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Despite all knowledge acquired regarding the mutational profile of pediatric myelodysplastic syndrome (MDS), the somatic genomic landscape underlying that disease remains unclear. We evaluated the presence of somatic variants in 37 genes related to myeloid malignancies through targeted NGS in 20 Brazilian patients with refractory cytopenia of childhood (RCC). Only 15% (3/20) of patients showed at least one somatic driver mutation – all in genes coding to regulators of cell signaling (TP53 and CBLB) or epigenetics (ASXL1 and DNMT3A). Interestingly, those variants were identified in patients with no detected clonal chromosomal abnormalities.

Summary Background Staging and treatment of human African trypanosomiasis caused by Trypanosoma brucei gambiense (g-HAT) required lumbar puncture to assess cerebrospinal fluid (CSF) and intravenous drugs that cross the blood–brain barrier for late-stage infection. These procedures are inconvenient in rural health systems of disease-endemic countries. A pivotal study established fexinidazole as the first oral monotherapy to be effective against non-severe stage 2 g-HAT. We aimed to assess the safety and efficacy of fexinidazole in early g-HAT. Methods In this prospective, multicentre, open-label, single-arm cohort study, patients with stage 1 or early stage 2 g-HAT were recruited from eight treatment centres in the Democratic Republic of the Congo. Primary inclusion criteria included being older than 15 years, being able to ingest at least one complete meal per day (or at least one sachet of Plumpy'Nut®), a Karnofsky score higher than 50, evidence of trypanosomes in the blood or lymph but no evidence of trypanosomes in the CSF, willingness to be admitted to hospital to receive treatment, having a permanent address, and being able to comply with the follow-up visit schedule. Exclusion criteria included severe malnutrition, inability to take medication orally, pregnant or breastfeeding women, any clinically important medical condition that could jeopardise patient safety or participation in the study, severely deteriorated general status, any contraindication to imidazole drugs, HAT treatment in the past 2 years, previous enrolment in the study or previous intake of fexinidazole, abnormalities on electrocardiogram that did not return to normal in pretreatment repeated assessments or were considered clinically important, QT interval corrected using Fridericia's formula of at least 450 ms, and patients not tested for malaria or not having received appropriate treatment for malaria or for soil-transmitted helminthiasis. Patients were classified into stage 1 or early stage 2 g-HAT groups following evidence of trypanosomes in the blood, lymph, and absence in CSF, and using white-blood-cell count in CSF. Patients received 1800 mg fexinidazole once per day on days 1–4 then 1200 mg fexinidazole on days 5–10. Patients were observed for approximately 19 months in total. Study participants were followed up on day 5 and day 8 during treatment, at end of treatment on day 11, at end of hospitalisation on days 11–18, at week 9 for a subset of patients, and after 6 months, 12 months, and 18 months. The primary endpoint was treatment success at 12 months. Safety was assessed through routine monitoring. Analyses were done in the intention-to-treat population. The acceptable success rate was defined as treatment efficacy in more than 80% of patients. This study is completed and registered with ClinicalTrials.gov ( NCT02169557 ). Findings Patients were enrolled between April 30, 2014, and April 25, 2017. 238 patients were recruited: 195 (82%) patients with stage 1 g-HAT and 43 (18%) with early stage 2 g-HAT. 189 (97%) of 195 patients with stage 1 g-HAT and 41 (95%) of 43 patients with early stage 2 g-HAT were finally included and completed the 10 day treatment period. Three patients with stage 1 g-HAT died after the 10 day treatment period and before the 12 month primary follow-up visit, considered as treatment failure and were withdrawn from the study. Treatment was effective at 12 months for 227 (99%) of 230 patients (95% CI 96·2–99·7): 186 (98%) of 189 patients (95·4–99·7) with stage 1 and 41 (100%) of 41 patients (91·4–100·0) with early stage 2, indicating that the primary study endpoint was met. No new safety issues were observed. The most frequent adverse events were headache and vomiting. In total, 214 (93%) of 230 patients had treatment-emergent adverse events, mainly common-terminology criteria for adverse events grades 1 to 3. None led to treatment discontinuation. Interpretation Fexinidazole is a valuable first-line treatment option in the early stages of g-HAT. Funding Through the Drugs for Neglected Diseases initiative: the Bill & Melinda Gates Foundation, the Republic and Canton of Geneva (Switzerland), the Dutch Ministry of Foreign Affairs (also known as DGIS; Netherlands), the Norwegian Agency for Development Cooperation (also known as Norad; Norway), the Federal Ministry of Education and Research (also known as BMBF) through KfW (Germany), the Brian Mercer Charitable Trust (UK), and other private foundations and individuals from the HAT campaign. Translation For the French translation of the abstract see Supplementary Materials section.

Background and aim: Access to contraceptive methods remains low in the world in general and in Sub-Saharan Africa (SSA). Data of these contraceptive methods in rural areas of the Democratic Republic of Congo (DRC) remain poorly known. The aim is to identify the socio-demographic characteristics of clients associated with purchasing contraceptives methods via different distribution system in Kongo Central province. Methods: Cross-sectional study including data from mini Lelo Family Planning contraceptive method distribution campaigns organized in 11 health zones of Kongo Central province, from January to March 2020 by community-based distributors (DBC), learner DBCs (DBCa), graduated DBCs (DBCg) and clinical providers (CP). Results: The median age of clients was 25 years old. A quarter of them were men and almost half of the clients were in a conjugal relationship and 46.5% were single. The majority (70.4%) had a high school education. The male condom was the most requested method during Lelo Family Planning, followed by implants. Natural methods remain the methods preferred by clients 25 years. Among the hormonal methods, the implant was the most popular modern method, while the short and long-lasting injectable hormonal methods were more in demand by women Conclusion: Natural methods are still the most preferred among male clients despite the poor protection they provide. Modern methods have to be promoted for male’s partners to assure better couple protection especially in rural area where maternal mortality remains high.

Falsified antibacterial agents continue to pose serious public health problems around the world. They are notably responsible for resistance emergence in the treatment of infectious diseases that can lead to death. The aim of this study was to summarize the literature on the methods developed and validated to detect poor quality antibacterial agents in order to assess the impact of these available methods in the fighting against Counterfeit/substandard medicines. Thus, studies published in the time from January 2000 to July 2017, were accessible via Google Scholar and Pubmed and allowed to analyze 41 papers. The majority (30) of developed and validated methods concerned LC methods, 9 regarded UV/V is spectrophotometry and two studies simultaneously developed both methods. Antibacterial agents belonging to beta-lactams group were the most concerned by the methods developed and validated (39%), followed by quinolones (18%) and macrolides (12%). Regarding active ingredients, amoxicillin (12%) was the most concerned by the development and validation methods. In spite of several available methods to detect substandard drugs, antibacterial agents for which methods were developed and validated were the most concerned by worldwide detected non-conformities. The fight against this scourge should not be only limited by their detection, but it also requires an effective involvement of different actors notably: health authorities, international organizations, pharmaceutical industries etc.

Objectif : L’objectif de cette etude etait d’identifier les facteurs associes a la survie chez les detenus a la prison centrale de Mbuji-Mayi, situee en Republique democratique du Congo, entre janvier 2014 et decembre 2016.Methodes : Il s’agit d’une etude de cohorte retrospective. Le taux de mortalite a ete calcule durant la periode de suivi de trois ans et la courbe de survie de Kaplan-Meier determinee. La regression de Cox et le rapport de risque (HR) ont ete utilises pour analyser et quantifier les facteurs associes a la survie. L’etude a porte sur un total de 793 detenus.Resultats : L’âge moyen des detenus etait de 33 ± 10 ans (extremes : 17-67 ans) La duree mediane de suivi etait de 12 mois pour un total de 7 513 personnes-mois. Le nombre de deces repertorie etait de 135, soit un taux de mortalite de 17,9/1 000 personnes-mois. Les facteurs de risque associes au deces etaient la malnutrition (HR = 17,5 ; IC 95 % = [12,1 ; 25,4]) et la tuberculose (HR = 11,8 ; IC 95 % = [7,7 ; 17,8]).Conclusion : Cette etude met en evidence un taux eleve de deces en milieu carceral et identifie les deux facteurs potentiels (malnutrition et tuberculose) sur lesquels les autorites penitentiaires et sanitaires se doivent d’agir.

