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Background Representative data describing serious infections in children aged ≥5 years and adults in Africa are limited. Methods We conducted population-based surveillance for pneumonia, meningitis, and septicemia in a demographic surveillance area in The Gambia between 12 May 2008 and 31 December 2015. We used standardized criteria to identify, diagnose, and investigate patients aged ≥5 years using conventional microbiology and radiology. Results We enrolled 1638 of 1657 eligible patients and investigated 1618. Suspected pneumonia, septicemia, or meningitis was diagnosed in 1392, 135, and 111 patients, respectively. Bacterial pathogens from sterile sites were isolated from 105 (7.5%) patients with suspected pneumonia, 11 (8.1%) with suspected septicemia, and 28 (25.2%) with suspected meningitis. Streptococcus pneumoniae (n = 84), Neisseria meningitidis (n = 16), and Staphylococcus aureus (n = 15) were the most common pathogens. Twenty-eight (1.7%) patients died in hospital and 40 (4.1%) died during the 4 months after discharge. Thirty postdischarge deaths occurred in patients aged ≥10 years with suspected pneumonia. The minimum annual incidence was 133 cases per 100 000 person-years for suspected pneumonia, 13 for meningitis, 11 for septicemia, 14 for culture-positive disease, and 46 for radiological pneumonia. At least 2.7% of all deaths in the surveillance area were due to suspected pneumonia, meningitis, or septicemia. Conclusions Pneumonia, meningitis, and septicemia in children aged ≥5 years and adults in The Gambia are responsible for significant morbidity and mortality. Many deaths occur after hospital discharge and most cases are culture negative. Improvements in prevention, diagnosis, inpatient, and follow-up management are urgently needed. [ABSTRACT FROM AUTHOR]

Many plant species adapted to semi-arid environments are grown in the Sahelian region in northern Africa. One such species is Acacia seyal (Delile), a multipurpose leguminous tree grown in various agroecological zones, including saline soils. These challenging arid and semi-arid environments harbor a diversity of arbuscular mycorrhizal fungi (AMF) communities that can develop symbiotic associations with plants to improve their hydromineral nutrition. This study compared the effects of native AMF communities isolated from semi-arid sites (high, moderate, and low salinity zones Ndiafate, Ngane, and Bambey, respectively) and the AMF Rhizoglomus aggregatum on the development and phosphate nutrition of A. seyal seedlings subject to three salinity treatments (0, 340, and 680 mM). Plant height, dry matter weight of the shoots and roots, and phosphorus uptake from the soil were measured. Plants inoculated with AMF native species from each site that were provided with up to 340 mM of NaCl had greater shoot height than plants grown under 680 mM salinity. At NaCl concentrations above 340 mM, shoot and root development of A. seyal seedlings diminished. However, dry matter production of shoots (7%) and roots (15%) improved following AMF inoculation compared with the control (respectively 0.020 and 0.07 g for shoots and roots). When inoculated with AMF isolates from the high salinity zone (Ndiafate), phosphate content/nutrition was increased by 10% around 30 days after inoculation compared with non-inoculated seedlings (2.84 mg/kg of substrate). These results demonstrate that native AMF inoculants are capable of helping plants withstand environmental constraints, especially those exposing plants to harsh climatic conditions. We discuss insights on how AMF influences the interplay between soil phosphorus and perceived salinity that may have implications for broader relationships between plants and symbiotic fungi. [ABSTRACT FROM AUTHOR]

The hydraulic model is a set of closed-form, deterministic equations used to predict average crowd speeds and movement times of evacuees exiting a building. The standard SFPE hydraulic model assumes that crowd speed is only influenced by crowd congestion and type of terrain, when in fact, it is also affected heavily influenced by smoke, which not only causes evacuees to slow down due to poorer visibility but may also force them to switch a different movement mode: crawling. This paper gathers and refines empirical data from various published experiments involving individuals and groups moving through smoke by walking upright and crawling, to establish two new variants of the hydraulic model describing the movement of crowds through smoke by the two movement modes. [ABSTRACT FROM AUTHOR]

