCLUSION

In FA, LS was not an independent predictor of mortality, LVEF remained the only independent predictor in the present study.

Capturing complex right ventricular wall motion abnormalities in arrhythmogenic right ventricular cardiomyopathy by combining longitudinal and radial myocardial dynamics in feature-tracking MRI

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): INSERM Liliane Bettencourt doctoral grant

Background

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is ass­­ociated with complex spatial and temporal right ventricular (RV) wall motion abnormalities. While cardiac magnetic resonance (CMR) is the gold-standard imaging technique, its diagnosic performance remains suboptimal and additional CMR biomarkers reflecting ARVC pathophysiology are needed.

Purpose

To evaluate the performance of a CMR feature-tracking (FT)-derived parameter combining both longitudinal and radial RV deformation and motion for the characterization of RV wall motion abnormalities in ARVC.

Methods

Thirty-nine patients with definite or borderline ARVC (median age 45 years, interquartile range 31–51, 56% males) were compared to 20 healthy controls with comparable age, sex and weight distributions. All subjects had 1.5T CMR including short axis and 4-chamber views steady-state free precession acquisitions. A custom FT software adapted to RV wall segmentation and tracking was used to assess RV wall deformation and motion in the 3 space directions resulting in: 1) global longitudinal strain (GLS) estimated on the 4 chamber view from the RV free wall, 2) basal circumferential strain (BCS) and radial motion fraction (BRMF) estimated as an average of short-axis slices comprised in the RV third basal portion. To capture the complex RV motion in ARCV, a longitudinal to radial strain loop (LRSL) was displayed and its area was calculated.

Results

The ARVC group comprised 28 (72%) patients with definite and 11 (28%) with borderline diagnosis . As compared to controls, LVEF and RVEF were significantly lower in ARVC patients (61(interquartile range (IQR) 52-71) vs. 71%(IQR 55-88) , p = 0.03 and 47%(IQR 16-63) vs. 57%(IQR 49-63) , p = 0.02, respectively), LVEF remaining within normal range limits. While there was no significant difference in RV GLS between ARVC patients and controls (median -17.7%(IQR -24–15) vs. -17.5%(IQR -20.1–15.2), p = 0.67) , BCS and BRMF were significantly lower in ARVC patients vs. controls [-7.5%(IQR -12.3–8.4.) vs. -9.8%(IQR -13.8–8.6.), p = 0.004 and -12.2(IQR -14.4–8.7.) vs. -14.9%(IQR -16.6–13.2) p = 0.0007, respectively] . The LRSL area was significantly and markedly lower in ARVC patients vs. controls [70.6 (IQR 16.3-63.1) vs. 144.1 (IQR 110.4-251.3), p = 0.0002] . LRSL area outperformed RVEF, BCS and BRS in separating ARVC from controls (area under receiving operator characteristics curve 0.82 vs. 0.78, 0.73 and 0.78, respectively).

Conclusion

In ARVC, a FT-derived parameter combining longitudinal and radial RV wall deformation and motion provided better discrimination of ARVC patients from controls than conventional FT measurements. Its implementation in clinical practice may bolster CMR performance to characterize ARVC wall motion abnormalities.

Abstract Figure

[Management of chronic osteomyilitis of limbs at kati teaching hospital]

OBJECTIVES

the purpose of this work was to describe the epidemiological, clinical, paraclinical and therapeutic aspect of surgical treatment of chronic osteomyilitis of limbs.

PATIENTS METHODS

it was a retrospective study over a period of 12 years, from January 2003 to December 2014. It covered all cases of chronic osteomyelitis osteonecrosis treated our service.

RESULTS

The authors report the results of the surgical treatment of a series 56 patients operated on for chronic limb osteomyelitis. The mean age was 20.7 years with extremes of 6 months and 56 years. The tibia and femur were the most affected segments. Staphylococcus aureus was the most frequently found germ, 80% of the cases. We obtained complete healing with total cure in 68% of cases and recurrence of suppuration in 32% of cases.

CONCLUSION

Chronic osteomyelitis of limbs is a frequent pathology in Africa. Staphylococcus aureus was the most frequently found germ. Surgery in a time seems a good alternative. The rate of recurrence of the suppuration remains high.