Purpose Acute renal failure (ARF) or acute kidney injury (AKI) is one of the major criteria for the severity of malaria according to WHO. The objective was to determine the frequency as well as to evaluate the management and follow-up of ARF during malaria in children in Lubumbashi. Material and methods This is a descriptive cross-sectional study over 48 months (January 1st, 2016 to December 30th, 2019) carried out at the pediatric service of the University Clinics of Lubumbashi. All children with an ARF with a positive thick blood smear were included in the study. Data were analyzed with SPSS 19 software. Results During this period, 910 patients (49.1%) were admitted for malaria. Among them, 14 patients, i.e. an intra-hospital prevalence of 0.78%, of which 6 boys (42.9%) and 8 girls (57.1%) had ARF. The mean age is 7.9±3.5 years. The serum creatinine level was between 0.54 and 15.2 mg/dL with a mean of 5.7 mg/dL. Kidney dialysis was only effective in 3 patients (21.4%) and diuretics were given 100% in all children. The mean length of stay was 13.4±8.7 days (range: 1 day and 18 days). Mortality was 21.4%. Conclusion The present study shows that ARF in childhood malaria in Lubumbashi is infrequent but of high mortality in our environment with limited resources where care is lacking and monitoring difficult.

Background Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa. Methods and findings This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive age (15 to 49 years) to identify pregnancies. Pregnant women who gave consent were include in the study and followed up to birth and 42 days postpartum from 2012 to 2015. We used standard operating procedures, data collection tools, and training to harmonise study implementation across sites. Three home visits during pregnancy and 2 home visits after birth were conducted to collect maternal morbidity information and maternal, foetal, and newborn outcomes. We measured blood pressure and proteinuria to define hypertensive disorders of pregnancy and woman’s self-report to identify obstetric haemorrhage, pregnancy-related infection, and prolonged or obstructed labour. Enrolled women whose pregnancy lasted at least 28 weeks or those who died during pregnancy were included in the analysis. We used meta-analysis to combine site-specific estimates of burden, and regression analysis combining all data from all sites to examine associations between the maternal morbidities and adverse outcomes. Among approximately 735,000 women of reproductive age in the study population, and 133,238 pregnancies during the study period, only 1.6% refused consent. Of these, 114,927 pregnancies had morbidity data collected at least once in both antenatal and in postnatal period, and 114,050 of them were included in the analysis. Overall, 32.7% of included pregnancies had at least one major direct maternal morbidity; South Asia had almost double the burden compared to sub-Saharan Africa (43.9%, 95% CI 27.8% to 60.0% in South Asia; 23.7%, 95% CI 19.8% to 27.6% in sub-Saharan Africa). Antepartum haemorrhage was reported in 2.2% (95% CI 1.5% to 2.9%) pregnancies and severe postpartum in 1.7% (95% CI 1.2% to 2.2%) pregnancies. Preeclampsia or eclampsia was reported in 1.4% (95% CI 0.9% to 2.0%) pregnancies, and gestational hypertension alone was reported in 7.4% (95% CI 4.6% to 10.1%) pregnancies. Prolonged or obstructed labour was reported in about 11.1% (95% CI 5.4% to 16.8%) pregnancies. Clinical features of late third trimester antepartum infection were present in 9.1% (95% CI 5.6% to 12.6%) pregnancies and those of postpartum infection in 8.6% (95% CI 4.4% to 12.8%) pregnancies. There were 187 pregnancy-related deaths per 100,000 births, 27 stillbirths per 1,000 births, and 28 neonatal deaths per 1,000 live births with variation by country and region. Direct maternal morbidities were associated with each of these outcomes. Conclusions Our findings imply that health programmes in sub-Saharan Africa and South Asia must intensify their efforts to identify and treat maternal morbidities, which affected about one-third of all pregnancies and to prevent associated maternal and neonatal deaths and stillbirths. Trial registration The study is not a clinical trial., Author summary Why was this study done? Estimates of severe direct maternal morbidity are largely based on hospital-based studies with inconsistent definitions and varying selection criteria. Limited data are available from South Asia and sub-Saharan Africa, the 2 regions with the highest maternal and newborn morbidity and mortality, where a larger proportion of births occur at home. What did the researchers do and find? We collected data on maternal morbidities from a cohort of women in the community in multiple sites in sub-Saharan Africa and in South Asia. Out of a cohort of >114,000 women, we found that about 1 in 3 women suffer a maternal morbidity, which was notably higher than the previously reported data. We found that the prevalence of preeclampsia and eclampsia was about 1%, which was lower than previously reported. About 11% of women reported having prolonged or obstructed labour, which was somewhat higher than published estimates. The burden of pregnancy-related infection in postpartum period was higher in South Asia than in sub-Saharan Africa. This is the first study, to our knowledge, to describe the burden of antepartum haemorrhage and late antepartum infection and to clearly demonstrate the association of direct maternal morbidity with adverse pregnancy outcomes. What do these findings mean? Higher burden of direct maternal morbidity and its association with adverse outcomes highlights the need for improving health of women and mothers, including promotion of preconception health and nutrition, and high-quality antepartum, intrapartum and postpartum care.

Background A safe, effective vaccine is essential to eradicating human immunodeficiency virus (HIV) infection. A canarypox-protein HIV vaccine regimen (ALVAC-HIV plus AIDSVAX B/E) showed modest efficacy in reducing infection in Thailand. An analogous regimen using HIV-1 subtype C virus showed potent humoral and cellular responses in a phase 1-2a trial in South Africa. Efficacy data and additional safety data were needed for this regimen in a larger population in South Africa. Methods In this phase 2b-3 trial, we randomly assigned 5404 adults without HIV-1 infection to receive the vaccine (2704 participants) or placebo (2700 participants). The vaccine regimen consisted of injections of ALVAC-HIV at months 0 and 1, followed by four booster injections of ALVAC-HIV plus bivalent subtype C gp120-MF59 adjuvant at months 3, 6, 12, and 18. The primary efficacy outcome was the occurrence of HIV-1 infection from randomization to 24 months. Results In January 2020, prespecified criteria for nonefficacy were met at an interim analysis; further vaccinations were subsequently halted. The median age of the trial participants was 24 years; 70% of the participants were women. The incidence of adverse events was similar in the vaccine and placebo groups. During the 24-month follow-up, HIV-1 infection was diagnosed in 138 participants in the vaccine group and in 133 in the placebo group (hazard ratio, 1.02; 95% confidence interval, 0.81 to 1.30; P = 0.84). Conclusions The ALVAC-gp120 regimen did not prevent HIV-1 infection among participants in South Africa despite previous evidence of immunogenicity. (HVTN 702 ClinicalTrials.gov number, NCT02968849.).

The majority of Plasmodium falciparum malaria diagnoses in Africa are made using rapid diagnostic tests (RDTs) that detect histidine-rich protein 2. Increasing reports of false-negative RDT results due to parasites with deletions of the pfhrp2 and/or pfhrp3 genes (pfhrp2/3) raise concern about existing malaria diagnostic strategies. We previously identified pfhrp2-negative parasites among asymptomatic children in the Democratic Republic of the Congo (DRC), but their impact on diagnosis of symptomatic malaria is unknown. We performed a cross-sectional study of false-negative RDTs in symptomatic subjects in 2017. Parasites were characterized by microscopy; RDT; pfhrp2/3 genotyping and species-specific PCR assays; a bead-based immunoassay for Plasmodium antigens; and/or whole-genome sequencing. Among 3627 symptomatic subjects, 427 (11.8%) had RDT-/microscopy + results. Parasites from eight (0.2%) samples were initially classified as putative pfhrp2/3 deletions by PCR, but antigen testing and whole-genome sequencing confirmed the presence of intact genes. 56.8% of subjects had PCR-confirmed malaria. Non-falciparum co-infection with P. falciparum was common (13.2%). Agreement between PCR and HRP2-based RDTs was satisfactory (Cohen’s kappa = 0.66) and superior to microscopy (0.33). Symptomatic malaria due to pfhrp2/3-deleted P. falciparum was not observed. Ongoing HRP2-based RDT use is appropriate for the detection of falciparum malaria in the DRC.