Background: The ongoing revolution in health care, driven by wearable technology, virtual reality, and the Internet of Things, is reshaping both health care operations and our daily lives. This digital transformation ensures broader access to health care options, fosters patient-centered care and affects both health care institutions and individuals. In Sweden, health care is undergoing a digital shift, with initiatives like personal health management, remote monitoring, and virtual care enhancing patient involvement. This article reviews Sweden's health care digital transformation and compares it with the United Arab Emirates (UAE's) initiatives to assess viability. Methods: Using systematic literature review methods, databases from 2011 to 2023 were searched, supplemented by reference lists. Results: Database searches identified 761 records. A total of 480 articles were screened on basis of title and abstract, yielding 184 that were assessed for eligibility, leading to 40 academic studies to be included and 12 grey literature. Conclusions: The findings highlight Sweden's success in empowering patients through enhanced connectivity with clinical teams, knowledge sharing, and care management. However, due to contextual differences, the UAE should not blindly replicate Sweden's strategy. In conclusion, Sweden's efforts have positively engaged patients in health care, but challenges such as emerging technologies, demographic shifts, and budget constraints persist. Proactive planning and adaptation are crucial, with lessons applicable to the UAE market. Establishing a clear regulatory framework for digital care is imperative for future resilience. [ABSTRACT FROM AUTHOR]

The prediction of intercity distances by means of distance functions has been widely discussed in the field of location analysis. In this study, we develop distance parameter estimations for the region of Saudi Arabia, using two different methodologies for two commonly used functions, the weighted l norm and the $${l_{b_1,b_2, \theta}}$$ norm. We first use a more traditional approach of determining global parameters for the country taking into consideration the cities spread across the region. In a second approach, we introduce separate city-wise parameters for all considered cities and use the result to present a new parametric distance map for the country. Finally, we determine the confidence interval of the distance estimators for the two approaches to show that the new mapping method provides consistently a better interval estimates. [ABSTRACT FROM AUTHOR]

Introducing sorghum (Sorghum bicolor L. Moench) genotypes into new environments is necessary for expanding the production of food and fuel, but these efforts are complicated by significant genotype × environment interactions that can reduce their effectiveness. This study set out to thoroughly analyze genotype × environment interactions and assess trade-offs between the agronomic performance and the stability of grain and biomass yields of ten contrasting genotypes under Sudano-Sahelian conditions. Experiments were carried out in a randomized complete block design with four replicates. They were conducted from 2013 to 2016 in Bambey, Sinthiou Malem and Nioro du Rip in Senegal. The joint analysis of variance revealed a highly significant effect (p < 0.0001) of genotypes (G), environments (E) and G × E interaction. Most genotypes showed specific adaptations. The best grain yields were obtained by the Nieleni and Fadda hybrids, while the improved varieties IS15401 and SK5912 were best for biomass production. An Additive Main effect and Multiplicative Interaction (AMMI) analysis showed that good grain yields were associated with environments having good soil fertility and good rainfall, while biomass yields were more influenced by the sowing date and rainfall. Similarly, we were able to confirm for our 10 sorghum genotypes that yield stability was generally associated with low performance, except for the Nieleni and Fadda hybrids, which performed well for grain and biomass production regardless of the environment. The Senegalese control genotype, 621B, showed particular susceptibility to growing conditions (soil), but remained very productive (more than 3 tons per hectare) under good agro-pedological conditions. These results lead us to recommend the Fadda and Nieleni hybrids for the entire study region, while 621B can also be recommended, but only for highly specific environments with good soils. [ABSTRACT FROM AUTHOR]

Poorly tolerated cardiac rhythm disorders in the newborn are a real emergency requiring early and adequate management. We here report the case of 15-day old newborn with atrial tachycardia associated with acute heart failure requiring electrical cardioversion. [ABSTRACT FROM AUTHOR]

