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Abstract Background Despite the progress made in recent years in the treatment of Acute Heart Failure (AHF), its prognosis remains poor in the developing country. The objective of this study is to analyze the survival and predictors of mortality of patients with acute heart failure in the cardiology department of the Basse Terre Hospital Center in Guadeloupe. Methods this was a historical cohort study carried out over a period from June 2021 to June 2022, targeting all acute heart failure patients undergoing cardiac monitoring in the cardiology department of the Basse Terre Hospital Center in Guadeloupe. Sociodemographic, clinical, biological characteristics and outcome (recovery or death) were studied. Survival was described using the Kaplan Meier method α = 5%. Results this study involved 242 acute heart failure patients whose median age was 75 years and the majority were male (sex ratio 2 M/1F). Among these patients, 14.9% died, the most common cause of death was cardiogenic shock (52.8%). After adjustment, tobacco consumption (aHR: 2.90; 95% CI: 1.36–8.09), Chronic Kidney Disease (aHR: 2.52; 95% CI: 1.22–5.20), infection (aHR: 2.14; 95CI %: 1.99–4.58), hyponatremia (aHR: 1.90; 95% CI: 1.10–2.86), mitral regurgitation (aHR: 3.04; 95% CI: 1.98–9.47) and N-terminal pro Brain Natriuretic Peptide > 10000ng/ml (aHR: 2.57; 95% CI: 1.21–5.49) were independently associated with the risk of death in heart failure patients. Conclusion Acute heart failure leads to high mortality, mainly due to cardiogenic shock and factors of multiple organ failure.

Abstract Background Although aging and being of African descent are well-known risk factors for masked uncontrolled hypertension (MUCH), data on MUCH among elderly black sub-Saharan Africans (BSSA) are limited. Furthermore, it is unclear whether the determinants of MUCH in younger individuals differ from those in the elderly. Objective This study aimed to determine the prevalence and risk factors associated with MUCH in both elderly and younger BSSA individuals. Methods In this study, 168 patients with treated hypertension were assessed for medical history, clinical examination, fundoscopy, echocardiography, and laboratory data. All patients underwent ambulatory blood pressure (BP) monitoring for 24 h. MUCH was diagnosed if the average 24-h mean BP ≥ 130/80 mmHg, the daytime mean BP ≥ 135/85 mmHg, and/or the nighttime mean BP ≥ 120/70 mmHg, despite controlled clinic BP (≤ 140/90 mmHg). Logistic regression analysis was performed to assess independent factors associated with MUCH, including elderly and younger adults separately. P-values

Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) infection is well established as a systemic disease including kidney damage. The entry point into the renal cell remains the angiotensin-converting enzyme 2 (ACE-2) receptor and the spectrum of renal lesions is broad, with a clear predominance of structural and functional tubular lesions. The most common form of glomerular injury is collapsing glomerulopathy (CG), which is strongly associated with apolipoprotein L1(APOL-1) risk variants. These acute lesions, which are secondary to the direct or indirect effects of SARS-CoV-2, can progress to chronicity and are specific to long COVID-19 in the absence of any other cause. Residual inflammation associated with SARS-CoV-2 infection, in addition to acute kidney injury (AKI) as a transitional state with or without severe histological lesions, may be responsible for greater kidney function decline in mild-to-moderate COVID-19. This review discusses the evidence for renal histological markers of chronicity in COVID-19 patients and triggers of low-grade inflammation that may explain the decline in kidney function in the post-COVID-19 period.

Understanding the complexity of climate dynamics is of paramount importance, because climate variability and change significantly affect water cycles and ecosystems. However, recurrent hydrological droughts that have been observed every 10 years on the two primary tributaries of the Congo River (the Ubangui and Kasaï Rivers) since the advent of the 1969 drought lack a plausible explanation for variability or climate change. This study proposes a plausible explanation for recurring hydrological droughts. Given the low rate of human activity and vegetation cover evolution in the Congo Watershed, we propose that climate dynamics play a crucial role in hydrological drought dynamics. By applying the Bayesian approach to a gridded precipitation database, we obtained posterior probability maps for each annual time step during our observational period (1940–2020). This provided a spatiotemporal representation of the areas affected by climatic disturbances, unlike previous studies that were limited to a spatial representation of the temporal location of the disturbances. Our qualitative analysis of the maximum intensity of the climate disturbance signal (CPS) revealed an average cycle of 10 years and eight months of signal migration. However, we observed that every 10 years since the advent of the drought during 1969, the hydrological drought occurrence dates coincided with CPS migration dates. This highlights the influence of this cycle on the hydrological drought dynamics. Nevertheless, because of the monthly scale involved in the propagation time from meteorological to hydrological drought, the error in this cycle was considered to be the propagation time of disturbances. Therefore, we recommend that future research should focus on estimating this time to test this hypothesis. This study underscores the significance of the cyclic dynamics of lengthy transient processes in understanding hydrological drought dynamics.