Purpose: The purpose of this study is to determine if computer-based videos can successfully educate patients about the health benefits of a whole-food, plant-based diet (WFPBD) during the clinic wait time. As physicians, we recognize the importance of nutrition in disease prevention and treatment. Therefore, we investigated the effectiveness of a video-based educational model in increasing patient knowledge and confidence regarding diet. Methods: Subjects (n = 77) were recruited from an outpatient clinic. An electronic survey was developed and administered to patients before and after watching a 5-minute educational computer-based video about the beneficial health effects of WFPBD. Responses to the survey’s 10 knowledge-based (KB) questions were scoredon a dichotomous incorrect/correct scale, and the survey’s 9 confidence-based (CB) questions were scored on a likert scale from 1 (strongly disagree) to 5 (strongly agree). Paired pre- to post-video intervention difference scores (knowledge and confidence) were calculated for each patient and independently analyzed using a related-samples Wilcoxon signed rank test. one-way ANoVA tests were used to investigate survey questions demonstrating the greatest improvement post-video intervention. Results: Statistically significant improvements in patient knowledge and confidence in their knowledge of nutrition after watching the brief educational video on nutrition were found. Patients scored significantly higher post-video intervention than pre-video intervention on KB survey questions (z = 5.748; P< .001) and CB survey questions (z= 6.605; P< .001). Statistical significance remained across all self-reported chronic condition groups, except for obesity (oB) and atherosclerosis (AS) groups for total knowledge and AS group for total confidence. one-way ANoVA tests confirmed that self-reported chronic conditions did not significantly predict baseline (pre-intervention) total KB or CB scores. The exploratory question-specific analysis demonstrated that the survey questions regarding average daily fiber consumption (P< 0.001) and the association of saturated fats with chronic disease (P= 0.001) were the most significant predictors of the increase in patient knowledge post-intervention. Conclusion: our findings indicate that providing patients with a short computerbased educational video during clinic wait time can significantly increase patient knowledge on the health benefits of a WFPBD. Future studies can test the model on a larger, more varied sample of patients and gauge the longevity of the knowledge gained from this educational model.

Public transport is a fundamental service for the resumption of work and production, but the enclosed environment and dense population create very favorable conditions for the spread of epidemic infections. Thus, effective public health interventions are urgently introduced. The objective of this paper is to quantitatively estimate the SARS-CoV-2 transmission probability and evaluate the influence of environmental parameters and individual intervention on the epidemic prevention. For this purpose, (1) we estimate the virus emission rate with Diamond Princess Cruise Ship infection data by Monte Carlo simulation and the improved Wells-Riley model, and (2) employ the reproductive number R to quantify diverse mitigation strategies. Different determinants are examined such as the duration of exposure, the number of passengers combined with individual interventions such as mask type and mask-wearing rate. The results show that the SARS-CoV-2 quantum generation rate is 185.63. The R shows a stronger positive correlation with the exposure time comparing to the number of passengers. In this light, reducing the frequency of long-distance journeys on crowded public transportation may be required to reduce the spread of the virus during the pandemic. N95 mask and surgical mask can reduce the transmission risk by 97 and 84%, respectively, and even homemade mask can reduce the risk by 67%, which indicates that it is necessary to advocate wearing masks on public transportation. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-021-13617-y.

BackgroundThe majority of Plasmodium falciparum malaria diagnoses in Africa are made using rapid diagnostic tests (RDTs) that detect histidine-rich protein 2. Increasing reports of false-negative RDT results due to parasites with deletions of the pfhrp2 and/or pfhrp3 genes (pfhrp2/3) raise concern about existing malaria diagnostic strategies. We previously identified pfhrp2-negative parasites among asymptomatic children in the Democratic Republic of the Congo (DRC), but their impact on diagnosis of symptomatic malaria is unknown.MethodsWe performed a cross-sectional study of false-negative RDTs in symptomatic subjects in 2017. Parasites were characterized by microscopy; RDT; pfhrp2/3 genotyping and species-specific PCR assays; a multiplex bead-based immunoassay; and/or whole-genome sequencing.ResultsAmong 3,627 symptomatic subjects, we identified 427 (11.8%) RDT-/microscopy+ cases. Parasites from eight (0.2%) samples were initially classified as putative pfhrp2/3 deletions by PCR, but antigen testing and whole-genome sequencing confirmed the presence of intact genes. Malaria prevalence was high (57%) and non-falciparum co-infection common (15%). HRP2-based RDT performance was satisfactory and superior to microscopy.ConclusionsSymptomatic malaria due to pfhrp2/3-deleted P. falciparum was not observed in the DRC.Ongoing HRP2-based RDT use is appropriate for the detection of falciparum malaria in the DRC.

Purpose: The purpose of this study is to determine if computer-based videos successfully educate patients on a whole food, plant-based diet (WFPBD) during clinic wait time. We recognize the importance of nutrition in disease prevention and treatment, particularly for diabetes, obesity, hypertension, and vascular disease. We investigated the effectiveness of this model in increasing patient knowledge and confidence about diet. Methods: Subjects (n = 77) were recruited at a radiology clinic. A 19-question survey was administered using an iPad. Patients completed the survey before and after watching a 5-minute computer-based video about the beneficial health effects of WFPBD. To assess knowledge, patients’ responses to the survey’s 10 knowledge-based (KB) questions were scored on a dichotomous incorrect/correct scale. To assess confidence in their knowledge, patients’ responses to the survey’s 9 confidence-based (CB) questions were scored on a Likert scale from 1 (strongly disagree) to 5 (strongly agree). Two paired difference scores (knowledge and confidence) were calculated and independently analyzed using a Related-Samples Wilcoxon Signed Rank Test. A Stepwise Linear Regression was used to investigate which survey questions were most educational. Results: The Related-Samples Wilcoxon Signed Rank Test showed a statistically significant improvement in both patients’ knowledge and confidence in their knowledge of nutrition. Patients scored significantly higher on KB survey questions (p < 0.001) and CB survey questions (p < 0.001) post-video. Stepwise Linear Regression showed that the most educational survey questions included information on fiber, plant-based foods, and saturated fats. Conclusion: Our findings indicate that providing patients with a computer-based educational video during clinic wait time significantly increases patient knowledge on the benefits of a WFPBD. Future studies can test a larger sample of patients and gauge the longevity of knowledge gained. Disclosure K. Cole: None. D. Wenger: None. A. Guha: None. C. Yarosh: None. C. Hoffman: None. Funding University of California, Los Angeles

Two phase 3 clinical trials showed that use of a monthly vaginal ring containing 25 mg dapivirine was well tolerated and reduced HIV-1 incidence in women by approximately 30% compared with placebo. We aimed to evaluate use and safety of the dapivirine vaginal ring (DVR) in open-label settings with high background rates of HIV-1 infection, an important step for future implementation.We did a phase 3B open-label extension trial of the DVR (MTN-025/HIV Open-label Prevention Extension [HOPE]). Women who were HIV-1-negative and had participated in the MTN-020/ASPIRE phase 3 trial were offered 12 months of access to the DVR at 14 clinical research centres in Malawi, South Africa, Uganda, and Zimbabwe. At each visit (monthly for 3 months, then once every 3 months), women chose whether or not to accept the offer of the ring. Used, returned rings were tested for residual amounts of dapivirine as a surrogate marker for adherence. HIV-1 serological testing was done at each visit. Dapivirine amounts in returned rings and HIV-1 incidence were compared with data from the ASPIRE trial, and safety was assessed. This study is registered with ClinicalTrials.gov, NCT02858037.Between July 16, 2016, and Oct 10, 2018, of 1756 women assessed for eligibility, 1456 were enrolled and participated in the study. Median age was 31 years (IQR 27-37). At baseline, 1342 (92·2%) women chose to take the DVR; ring acceptance was more than 79% at each visit up until 12 months and 936 (73·2%) of 1279 chose to take the ring at all visits. 12 530 (89·3%) of 14 034 returned rings had residual dapivirine amounts consistent with some use during the previous month (0·9 mg released) and the mean dapivirine amount released was greater than in the ASPIRE trial (by 0·21 mg; p0·0001). HIV-1 incidence was 2·7 per 100 person-years (95% CI 1·9-3·8, 35 infections), compared with an expected incidence of 4·4 per 100 person-years (3·2-5·8) among a population matched on age, site, and presence of a sexually transmitted infection from the placebo group of ASPIRE. No serious adverse events or grade 3 or higher adverse events observed were assessed as related to the DVR.High uptake and persistent use in this open-label extension study support the DVR as an HIV-1 prevention option for women. With an increasing number of HIV-1 prophylaxis choices on the horizon, these results suggest that the DVR will be an acceptable and practical option for women in Africa.The Microbicide Trials Network and the National Institute of Allergy and Infectious Diseases, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health, all components of the US National Institutes of Health.