[Drug use for abortifacient purposes among teenage hairdressers and seamstresses in one suburb of Lome]

The use of drugs is not solely determined by its therapeutic properties but refers to diversions of these properties.

OBJECTIVE

To assess the level of knowledge of the diversion of drugs for abortifacient purposes among hairdressers and seamstresses of the suburb of Togblékopé.

MATERIAL AND METHOD

We conducted a cross-sectional study among hairdressers and seamstresses living in Togblékopé, a suburb on the outskirts of the city of Lomé.

RESULTS

Of the 114 respondents, 74.6% knew that drugs were diverted for abortion, mostly among older young people, singles and apprentices. In addition, 70.6% reported having at least once attended a drug abortion by someone. Thus, drugs such as paracetamol, chloroquine and acetylsalicylic acid have been reported for abortifacient purposes' diversion, most often purchased on the street and responsible for serious side effects.

CONCLUSION

This study has highlighted the knowledge of drugs' use for abortifacient purposes among hairdressers and seamstresses. It is necessary to carry out actions that will aim at teaching the risks of drug intoxication and reduce the risk of pregnancy through family planning.

Fungemia in the French department of Mayotte, Indian Ocean: A 10 years survey

OBJECTIVE

This study aimed at providing original data on fungemia in the Centre Hospitalier de Mayotte in terms of prevalence, epidemiological characteristics of infected patients, yeast species distribution and profile of in vitro antifungals susceptibility.

METHODS

A total of 223 positive blood cultures for yeasts were retrospectively reported during the period April 2010-April 2020.

RESULTS

Ninety-five episodes were identified corresponding to an incidence rate of 3.7 cases/100,000 inhabitants. The average age of patients was 33.5 years, and 63.3% patients were hospitalized in intensive care unit. The main co-morbidities were surgery in the 30 days prior to fungemia (27.8%), neoplasia (22.8%), parenteral nutrition (17.7%), diabetes (16.5%) and immunosuppressive medications (31.6%). Candida spp accounted for the majority of isolates (92.4%) with a predominance of non-albicans species (55.8% vs 33.7%), including C. albicans (33.7%), C. tropicalis (30.5%) and C. parapsilosis (20%). The antifungal susceptibility profiles did not differ from expected results for each species and did not change significantly over time.

DISCUSSION

Fungemia remain frequent hospital infections associated with high mortality in Mayotte. The vast majority of fungemia was due to Candida spp. Non-albicansCandida species reach half of the Candida isolates with a high percentage of C. tropicalis. Surprisingly, no case of candidemia due to C. glabrata were identified. The management of candidemia remains satisfactory and the treatment was adapted according to the international recommendations. However, the high susceptibility of Candida spp. isolates to fluconazole may invite to reconsider the use of this molecule as empirical and first-line treatment of candidemia in Mayotte.

W-band system-on-chip electron cyclotron emission imaging system on DIII-D

Monolithic, millimeter-wave "system-on-chip" (SoC) technology has been employed in heterodyne receiver integrated circuit radiometers in a newly developed Electron Cyclotron Emission Imaging (ECEI) system on the DIII-D tokamak for 2D electron temperature profile and fluctuation evolution diagnostics. A prototype module operating in the E-band (72 GHz-80 GHz) was first employed in a 2 × 10 element array that demonstrated significant improvements over the previous quasi-optical Schottky diode mixer arrays during the 2018 operational campaign of the DIII-D tokamak. For compatibility with International Thermonuclear Experimental Reactor relevant scenarios on DIII-D, the SoC ECEI system was upgraded with 20 horn-waveguide receiver modules. Each individual module contains a University of California Davis designed W-band (75 GHz-110 GHz) receiver die that integrates a broadband low noise amplifier, a double balanced down-converting mixer, and a ×4 multiplier on the local oscillator (LO) chain. A ×2 multiplier and two IF amplifiers are packaged and selected to further boost the signal strength and downconvert the signal frequency. The upgraded W-band array exhibits >30 dB additional gain and 20× improvement in noise temperature compared with the previous Schottky diode radio frequency mixer input systems; an internal 8 times multiplier chain is used to bring down the LO frequency below 12 GHz, thereby obviating the need for a large aperture for quasi-optical LO coupling and replacing it with coaxial connectors. Horn-waveguide shielding housing avoids out-of-band noise interference on each individual module. The upgraded ECEI system plays an important role for absolute electron temperature evolution and fluctuation measurements for edge and core region transport physics studies.

