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.

Hepatitis B prevention and treatment needs in women in Senegal (ANRS 12356 AmBASS survey)

BACKGROUND

Although mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is prevalent in West Africa, epidemiological data on HBV infection in women remain scarce. We studied i) hepatitis B surface antigen (HBsAg) prevalence and its correlates, ii) HBV screening history and serological status awareness, iii) MTCT risk and treatment needs in Senegalese women.

METHODS

A cross-sectional population-based serosurvey for HBsAg positivity was conducted in 2018-2019 in the rural area of Niakhar (Fatick region, Senegal). Participants were offered home-based HBV screening and answered face-to-face questionnaires. HBsAg-positive participants underwent clinical and biological assessments. Data were weighted and calibrated to be representative of the area's population. Logistic regression models helped identify factors associated with HBsAg-positivity in adult women (> 15 years old).

RESULTS

HBsAg prevalence in adult women was 9.2% [95% confidence interval: 7.0-11.4]. Factors associated with HBsAg-positivity were being 15-49 years old (ref: ≥ 50), living in a household with > 2 other HBsAg-positive members, and knowing someone with liver disease. Only 1.6% of women had already been tested for HBV; no one who tested HBsAg positive was already aware of their serological status. In women 15-49 years old, 5% risked MTCT and none were eligible for long-term antiviral treatment.

CONCLUSIONS

Adult women have a high HBsAg prevalence but a low MTCT risk. Low rates of HBV screening and serological status awareness argue for the adoption of systematic screening during pregnancy using free and rapid diagnostic tests. Additionally, screening household members of HBsAg-positive women may greatly improve the cascade of care in rural Senegal.

TRIAL REGISTRATION

ClinicalTrials.gov identifier (NCT number): NCT03215732.

Molecular diagnosis of urogenital schistosomiasis in pre-school children, school-aged children and women of reproductive age at community level in central Senegal

BACKGROUND

Urogenital schistosomiasis is a major public health concern in sub-Saharan Africa. In Senegal, the disease is endemic in all regions of the country. Recently, WHO strongly recommended including pre-school children and women of reproductive age during a mass drug administration campaign. It is important to describe the burden of the disease in these group at risk using innovative diagnostic tools. This study aimed to assess the use of real-time PCR in the detection of schistosomiasis cases at the community level in a seasonal transmission area.

METHODS

A cross-sectional survey was carried out in Niakhar located in the centre of Senegal. Pre-schoolchildren, school-aged children and female adolescents and adults were invited to participate in the study in April 2018. Urine samples were collected and examined using Hemastix reagent strips, filtration technique and real-time PCR. Schistosoma haematobium was detected, identified by targeting the Dra1 gene. The prevalence of urogenital schistosomiasis was determined for each group and the performance of the real-time PCR was compared with the conventional techniques.

RESULTS

A total of 428 participants were enrolled in this study including 87 (20.4%) pre-school children (1-5 years), 262 (61.3%) school-aged children between (5-14 years), 17 (3.9%) adolescents (15-17 years) and 62 (14.4%) female adults. The comparison of the diagnostic techniques has shown that the prevalence of urogenital schistosomiasis is higher using molecular technique (34.6%) compared to microscopy (20.3%). The percentage rate of haematuria using Hemastix was 23.1%. School-aged children between 5 and 14 years old were the most affected with 29.0% and 43.1% under microscopy and RT-PCR, respectively. In female participants, microscopic prevalence decreases with age, from 21.4% in school-aged children to 17.6% in adolescents and 9.7% in adults. There was good correlation between the number of eggs per 10 ml and the cycle threshold range.

CONCLUSION

These results show the importance of using molecular tools in the surveillance of schistosomiasis particularly in pre-school children and women of reproductive age.

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.