Background Non-typhoidal Salmonella (NTS) are a major cause of bloodstream infection (BSI) in sub-Saharan Africa. This study aimed to assess its longitudinal evolution as cause of BSI, its serotype distribution and its antibiotic resistance pattern in Kisantu, DR Congo. Methods As part of a national surveillance network, blood cultures were sampled in patients with suspected BSI admitted to Kisantu referral hospital from 2015–2017. Blood cultures were worked-up according to international standards. Results were compared to similar data from 2007 onwards. Results In 2015–2017, NTS (n = 896) represented the primary cause of BSI. NTS were isolated from 7.6% of 11,764 suspected and 65.4% of 1371 confirmed BSI. In children, Author summary We reviewed bloodstream infections caused by non-typhoidal Salmonella over a 10 year period (2007–2017) in the Democratic Republic of the Congo, with Kisantu in the Kongo Central province as the major sampling site. Non-typhoidal Salmonella were the most common cause of bloodstream infections in children in a sentinel network in DR Congo. The disease mainly occurred in young children and had a high mortality. We showed that non-typhoidal Salmonella persisted to frequently cause bloodstream infections in children under 5 years old. Salmonella Enteritidis and Salmonella Typhimurium were the main serotypes causing non-typhoidal Salmonella bloodstream infections. The emergence of O5-antigen negative Salmonella Typhimurium (i.e. variant Copenhagen) was observed and this needs to be considered when developing vaccines. Multidrug resistance to ampicillin, trimethoprim-sulfamethoxazole and chloramphenicol was widespread during the whole decade. From 2013 onwards, resistance to all other available antibiotics, i.e. third generation cephalosporins, fluoroquinolones and azithromycin, emerged. Likewise, extensive drug resistance (multidrug, ceftriaxone and azithromycin co-resistance) and multidrug resistance combined with decreased ciprofloxacin susceptibility in Salmonella Typhimurium emerged. Unfortunately, there are no clinical studies on antibiotic treatment in non-typhoidal Salmonella bloodstream infection that could allow the development of evidence based treatment guidelines. Therefore, dedicated observational studies and clinical studies are urgently needed to optimize antibiotic stewardship.

This work is of particular interest in the field of rational and sustainable management of water wells since the study of the capacity of the aquifer makes it possible to know the quantity of water that can be taken from the tablecloth, so as not to lead to its exhaustion. The hydrogeological characteristics obtained also make it possible to understand the capacity of the aquifer to react to its drainage by wells or to natural drainage by rivers in its hydrogeological watershed or to its water supply. The objective of this work is to determine the best hydrogeological method, the hydrogeological characteristics of the aquifer that feeds the Mikala 2 well in the municipality of Nsele. These are the transmissivity, the hydraulic conductivity, the storage coefficient and the diffusivity coefficient of the water table in the municipality of Nsele.

Resume Introduction La tuberculose et le VIH/SIDA constituent un couple meurtrier en Afrique subsaharienne. Ce travail a comme objectif d’evaluer la prevalence de la co-infection tuberculose/VIH/SIDA ainsi que l’impact de ce dernier sur l’issue des patients tuberculeux pris en charge dans la zone de sante de Lubumbashi (ZSL). Materiel et methodes Cette etude retrospective transversale a porte sur l’analyse des dossiers de tuberculeux ayant consulte les centres de sante de diagnostic et traitement (CSDT) de la ZSL entre 2014–2015. Les cas de co-infection tuberculose-VIH/SIDA et les issues seront analyses. Resultats et discussion Dans trois CSDT de la ZSL, 1368 cas de tuberculose ont ete enregistres et parmi eux 334 cas de co-infections. La tranche d’âge la plus incriminee est celle de 40–50 ans. L’âge moyen de patients est de 32,84 ± 15,32 ans et le sex ratio homme/femme est 1,70. La forme clinique la plus rencontree est extra pulmonaire (52,70 %). Chez les co-infectes, la forme predominante est la forme pulmonaire a microscopie negative ; le taux de succes therapeutique etait de 65,49 % alors que chez les non co-infectes il s’elevait a 75,48 %. Sur les 51 cas de deces enregistres, 23 (45,10 %) etaient seropositifs pour le VIH tandis que 28 (54,90 %) etaient seronegatifs. Il a ete constate une augmentation de co-infection TB-VIH/SIDA de 11,6 % de 2014 a 2015. Conclusion La co-infection tuberculose-VIH/SIDA est une realite dans la ZSL surtout chez les patients souffrant de tuberculose a baccilloscopie negative et l’impact du VIH sur le deces des tuberculeux est inquietant.

Summary Background Few therapeutic options are available to treat the late-stage of human African trypanosomiasis, a neglected tropical disease, caused by Trypanosoma brucei gambiense (g-HAT). The firstline treatment is a combination therapy of oral nifurtimox and intravenous eflornithine that needs to be administered in a hospital setting by trained personnel, which is not optimal given that patients often live in remote areas with few health resources. Therefore, we aimed to assess the safety and efficacy of an oral regimen of fexinidazole (a 2-substituted 5-nitroimidazole with proven trypanocidal activity) versus nifurtimox eflornithine combination therapy in patients with late-stage g-HAT. Methods In this randomised, phase 2/3, open-label, non-inferiority trial, we recruited patients aged 15 years and older with late-stage g-HAT from g-HAT treatment centres in the Democratic Republic of the Congo (n=9) and the Central African Republic (n=1). Patients were randomly assigned (2:1) to receive either fexinidazole or nifurtimox eflornithine combination therapy according to a predefined randomisation list (block size six). The funder, data management personnel, and study statisticians were masked to treatment. Oral fexinidazole was given once a day (days 1–4: 1800 mg, days 5–10: 1200 mg). Oral nifurtimox was given three times a day (days 1–10: 15 mg/kg per day) with eflornithine twice a day as 2 h infusions (days 1–7: 400 mg/kg per day). The primary endpoint was success at 18 months (ie, deemed as patients being alive, having no evidence of trypanosomes in any body fluid, not requiring rescue medication, and having a cerebrospinal fluid white blood cell count ≤20 cells per μL). Safety was assessed through routine monitoring. Primary efficacy analysis was done in the modified intention-to-treat population and safety analyses in the intention-to-treat population. The acceptable margin for the difference in success rates was defined as 13%. This study has been completed and is registered with ClinicalTrials.gov, number NCT01685827. Findings Between October, 2012, and November, 2016, 419 patients were pre-screened. Of the 409 eligible patients, 14 were not included because they did not meet all inclusion criteria (n=12) or for another reason (n=2). Therefore, 394 patients were randomly assigned, 264 to receive fexinidazole and 130 to receive nifurtimox eflornithine combination therapy. Success at 18 months was recorded in 239 (91%) patients given fexinidazole and 124 (98%) patients given nifurtimox eflornithine combination therapy, within the margin of acceptable difference of −6·4% (97·06% CI −11·2 to −1·6; p=0·0029). We noted no difference in the proportion of patients who experienced treatment-related adverse events (215 [81%] in the fexinidazole group vs 102 [79%] in the nifurtimox eflornithine combination therapy group). Treatment discontinuations were unrelated to treatment (n=2 [1%] in the fexinidazole group). Temporary nifurtimox eflornithine combination therapy interruption occurred in three (2%) patients. 11 patients died during the study (nine [3%] in the fexinidazole group vs two [2%] in the nifurtimox eflornithine combination therapy group). Interpretation Our findings show that oral fexinidazole is effective and safe for the treatment of T b gambiense infection compared with nifurtimox eflornithine combination therapy in late-stage HAT patients. Fexinidazole could be a key asset in the elimination of this fatal neglected disease. Funding Drugs for Neglected Diseases initiative .

The use of plants in our immediate environment in primary health care in Africa and especially among the poor, is a very common practice. Our study aimed to determine the profile and frequency of pregnant using medicinal plants; and to identify medicinal plants most frequently used during pregnancy. We have done a descriptive cross-sectional study, conducted for up March 2014 to June 2014, on a sample of 400 pregnant women who consulted health centers of the city Kipushi during prenatal consultations. Of a total of 400 pregnant consulted during the investigation period, 30% or 7.5% used medicinal plants, 46.67% had an age between 26 and 30 years, the majority of pregnant or 56.67% had a secondary consideration; 13 pregnant using medicinal plants is 43.33% were multiparous pregnant while 10, 33.33% were large multiparous pregnant 12% or 40% were married and 9% or 30% of pregnant were single. The Birsocorpus orientaris was the most used plants in pregnant or 16.67% of pregnant monitoring and Uapaca kirkiana, Ficus capensis or 13.33% and 10% of these used the pregnant Thespesia garckeana, Hibiscus cannabinus or Liposes. These results provide the basis for subsequent studies to experimentally evaluate the potential of these plants. This will make available for women in labor, new substances of natural origin.