A petrochemical industry produces multiple grades of products along with a significant amount of ‘off-spec’ grades which are bi-products resulting from a transition phase between production of any two grades. While the optimization of grades production in different reactors is important, it is equally important to minimize the production of off-spec grades to minimize loss and reduce safety risks imposed on the reactor in every transition. The production of off-spec grades depends on many factors, particularly the number of grades produced in the reactor and the nature and duration of the transitions. In this study, an adoption of a ‘focused plant’ approach is used that meets the demand of different grades by assigning limited or focused grades to selected reactors based on their capabilities and constraints. A mixed-integer linear programming model is presented to determine the optimum grades selection for focused reactors of a plant and the quantity to be produced in each reactor to maximize overall profit. The model is applied on a case study with six reactors and twelve grades over a period of 1 year. [ABSTRACT FROM AUTHOR]

Thyroid gland is an endocrine gland playing a major role in energy and phosphocalcic metabolism, among others. It commonly occurs in the anterior cervical and pretracheal region. Ectopic thyroid is quite rare. It is dominated by ectopic basilingual thyroid. We here report the case of a patient with goiter in normal cervical position (eutopic) and ectopic thyroid tissue in basicervical position. Cervicotomy revealed the ectopic nodule and the diagnosis was confirmed by histology. This clinical case illustrates a differential diagnosis of cervical masses. [ABSTRACT FROM AUTHOR]

Background: The introduction in many countries of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to significant reductions in acute bacterial meningitis (ABM) in children. However, recent population-based data on ABM in sub-Saharan Africa are limited. Methods: Population-based surveillance for meningitis was carried out in a rural area of The Gambia under demographic surveillance from 2008 to 2017, using standardised criteria for referral, diagnosis and investigation. We calculated incidence using population denominators. Results: We diagnosed 1,666 patients with suspected meningitis and collected cerebrospinal fluid (n = 1,121) and/or blood (n = 1,070) from 1,427 (88%) of cases. We identified 169 cases of ABM, 209 cases of suspected non-bacterial meningitis (SNBM) and 1,049 cases of clinically suspected meningitis (CSM). The estimated average annual incidence of ABM was high at 145 per 100,000 population in the <2-month age group, 56 per 100,000 in the 2–23-month age group, but lower at 5 per 100,000 in the 5–14-year age group. The most common causes of ABM were Streptococcus pneumoniae (n = 44), Neisseria meningitidis (n = 42), and Gram-negative coliform bacteria (n = 26). Eighteen of 22 cases caused by pneumococcal serotypes included in PCV13 occurred prior to vaccine introduction and four afterwards. The overall case fatality ratio for ABM was 29% (49/169) and was highest in the <2-month age group 37% (10/27). The case fatality ratio was 8.6% (18/209) for suspected non-bacterial meningitis and 12.8% (134/1049) for clinically suspected meningitis cases. Conclusions: Gambian children continue to experience substantial morbidity and mortality associated with suspected meningitis, especially acute bacterial meningitis. Such severely ill children in sub-Saharan Africa require improved diagnostics and clinical care. [ABSTRACT FROM AUTHOR]

Improving maize yield is an objective of utmost importance for food security in Uganda. In the evaluation of soil microorganisms in crop production, it is important to assess the composition and diversity of the arbuscular mycorrhizal fungi (AMF) species in different agroecosystems. AMF play an important role in improving crop growth and yield. We present a study of the morphological diversity of native AMF species associated with the rhizosphere of maize in two locations in eastern Uganda (the Amuria and Serere districts). The effects of soil chemical properties on this diversity are also assessed. AMF diversity is assessed by the morphological identification of the spores extracted from soils samples by the wet sieving method. Spores abundance, species richness, and diversity are determined. A total of 19 AMF morphotypes distributed in 7 genera (Gigaspora, Scutellospora, Glomus, Acaulospora, Archaeospora, Entrophospora, and Paraglomus) are observed. Glomus species are abundant in all sites. Spore densities are higher in Amuria than in Serere. Soil pH, CEC, and phosphorus content influence AMF distribution. Finding the species in various agroecological environments indicates that they are adapted to the environments. Maize grown in eastern Uganda is associated with a diversity of AMF that could be selected as bio-fertilizers to improve crop production. [ABSTRACT FROM AUTHOR]