Summary: Background: Research in healthy young adults shows that characteristic patterns of brain activity define individual “brain-fingerprints” that are unique to each person. However, variability in these brain-fingerprints increases in individuals with neurological conditions, challenging the clinical relevance and potential impact of the approach. Our study shows that brain-fingerprints derived from neurophysiological brain activity are associated with pathophysiological and clinical traits of individual patients with Parkinson’s disease (PD). Methods: We created brain-fingerprints from task-free brain activity recorded through magnetoencephalography in 79 PD patients and compared them with those from two independent samples of age-matched healthy controls (N = 424 total). We decomposed brain activity into arrhythmic and rhythmic components, defining distinct brain-fingerprints for each type from recording durations of up to 4 min and as short as 30 s. Findings: The arrhythmic spectral components of cortical activity in patients with Parkinson’s disease are more variable over short periods, challenging the definition of a reliable brain-fingerprint. However, by isolating the rhythmic components of cortical activity, we derived brain-fingerprints that distinguished between patients and healthy controls with about 90% accuracy. The most prominent cortical features of the resulting Parkinson’s brain-fingerprint are mapped to polyrhythmic activity in unimodal sensorimotor regions. Leveraging these features, we also demonstrate that Parkinson’s symptom laterality can be decoded directly from cortical neurophysiological activity. Furthermore, our study reveals that the cortical topography of the Parkinson’s brain-fingerprint aligns with that of neurotransmitter systems affected by the disease’s pathophysiology. Interpretation: The increased moment-to-moment variability of arrhythmic brain-fingerprints challenges patient differentiation and explains previously published results. We outline patient-specific rhythmic brain signaling features that provide insights into both the neurophysiological signature and symptom laterality of Parkinson’s disease. Thus, the proposed definition of a rhythmic brain-fingerprint of Parkinson’s disease may contribute to novel, refined approaches to patient stratification. Symmetrically, we discuss how rhythmic brain-fingerprints may contribute to the improved identification and testing of therapeutic neurostimulation targets. Funding: Data collection and sharing for this project was provided by the Quebec Parkinson Network (QPN), the Pre-symptomatic Evaluation of Novel or Experimental Treatments for Alzheimer’s Disease (PREVENT-AD; release 6.0) program, the Cambridge Centre for Aging Neuroscience (Cam-CAN), and the Open MEG Archives (OMEGA). The QPN is funded by a grant from Fonds de Recherche du Québec - Santé (FRQS). PREVENT-AD was launched in 2011 as a $13.5 million, 7-year public-private partnership using funds provided by McGill University, the FRQS, an unrestricted research grant from Pfizer Canada, the Levesque Foundation, the Douglas Hospital Research Centre and Foundation, the Government of Canada, and the Canada Fund for Innovation. The Brainstorm project is supported by funding to SB from the NIH (R01-EB026299-05). Further funding to SB for this study included a Discovery grant from the Natural Sciences and Engineering Research Council of Canada of Canada (436355-13), and the CIHR Canada research Chair in Neural Dynamics of Brain Systems (CRC-2017-00311).