[Foreskin Cyst After Circumcision At The Hospital Of Sikasso (MALI)]

Cyst scar post circumcision of the stump of the prepuce is pathology of which we have not found any cases in the literature. The circumcision traditional is still practiced in our regions with its attendant complications, in particular, the high section, the whole or part of the gland, infections. The case we report concerns a patient 24 years of age, having a large cyst of 8cm diameter, evolving for the past 17 years. The patient has not informed his parents that when the desire to marry has become very pressing. The consultation was motivated by the psychological trauma, the discomfort and the pain caused by the infection, and the fistulisation. The treatment was surgical with bedroom suites. This observation underscores the importance of the knowledge of good surgical technique in order to minimize complications; it also sheds light on the taboo side of the pathologies the sphere uro-genitale.

[Umbilical Artery Doppler Study Role In The Monitoring And Obstetric Management Of High-Risk Pregnancies]

OBJECTIVE

to compare aspects of the diastolic component of umbilical artery flow with fetal fate parameters.

MATERIAL AND METHODS

this was a prospective, cross-sectional study at the Kaolack Regional Hospital over 6 months including patients with an at-risk pregnancy and a gestational age greater than 20 SA. The aspect of umbilical artery flow, umbilical artery IR and cerebro-placental index were studied.We compared the velocity data with the rates of fetal suffering, low birth weight and perinatal mortality. The statistical analysis was done with EPI info software version 7, Excel 2010 and SPSS 20.0 with a p-value of less than 5%.

RESULTS

46 patients were included with an average age of 24.54 years. The mean gestational age was 33.7 AS. The diastolic component of umbilical artery flow was null in 19.6%; reversed in 10.9%; decreased in 21.7% and normal in 47.8%. Confrontation with fetal fate parameters found a rate of 78.6% fetal suffering in the null or reversed diastolic components group compared to 34.4% in the non-zero diastolic components group. For low birth weight, this rate was 92.9% compared to 28.1%. The perinatal mortality rate was 64.2% compared to 12.5%.

CONCLUSION

The umbilical artery Doppler study plays a major role in the monitoring and obstetric management of high-risk pregnancies. Our results demonstrate the correlation between a diastolic component of the flow of the pathological umbilical artery and the adverse outcome of the pregnancy at risk.

[Diagnostic performance of imaging examinations in acute non-traumatic abdominal pain in the radiology department of the Kaolack Regional Hospital]

AIM

The aim of this work was to evaluate the diagnostic performance of imaging examinations in the presence of acute non-traumatic abdominal pain.

MATERIALS AND METHODS

This was a prospective, cross-sectional and descriptive study over 6 months in the radiology and medical imaging department of the Kaolack Regional Hospital, including any patient received for acute non-traumatic abdominal pain with informed consent in whom the etiological diagnosis is supported by an imaging examination. We investigated the etiologies of acute abdominal pain and compared the imaging findings with surgical exploration. Our data were analyzed using SPSS 24.0 and Excel 2013 with a coefficient of significance of less than 5%.

RESULTS

106 patients were enrolled. The mean age was 32 years and the gender-ratio was 1.52 in favour of women. Acute abdominal pain was diffuse in 25.5% of patients and localized in 74.5%, of which 18.9% were at right iliac fossa.Abdominal X-ray was performed alone in 4 patients (3.8%), ultrasound alone in 46 patients (43.3%) and abdominal CT scan in 34 patients (32%). CT was combined with ultrasound in 6 patients (5.7%) and with abdominal X-ray in 16 patients (15%). The initial clinical diagnosis was corrected in 49.1% of patients. The sensitivity of the imaging compared to the final diagnosis retained was 96.2%.

CONCLUSION

Imaging represents a turning point in the management of patients with acute non-traumatic abdominal pain by providing better diagnostic guidance and avoiding serious complications and unnecessary interventions.