Background: Tuberculosis (TB) is the most common presenting illness among people living with human immunodeficiency virus (HIV), with co-infection occurring in up to 60% of cases in South Africa. In line with international guidelines, South Africa has adopted an integrated model at primary healthcare level to provide HIV and TB services by the same healthcare provider at the same visit. Aim: The aim of the study was to conduct a rapid appraisal of integration of HIV and TB services at primary healthcare level in eThekwini District in 2015. Setting: The study was conducted in 10 provincial primary healthcare clinics in the eThekwini Metropolitan Health District in KwaZulu-Natal Province. Methods: An observational, cross-sectional study was conducted. Key informant interviews with operational managers and community health workers were conducted, as well as a review of registers and electronic databases for the period of January to March 2015. Results: Two clinics complied with the mandated integrated model. Three clinics were partially integrated; while five clinics maintained the stand-alone model. Possible constraints included reorganisation of on-site location of services, drug provision, TB infection control and inadequate capacity building, while potential enablers comprised structural infrastructure, staffing ratios and stakeholder engagement. Conclusion: HIV and TB integration is suboptimal and will need to be improved by addressing the systemic challenges affecting health service delivery, including strengthening supervision, training and the implementation of a change management programme.

Background This study gives an overview of a decade (2007–2017) of hospital-based Salmonella Typhi bloodstream infection (BSI) surveillance in the Democratic Republic of the Congo (DRC), at 4 main sampling sites. Methods Blood cultures were sampled in hospital-admitted patients with suspected BSI, according to standardized clinical indications. The results of the surveillance period 2015–2017 were compiled with those of previous surveillance periods (2007–2010 and 2011–2014). Whole genome sequencing of isolates with decreased ciprofloxacin susceptibility (DCS) was performed. Results Salmonella Typhi was isolated in 1.4% (531/37 388) and 10.3% (531/5177) of suspected and culture-confirmed BSI episodes, respectively. Salmonella Typhi ranked first among the BSI pathogens in adults (n = 220), but was mostly (n = 301 [56.7%]) isolated from children, of which 72.1% (217/301) and 31.6% (95/301) were Conclusions Salmonella Typhi was a frequent cause of BSI in adults and children in DRC, with high rates of antibiotic resistance. Sustainable surveillance and implementation of vaccination are compelling.

Self-medication refers to the act of medicating oneself with no guidance from a physician. There are sevral factors that promote self-medication along with drug misuse among the population. In the frame of developing countries, such as the Democratic Republic of Congo (DRC), these factors include lack of enforcement of laws governing the pharmaceutical sector, poor mindset of the population as well as easy access to drugs without official medical prescriptions. The purpose of this study was to evaluate the extent to which self-medication and drug misuse practices affect the youth Congolese population health in the DRC’s capital city, Kinshasa. Three sectors of Kinshasa were selected for a cross-sectional study conducted for five months (January to Mai 2020). Pharmacists or their auxiliairies were asked to draw up the list of ten drugs often purchased without medical prescriptions. In each of the selected pharmacies, 3 patients using self-medication were interviewed. A total of 120 phrarmacists or their auxiliairies and 360 patients (180 men and 180 women) were selected using systematic random sampling technique. Of the 120 questionnaires completed, a list of ten most used drugs in self-medication was established in the following dicreasing quantitative order: 106, 85, 83, 66, 66, 58, 51, 38, 29 and 23 pharmacists or their auxiliairies cited Amoxicillin capsule, Emergency Contraceptive Pill tablet, Paracetamol tablet, Dexamethasone tablet, Cyproheptadine tablet, Tetracyclin capsule, Levamisole tablet, Albendazole tablet, Quinine and Diclofenac injectables, respectively. Out of 360 questionnaires distributed, all medicines were administered by the route recommended by the physician except Dexamethasone tablet, Cyproheptadine tablet and Diclofenac injection where in 30.1%, 38.1% and 89.7% of self-medication cases the route of administration was other than the recommended route. From the recorded data, the age of most patients varied between 15-24 years old. Girls were more in self-medication than boys. Sometimes, the disease for which the drug was used, as well as the dosing, were found to be different from the instructions in patients’ leaflet. And lastly, for most patients, the main source of information was family and/or friends. This study demonstrated that the practice of self-medication is very widespread in Kinshasa, unfortunately even antibiotics are misused, exposing the population to high risk of antimicrobial resistance development. The present findings encourage further investigations at national level to better advise the dicision makers to take appropriate measures to substantially mitigate self-medication and drug misuse practices.

// Kalonji Ntumba 1 , Naoufal Akla 2 , S. Paul Oh 5 , Anne Eichmann 6,7 and Bruno Larrivee 1,3,4,8 1 Department of Biomedical Sciences, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada 2 Department of Biochemistry, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada 3 Department of Molecular Biology, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada 4 Department of Ophthalmology, Maisonneuve-Rosemont Hospital Research Center, University of Montreal, Montreal, Quebec, Canada 5 Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, USA 6 Yale Cardiovascular Research Center, New Haven, CT, USA 7 Inserm U970, Paris Cardiovascular Research Center, Paris, France 8 Department of Biological Sciences, Universite du Quebec a Montreal, Montreal, Quebec, Canada Correspondence to: Bruno Larrivee, email: // Keywords : age-related macular degeneration, ocular pathologies, angiogenesis, BMP signaling, Gerotarget Received : April 20, 2016 Accepted : July 13, 2016 Published : August 10, 2016 Abstract Age-related macular degeneration (AMD) is the leading cause of blindness in aging populations of industrialized countries. The drawbacks of inhibitors of vascular endothelial growth factor (VEGFs) currently used for the treatment of AMD, which include resistance and potential serious side-effects, require the identification of new therapeutic targets to modulate angiogenesis. BMP9 signaling through the endothelial Alk1 serine-threonine kinase receptor modulates the response of endothelial cells to VEGF and promotes vessel quiescence and maturation during development. Here, we show that BMP9/Alk1 signaling inhibits neovessel formation in mouse models of pathological ocular angiogenesis relevant to AMD. Activating Alk1 signaling in laser-induced choroidal neovascularization (CNV) and oxygen-induced retinopathy (OIR) inhibited neovascularization and reduced the volume of vascular lesions. Alk1 signaling was also found to interfere with VEGF signaling in endothelial cells whereas BMP9 potentiated the inhibitory effects of VEGFR2 signaling blockade, both in OIR and laser-induced CNV. Together, our data show that targeting BMP9/Alk1 efficiently prevents the growth of neovessels in AMD models and introduce a new approach to improve conventional anti-VEGF therapies.

International audience; AbstractAlthough copper (Cu) is recognized as an essential trace element, uncertainties remain regarding Cu reference values for humans, as illustrated by discrepancies between recommendations issued by different national authorities. This review examines human studies published since 1990 on relationships between Cu intake, Cu balance, biomarkers of Cu status, and health. It points out several gaps and unresolved issues which make it difficult to assess Cu requirements. Results from balance studies suggest that daily intakes below 0.8 mg/day lead to net Cu losses, while net gains are consistently observed above 2.4 mg/day. However, because of an incomplete collection of losses in all studies, a precise estimation of Cu requirements cannot be derived from available data. Data regarding the relationship between Cu intake and potential biomarkers are either too preliminary or inconclusive because of low specificity or low sensitivity to change in dietary Cu over a wide range of intakes. Results from observation and intervention studies do not support a link between Cu and a risk of cardiovascular disease, cognitive decline, arthritis or cancer for intakes ranging from 0.6 to 3 mg/day, and limited evidence exists for impaired immune function in healthy subjects with a very low (0.38 mg/day) Cu intake. However, data from observation studies should be regarded with caution because of uncertainties regarding Cu concentration in various foods and water. Further studies that accurately evaluate Cu exposure based on reliable biomarkers of Cu status are needed.

Pharmaceutical counterfeiting is a health scourge responsible for several cases of morbidity and mortality. Counterfeit medicines cause therapeutic failure, emergence of resistance in the treatment of infections. This study was conducted in order to identify counterfeit and authentic medicines in circulation in Lubumbashi. The study included artemether and artesunate for oral administration. A careful visual inspection of medicine, investigation of authenticity of pharmaceutical products from manufacturers and pharmaceutical regulatory authorities and determination of content were used as study parameters. 52 samples: 37 artemether and 15 of artesunate were collected. 7 samples (13%) have proven to be counterfeit. Artemether was the most counterfeit (71%) and 29% for artesunate. 6 (12%) samples were substandard according to the international pharmacopoeia in terms of content of active ingredient. Sixty-seven percent of non-compliance concerned counterfeit medicines. The proportion of non-compliance is highest among counterfeit medicines (71.43% vs 2.22%; p = 0.000004). It is obvious that strengthening the capacity of the drug regulatory authority of the DRC reduces the influx of counterfeit drug and substandard.