Background: We investigated the pathogenesis of pneumococcal pneumonia using clinical specimens collected for pneumonia surveillance in The Gambia.Methods: Lung aspirates and nasopharyngeal swabs from 31 patients were examined by culture, quantitative polymerase chain reaction (qPCR), whole genome sequencing, serotyping, and reverse-transcription qPCR.Results: Five lung aspirates cultured pneumococci, with a matching strain identified in the nasopharynx. Three virulence genes including ply (pneumolysin) were upregulated >20-fold in the lung compared with the nasopharynx. Nasopharyngeal pneumococcal density was higher in pediatric pneumonia patients compared with controls (P < .0001).Conclusions: Findings suggest that changes in pneumococcal gene expression occurring in the lung environment may be important in pathogenesis. [ABSTRACT FROM AUTHOR]

The financial data supply chain is vital to the economy, especially for banks. It affects their customer service level, therefore, it is crucial to manage the scheduling of the financial data supply chain to elevate the efficiency of banking sectors' performance. The primary tool used in the data supply chain is data batch processing which requires efficient scheduling. This work investigates the problem of scheduling the processing of tasks with non-identical sizes and different priorities on a set of parallel processors. An iterative dynamic scheduling algorithm (DCSDBP) was developed to address the data batching process. The objective is to minimize different cost types while satisfying constraints such as resources availability, customer service level, and tasks dependency relation. The algorithm proved its effectiveness by allocating tasks with higher priority and weight while taking into consideration customers' Service Level Agreement, time, and different types of costs, which led to a lower total cost of the batching process. The developed algorithm proved effective by testing it on an illustrative network. Also, a sensitivity analysis is conducted by varying the model parameters for networks with different sizes and complexities to study their impact on the total cost and the problem under study. [ABSTRACT FROM AUTHOR]

Background: The Gambia introduced seven-valent pneumococcal conjugate vaccine (PCV7) in August 2009, followed by PCV13 in May, 2011, using a schedule of three primary doses without a booster dose or catch-up immunisation. We aimed to assess the long-term impact of PCV on disease incidence.Methods: We did 10 years of population-based surveillance for invasive pneumococcal disease (IPD) and WHO defined radiological pneumonia with consolidation in rural Gambia. The surveillance population included all Basse Health and Demographic Surveillance System residents aged 2 months or older. Nurses screened all outpatients and inpatients at all health facilities using standardised criteria for referral. Clinicians then applied criteria for patient investigation. We defined IPD as a compatible illness with isolation of Streptococcus pneumoniae from a normally sterile site (cerebrospinal fluid, blood, or pleural fluid). We compared disease incidence between baseline (May 12, 2008-May 11, 2010) and post-vaccine years (2016-2017), in children aged 2 months to 14 years, adjusting for changes in case ascertainment over time.Findings: We identified 22 728 patients for investigation and detected 342 cases of IPD and 2623 cases of radiological pneumonia. Among children aged 2-59 months, IPD incidence declined from 184 cases per 100 000 person-years to 38 cases per 100 000 person-years, an 80% reduction (95% CI 69-87). Non-pneumococcal bacteraemia incidence did not change significantly over time (incidence rate ratio 0·88; 95% CI, 0·64-1·21). We detected zero cases of vaccine-type IPD in the 2-11 month age group in 2016-17. Incidence of radiological pneumonia decreased by 33% (95% CI 24-40), from 10·5 to 7·0 per 1000 person-years in the 2-59 month age group, while pneumonia hospitalisations declined by 27% (95% CI 22-31). In the 5-14 year age group, IPD incidence declined by 69% (95% CI -28 to 91) and radiological pneumonia by 27% (95% CI -5 to 49).Interpretation: Routine introduction of PCV13 substantially reduced the incidence of childhood IPD and pneumonia in rural Gambia, including elimination of vaccine-type IPD in infants. Other low-income countries can expect substantial impact from the introduction of PCV13 using a schedule of three primary doses.Funding: Gavi, The Vaccine Alliance; Bill & Melinda Gates Foundation; UK Medical Research Council; Pfizer Ltd. [ABSTRACT FROM AUTHOR]