Prenatal care: missed opportunity for HBV prevention in women of childbearing age in rural Senegal

Background

Perinatal transmission of hepatitis B virus (HBV) constitutes an important risk in highly endemic countries including Senegal. Although the prevalence of chronic HBV infection is estimated at 11% in this country, specific data on women of childbearing age are sorely lacking. We described in this study the prevalence of the HBV antigen (HbsAg) in women of childbearing age in rural Senegal, as well as general knowledge on HBV and hepatitis B status awareness.

Methods

A cross-sectional study including HBV screening was conducted at home in the rural Niakhar area. Chronic HBV infection was determined through HBsAg detection using dried blood spots. Socio-demographic and behavioral data were collected through standardized face-to-face questionnaires. The analyzes included 368 women aged 15-49 (67% married; 65% with at least 1 child) enrolled from October 2018 to March 2019.

Results

Preliminary results show that 49 women (13%) had positive HBsAg. Only 68 women (18%) have already heard about HBV. Among them, 53% knew that there exists an HBV vaccine and 78%, 75% and 67% correctly answered that HBV can be transmitted through blood contact, childbirth and sexual intercourse, respectively.

Among the 233 (63%) women who had already given birth, 76% had attended at least 4 antenatal care sessions and 74% had given birth in a healthcare facility for their last pregnancy. However, only 1% reported to have already been screened for HBV. Main reasons reported for not having been screened were having never heard about this test (80%) and not having been offered screening during antenatal care sessions (10%).

Conclusions

General knowledge and awareness of HBV status are particularly low in women of childbearing age living in rural Senegal, despite high antenatal care sessions attendance. Given the high prevalence of chronic HBV infection found in this population, it is urgent to ensure systematic HVB screening and to provide adequate information to women during pregnancy.

Key messages

The prevalence of chronic HBV is high in women of childbearing age in Senegal. National recommendations for women attending antenatal care sessions should include HBV screening and counselling.

Hepatitis B vaccination status and vaccine immune response among children in rural Senegal

Background

Hepatitis B vaccination during childhood is key to reduce the prevalence of Hepatitis B virus (HBV) infection. In Senegal, a highly endemic country, the three-dose hepatitis B vaccine and the birth dose vaccine were introduced in the Expanded Programme on Immunization (EPI) in 2004 and 2016 respectively. This study aimed to determine chronic HBV infection prevalence, hepatitis B vaccination status and vaccine immunity among children in Senegal.

Methods

A cross-sectional study including HBV screening was conducted at home among children aged 6 months to 15 years (i.e. born after the introduction of the HBV vaccine in the EPI) in the rural zone of Niakhar. Dried Blood Spot (DBS) samples were collected for the detection of HBsAg, anti-HBc Ab and anti-HBs Ab using chemoluminescence. Vaccination status was assessed using information on vaccination cards. Detectable vaccine immunity was defined with an adjusted DBS threshold of DOI≥0.36 IU/mL (corresponding to 10 IU/mL in venous blood sampling).

Results

Between October and December 2018, 455 children were enrolled. Preliminary results show that 7/455 (1.5%) had been in contact with HBV (positive anti-HBc Ab) and 5/455 (1.1%) had chronic HBV infection (positive HBsAg).

Only 161/455 (35.4%) children had a vaccination card available. Among those, 150/161 (93.2%) received at least 3 doses of hepatitis B vaccine, of which 83/150 (55.3%) had detectable vaccine immunity. The proportion of children with detectable vaccine immunity was significantly higher in children &lt;5 years than in children aged 5-9 and 10-15 (72.3% versus 47.3%, p = 0.006 and 72.3% versus 14.3%, p &lt; 0.001).

Conclusions

Preliminary results suggest a low prevalence of HBV chronic infection among children born after the introduction of HBV vaccination in Senegal. However, detectable vaccine immunity rapidly decreases with age among vaccinated children, signalling a need for further studies on the immune response to HBV vaccination in this context.

Key messages

HBV chronic infection is low among children born after the introduction of HBV vaccination in Senegal. Further studies on the immune response to HBV vaccination in this context are needed.

P903Is left ventricular longitudinal strain a good pronostic factor in friedreich ataxia?