The main difference between an open-water (regular) flood and an ice jam flood is that it is normally the whole river length that is overtopped whereas an ice jam flood is localized to where the jam is located. Comparatively, the regular flood analysis can use the value of the extreme discharge as the main input parameter for a long river section, an ice jam flood needs to account for the probability of jams of various lengths and intensities occurring at specific locations under significantly variable discharges while having several mechanical ice parameters to be considered. Through the case study of the Chaudière River, the methodology presented in this paper demonstrates how to statistically characterize four significant inputs (jam location, jam length, jam properties and river discharge during jam event) into the widely used numerical river water model (HEC-RAS) and how Monte–Carlo simulations are generated to estimate probable ice jam floods along a whole river reach. The purpose of this article is to propose a robust methodology through a case study and asses the sensitivity that historical and mechanical parameters have as to why specific locations along the reach have higher 1:100 AEP ice-induced water levels as to 1:100 AEP open-water levels. HIGHLIGHTS Comparison of 1:100 AEP open-water flood and ice jam flood.; Historical distribution of input parameters.; Using stochastic modelling with HEC-RAS with external control via Python.; Strength of the Monte–Carlo method.;

Background and Objectives. The chest computed tomography (chest CT) has played an important role in the management of COVID-19. Few data on its use in sub-Saharan Africa (SSA) are reported. The objectives of this study conducted in Kinshasa, DR Congo, were to describe the lung lesions on day 1 of hospitalization in patients admitted for suspected COVID-19 and to identify those that were most associated with SARS-CoV-2 infection/RT-PCR and the determinants of chest CT associated with death. Methods. We included all patients with respiratory symptoms (dyspnea, fever, and cough) and/or respiratory failure admitted to the SOS Médecins de nuit SARL hospital, DR Congo, during the 2nd and 3rd waves of the COVID-19 pandemic. The diagnosis of COVID-19 was established based on RT-PCR anti-SARS-CoV-2 tests (G1 (RT-PCR positive) vs. G2 (RT-PCR negative)), and all patients had a chest CT on the day of admission. We retrieved the digital files of patients, precisely the clinical, biological, and chest CT parameters of the day of admission as well as the vital outcome (survival or death). Chest CT were read by a very high-definition console using Advantage Windows software and exported to the hospital network using the RadiAnt DICOM viewer. To determine the threshold for the percentage of lung lesions associated with all-cause mortality, we used ROC curves. Factors associated with death, including chest CT parameters, were investigated using logistic regression analysis. Results. The study included 200 patients (average age 56.2±15.2 years; 19% diabetics and 4.5% obese), and COVID-19 was confirmed among 56% of them (G1). Chest CT showed that ground glass (72.3 vs. 39.8%), crazy paving (69.6 vs. 17.0%), and consolidation (83.9 vs. 22.7%), with bilateral and peripheral locations (68.8 vs. 30.7%), were more frequent in G1 vs. G2 (p

Introduction. Nauclea latifolia est une espèce médicinale largement utilisée dans la médecine traditionnelle béninoise pour traiter les gastrites. La présente étude vise à déterminer quelques paramètres toxicologiques d'un phytomédicament à base de décoction de racines de N. latifolia afin de mieux contrôler son dosage et sa posologie. Matériel et Méthodes. La toxicité orale aiguë a été évaluée chez des rats Sprague-Dawley à partir de 5 doses dont la première de 2500 mg/kg/vo a été déterminée par correspondance à la concentration à la limite de la solubilité de l’extrait croissantes du phytomédicament. Les 4 autres doses en ont été déduite (156,25 ; 31,25 ; 62,5 et 125 mg/kg/vo). La Dose Maximale Tolérée et la Dose Journalière Recommandée ont été déterminée au moyen des calculs de correspondance proposés par N’Guessan. Résultats et discussion. L'administration per os du phytomédicament à base de racines de N. latifolia n'a entraîné aucune mortalité ni aucun signe de toxicité chez les rats testés. La dose maximale tolérée qui équivaut à 2500 mg/kg/vo. Par ailleurs, les résultats indiquent que cette (2500 mg/kg/vo) enregistré est nettement supérieure à la Dose Journalière Recommandée (26,35 mg/kg/vo) par les praticiens de santé pour avoir l'effet thérapeutique attendu. Ainsi, ces données rassurent que dans les conditions traditionnelles de la préparation du phytomédicament car il est presque impossible d'atteindre la Dose Maximale Tolérée chez un homme de poids moyen de 60 kg. Toutefois, les résultats des tests biochimiques montrent que le phytomédicament entraîne quelques modifications des paramètres biochimiques. Conclusion. Au vu de ces données, le phytomédicament à base de décoction de N. latifolia dans les conditions traditionnelles d'utilisation thérapeutique ne semble pas toxique.