The WHO estimates that about 130 million children born each year worldwide, and about 4 million die during the neonatal period. Neonatal mortality remains until now a major public health problem in the world and is the socio-economic indicators of progress and health of a country by its frequency. This study aimed to identify risk factors of neonatal mortality through maternal and new-born characteristics susceptible to influence this last. We conducted a longitudinal study from January 1st to December 2014 based on data collected through a questionnaire developed for this purpose. This questionnaire was tested, standardized and administered in the maternity and neonatology service in the language spoken by the mother (Swahili or French). Results: Anemia and neonatal asphyxia were significantly associated with the occurrence of death with adjusted odds ratio of 34.570 respectively (CI: 5.633 to 212.149, 95%) and 7861 (CI: 2.017 to 30.644). The history of fetal deaths and HIV in mothers was also recognized as an explanatory factor for the occurrence of neonatal mortality. But it should be noted that the CPN followed and the history of genital bleeding in the first trimester of pregnancy have made protective factors for developing neonatal mortality with their respective adjusted OR of 0.169 (CI: 0.037 to 0.775, 95%) and 0.066 (CI: 0.005 to 0.906). Conclusion: To address this problem, the management of various risk factors that may influence the occurrence of neonatal mortality should be taken into account.

This article summarizes the proceedings of the four-session meeting (webinar) conducted by the Alliance of International Science Organizations on Disaster Risk Reduction (ANSO-DRR) on 18 May 2020. ANSO-DRR is an international, nonprofit and nongovernmental scientific alliance bringing together academies of science, research organizations and universities which share a strong interest in disaster risk reduction in the regions along the land-based and maritime routes of the Belt and Road Initiative. ANSO-DRR convenes an annual meeting to review its work progress and discuss its scientific programs. The first session was the opening statements and was followed by the introduction and updates on ANSO-DRR in the second session. The third session was the depiction of the big picture of ANSO, the umbrella organization of ANSO-DRR, led by the Assistant Executive Director of ANSO, while the fourth session was a presentation of perspectives on the strategic development of ANSO-DRR. One of ANSO-DRR’s key strategies is to enhance disaster mitigation and response through multidisciplinary cooperation among disaster and healthcare sciences (i.e., health emergency and disaster risk management (Health-EDRM)). It aims to enhance DRR efforts by performing as an instrument in connecting people along the Belt and Road regions, focusing on DRR resource and database development, involving higher education institutions in DRR efforts and increasing disaster resilience in built infrastructures.

Infective endocarditis (IE) in the pediatric population is uncommon and presents with nonspecific signs. Nonetheless, prompt diagnosis and management are critical given its high mortality rate. We present the case of a 15-year-old boy who initially presented with bilateral multifocal pneumonia and was found to have IE with a right ventricular vegetation. The vegetation was removed percutaneously, obviating a more invasive surgical approach. The patient tolerated the procedure well and rapidly improved following removal of the vegetation. This case report highlights the utility of a novel, minimally invasive approach for the management of cardiac masses.

Background In early 2016, we implemented a community-based maternal, newborn, and child health (MNCH) surveillance using mobile phones to collect, analyze, and use data by village health volunteers (VHV) in Kenge Health Zone (KHZ), in the Democratic Republic of Congo (DRC). The objective of this study was to determine the perceptions of households, attitudes of community health volunteers, and opinions of nurses in Health center and administrative authorities towards the use of mobile phones for MNCH surveillance in the rural KHZ in the DRC. Methods We used mixed methods combining phenomenological and descriptive cross-sectional study. Between 3 and 24 March 2016, we collected the data through focus group discussions (FGD) with households, and structured interviews with VHV, local health and administrative authority, and nurses to explore the perceptions on MNCH surveillance using mobile phone. Data from the FGD and interviews were analyzed using thematic analysis techniques and descriptive statistics respectively. Results Health issues and services for under-five children were well known by community; however, beliefs and cultural norms contributed to the practices of seeking behavior for households. Mobile phones were perceived as devices that render quick services for people who needed help; and the community’s attitudes towards the mobile phone use for collection of data, analysis, and use activities were good. Although some of community members did not see a direct linkage between this surveillance approach and health benefits, majority believed that there would be better MNCH services with the use of mobile phone. In addition, VHV will benefit from free healthcare for households and some material benefits and training. The best time to undertake these activities were in the afternoon with mother of the child, being the best respondent at the household. Conclusion Health issues and services for under-five children are well known and MNCH surveillance using mobile phone by VHV in which the mother can be involved as respondent is accepted. Electronic supplementary material The online version of this article (10.1186/s12889-018-5186-2) contains supplementary material, which is available to authorized users.

Background Addressing social and behavioral determinants of health (SBDs) may help improve health outcomes of community clinic patients. This cross-sectional study explored how assessing SBDs can be used to complement health data collection strategies and provide clinicians with a more in-depth understanding of their patients. Methods Adult patients, ages 18 and older, at an urban community health care clinic in Tennessee, U.S.A., were asked to complete a questionnaire regarding health status, health history and SBDs while waiting for their clinic appointment. The SBD component included items from the National Academy of Medicine, the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences instrument, and the Survey of Household Economics and Decisionmaking. Data collection and analysis occurred in 2017. Results One hundred participants completed the study. The questionnaire took approximately 11 min to complete, and the response rate was 90% or higher for all items except annual household income (unanswered by 40 participants). The median number of negative SBDs was 4 (IQR 2.75–7.0), 96 participants had at least one unmet need, and the most common negative SBD was physical activity (75%; 75/100). Conclusions The hybrid questionnaire provided insight into a community clinic population’s SBDs and allowed for a more complete understanding than a single questionnaire alone. The brief questionnaire administration time and low non-response rate support the questionnaire’s feasibility in the community clinic setting, and results can be used by clinicians to further the personalization goals of precision medicine. Next steps include evaluating how to connect patients with appropriate resources for addressing their SBDs.

Aims: Adequate coverage of nutrient requirements is a real health concern and surveillance of the nutritional status of a population is a key element for public policies. This study aimed at providing a reliable nutritional risk assessment of the French populati on based on prevalences of inadequate and excessive intakes of eleven minerals and trace elements. Methodology: Intakes from foods (dietary supplements excluded) were estimated by combining composition data from the second national Total Diet Study (TDS2/2 007 - 2009) and consumption data from the Individual and National Study on Food Consumption. Results were compared with those from other TDSs. Results: Sodium intakes exceeded World Health Organization (WHO) guidance values, respectively for 74% of adults, and for 76% of children. For calcium and magnesium, the prevalence of inadequate intakes in adults and children ranged from approximately 50 to 70% to

Objectives: Since studies demonstrate that neonates born to mothers having been cared for premature labor will suffer from congenital neonatal sepsis, we aimed to evaluate the prevalence and main risk factors of neonatal infection among mothers having experienced a prior premature labor. Methods: This was a cross sectional study carried out from January 1st throughout 31st December, 2013 at the university clinics of Kinshasa. It concerned all delivered women at term having been cared for premature labor prior to giving birth a live newborn. Maternal variables of interest were: parity, gestation, age, intrapartum fever, malaria, urogenital infection during the last 2 weeks before delivery (UGI), premature rupture of membranes (PROM), cervical cerclage, meconium-stained amniotic fluid (MSAF) and the way of delivery. For neonates attention was paid on gestational age, birth weight, admission at neonatal intensive care unit (ANICU) and infection as stated within three days after birth. T-test and Chi-square were used where appropriate. Logistic analysis was used to determine the risk for maternal variables to induce neonatal infection (OR and CI), the significance stated at p < 0.05. Results: Fifty two mother-infant couples were recruited. Of these 19 neonates were infected (prevalence of 36.5%). Mean age, gestational age and birth weight were 30.19 ± 5.32 years, 37.2 ± 2 weeks and 2638 ± 588 g, respectively. Infected neonates had their gestational age and birth weight significantly lower whilst proportion of ANICU higher than that on non infected. Prematurity, PROM, UGI, prior cerclage and MSAF were significantly more frequent in couples with neonatal infection. Prematurity, birth weight

Rhinoviral infection is associated with an increased risk of asthma attacks. The macrolide clarithromycin decreases cytokine production in nasopharyngeal aspirates from patients with wheezing, but the effects of macrolides on cytokine production in nasal epithelial cells obtained from asthmatic subjects remain unclear. Here, human nasal epithelial cells were infected with type-14 rhinovirus (RV14), a major RV group. Titers and RNA of RV14 and cytokine concentrations, including IL-1β and IL-6, were higher in the supernatants of the cells obtained from subjects with bronchial asthma (asthmatic group) than in those from the non-asthmatic group. Pretreatment with clarithromycin decreased RV14 titers, viral RNA and cytokine concentrations, and susceptibility to RV14 infection. Pretreatment with clarithromycin also decreased IL-33 production, which was detected after infection. Pretreatment with clarithromycin decreased the expression of intercellular adhesion molecule-1, the receptor for RV14, after infection, the number and fluorescence intensity of the acidic endosomes through which RV RNA enters the cytoplasm, and the activation of nuclear factor kappa-B proteins in nuclear extracts. These findings suggested that RV replication and cytokine production may be enhanced in nasal epithelial cells obtained from subjects with bronchial asthma and may be modulated by clarithromycin.