Introduction

Friedreich ataxia (FRDA) is a rare genetic sensory ataxia. The causal mutation is an expanded trinucleotide repeat (GAA) in the frataxin gene. Hypertrophic cardiomyopathy is associated with FRDA and is the major cause of early death before 40 years old. Patients with progressive decline of the left ventricular ejection fraction (LVEF) have the worse prognosis. Speckle tracking echography with 2D longitudinal myocardial strain (GLS) is recognized as a more effective technique than conventional LVEF in detecting subtle changes in LV function.

Purpose

Evaluate the prognostic value of global longitudinal strain (GLS) in patients with FRDA as compared to LVEF.

Methods

From 2003 to 2017 consecutive patients with genetically confirmed FRDA were included. Longitudinal strain analysis was retrospectively performed with Tomtec software. News were obtained until April 2018, no patient was lost during follow-up.

Results

The study included 156 patients (51% male) of 35±12 years (mean ± SD) with an age at disease onset of 17±11 years, age at wheelchair use of 26±10 years, and GAA repeat on the shorter allele of 590±241 pb. The following echocardiographic parameters were studied at baseline: LVEF 64±9%, GLS −19.8±5% (n=141), septal wall thickness (SWT) 11.4±2.5 mm, posterior wall thickness (PWT) 10.4±1.8 mm, LV end diastolic diameter (LVEDD) 44.4±6mm. Correlation between GLS and LVEF was 0.31 (p=0.0002).

After a mean follow-up of 7.7±4.0 years, 17 (11%) patients died and the outcome (cardiac arrhythmia, heart failure, stroke or death) concerned 28 (18%) patients. In univariate analysis (Cox model), factors associated with mortality were: GLS (HR: 1.2; 95% CI 1.10–1.32, p=0.0001), LVEF (HR: 0.88; 95% CI 0.85–0.92, p<0.0001), GAA (HR: 1.28; 95% CI 1.11–1.47, p=0.0008), age at onset (HR: 0.84; 95% CI 0.76–0.94, p=0.002), LVMi (HR: 1.02; 95% CI 1.01–1.04, p=0.0078), SWT (HR: 1.18 95% CI 1.01–1.36, p=0.03) and LVEDD (HR: 1.09; 95% CI 1.00–1.19, p=0.04). In multivariate analysis LVEF was the only independent predictor of long-term mortality (HR: 0.93; 95% CI 0.88; 0.99, p=0.02). Similarly GLS was not an independent predictor of the composite outcome in multivariate analysis.

Conclusion

GLS is a predictor of morbimortality but is not superior to LVEF in FRDA patients. Further prospective studies are mandatory to assess the early predictive value of 2D GLS.

DNA Rchitect: an R based visualizer for network analysis of chromatin interaction data

MOTIVATION

Visualization of multiple genomic data generally requires the use of public or commercially hosted browsers. Flexible visualization of chromatin interaction data as genomic features and network components offer informative insights to gene expression. An open source application for visualizing HiC and chromatin conformation-based data as 2D-arcs accompanied by interactive network analyses is valuable.

RESULTS

DNA Rchitect is a new tool created to visualize HiC and chromatin conformation-based contacts at high (Kb) and low (Mb) genomic resolutions. The user can upload their pre-filtered HiC experiment in bedpe format to the DNA Rchitect web app that we have hosted or to a version they themselves have deployed. Using DNA Rchitect, the uploaded data allows the user to visualize different interactions of their sample, perform simple network analyses, while also offering visualization of other genomic data types. The user can then download their results for additional network functionality offered in network based programs such as Cytoscape.

AVAILABILITY AND IMPLEMENTATION

DNA Rchitect is freely available both as a web application written primarily in R available at http://shiny.immgen.org/DNARchitect/ and as an open source released under an MIT license at: https://github.com/alosdiallo/DNA_Rchitect.