Introduction Acute kidney injury (AKI) is a complication of severe coronavirus disease 2019 (COVID-19). Kidney damage associated with COVID-19 could take specific features due to environmental and socio-cultural factors. This study evaluates the incidence of AKI, the associated factors, and mortality in COVID-19 patients in a Sub-Saharan African intensive care unit.Methods In a prospective cohort study conducted in the intensive care unit (ICU) of the Centre Médical de Kinshasa (CMK), consecutive patients admitted for COVID-19 were screened for the presence of AKI between 27 March, 2020 and 27 January 2022. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) guidelines. The primary outcome was occurrence of AKI. The secondary outcome was 48 days’ mortality and recovery of the renal function at intensive care unit (ICU) discharge. Survival (time-to death) curves were built using the Kaplan Meier methods. Multivariate analyses were performed by logistic regression to identify factors associated with AKI and Cox regression to explore the association between AKI and in-hospital mortality. The significance level of the p-value was set at 0.05.Results The median(IQR) sequential organ failure assessment score (SOFA) score and mean age of patients (215) including in our cohort were respectively 3(2-4) and 58.9 ± 14.9 years. The incidence of AKI was 28.4% with stages 1, 2, or 3 AKI accounted for 39.3%, 11.5%, and 49.2%, respectively. Hemodialysis was required in 16 out 215 (7.4%) patients. Dyspnea (adjusted odds ratio (aOR):2.27 [1.1–-4.57] p = 0.021), SOFA ≥5 (aOR:3.11[1.29–7.53] p = 0.012), AST/ALT ratio (aOR: 1.53 [1.09–1.79] p = 0.015), N/L ratio (aOR:2.09 [1.09–3.20] p = 0.016), mechanical ventilation (aOR: 3.20 [1.66–10.51] p = 0.005) and Amikacin (aOR: 2.91 [1.37–6.18] p = 0.006) were the main factors associated with AKI. Patients with AKI had a mortality rate of 52.5% and 67.2% of the survivors did not recover kidney function at the end of hospitalization. Adjusted Cox regression analysis revealed that COVID-19-associated AKI was independently associated with in-hospital death (HR:2.96 [1.93–4.65] p = 0.013) compared to non-AKI patients.Conclusions AKI was present in three out of ten COVID-19 patients. The most significant factors associated with AKI were dyspnea, SOFA ≥ 5, AST/ALT and N/L ratio, mechanical ventilation and Amikacin. AKI has been associated with an almost threefold increase in overall mortality and seven out of ten survivors did not recover kidney function after AKI.

Summary Background One year after the coronavirus disease 2019 (COVID-19) pandemic, the focus of attention has shifted to the emergence and spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants of concern (VOCs). The aim of the study was to assess the frequency of VOCs in patients followed for COVID-19 at Kinshasa university hospital (KUH) during the 3rd and 4th waves of the pandemic in Kinshasa. Hospital mortality was compared to that of the first two waves. Method The present study included all patients in whom the diagnosis of SARS-CoV-2 infection was confirmed by the polymerase chain reaction (PCR). The laboratory team sequenced a subset of all SARS-CoV-2 positive samples with high viral loads define as Ct

Antimicrobial resistance (AMR) is a global public health threat. Quality data on AMR are needed to tackle the rise of multidrug-resistant clones. These data are rare in low-income countries, especially in sub-Saharan Africa. In this study, we investigated the rise of extended-spectrum β-lactamase–producing (ESBL) Enterobacteriaceae in Bangui, Central African Republic. We collected 278 fecal samples from 0–5-year-old children admitted to the Pediatric University Hospital Complex in Bangui from July to September 2021. Enterobacteriaceae were isolated and identified, and their susceptibility to 19 antibiotics was tested. We recovered one and two Enterobacteriaceae species from 208 and 29 samples, respectively. One clone of each species from each sample was further characterized, for a total of 266 isolates. Escherichia coli predominated, followed by Klebsiella. AMR was frequent, with 98.5% (262/266) of the isolates resistant to at least one antibiotic. Additionally, 89.5% (238/266) of the isolates were multidrug resistant, with resistance being frequent against all tested antibiotics except carbapenems and tigecycline, for which no resistance was found. Importantly, 71.2% (198/278) of the children carried at least one ESBL species, and 85.3% (227/266) of the isolates displayed this phenotype. This study confirms the rise of ESBL Enterobacteriaceae in Bangui and stresses the need for action to preserve the efficacy of antibiotics, as crucial for the treatment of bacterial infections.