Soil nutrient deficiency and rainfall variability impair the production of sorghum (Sorghum bicolor (L). Moench) in Sudano-Sahelian zone. The aim is to study the environmental factors that can determine the effect of fertilizer application on sorghum grain yield and to formulate tailored fertilization strategies according to sorghum varieties (hybrid and open pollinated improved varieties) and environmental context. Field experiments were conducted during the 2015 and 2016 growing seasons in Nioro du Rip and in Sinthiou Malème (Senegal). In a randomized complete block design arranged in a split-plot with four replications, three factors were tested: sorghum genotype (G: Fadda, Faourou, Soumalemba and Soumba with different cycle lengths), environment (E: irrigation and rainfed, different soil types and fertility levels), and fertilization management (M: five different combinations of application dose and application time) including T1 = no fertilizer applied; T2 (recommended practice, 100%) = 150 kg/ha of NPK (15-15-15) at emergence + 50 Kg/ha of urea (46%) at tillering + 50 kg/ha of urea at stem extension; T3 = 50% T2; T4 (100% delay) = 150 kg/ha of NPK +50 kg/ha of urea at stem extension +50 kg/ha of urea at heading ; T5 = 50% T4. Results showed that: (i) in most environments, stressed plants under late application treatments (T4 and T5) recovered biomass once the fertilizer was applied (ii); grain yield with T5 was higher than with T4 under well-watered conditions (sufficient and well distributed rainfall and eventual complementary irrigations) ; (iii) Fadda, a hybrid, responded differently to fertilization than the other varieties only for biomass production, (iv) late fertilizer application treatment (T4) gave higher grain yield than the recommended practice (T2) in the environment with low yield potential, and (v) long cycle duration genotypes benefited better from late fertilization compared to short cycle duration genotypes. This study showed that under Sudano-Sahelian conditions late fertilization of sorghum can be beneficial to grain yield if the rainy season has a slow start, depending on sorghum genotypes (i.e., cycle length), and on the initial N content of the soil. [ABSTRACT FROM AUTHOR]

Lesions of the inferior laryngeal nerve are the most devastating complications of thyroid surgery. Identifying the inferior laryngeal nerve is all the more difficult when its path is atypical. We report a case of right non-recurrent inferior laryngeal nerve detected during thyroidectomy. [ABSTRACT FROM AUTHOR]

Introduction: Inverted Papilloma (IP) is a rare benign tumour of the nose and paranasal sinuses histologically characterized by invagination of the outer layer of the epithelium in the underlying chorion. Its most distinctive feature is a strong local aggressiveness, a tendency to recur and an unpredictable risk of association with epidermoid carcinoma. The purpose of this study was to report the epidemiological, clinical, paraclinical data as well as to assess the outcomes of endoscopic endonasal surgery. Methods: we conducted a retrospective study on a series of 13 patients whose data were collected in the Oto-Rhino-Laryngology at the National University Hospital Center of Fann, from 1st January 2012 to 31st December 2017. All patients followed up for inverted papilloma confirmed by anathomopathological examination were included in the study. Results: the average age of patients was 44 years, the sex-ratio was 2.25. All patients had nasal obstruction; 53% of them had rhinorrhea followed by epistaxis in 30% of cases. Right-sided symptoms were reported by 69% of patients, left-sided symptoms by 23% and bilateral symptoms by 7% of patients. Anterior rhinoscopy showed endonasal mass in all patients. All patients underwent CT scan; the MRI was performed in a single patient. Endoscopic resection of IP was performed in 10 patients (76.9%) while external approach was used in 23% of cases. Surgery helped to clarify where the tumor had originated: in 46% of cases in the maxillary sinus, in 15% in the lower nasal turbinate, in 15% in the mid-turbinate, in 7% in the ethmoid bulla and in 7% in the lateral wall of the nasal fossa. One patient had recurrence after an average period of 26 months. Malignant transformation to squamous cell carcinoma occurred in one patient. Conclusion: inverted papilloma is a very aggressive tumor. CT scan is essential to highlight its spread, especially to bone. The advent of endoscopic surgery has revolutionised treatment, providing excellent results. But, there is nevertheless a risk of recurrence after surgery which motivates an indication for long term monitoring. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus bacteremia is a substantial cause of childhood disease and death, but few studies have described its epidemiology in developing countries. Using a population-based surveillance system for pneumonia, sepsis, and meningitis, we estimated S. aureus bacteremia incidence and the case-fatality ratio in children <5 years of age in 2 regions in the eastern part of The Gambia during 2008-2015. Among 33,060 children with suspected pneumonia, sepsis, or meningitis, we performed blood culture for 27,851; of 1,130 patients with bacteremia, 198 (17.5%) were positive for S. aureus. S. aureus bacteremia incidence was 78 (95% CI 67-91) cases/100,000 person-years in children <5 years of age and 2,080 (95% CI 1,621-2,627) cases/100,000 person-years in neonates. Incidence did not change after introduction of the pneumococcal conjugate vaccine. The case-fatality ratio was 14.1% (95% CI 9.6%-19.8%). Interventions are needed to reduce the S. aureus bacteremia burden in The Gambia, particularly among neonates. [ABSTRACT FROM AUTHOR]