Canine papillomavirus types 1 and 2 in classical papillomas: High abundance, different morphological associations and frequent co-infections

Canine papillomatosis is mainly attributed to papillomavirus infections. Papillomavirus DNA is also frequently identified in healthy skin, and evidence of high papillomavirus diversity complicates this simplistic view of causality. The aim of this study was to determine how frequently canine papillomas contain papillomavirus DNA and express viral protein, and how these factors correlate to the histology and anatomic location. Fifty-three archived, formalin-fixed samples of canine papillomas and eight samples of other proliferative skin lesions from dogs were included. Samples were re-evaluated histologically, tested for papillomavirus L1-antigen using immunohistochemistry, and for papillomavirus DNA with PCR assays and molecular sequencing. Most papillomas from haired skin contained papillomavirus DNA (96%) and antigen (92%). Of oral papillomas, 88% were positive for both papillomavirus DNA and antigen. Approximately 50% of non-papilloma proliferations and papillomas from eyelid/conjunctiva specimens contained viral DNA, but antigen was present in only 12% of eyelid/conjunctiva papillomas and in none of the non-papilloma proliferations. The presence of viral antigen was highly correlated with histological indicators of viral infection, including intranuclear inclusions, koilocytes, cytoplasmatic vacuolation and dysplasia. The viruses found were mainly CPV1 and CPV2. CPV1 dominated in oral infections, while CPV2 dominated in cutaneous endophytic papillomas. Co-infections with CPV1 and CPV2 accounted for about 20% of all detected infections. These results support a role for papillomaviruses in canine cutaneous and oral, exophytic and endophytic papillomas and support previously raised doubts about their role in squamous papillomas from eyelid/conjunctiva specimens.

A scalable real-time framework for Thomson scattering analysis: Application to NSTX-U

A detailed description of a prototype setup for real-time (RT) Thomson scattering (TS) analysis is presented and implemented in the multi-point Thomson scattering (MPTS) diagnostic system at the National Spherical Torus Experiment Upgrade (NSTX-U). The data acquisition hardware was upgraded with RT capable electronics (RT-analog digital converters and a RT server) that allow for fast digitization of the laser pulse signal of eight radial MPTS channels. In addition, a new TS spectrum analysis software for a rapid calculation of electron temperature (T_e) and electron density (n_e) was developed. Testing of the RT hardware and data analysis software was successfully completed and benchmarked against the standard, post-shot evaluation. Timing tests were performed showing that the end-to-end processing time was reproducibly below 17 ms for the duration of at least 5 s, meeting a 60 Hz deadline by the laser pulse repetition rate over the length of a NSTX-U discharge. The presented RT framework is designed to be scalable in system size, i.e., incorporation of additional radial channels by solely adding additional RT capable hardware. Furthermore, it is scalable in its operation duration and was continuously running for up to 30 min, making it an attractive solution for machines with long discharges such as advanced, non-inductive tokamaks or stellarators.

Low incidence of acute rejection within 6 months of kidney transplantation in HIV-infected recipients treated with raltegravir: the Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS) 153 TREVE trial

OBJECTIVES

High rates of clinical acute rejection after kidney transplantation have been reported in people living with HIV (PLHIV), probably as a consequence of drug interactions. We therefore investigated the incidence of acute rejection within 6 months of transplantation in HIV-infected recipients treated with a protease-inhibitor-free raltegravir-based regimen.

METHODS

The Agence Nationale de Recherche sur le Sida et les Hépatites Virales (ANRS) 153 TREVE (NCT01453192) study was a prospective multicentre single-arm trial in adult PLHIV awaiting kidney transplantation, with viral load < 50 HIV-1 RNA copies/mL, CD4 T-cell count > 200 cells/μL, and HIV-1 strains sensitive to raltegravir, aiming to demonstrate 6-month clinical acute rejection rates < 30%. Time to transplantation was compared with that for uninfected subjects matched for age, sex and registration date.

RESULTS

In total, 61 participants were enrolled in the study, and 26 underwent kidney transplantation. Two participants experienced clinical acute rejection, corresponding to an estimated clinical acute rejection rate of 8% [95% confidence interval (CI) 2-24%] at 6 and 12 months post-transplantation. HIV infection remained under control in all but one participant, who temporarily stopped antiretroviral treatment. Median time to transplantation was longer in PLHIV than in controls (4.3 versus 2.8 years, respectively; P = 0.002) and was not influenced by blood group.

CONCLUSIONS

Acute rejection rates were low after kidney transplantation in PLHIV treated with a raltegravir-based regimen. However, PLHIV have poorer access to transplantation than HIV-uninfected individuals after registration on the waiting list.