L'intelligence artificielle (IA) est de plus en plus utilisée pour le diagnostic en ligne dans le domaine de la radiographie industrielle. Les avancées dans les algorithmes de classification et de segmentation sémantique ces dernières années constituent des outils qui permettent une détection plus précise des détails dans les images radiographiques, ce qui constitue une avancée majeure par rapports aux algorithmes traditionnels à base de traitements d’images « classiques » ou méthodes statistiques. Nous présentons ici 3 approches IA en radiographie industrielle, développées à des fins de diagnostic pour du contrôle sur ligne de production. ▪ La première approche, basée sur la classification, consiste à élaborer et entrainer un réseau de neurones de type CNN pour un établir un diagnostic qualité sur ligne de production sur image radiographique. Les images d’acquisition radiographique dont il est question ici sont des images acquises au moyen d’un capteur matriciel (projection conique). ▪ Les deux autres approches traitent du contrôle radiographique industriel sur ligne de production acquises au moyen d’un capteur linéaire (donc géométrie de projection semi-conique). ▪ La première de ces deux approches consiste à apprendre à un modèle de type Variational Autoencoder un pattern de « normalité », de la structure du matériau analysé, permettant ainsi de s’affranchir de l’apprentissage des défauts. ▪ La deuxième de ces deux approches consiste par des moyens de segmentation sémantique à détecter des défauts sur un produit à sur l’image. Le modèle ainsi conçu et entrainé, consiste en une segmentation sémantique à 5 sorties (4 classes de défauts et le background).

Résumé La Province du Bas-Uélé est entièrement agricole, les cultures pratiquées jadis étaient l’arachide, le coton et le caféier. Actuellement, les cultures vivrières pratiquées ne peuvent pas seules resoudre le problème de la pauvreté dont souffre la population. Il est donc le moment de penser à introduire les cultures de rente, en particulier le cacao à partir du Territoire de Bambesa. Cette étude qui a consistée à évaluer le comportement phenologique des cultivars de Yangambi a démontré que le cacaoyer peut être cultivé dans les conditions pedoclimatiques de Bambesa : Tous les trois hybrides introduits à Bambesa se sont bien comportés et peuvent être diffusés quant à leur comportement donc leur capacité d’adaptation. Abstract Bas-Uélé Province is entirely agricultural, crops grown in the past were peanuts, cotton and coffee. Currently, animal crops can not alone solve the problem of poverty that afflicts the population. It is therefore time to think about introducing cash crops, especially cocoa from the Bambesa Territory. This study, which evaluated the phenological behavior of Yangambi cultivars, showed that the cocoa tree can be cultivated under Bambesa pedoclimatic conditions: All three hybrids introduced at Bambesa have behaved well and can be disseminated as far as possible. their behavior and their ability to adapt.

Abstract Background Africa has a rich and diverse flora that people use for their food and health needs. This study aims to explore the possibility of using aqueous and/or ethanolic extracts of Alchornea cordifolia leaves as an alternative in the fight against multi-resistant bacteria responsible for gastritis and urinary tract infections. Results The results show that 100% of the tested bacilli (E. coli, K. pneumoniae, P. aeruginosa) are resistant to the 10 antibiotic disks tested. This resistance is 66.66% for quinolones and fluoroquinolones. S. aureus was found to be resistant to glycopeptides and aminoglycosides. Three ESBL genes are identified in bacilli against only one type of ESBL gene in cocci. 100% of the bacilli carry the SHV genes, and S. aureus has the Mec A gene. The aqueous extract exerted a bactericidal effect on all the strains with MICs and BMCs varying, respectively, from 0.76 to 50 mg/ml and BMCs from 0.76 to 100 mg/ml. Only 40% of the chemical groups (tannin, flavonoids, mucilages and sterol-terpenes) sought were present in the aqueous extract. The ethanolic extract is not active. Conclusions Based on these data, the aqueous extract of A. cordifolia leaves is a good phytomedical candidate for the treatment of gastritis (stomach cramps, watery or bloody diarrhea) and urinary tract infections caused by multi-resistant Gram-negative and Gram-positive bacteria.