We report a case of metastasis to the gingiva of breast carcinoma. The breast tumor was treated with neoadjuvant chemotherapy followed by a radical mastectomy associated with axillary dissection. The gingival lesion occurred 7 months after surgery; the metastasis was confirmed by a biopsy. [ABSTRACT FROM AUTHOR]

Objectives. To describe reoperative thyroid surgeries in our department. Study Design. Retrospective cross-sectional and descriptive study at the Ouakam Military Hospital in Dakar (Senegal), over a period of eight and a half years. Methods. The study involved all records of patients who had a reoperative thyroidectomy regardless of the indication and time of the second surgery. Parameters evaluated for first and reoperative surgery were time interval between the two surgeries, operative indications, surgical procedures, intraoperative findings, pathological examination, and morbidity. Results. 30 records of patients were selected out of a total of 698 thyroidectomies (4.3%). Thyroid cancers diagnosed on first surgical specimens were the first indications of reoperations (46.67%) followed by neck hematoma (20%). Completion thyroidectomy with a prophylactic central lymph nodes dissection was the most performed surgical procedure (43.33%) followed by haemostasis (20%). During reoperation, we found active bleeding (20%), textiloma (6.67%), and fourth branchial cleft fistula (3.33%). The morbidity accounted for 10%: lymphorrhea, permanent hypocalcemia, and permanent recurrent nerve palsy, in one case, respectively. There were no statistically significant differences between the morbidity in patients reoperated on and the one for patients operated on once. Conclusion. We did not find an increased risk of postoperative morbidity after reintervention. [ABSTRACT FROM AUTHOR]