Direct Observation of Nonlinear Coupling between Pedestal Modes Leading to the Onset of Edge Localized Modes

Prior to eruptive events such as edge localized modes (ELMs), quasicoherent fluctuations, referred to as pedestal modes, are observed in the edge of fusion devices. We report on the investigations of nonlinear coupling between these modes during quasistationary inter-ELM phases leading to the ELM onset. Three dominant modes, with density and magnetic signatures, are identified as key players in the triggering mechanism of certain classes of ELMs. We demonstrate that one of these modes is amplified by the two others through three wave interactions. The amplified mode is radially shifted relative to the other two modes towards the last-closed flux surface as the ELM event approaches. Our results suggest that nonlinear coupling of pedestal modes, associated with radial distortions pushing out of the pedestal, is a possible mechanism for the triggering of low frequency ELMs relevant for future fusion devices.

Treponema species enrich the gut microbiota of traditional rural populations but are absent from urban individuals

There is a significant gap in our knowledge of the microbe–host relationship between urban and traditional rural populations. We conducted a large-scale study to examine the gut microbiota of different traditional rural and urban lifestyles in human populations. Using high-throughput 16S ribosomal RNA gene amplicon sequencing, we tested urban French, Saudi, Senegalese, Nigerian and Polynesian individuals as well as individuals living in traditional rural societies, including Amazonians from French Guiana, Congolese Pygmies, Saudi Bedouins and Algerian Tuaregs. The gut microbiota from individuals living in traditional rural settings clustered differently and presented significantly higher diversity than those of urban populations (p 0.01). The bacterial taxa identified by class analysis as contributing most significantly to each cluster were Phascolarctobacterium for traditional rural individuals and Bifidobacterium for urban individuals. Spirochaetae were only present in the gut microbiota of individuals from traditional rural societies, and the gut microbiota of all traditional rural populations was enriched with Treponema succinifaciens. Cross-transmission of Treponema from termites or swine to humans or the increased use of antibiotics in nontraditional populations may explain why Treponema is present only in the gut microbiota of traditional rural populations.

Liquid crystal polymer receiver modules for electron cyclotron emission imaging on the DIII-D tokamak

A new generation of millimeter-wave heterodyne imaging receiver arrays has been developed and demonstrated on the DIII-D electron cyclotron emission imaging (ECEI) system. Improved circuit integration, improved noise performance, and enhanced shielding from out-of-band emission are made possible by using advanced liquid crystal polymer (LCP) substrates and monolithic microwave integrated circuit (MMIC) receiver chips. This array exhibits ∼15 dB additional gain and >30× reduction in noise temperature compared to previous generation ECEI arrays. Each LCP horn-waveguide module houses a 3 × 3 mm GaAs MMIC receiver chip, which consists of a low noise millimeter-wave preamplifier, balanced mixer, and IF amplifier together with a local oscillator multiplier chain driven at ∼12 GHz. A proof-of-principle partial LCP instrument with 5 poloidal channels was installed on DIII-D in 2017, with a full proof-of-principle system (20 poloidal × 8 radial channels) installed and commissioned in early 2018. The enhanced shielding of the LCP modules is seen to greatly reduce the sensitivity of ECEI signals to out-of-band microwave noise which has plagued previous ECEI studies on DIII-D. The LCP ECEI system is expected to be a valuable diagnostic tool for pedestal region measurements, focusing particularly on electron temperature evolution during edge localized mode bursting.

Using Laser-Induced Rydberg Spectroscopy diagnostic for direct measurements of the local electric field in the edge region of NSTX/NSTX-U: Modeling

We discuss a novel diagnostic allowing direct measurements of the local electric field in the edge region of NSTX/NSTX-U. This laser based diagnostic's principle consists of depleting the naturally populated n = 3 level to a Rydberg state-sensitive to electric fields-that will result in a suppression of part of the D _α emission. We refer to this approach as Laser-Induced Rydberg Spectroscopy. It is shown that the local electric field can be measured through the Stark induced resonances observed as dips in the D _α emission. Using forward-modeling of simulated absorption spectra, we show precisions reaching ±2 kV m^-1 in regions with a local electric field of 15 kV m^-1.