Draft genomes and descriptions of Urmitella timonensis gen. nov., sp. nov. and Marasmitruncus massiliensis gen. nov., sp. nov., isolated from severely malnourished African children using culturomics

Two strains, designated as Marseille-P2918^T and Marseille-P3646^T, were isolated from a 14-week-old Senegalese girl using culturomics: Urmitella timonensis strain Marseille-P2918^T (= CSUR P2918, = DSM 103634) and Marasmitruncus massiliensis strain Marseille-P3646^T (= CSUR P3646, = CCUG72353). Both strains were rod-shaped, anaerobic, spore forming motile bacteria. The 16S rRNA gene sequences of strains Marseille-P2918^T (LT598554) and Marseille-P3646^T (LT725660) shared 93.25% and 94.34% identity with Tissierella praeacuta ATCC 25539^T and Anaerotruncus colihominis CIP 107754^T, their respective phylogenetically closest species with standing in nomenclature. Therefore, strain Marseille-P2918^T is classified within the family Tissierellaceae and order Tissierellales whereas strain Marseille-P3646^T is classified within the family Oscillospiraceae and order Eubacteriales. The genome of strain Marseille-P2918^T had a size of 2.13 Mb with a GC content of 50.52% and includes six scaffolds and six contigs, and that of strain Marseille-P3646^T was 3.76 Mbp long consisting of five contigs with a 50.04% GC content. The genomes of both strains presented a high percentage of genes encoding enzymes involved in genetic information and processing, suggesting a high growth rate and adaptability. These new taxa are extensively described and characterised in this paper, using the concept of taxono-genomic description.

Hepatitis B in Senegal: A Successful Infant Vaccination Program but Urgent Need to Scale Up Screening and Treatment (ANRS 12356 AmBASS survey)

Senegal introduced the infant hepatitis B virus (HBV) vaccination in 2004 and recently committed to eliminating hepatitis B by 2030. Updated epidemiological data are needed to provide information on the progress being made and to develop new interventions. We estimated the prevalence of hepatitis B surface antigen (HBsAg) in children and adults living in rural Senegal and assessed hepatitis B treatment eligibility. A cross-sectional population-based serosurvey of HBsAg was conducted in 2018-2019 in a large sample (n = 3,118) of residents living in the Niakhar area (Fatick region, Senegal). Individuals positive for HBsAg subsequently underwent clinical and biological assessments. Data were weighted for age and sex and calibrated to be representative of the area's population. Among the 3,118 participants, 206 were HBsAg positive (prevalence, 6.9%; 95% confidence interval [CI], 5.6-8.1). Prevalence varied markedly according to age group in individuals aged 0-4, 5-14, 15-34, and ≥35 years as follows: 0.0% (95% CI, 0.00-0.01); 1.5% (95% CI, 0.0-2.3); 12.4% (95% CI, 9.1-15.6); and 8.8% (95% CI, 6.1-11.5), respectively. Of those subsequently assessed, 50.9% (95% CI, 41.8-60.0) had active HBV infection; 4 (2.9%; 95% CI, 0.9-9.4) were eligible for hepatitis B treatment. Conclusion: In this first population-based serosurvey targeting children and adults in rural Senegal, HBsAg prevalence was very low in the former, meeting the World Health Organization's (WHO) < 1% HBsAg 2020 target; however, it was high in young adults (15-34 years old) born before the HBV vaccine was introduced in 2004. To reach national and WHO hepatitis elimination goals, general population testing (particularly for adolescents and young adults), care, and treatment scale-up need to be implemented.

Applying the health capability profile to empirically study chronic hepatitis B in rural Senegal: a social justice mixed-methods study protocol

INTRODUCTION

Despite the early implementation of hepatitis B vaccination and the ongoing decentralisation of chronic hepatitis B (CHB) care, over 10% of the Senegalese adult population lives with CHB and liver cancer remains a main cause of death. Investigating factors associated with CHB infection, prevention of CHB-related morbidity, and prevention and treatment of mortality secondary to CHB calls for a holistic and multidimensional approach. This paper presents the adaptation of the health capability profile (HCP) to a specific epidemiological issue and empirical setting: it seeks to identify and analyse inter-related abilities and conditions (health capabilities) in relation to the CHB epidemic in the rural area of Niakhar, Senegal.

METHODS AND ANALYSIS

This ongoing study relies on a sequential social justice mixed-methods design. The HCP is comprehensively adapted to CHB in rural Senegal and guides the design and conduct of the study. Objective and subjective data are collected at the individual level following a mixed-methods explanatory core design. The quantitative module, embedded in the ANRS12356 AmBASS cross-sectional survey (exhaustive sampling), is used to select a purposeful sampling of participants invited for one-on-one qualitative interviews. Additional data are collected at the institutional and community level through health facility surveys and an ethnography (in-depth interviews) of local and national CHB stakeholders. Data analysis adopts a synergistic approach to produce a multilayered analysis of individual HCPs and crosscutting analysis of the 15 health capabilities. The data integration strategy relies on a mixed-methods convergent core design, and will use 0-100 health capability scores as well as flow diagrams to measure and characterise levels of development and interactions among health capabilities, respectively.