The paper proposes Hierarchical EigenTrust, an extension of EigenTrust, a trust and reputation algorithm that was proposed for flat peer-to-peer networks. The paper introduces the components of the hierarchical model architecture based on Chord, a scalable P2P (Peer-to-Peer) lookup service for Internet applications. The paper also extends the EigenTrust scheme to the hierarchically structured Chord P2P network. The proposed algorithm handles a huge number of nodes disseminated in different Chord rings, which improves complexity and reduces the number of malicious nodes. The experiments verify and compare the reduction of downloads from malicious peers, load distribution as well as convergence speed between a flat structured network and a hierarchically structured network. Results of the experiments show that hierarchical EigenTrust outperforms the flat EigenTrust in a P2P network that uses only one big ring.

The management of diversity for conservation and breeding is of great importance for all plant species and is particularly true in perennial species, such as the coffee Coffea canephora. This species exhibits a large genetic and phenotypic diversity with six different diversity groups. Large field collections are available in the Ivory Coast, Uganda and other Asian, American and African countries but are very expensive and time consuming to establish and maintain in large areas. We propose to improve coffee germplasm management through the construction of genetic core collections derived from a set of 565 accessions that are characterized with 13 microsatellite markers. Core collections of 12, 24 and 48 accessions were defined using two methods aimed to maximize the allelic diversity (Maximization strategy) or genetic distance (Maximum- Length Sub-Tree method). A composite core collection of 77 accessions is proposed for both objectives of an optimal management of diversity and breeding. This core collection presents a gene diversity value of 0.8 and exhibits the totality of the major alleles (i.e., 184) that are present in the initial set. The seven proposed core collections constitute a valuable tool for diversity management and a foundation for breeding programs. The use of these collections for collection management in research centers and breeding perspectives for coffee improvement are discussed.

Banana bunchy top virus (BBTV) is one of the most severe and widespread virus limiting produc- tion and distribution of planting material of banana (Musa spp.) crops in the world. In Democratic Republic of Congo (DRC), these crops play a major role in daily life of almost 70% of citizen. Many factors influence banana production negatively such as Banana bunchy top disease. Epidemiol- ogical survey was conducted in experimental stations and farmers' fields for two consecutive sea- sons covering 72 sites in five provinces of south western of RDC. The objective of this study was to evaluate the presence and distribution of the Banana bunchy top virus in five provinces of South Western of DRC, with emphasis on the agro-ecological factors. A total of 174 Musa spp. leaves samples were collected and analyzed by PCR. The results revealed the presence of BBTV in all provinces investigated. The frequency of BBTV was 6.3% in Bandundu, 12.1% in Kasai Oriental, 17.8% Bas Congo, 1.1% in Katanga and 7.5% Kinshasa Urban and Peri-urban. Results also re- vealed that BBTV occurred in experimental station and farmers' fields, both having all cooking and dessert bananas. The high prevalence of BBTV seemed to be linked to multiple introductions of planting materials in the Bas Congo province during 1990 and 2002. However, the province of Ka- * Corresponding author.

HIV and HBV Seroprevalence in Volunteer Blood Donors in Lubumbashi Kabamba N. Michel1*, Bwana K. Ignace2, Kilolo N.U. Elie2, Kalonji C. Deddy3, Kabyla I. Benjamin4, Luboya N. Oscar4 1Department of Public Health, University of Kamina, Kamina, Democratic Republic of Congo 2Department of Obstetrics and Gynecology, University of Kamina, Kamina, Democratic Republic of Congo 3Department of Pediatrics, University of Kamina, Kamina, Democratic Republic of Congo 4Department of Public Health, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo SOJ Immunology Open Access Research Article

Background Tuberculosis still remains a major public health concern in several provinces of the Democratic Republic of Congo, especially in prison settings. The present study aimed at determining tuberculosis (TB) prevalence and associated risk factors in inmates of the Mbuji-Mayi Central Prison. Methods This cross-sectional study was performed over a 6-month period (January to June 2015) in Mbuji-Mayi Central Prison. A total of 733 inmates were screened systematically for TB. The diagnosis was based on clinical examination and bacteriological tests. Results Tuberculosis was diagnosed in 130 inmates, what amounts to a 17.7 % prevalence (95 % confidence interval [CI] 15.1–20.6 %). The mean age ± SD of infected inmates was 31 ± 9.5 years old, and 94.8 % of them were male. Inmates were detained for a median period of 24 months (range: 3 months to 12 years). A cough lasting more than 2 weeks, body temperature higher than 39 °C, and weight loss were the predominating clinical signs. Factors independently associated with TB infection were overcrowding; highest population attributable fraction ([PAF] 88.2 %; adjusted odds ratio [OR] 9.8 [95 % CI 3.1–31.6]); malnutrition (body mass index of less than 18.5 kg/m2) (PAF 35.6 %; adjusted OR 2.1 [1.3–3.0]); and a detention period equal to or greater than 12 months (PAF 38.7 %; adjusted OR 2.1 [1.4–3.1]). Conclusions Improving detention and sanitary conditions, as well as providing an adequate and early healthcare, are urgently needed to reduce TB prevalence in the prison environment.

The purpose of this study was to evaluate the quality of three generics of 50 mg diclofenac sodium (DS) tablets manufactured and marketed in DR Congo in comparison to the original formulation Voltarene® from Novartis Pharma. Drug content and drug release were respectively determined by HPLC and UV spectrophotometry before storage and at 3 and 6 months of storage in the accelerated-aging conditions of temperature (40°C) and relative humidity (75%) recommended by the WHO for tropical climate areas. Before storage, only generic 2 contained the correct amount of active pharmaceutical ingredient (API). Generics 1 and 3 did not comply with established limits for API, one was overdosed (Generic 1) and one underdosed (generic 3). None of the generics resisted to stress conditions with respect to the API content. Moreover, all generics failed the dissolution tests when they were submitted to tropical climate simulation. Differences to explain the different dissolution profiles were searched with 1H NMR that gives a complete profile of the formulation (API and excipients) and infrared spectroscopy which evaluates the overall distribution of the API in the tablets, on the initial samples. Generic 1 contained the acid form of diclofenac instead of its sodium salt, and generic 2 a mixture of acid and salt forms. Generic 3 displayed a poor DS distribution in the tablets. Taken together, our data demonstrated that the three generics analyzed were substandard.

Very few studies have been conducted to develop new quality protein maize (QPM) varieties adapted to various agro-ecological conditions in Africa. Such QPM varieties with high grain yield, genes for resistance to local disease and pests would contribute to increased grain production and to alleviate poverty and malnutrition. During the first step of the QPM breeding program in the DR-Congo, 137 inbred lines were developed and selected in the field based on various agro-morphometric characteristics. Molecular analysis revealed high level of genetic variability among inbreds. The level of polymorphic loci observed with ISSR markers varied between 74% and 80%. Nei’s gene diversity and Shannon’s information index values varied from 0.22 to 0.27 and from 0.34 to 0.41, respectively. The majority of inbred lines were distantly related. In fact, more than 87% of genetic distance values were above 0.50. The genetic distance values among the different parental maize accessions varied from 0.39 to 0.72. Inbred lines from the same parental accession were also not genetically close with genetic distance values varying from 0.28 to 0.59. More importantly, the ISSR data are useful in the selection of inbred lines to be tested for general and specific combining abilities and further development of synthetics.