Background: Pneumococcal conjugate vaccines (PCVs) are used in many low-income countries but their impact on the incidence of pneumonia is unclear. The Gambia introduced PCV7 in August, 2009, and PCV13 in May, 2011. We aimed to measure the impact of the introduction of these vaccines on pneumonia incidence.Methods: We did population-based surveillance and case-control studies. The primary endpoint was WHO-defined radiological pneumonia with pulmonary consolidation. Population-based surveillance was for suspected pneumonia in children aged 2-59 months (minimum age 3 months in the case-control study) between May 12, 2008, and Dec 31, 2015. Surveillance for the impact study was limited to the Basse Health and Demographic Surveillance System (BHDSS), whereas surveillance for the case-control study included both the BHDSS and Fuladu West Health and Demographic Surveillance System. Nurses screened all outpatients and inpatients at all health facilities in the surveillance area using standardised criteria for referral to clinicians in Basse and Bansang. These clinicians recorded clinical findings and applied standardised criteria to identify patients with suspected pneumonia. We compared the incidence of pneumonia during the baseline period (May 12, 2008, to May 11, 2010) and the PCV13 period (Jan 1, 2014, to Dec 31, 2015). We also investigated the effectiveness of PCV13 using case-control methods between Sept 12, 2011, and Sept 31, 2014. Controls were aged 90 days or older, and were eligible to have received at least one dose of PCV13; cases had the same eligibility criteria with the addition of having WHO-defined radiological pneumonia.Findings: We investigated 18 833 children with clinical pneumonia and identified 2156 cases of radiological pneumonia. Among children aged 2-11 months, the incidence of radiological pneumonia fell from 21·0 cases per 1000 person-years in the baseline period to 16·2 cases per 1000 person-years (23% decline, 95% CI 7-36) in 2014-15. In the 12-23 month age group, radiological pneumonia decreased from 15·3 to 10·9 cases per 1000 person-years (29% decline, 12-42). In children aged 2-4 years, incidence fell from 5·2 to 4·1 cases per 1000 person-years (22% decline, 1-39). Incidence of all clinical pneumonia increased by 4% (-1 to 8), but hospitalised cases declined by 8% (3-13). Pneumococcal pneumonia declined from 2·9 to 1·2 cases per 1000 person-years (58% decline, 22-77) in children aged 2-11 months and from 2·6 to 0·7 cases per 1000 person-years (75% decline, 47-88) in children aged 12-23 months. Hypoxic pneumonia fell from 13·1 to 5·7 cases per 1000 person-years (57% decline, 42-67) in children aged 2-11 months and from 6·8 to 1·9 cases per 1000 person-years (72% decline, 58-82) in children aged 12-23 months. In the case-control study, the best estimate of the effectiveness of three doses of PCV13 against radiological pneumonia was an adjusted odds ratio of 0·57 (0·30-1·08) in children aged 3-11 months and vaccine effectiveness increased with greater numbers of doses (p=0·026). The analysis in children aged 12 months and older was underpowered because there were few unvaccinated cases and controls.Interpretation: The introduction of PCV in The Gambia was associated with a moderate impact on the incidence of radiological pneumonia, a small reduction in cases of hospitalised pneumonia, and substantial reductions of pneumococcal and hypoxic pneumonia in young children. Low-income countries that introduce PCV13 with reasonable coverage can expect modest reductions in hospitalised cases of pneumonia and a marked impact on the incidence of severe childhood pneumonia.Funding: GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan, Bill & Melinda Gates Foundation, and UK Medical Research Council. [ABSTRACT FROM AUTHOR]

Background: Little information is available about the effect of pneumococcal conjugate vaccines (PCVs) in low-income countries. We measured the effect of these vaccines on invasive pneumococcal disease in The Gambia where the 7-valent vaccine (PCV7) was introduced in August, 2009, followed by the 13-valent vaccine (PCV13) in May, 2011.Methods: We conducted population-based surveillance for invasive pneumococcal disease in individuals aged 2 months and older who were residents of the Basse Health and Demographic Surveillance System (BHDSS) in the Upper River Region, The Gambia, using standardised criteria to identify and investigate patients. Surveillance was done between May, 2008, and December, 2014. We compared the incidence of invasive pneumococcal disease between baseline (May 12, 2008-May 11, 2010) and after the introduction of PCV13 (Jan 1, 2013-Dec 31, 2014), adjusting for changes in case ascertainment over time.Findings: We investigated 14 650 patients, in whom we identified 320 cases of invasive pneumococcal disease. Compared with baseline, after the introduction of the PCV programme, the incidence of invasive pneumococcal disease decreased by 55% (95% CI 30-71) in the 2-23 months age group, from 253 to 113 per 100 000 population. This decrease was due to an 82% (95% CI 64-91) reduction in serotypes covered by the PCV13 vaccine. In the 2-4 years age group, the incidence of invasive pneumococcal disease decreased by 56% (95% CI 25-75), from 113 to 49 cases per 100 000, with a 68% (95% CI 39-83) reduction in PCV13 serotypes. The incidence of non-PCV13 serotypes in children aged 2-59 months increased by 47% (-21 to 275) from 28 to 41 per 100 000, with a broad range of serotypes. The incidence of non-pneumococcal bacteraemia varied little over time.Interpretation: The Gambian PCV programme reduced the incidence of invasive pneumococcal disease in children aged 2-59 months by around 55%. Further surveillance is needed to ascertain the maximum effect of the vaccine in the 2-4 years and older age groups, and to monitor serotype replacement. Low-income and middle-income countries that introduce PCV13 can expect substantial reductions in invasive pneumococcal disease.Funding: GAVI's Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP), Bill & Melinda Gates Foundation, and the UK Medical Research Council. [ABSTRACT FROM AUTHOR]