ETHICS AND DISSEMINATION

This study was approved by Senegalese and French authorities. Results dissemination through local workshops and scientific publications aim at fuelling effective policy change towards CHB-related health capability.

Using social contact data to improve the overall effect estimate of a cluster-randomized influenza vaccination program in Senegal

This study estimates the overall effect of two influenza vaccination programs consecutively administered in a cluster-randomized trial in western Senegal over the course of two influenza seasons from 2009-2011. We apply cutting-edge methodology combining social contact data with infection data to reduce bias in estimation arising from contamination between clusters. Our time-varying estimates reveal a reduction in seasonal influenza from the intervention and a nonsignificant increase in H1N1 pandemic influenza. We estimate an additive change in overall cumulative incidence (which was 6.13% in the control arm) of -0.68 percentage points during Year 1 of the study (95% CI: -2.53, 1.18). When H1N1 pandemic infections were excluded from analysis, the estimated change was -1.45 percentage points and was significant (95% CI, -2.81, -0.08). Because cross-cluster contamination was low (0-3% of contacts for most villages), an estimator assuming no contamination was only slightly attenuated (-0.65 percentage points). These findings are encouraging for studies carefully designed to minimize spillover. Further work is needed to estimate contamination - and its effect on estimation - in a variety of settings.

[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.

Social contact patterns and implications for infectious disease transmission: a systematic review and meta-analysis of contact surveys

Background:

Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focused on high-income settings.

Methods:

Here, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys, we explored how contact characteristics (number, location, duration, and whether physical) vary across income settings.

Results:

Contact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, with low-income settings characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income strata on the frequency, duration, and type of contacts individuals made.

Conclusions:

These differences in contact patterns between settings have material consequences for both spread of respiratory pathogens and the effectiveness of different non-pharmaceutical interventions.

Funding:

This work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1).

Infectious diseases, particularly those caused by airborne pathogens like SARS-CoV-2, spread by social contact, and understanding how people mix is critical in controlling outbreaks. To explore these patterns, researchers typically carry out large contact surveys. Participants are asked for personal information (such as gender, age and occupation), as well as details of recent social contacts, usually those that happened in the last 24 hours. This information includes, the age and gender of the contact, where the interaction happened, how long it lasted, and whether it involved physical touch.

These kinds of surveys help scientists to predict how infectious diseases might spread. But there is a problem: most of the data come from high-income countries, and there is evidence to suggest that social contact patterns differ between places. Therefore, data from these countries might not be useful for predicting how infections spread in lower-income regions.

Here, Mousa et al. have collected and combined data from 27 contact surveys carried out before the COVID-19 pandemic to see how baseline social interactions vary between high- and lower-income settings. The comparison revealed that, in higher-income countries, the number of daily contacts people made decreased with age. But, in lower-income countries, younger and older individuals made similar numbers of contacts and mixed with all age groups.

In higher-income countries, more contacts happened at work or school, while in low-income settings, more interactions happened at home and people were also more likely to live in larger, intergenerational households. Mousa et al. also found that gender affected how long contacts lasted and whether they involved physical contact, both of which are key risk factors for transmitting airborne pathogens.

These findings can help researchers to predict how infectious diseases might spread in different settings. They can also be used to assess how effective non-medical restrictions, like shielding of the elderly and workplace closures, will be at reducing transmissions in different parts of the world.

Sibling status, home birth, tattoos and stitches are risk factors for chronic hepatitis B virus infection in Senegalese children: A cross-sectional survey