Abstract Background Magnetic resonance imaging (MRI) is currently considered a safe imaging technique because, unlike computed tomography, MRI does not expose patients to ionising radiation. However, conflicting literature reports possible genotoxic effects of MRI. We herein examine the chromosomal effects of repeated MRI scans by performing a longitudinal follow-up of chromosomal integrity in volunteers. Methods This ethically approved study was performed on 13 healthy volunteers (mean age 33 years) exposed to up to 26 3-T MRI sessions. The characterisation of chromosome damage in peripheral blood lymphocytes was performed using the gold-standard biodosimetry technique augmented with telomere and centromere staining. Results Cytogenetic analysis showed no detectable effect after a single MRI scan. However, repeated MRI sessions (from 10 to 20 scans) were associated with a small but significant increase in chromosomal breaks with the accumulation of cells with chromosomal terminal deletions with a coefficient of 9.5% (95% confidence interval 6.5–12.5%) per MRI (p

Abstract Background Cardiovascular (CV) disease is the leading cause of mortality in patients with end-stage kidney disease (ESKD). The aim of the present study was to determine whether Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) could be an independent predictor of CV events and all-cause mortality in black African haemodialysis patients. Methods We carried out a prospective cohort study of all consecutive hemodialysis (HD) patients between August 2016 and July 2020, admitted in six hemodialysis centers of Kinshasa, Democratic Republic of Congo. Independent determinants of plasma PCSK-9 measured by ELISA were sought using multiple linear regression analysis. Kaplan-Meier’s method described the incidence of CV events while competitive and proportional risk models looked for independent risk factors for death at the .05 significance level. Results Out of 207 HD patients, 91 (43.9%) died; 116 (56.1%) have survived. PCSK9 level was significantly higher in deceased patients compared to survivors: 28.0 (24.0–31.0) ng/l vs 9.6 (8.6–11.6) ng/ml (p

Abstract Background In symptomatic patients, the diagnostic approach of COVID-19 should be holistic. We aimed to evaluate the concordance between RT-PCR and serological tests (IgM/IgG), and identify the factors that best predict mortality (clinical stages or viral load). Methods The study included 242 patients referred to the University hospital of Kinshasa for suspected COVID-19, dyspnea or ARDS between June 1st, 2020 and August 02, 2020. Both antibody-SARS-CoV2 IgM/IgG and RT-PCR method were performed on the day of admission to hospital. The clinical stages were established according to the COVID-19 WHO classification. The viral load was expressed by the CtN2 (cycle threshold value of the nucleoproteins) and the CtE (envelope) genes of SARS- CoV-2 detected using GeneXpert. Kappa test and Cox regression were used as appropriate. Results The GeneXpert was positive in 74 patients (30.6%). Seventy two patients (29.8%) had positive IgM and 34 patients (14.0%) had positive IgG. The combination of RT-PCR and serological tests made it possible to treat 104 patients as having COVID-19, which represented an increase in cases of around 41% compared to the result based on GeneXpert alone. The comparison between the two tests has shown that 57 patients (23.5%) had discordant results. The Kappa coefficient was 0.451 (p

Abstract Background Despite it being a global pandemic, there is little research examining the clinical features of severe COVID-19 in sub-Saharan Africa. This study aims to identify predictors of mortality in COVID-19 patients at Kinshasa Medical Center (KMC). Methods In this retrospective, observational, cohort study carried out at the Kinshasa Medical Center (KMC) between March 10, 2020 and July 10, 2020, we included all adult inpatients (≥ 18 years old) with a positive COVID-19 PCR result. The end point of the study was survival. The study population was dichotomized into survivors and non-survivors group. Kaplan–Meier plot was used for survival analyses. The Log-Rank test was employed to compare the survival curves. Predictors of mortality were identified by Cox regression models. The significance level of p value was set at 0.05. Results 432 patients with confirmed COVID-19 were identified and only 106 (24.5%) patients with moderate, severe or critical illness (mean age 55.6 ± 13.2 years old, 80.2% were male) were included in this study, of whom 34 (32%) died during their hospitalisation. The main complications of the patients included ARDS in 59/66 (89.4%) patients, coagulopathy in 35/93 (37.6%) patients, acute cardiac injury in 24/98 (24.5%) patients, AKI in 15/74 (20.3%) patients and secondary infection in 12/81 (14.8%) patients. The independent predictors of mortality were found to be age [aHR 1.38; 95% CI 1.10–1.82], AKI stage 3 [aHR 2.51; 95% CI 1.33–6.80], proteinuria [aHR 2.60; 95% CI 1.40–6.42], respiratory rate [aHR 1.42; 95% CI 1.09–1.92] and procalcitonin [aHR 1.08; 95% CI 1.03–1.14]. The median survival time of the entire group was 12 days. The cumulative survival rate of COVID-19 patients was 86.9%, 65.0% and 19.9% respectively at 5, 10 and 20 days. Levels of creatinine (p = 0.012), were clearly elevated in non-survivors compared with survivors throughout the clinical course and increased deterioration. Conclusion Mortality rate of COVID-19 patients is high, particularly in intubated patients and is associated with age, respiratory rate, proteinuria, procalcitonin and acute kidney injury.