Objective: To measure mortality and its risk factors among children discharged from a health centre in rural Gambia. Methods: We conducted a cohort study between 12 May 2008 and 11 May 2012. Children aged 2–59 months, admitted with suspected pneumonia, sepsis, or meningitis after presenting to primary and secondary care facilities, were followed for 180 days after discharge. We developed models associating post-discharge mortality with clinical syndrome on admission and clinical risk factors. Findings: One hundred and five of 3755 (2.8%) children died, 80% within 3 months of discharge. Among children aged 2–11 and 12–59 months, there were 30 and 29 deaths per 1000 children per 180 days respectively, compared to 11 and 5 respectively in the resident population. Children with suspected pneumonia unaccompanied by clinically severe malnutrition (CSM) had the lowest risk of post-discharge mortality. Mortality increased in children with suspected meningitis or septicaemia without CSM (hazard ratio [HR] 2.6 and 2.2 respectively). The risk of mortality greatly increased with CSM on admission: CSM with suspected pneumonia (HR 8.1; 95% confidence interval (CI) 4.4 to 15), suspected sepsis (HR 18.4; 95% CI 11.3 to 30), or suspected meningitis (HR 13.7; 95% CI 4.2 to 45). Independent associations with mortality were: mid-upper arm circumference (MUAC) of 11.5–13.0 cm compared to >13.0 cm (HR 7.2; 95% CI 3.0 to 17.0), MUAC 10.5–11.4 cm (HR 24; 95% CI 9.4 to 62), and MUAC <10.5 cm (HR 44; 95% CI 18 to 108), neck stiffness (HR 10.4; 95% CI 3.1 to 34.8), non-medical discharge (HR 4.7; 95% CI 2.0 to 10.9), dry season discharge (HR 2.0; 95% CI 1.2 to 3.3), while greater haemoglobin (HR 0.82; 0.73 to 0.91), axillary temperature (HR 0.71; 95% CI 0.58 to 0.87), and oxygen saturation (HR 0.96; 95% CI 0.93 to 0.99) were associated with reduced mortality. Conclusion: Gambian children experience increased mortality after discharge from primary and secondary care. Interventions should target both moderately and severely malnourished children. [ABSTRACT FROM AUTHOR]

Abstract: Activation of dendritic cells (DCs) during malaria is poorly documented and has mainly been studied in rodent models. We conducted studies in Senegal to better understand the relationship between DC subset activation and susceptibility of pregnant women to malaria. For each woman, samples were collected at delivery from peripheral (WB), placental (PB) and cord blood (CB). The ex vivo phenotypes of DCs were assessed using flow cytometry on whole blood. The percentage of total DCs was the same for malaria-infected or non-infected pregnant women, except for PB where a decrease in DCs was observed during infection. Lymphoid dendritic cells (LDC) also decreased in the three blood compartments of infected pregnant women and less differentiated DCs (ldDCs) increased. During infection, Human Leucocyte Antigen DR (HLA-DR) expression decreased on LDCs, myeloid DCs (MDCs) and ldDCs. IL-10 increased in the three blood compartments. These data demonstrate a modulation of DC sub-populations during placental malaria. A decrease in LDCs during placental malaria could trigger major alterations in the immune response and a change in the Th1/Th2 balance. However, elevated IL-10 observed during infection substantiates a normal micro-environment triggering normal production of DCs. The decrease in LDCs could thus be due to their migration towards spleen or other lymphoid organs. [Copyright &y& Elsevier]

Presents a study in which the incorporation of clear procedures for obtaining individual informed consent were evaluated. The study taking place in a rural community in Senegal during the process of conducting a study on a pertussis vaccine; Methods of the study; Results; Discussion; References.