Sub-Saharan Africa's hepatitis B virus (HBV) burden is primarily due to infection in infancy. However, data on chronic HBV infection prevalence and associated risk factors in children born post-HBV vaccination introduction are scarce. We estimated hepatitis B surface antigen (HBsAg) prevalence and risk factors in Senegalese children born during the HBV vaccination era. In 2018-2019, a community-based cross-sectional survey was conducted in Senegal among children born between 2004 and 2015 (ie after the three-dose HBV vaccine series was introduced (2004) but before the birth dose's introduction (2016)). HBsAg-positive children were identified using dried blood spots. A standardized questionnaire collected socioeconomic information. Data were age-sex weighted and calibrated to be representative of children living in the study area. Risk factors associated with HBsAg positivity were identified using negative binomial regression. Among 1,327 children, 17 were HBsAg-positive (prevalence = 1.23% (95% confidence interval [CI] 0.61-1.85)). Older age (adjusted incidence-rate ratio [aIRR] 1.31 per one-year increase, 95% CI 1.10-1.57), home vs healthcare facility delivery (aIRR 3.55, 95% CI 1.39-9.02), stitches (lifetime) (aIRR 4.79; 95% CI 1.84-12.39), tattoos (aIRR 8.97, 95% CI 1.01-79.11) and having an HBsAg-positive sibling with the same mother (aIRR 3.05, 95% CI 1.09-8.57) were all independently associated with HBsAg positivity. The low HBsAg prevalence highlights the success of the Senegalese HBV vaccination program. To further reduce HBV acquisition in children, high-risk groups, including pregnant women and siblings of HBsAg-positive individuals, must be screened. Vital HBV infection prevention measures include promoting delivery in healthcare facilities, and increasing awareness of prevention and control procedures.

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.

A Listeria monocytogenes clone in human breast milk associated with severe acute malnutrition in West Africa: A multicentric case-controlled study

Background

Severe acute malnutrition (SAM) is a major public health problem affecting children under the age of five in many low- and middle-income countries, and its resolution would contribute towards achieving the several sustainable development goals. The etiology of SAM is pluri-factorial, including delayed maturation of the gut microbiota, suboptimal feeding practices and dysfunctional breastfeeding. The recent serendipitous detection of Listeria monocytogenes in the breast milk of Malian women, in contrast to French women, suggests a possible association with SAM.

Methodology/ Principal findings

To investigate the possible association of L. monocytogenes carriage in breast milk and SAM, a case-control study was performed in Senegal, with subjects recruited from two areas. Using 16S amplicon sequencing, a culture independent method, 100% (152/152) of the mothers were positive for L. monocytogenes in their breast milk while qPCR analysis gave lower recovery rates. Interestingly, after enrichment in Fraser broth and seeding on PALCALM agar, all 10 isolated strains were isolated from the milk of 10 mothers who had SAM children which also had a significantly increased relative abundance of L. monocytogenes (0.34 (SD 0.35) vs 0.05 (SD 0.07) in controls, p<0.0001). The high genomic similarity between these strains and Malian breast milk strains from a previous study supports the hypothesis of endemic clone carriage in West Africa. Moreover, the in vitro growth inhibition of L. monocytogenes using breast milk samples was obtained from only 50% of the milk of mothers who had SAM children, in contrast to control samples which systematically inhibited the growth of L. monocytogenes with a higher inhibition diameter (15.7 mm (SD 2.3) in controls versus 3.5 mm (SD 4.6) in SAM, p = 0.0001). Lactobacillus and Streptococcus isolated from the breast milk of controls inhibit L. monocytogenes in a species-dependent manner.

Conclusions/Significance

Our study reveals a previously unsuspected carriage of L. monocytogenes in the breast milk of West African women, which is associated with SAM. The inhibitory effect of human selected lactic acid bacterial species against L. monocytogenes might provide new therapeutic and inexpensive options to prevent and treat this neglected public health issue.

Severe acute malnutrition is a global public health issue which greatly impacts childhood mortality rates. Although still not fully understood, the multi-factorial pathology of severe acute malnutrition has been associated, among other factors, with sub-optimal feeding practices (including dysfunctional breastfeeding) and an altered gut microbiota. The serendipitous detection of Listeria monocytogenes in the breast milk of Malian women has raised the possibility of its involvement in the pathogenesis of severe acute malnutrition. To investigate this possibility, the presence of L. monocytogenes was assessed in a cohort of lactating Senegalese women, both mothers of healthy children as well as those of severely malnourished children using culture-dependent and independent methods. Our study confirms the previously unsuspected presence of L. monocytogenes in the breast milk of Senegalese women, which is increased in the milk of mothers of severely malnourished children. Moreover, breast milk samples from the mothers of healthy children more frequently induced a potent inhibition of L. monocytogenes than those from the mothers of severely malnourished children. An inhibition was also achieved using potential probiotics, Lactobacillus and Streptococcus species, isolated from breast milk. Our study reveals the previously unsuspected carriage of L. monocytogenes in the breast milk of West African women, which is associated with severe acute malnutrition. The inhibitory effect of human selected lactic acid bacterial species against L. monocytogenes might provide new therapeutic and inexpensive options to prevent and treat this neglected public health issue.