Les années 1920 voient exploser en France les initiatives en faveur d’un tourisme œno-gastronomique informé et exigeant. Le Guide Michelin accorde à partir de 1926 des « étoiles de bonne table » aux meilleurs restaurants. Maurice Edmond Sailland, dit Curnonsky (1872-1956), publie à partir de 1921 les 28 volumes (sur 32 prévus) de La France gastronomique qui recense les meilleures recettes des cuisines régionales et les meilleurs restaurants. Il est élu en 1927 « Prince des gastronomes », fonde en 1930 l’Académie des gastronomes et cofonde en 1933 l’Académie du Vin de France. C’est lui qui patronne une entreprise étonnante qui paraît pour la première fois en 1929, la Carte gastronomique de la France qui a pour auteur le chef cuisinier Alain Bourguignon, alors directeur de L’Écu de France, un restaurant situé devant la Gare de l’Est à Paris. Cette carte d’un mètre carré recense des centaines de productions agro-alimentaires localisées (viandes, charcuteries, fromages, poissons, légumes, fruits, etc.), de vins et d’eaux-de-vie (sept ans avant la loi sur les AOC) et de recettes traditionnelles. À l’heure de la mondialisation, il est essentiel, tant sur les plans culturel qu’économique, de maintenir et de faire vivre cette diversité des produits et des savoir-faire de terroir. Elle seule peut nourrir un tourisme œno-gastronomique qui concerne aujourd’hui des visiteurs venus de tous les continents qui recherchent tant dans les paysages, les monuments, les musées, les rencontres que dans leur assiette et dans leur verre des émotions géographiques. La cuisine-fusion et les vins passe-partout n’ont aucun avenir et passeront comme toutes les modes reposant sur l’inculture et la vanité. Il est vrai que rares sont aujourd’hui les critiques gastronomiques et œnologiques aussi érudits, compétents, diserts et joyeux que Curnonsky !

Abstract Background Urolithiasis is increasingly diagnosed worldwide. Stone analysis is an important part in the assessment of patients with urolithiasis. However, in sub-Saharan Africa, data on the composition of urinary stones are limited. This study aimed to describe the composition and sites of urinary stones and to investigate relationship between socio-demographic characteristics, clinical profile of patients, and the composition of urinary stones. Methods A retrospective analysis of 132 patients with urolithiasis who visited one of the seven hospitals in the Democratic Republic of Congo during eight years of study period (January 2010 to January 2018) was conducted. Stones were analyzed by infrared spectrophotometry. Results Most of stones analyzed (n = 82, 62.1%) originated from the upper urinary tract with a difference across gender (58.5% males vs. 41.5% females, p = 0.001). Only three stones (two from whewellite and one from anhydrous uric acid) were considered pure (2.3%), excluding the protein frame (less than 5%). Whewellite, proteins, and carbapatite were identified in 97.7%, 96.2%, and 80.3% of the stones analyzed, respectively; and in 91.7%, 89.4%, and 67.7% of the nuclei of the stones analyzed, respectively. Taking into account the proportion of each constituent in the stones analyzed, whewellite (68.9%), anhydrous uric acid (10.6%), and carbapatite (8.3%) were the main constituents in respectively 68, 9%, 10.6%, and 8.3% of the stones analyzed. Conclusion Whewellite, anhydrous uric acid, and carbapatite represented the most frequent main components of stones identified, suggesting that dietary hyperoxaluria could be an important factor in lithogenesis in the Democratic Republic of Congo.