Introduction : La production, la vente et la consommation des medicaments contrefaits sont de serieux problemes qui pesent sur la Sante Publique particulierement des pays en developpement et pour lesquels il existe peu d'informations dans certains pays. Cette etude a ete menee en vue de contribuer a la determination de la prevalence des medicaments contrefaits, particulierement celle des anti-infectieux consommes dans la ville de Lubumbashi en Republique Democratique du Congo. Methodes : L'etude a vise des medicaments anti-infectieux administres per os commercialises dans la ville de Lubumbashi. L'inspection visuelle attentive de l'emballage, l'interpretation de l'etiquetage et l'observation attentive du produit ont servi de parametres d'etudes. Les echantillons ont ete acquis par achat aupres des fournisseurs licites et illicites. Resultats : Cinq molecules: ampicilline, amoxycilline, ciprofloxacine, mebendazole et metronidazole ont ete colletees. Sur 60 echantillons rassembles: 31,7% se sont averes contrefaits. L'ampicilline et le mebendazole sont les produits les plus contrefaits dans cette etude avec 26,3%, suivi de metronidazole avec 21,05%. 78,9% des medicaments contrefaits proviennent du secteur informel. La provenance de 47,4% d'anti-infectieux contrefaits est l'Inde, suivi de la Chine avec 26,3%. Conclusion: Cette etude a montre la circulation des medicaments contrefaits dans la ville de Lubumbashi a un taux non negligeable. Une etude des caracteristiques physico-chimiques et de l'activite biologiques permettra d'evaluer l'impact de ces medicaments dans la prise en charge des infections. Key words : Medicaments, contrefacon, anti-infectieux, Lubumbashi, RD Congo

The European Union is implementing a new regulatory framework for nutrition and health claims (HCs) that will greatly impact the communication of health messages on foodstuffs. In particular, approved HCs will be included in a positive register of generic claims. In the currently available literature, assessment of the relevance of HCs has mainly been related to scientific substantiation, and the issue of relevance in terms of public health has tended to be overlooked. Interestingly, the new regulation states that claims must be well understood by the average consumer. This article delves beyond the issue of scientific substantiation of claims and reviews possible discrepancies between consumer perception/understanding of HCs and the public health nutrition reality, which can confuse or mislead the consumer and ultimately impact public health nutrition. Six pitfalls are described herein and a comprehensive overview of the critical examination of any HC is proposed.

Access to antiretroviral treatment (ART) has substantially increased in the Democratic Republic of Congo (DRC) over the past 5 years. Sante Rural (SANRU), a non-governmental organization established by l’Eglise de Christ du Congo (Christ’s Church of the Congo) in the 1980s to improve rural health in the DRC, is one of the principal recipients of Global fund in DRC with around 40000 people living with HIV/AIDS (PLWHIV) receiving ART in 129 health zones in the country. The continuous success of ART critically depends on sustained ART adherence. The objective of this study was to identify the determinants of adherence among PLWHIV in SANRU managed health zones in the Democratic Republic of Congo. Two thousand five hundred eighty-six PLWHIV’s files were extracted. Eighty-two percent (82%) were adherent to ART, while 85. 5% were alive after 12 months on anti-retroviral treatment, 5.2% were lost from follow-up and 2.2% were transferred. The average age was 37 years, and predominantly women formed 65.5% of the sample. The median distance between facilities and patient’s habitat was 5 kms. Close to three-fifth of the PLWHIV were living in urban settings (64.4%). Among 2586 patient’s files retrieved, 2495 (96, 5%) were followed up in facilities with at least an HIV-care trained physician and nurses, 1566 (60.6%) were followed up in facilities with at least one HIV care trained pharmacist; 1645 (63.6%) among the PLWHIV did not report ART stock run-outs. These findings highlight the relevance of healthcare providers’ training on HIV to improve HIV patient outcomes.

BACKGROUND This study reports the microbiological landscape of Salmonella Typhi and invasive nontyphoidal Salmonella (iNTS) in the Democratic Republic of the Congo (DRC). METHODS Blood cultures obtained from hospital-admitted patients suspected of bloodstream infection (BSI) in 4 of 11 provinces in DRC (Kinshasa, Bas-Congo, Equateur, and Orientale) were processed. Sampling had started in 2007; the results for the period 2011-2014 are reported. RESULTS Salmonella Typhi and iNTS were cultured from 194 (1.4%) and 840 (5.9%), respectively, of 14,110 BSI episodes and ranked first among BSI pathogens in adults (65/300 [21.7%]) and children (783/1901 [41.2%]), respectively. A total of 948 of 1034 (91.7%) isolates were available for analysis (164 Salmonella Typhi and 784 iNTS). Salmonella Typhimurium and Salmonella Enteritidis represented 386 (49.2%) and 391 (49.9%), respectively, of iNTS isolates, fluctuating over time and geography and increasing during the rainy season. Adults accounted for

Background Malaria is preventable and treatable when recommended interventions are properly implemented. Thus, diagnosis and treatment focus on symptomatic individuals while asymptomatic Plasmodium infection (PI) plays a role in the sustainability of the transmission and may also have an impact on the morbidity of the disease in terms of anaemia, nutritional status and even cognitive development of children. The objective of this study was to assess PI prevalence and its relationship with known morbidity factors in a vulnerable but asymptomatic stratum of the population. Methods A simple random sample, household survey in asymptomatic children under the age of five was conducted from April to September 2012 in two health areas of the health zone of Mont Ngafula 1, Kinshasa, Democratic Republic of Congo. Results The PI prevalence were 30.9% (95% CI: 26.5-35.9) and 14.3% (95% CI: 10.5-18.1) in Cité Pumbu and Kindele health areas, respectively, (OR: 2.7; p

Unfortunately, the original version of this article [1] contained an error. The author’s names were included incorrectly, the surnames were presented before the forename: Bruyère Olivier, Ahmed H. Serge, Atlan Catherine, Belegaud Jacques, Bortolotti Murielle, Canivenc-Lavier Marie-Chantal, Charrière Sybil, Girardet Jean-Philippe, Houdart Sabine, Kalonji Esther, Nadaud Perrine, Rajas Fabienne, Slama Gérard and Margaritis Irène The author list has been corrected in the original article and is also included correctly below: Olivier Bruyère, Serge H. Ahmed, Catherine Atlan, Jacques Belegaud, Murielle Bortolotti, Marie-Chantal Canivenc-Lavier, Sybil Charrière, Jean-Philippe Girardet, Sabine Houdart, Esther Kalonji, Perrine Nadaud, Fabienne Rajas, Gérard Slama, Irène Margaritis (NB: erratum 1 p. doi: in volume 73, 49, published 23 October 2015, (eCollection 2015, PMID: 26500771, PMCID: PMC4619575)); International audience; Background : The intense sweeteners currently authorised in Europe comprise ten compounds of various chemical natures. Their overall use has sharply risen in the last 20 years. These compounds are mainly used to formulate reduced-calorie products while maintaining sweetness.Methods : This extensive analysis of the literature reviews the data currently available on the potential nutritional benefits and risks related to the consumption of products containing intense sweeteners.Results and Conclusions : Regarding nutritional benefits, the available studies, while numerous, do not provide proof that the consumption of artificial sweeteners as sugar substitutes is beneficial in terms of weight management, blood glucose regulation in diabetic subjects or the incidence of type 2 diabetes. Regarding nutritional risks (incidence of type 2 diabetes, habituation to sweetness in adults, cancers, etc.), it is not possible based on the available data to establish a link between the occurrence of these risks and the consumption of artificial sweeteners. However, some studies underline the need to improve knowledge of the links between intense sweeteners consumption and certain risks.

The intense sweeteners currently authorised in Europe comprise ten compounds of various chemical natures. Their overall use has sharply risen in the last 20 years. These compounds are mainly used to formulate reduced-calorie products while maintaining sweetness.This extensive analysis of the literature reviews the data currently available on the potential nutritional benefits and risks related to the consumption of products containing intense sweeteners.Regarding nutritional benefits, the available studies, while numerous, do not provide proof that the consumption of artificial sweeteners as sugar substitutes is beneficial in terms of weight management, blood glucose regulation in diabetic subjects or the incidence of type 2 diabetes. Regarding nutritional risks (incidence of type 2 diabetes, habituation to sweetness in adults, cancers, etc.), it is not possible based on the available data to establish a link between the occurrence of these risks and the consumption of artificial sweeteners. However, some studies underline the need to improve knowledge of the links between intense sweeteners consumption and certain risks.