Estimates of Inactivated Influenza Vaccine Effectiveness Among Children in Senegal: Results From 2 Consecutive Cluster-Randomized Controlled Trials in 2010 and 2011

BACKGROUND

We report results of years 2 and 3 of consecutive cluster-randomized controlled trials of trivalent inactivated influenza vaccine (IIV3) in Senegal.

METHODS

We cluster-randomized (1:1) 20 villages to annual vaccination with IIV3 or inactivated poliovirus vaccine (IPV) of age-eligible residents (6 months-10 years). The primary outcome was total vaccine effectiveness against laboratory-confirmed influenza illness (LCI) among age-eligible children (modified intention-to-treat population [mITT]). Secondary outcomes were indirect (herd protection) and population (overall community) vaccine effectiveness.

RESULTS

We vaccinated 74% of 12 408 age-eligible children in year 2 (June 2010-April 11) and 74% of 11 988 age-eligible children in year 3 (April 2011-December 2011) with study vaccines. Annual cumulative incidence of LCI was 4.7 (year 2) and 4.2 (year 3) per 100 mITT child vaccinees of IPV villages. In year 2, IIV3 matched circulating influenza strains. The total effectiveness was 52.8% (95% confidence interval [CI], 32.3-67.0), and the population effectiveness was 36.0% (95% CI, 10.2-54.4) against LCI caused by any influenza strain. The indirect effectiveness against LCI by A/H3N2 was 56.4% (95% CI, 39.0-68.9). In year 3, 74% of influenza detections were vaccine-mismatched to circulating B/Yamagata and 24% were vaccine-matched to circulating A/H3N2. The year 3 total effectiveness against LCI was -14.5% (95% CI, -81.2-27.6). Vaccine effectiveness varied by type/subtype of influenza in both years.

CONCLUSIONS

IIV3 was variably effective against influenza illness in Senegalese children, with total and indirect vaccine effectiveness present during the year when all circulating strains matched the IIV3 formulation.

CLINICAL TRIALS REGISTRATION

NCT00893906.

Social Contact Patterns and Implications for Infectious Disease Transmission: A Systematic Review and Meta-Analysis of Contact Surveys

BACKGROUND

Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focussed on high-income settings.

METHODS

Here, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys we explored how contact characteristics (number, location, duration and whether physical) vary across income settings.

RESULTS

Contact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age-groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, but low-income settings were characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income-strata on the frequency, duration and type of contacts individuals made.

CONCLUSIONS

These differences in contact patterns between settings have material consequences for both spread of respiratory pathogens, as well as the effectiveness of different non-pharmaceutical interventions.

FUNDING

This work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1).

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.

The Costs of Introducing the Hepatitis B Birth Dose Vaccine into the National Immunization Programme in Senegal (NéoVac Study)

Some African countries are still reluctant to introduce the hepatitis B vaccine birth dose (HepB-BD) into their expanded program of immunization (EPI), partly because of logistical, economic, and cost information constraints. To assist decision-makers in these countries, we assessed the economic and financial costs of HepB-BD introduction in Senegal in 2016. We performed a micro-costing study in a representative sample of Senegal's EPI sites at all levels in 2018. Information on EPI and HepB-BD activity-related inputs and costs was collected using standardized questionnaires and semi-structured interviews. Using inverse probability weighting, we computed weighted average costs associated with HepB-BD introduction for each EPI level, country-level aggregated costs and estimated costs per newborn. Economic and financial costs from a government perspective were estimated in US dollars for 2015, 2016 and 2017. Total economic costs were USD 143,364 in 2015, USD 759,406 in 2016 and USD 867,311 in 2017, while financial costs were USD 127,745, USD 82,519 and USD 29,853, respectively. When annualizing pre-introduction and initial training costs, the economic (financial) cost per vaccinated newborn was USD 2.10 (USD 0.30) in 2016 and USD 1.90 (USD 0.20) in 2017. Our estimates provide valuable information to implement HepB-BD in Sub-Saharan African countries that have not yet integrated this vaccine.

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.

Meningococcal vaccines and protein-energy undernutrition in children in the African meningitis belt

BACKGROUND

Vaccines to prevent meningococcal meningitis in the African meningitis belt include PsACWY, a polysaccharide-only vaccine; and PsA-TT, a polysaccharide-protein conjugate vaccine. Protein-energy undernutrition, a condition where children do not receive enough macro- or micronutrients, is related to increased risk of infectious diseases and poor immune function. Reduced immune function could affect vaccine immunogenicity. We investigated connections between protein-energy undernutrition and vaccine immunogenicity and antibody waning to PsACWY and PsA-TT in children in the African meningitis belt.

METHODS

This is a secondary analysis of data collected as part of four clinical trials testing the safety and efficacy of PsA-TT in children in Mali, Ghana, and Senegal. We identified whether anthropometric growth indices (low height-for-age, weight-for-height, or weight-for-age Z-score categories) were related to reduced vaccine-elicited antibody (measured with rabbit complement) from pre- to 1 month post-vaccination, in linear regression models. We also identified whether these growth indices were related to increased waning for vaccine-elicited antibody over time, in linear regression models.

RESULTS

A total of 697 children were included in our analysis, of which 350 (50.2%) were female; the mean (SD) age was 1.0 (1.1) years, and 578 (83.0%) received PsA-TT. In linear regression models, no consistent statistical relationship was seen between pre-vaccination anthropometric Z-score categories and vaccine immunogenicity, or decline in antibody over time, for either vaccine, although children with low weight-for-height had a greater decline in antibody from 1 to 6 months post-vaccination.

CONCLUSIONS

Our analysis did not find protein-energy undernutrition to be associated with immunogenicity or waning of PsACWY- or PsA-TT-elicited antibody in children living in the African meningitis belt. Future studies should consider measuring antibody titers at additional time points post-vaccination, and for longer periods of time, to determine if the rate of antibody waning over a period of several years is associated with protein-energy undernutrition.

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.

Effectiveness of Seasonal Influenza Vaccination in Children in Senegal During a Year of Vaccine Mismatch: A Cluster-randomized Trial

BACKGROUND

The population effects of influenza vaccination in children have not been extensively studied, especially in tropical, developing countries. In rural Senegal, we assessed the total (primary objective) and indirect effectiveness of a trivalent inactivated influenza vaccine (IIV3).

METHODS

In this double-blind, cluster-randomized trial, villages were randomly allocated (1:1) for the high-coverage vaccination of children aged 6 months through 10 years with either the 2008-09 northern hemisphere IIV3 or an inactivated polio vaccine (IPV). Vaccinees were monitored for serious adverse events. All village residents, vaccinated and unvaccinated, were monitored for signs and symptoms of influenza illness using weekly home visits and surveillance in designated clinics. The primary outcome was all laboratory-confirmed symptomatic influenza.

RESULTS

Between 23 May and 11 July 2009, 20 villages were randomized, and 66.5% of age-eligible children were enrolled (3918 in IIV3 villages and 3848 in IPV villages). Follow-up continued until 28 May 2010. There were 4 unrelated serious adverse events identified. Among vaccinees, the total effectiveness against illness caused by the seasonal influenza virus (presumed to all be drifted A/H3N2, based on antigenic characterization data) circulating at high rates among children was 43.6% (95% confidence interval [CI] 18.6-60.9%). The indirect effectiveness against seasonal A/H3N2 was 15.4% (95% CI -22.0 to 41.3%). The total effectiveness against illness caused by the pandemic influenza virus (A/H1N1pdm09) was -52.1% (95% CI -177.2 to 16.6%).

CONCLUSIONS

IIV3 provided statistically significant, moderate protection to children in Senegal against circulating, pre-2010 seasonal influenza strains, but not against A/H1N1pdm09, which was not included in the vaccine. No indirect effects were measured. Further study in low-resource populations is warranted.

CLINICAL TRIALS REGISTRATION

NCT00893906.

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.

Senegal's Grand Magal of Touba: Syndromic Surveillance during the 2016 Mass Gathering

The Grand Magal of Touba (GMT) is an annual 1-day Muslim religious event that takes place in Touba in Senegal. The city of Touba swells from 800,000 to four million people during the GMT. All patients who attended one of the 154 dedicated medical care public healthcare structures of the medical region of Diourbel during the GMT were included in a cross-sectional survey from November 16 to November 21, 2016. Demographic, morbidity, and mortality data were collected on a daily basis using a standardized article form that allows data to be recorded in a free-text format. Data were obtained from a total of 20,850 healthcare encounters, and 30.9% patients were aged ≤ 15 years. The most frequent conditions were gastrointestinal and respiratory diseases. Most frequent gastrointestinal symptoms were abdominal and gastric pain, nausea and vomiting, and diarrhea, suggesting that most patients suffered gastroenteritis. The predominance of cough, rhinitis, influenza-like illness, and sore throat among patients with respiratory symptoms suggests that most patients suffered from upper respiratory tract infections. Other frequent symptoms were headaches and pain in various organs. Three percentage of patients were considered to have malaria, 29.8% of patients were prescribed antibiotics and 2.6% antimalarial drugs, and 1.5% of patients were hospitalized. Only one death was recorded. Preparedness of the medical infrastructure should target these syndromic features, in terms of diagnostic tools and specific treatments, including pediatric formulations. It is also essential to improve the quality and rapid availability of data to enable real-time analysis of medical events at the GMT and to implement a rapid response, if necessary.

[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.

Prevention and care of hepatitis B in the rural region of Fatick in Senegal: a healthcare workers' perspective using a mixed methods approach

Background

In countries where hepatitis B virus (HBV) is endemic, including Senegal, the World Health Organization recommends systematic HBV screening of pregnant women and vaccination at birth to prevent mother-to-child transmission (MTCT). This study investigated healthcare workers’ (HCW) knowledge and practices regarding HBV prevention and care in the rural region of Fatick in Senegal, as well as challenges they faced in implementing prevention activities related to HBV MTCT.

Methods

A mixed-methods survey was conducted between May–July 2017 among 112 HCW working in 15 healthcare facilities in two districts of the Fatick region using face-to-face questionnaires and semi-structured interviews. Descriptive statistics and chi-square/Mann-Whitney tests were used to analyze quantitative data, while qualitative data were analyzed thematically.

Results

The study population included 87 HCW in the quantitative component (83% women, median age [interquartile range, IQR] = 35 [31–40] years) and 11 in the qualitative component. A knowledge gap was observed in key areas of HBV infection: only 24, 51 and 38%, respectively, correctly reported that early HBV acquisition is associated with a high risk of developing chronic infection, that perinatal transmission is one of the main modes of HBV transmission in Senegal, and that three to four doses of HBV vaccine are required to ensure immunization in children. Despite good acceptability of systematic screening of pregnant women and vaccination at birth, only 48% of HCW mainly involved in prenatal care and 71% of those involved exclusively in vaccination routinely performed these two key interventions. HCW reported several structural barriers that may hinder their implementation: a lack of training in HBV and in counseling, poor availability of rapid diagnostic tests (RDT), high costs of both screening and treatment, a lack of adequate information on treatment options and missed opportunities for vaccination at birth.

Conclusions

HCW working in the Fatick region may be insufficiently trained and supported to effectively implement HBV prevention strategies. Our findings suggest an urgent need to strengthen MTCT prevention in this region, by improving HCW knowledge in key areas of HBV infection, providing RDT and antiviral treatment at low cost, and enhancing community-based interventions for the timely vaccination of newborns.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4416-3) contains supplementary material, which is available to authorized users.

Networks of face-to-face social contacts in Niakhar, Senegal

We present the first analysis of face-to-face contact network data from Niakhar, Senegal. Participants in a cluster-randomized influenza vaccine trial were interviewed about their contact patterns when they reported symptoms during their weekly household surveillance visit. We employ a negative binomial model to estimate effects of covariates on contact degree. We estimate the mean contact degree for asymptomatic Niakhar residents to be 16.5 (95% C.I. 14.3, 18.7) in the morning and 14.8 in the afternoon (95% C.I. 12.7, 16.9). We estimate that symptomatic people make 10% fewer contacts than asymptomatic people (95% C.I. 5%, 16%; p = 0.006), and those aged 0-5 make 33% fewer contacts than adults (95% C.I. 29%, 37%; p < 0.001). By explicitly modelling the partial rounding pattern observed in our data, we make inference for both the underlying (true) distribution of contacts as well as for the reported distribution. We created an estimator for homophily by compound (household) membership and estimate that 48% of contacts by symptomatic people are made to their own compound members in the morning (95% CI, 45%, 52%) and 60% in the afternoon/evening (95% CI, 56%, 64%). We did not find a significant effect of symptom status on compound homophily. We compare our findings to those from other countries and make design recommendations for future surveys.