Background and Objective: Liver enzyme abnormalities (LEA) are extremely common and sometimes severe in individuals infected with human immunodeficiency virus (HIV), but data for this disorder are lacking in the developing countries. The objective of this study was to identify factors associated with LEA in HIV–hepatitis B virus (HBV)/hepatitis C virus (HCV) co-infected patients in Kinshasa, Democratic Republic of the Congo. Methods: This cross-sectional analytical study included 180 people living with HIV (PLWHIV) mono-infected or co-infected with HBV/HCV between November 10, 2013 and January 10, 2014 in Kinshasa. Sociodemographic, clinical, biological, serological, and immunological data were analyzed. Levels of serum glutamate oxaloacetate transferase (SGOT) and serum glutamate pyruvate transaminase (SGPT) were determined. Antibody levels were determined using enzyme-linked immunosorbent assay (ELISA). Results: The mean age of patients was 44.2±11.0 years; female sex was predominant (76.7%). Co-infection, mainly with HBV, but also HCV, was found in 43 (23.9%) patients. Elevated liver enzymes were found in 77 (42.8%) of the patients. No difference was found in the rate of liver enzyme abnormalities between patients with HIV mono-infection or HIV co-infection (46.7% versus 30.2%, respectively; P=0.08). Factors associated with LEA were age ≥50 years (adjusted odds ratio [OR] 2.7; 95% CI 1.4–5.5), duration of HIV infection >3 years (adjusted OR 2.7; 95% CI 1.4–5.5), and CD4 count ≤303 cells/mm³ (adjusted OR 2.2; 95% CI 1.1–4.5). Conclusions: Liver enzyme abnormalities are frequent in patients co-infected with HIV–HBV/HCV as well as in HIV patients without co-infection. Diagnosis is determined based on age, immunodeficiency, and length of illness.

Four cholera outbreaks were reported in the Central African Republic during 1997–2016. We show that the outbreak isolates were Vibrio cholerae O1 serotype Inaba from 3 seventh pandemic El Tor sublineages originating from West Africa (sublineages T7 and T9) or the African Great Lakes Region (T10).

Abstract Background Although cardiovascular diseases in particular Pulmonary Arterial Hypertension (PAH) is associated with, high morbid-mortality in chronic hemodialysis, but its magnitude remains paradoxically unknown in sub-Saharan Africa. The aim of this study was to evaluate the prevalence of PAH and associated factors in chronic hemodialysis in Sub-Saharan African population. Method In a cross-sectional study, patients treated with HD for at least 6 months in 4 hemodialysis centers were examined. PAH was defined as estimated systolic pulmonary arterial pressure (sPAP) ≥ 35 mmHg using transthoracic Doppler echocardiography performed 24 h after the HD session. Results Eighty-five HD patients were included; their average age was 52.6 ± 15.9 years. Fifty-seven patients (67.1%) were male. Mean duration of HD was 13.3 ± 11 months. With reference to vascular access, 12 (14.1%), 29 (34.1%) and 44 (51.8%) patients had AVF, tunneled cuff and temporary catheter, respectively. The underlying cause of ESRD was diabetes in 30 patients (35.3%). The prevalence of PAH was 29.4%. Patients with PAH had more hyponatremia (11 (44%) vs 10 (16.7%), p = 0.010). In multivariate analysis, unsecured healthcare funding (aOR 4, 95% CI [1.18–6.018]), arrhythmia (aOR 3, 95% CI [1.29–7.34]), vascular access change (aOR 4, 95% CI [1.18–7.51]) and diastolic dysfunction (aOR 5, 95% CI [1.35–9.57] were independently associated with PAH. Conclusion One third of hemodialysis patients exhibit PAH, which is independently associated with low socioeconomic status (unsecured funding, vascular access change) and cardiovascular complications (arrhythmia, diastolic dysfunction).

Abstract Background Pancreatic neuroendocrine tumors (PNET) are rare, with a significant malignant potential. This study aimed to determine outcomes of patients with resected PNETs according to the cystic component and confirm the accuracy of preoperative staging. Methods From 1997 to 2016, 106 patients underwent resection of PNETs, including 73 purely solid (S-PNETs, 69%), 21 mixed (M-PNETs, 20%), and 12 purely cystic lesions (C-PNETs, 11%). To ensure consistent comparisons of overall (OS) and disease-free (DFS) survival outcomes between the 3 groups, the patients were matched according to the World Health Organization (WHO) grade and tumor height. Results Overall, the rate of correlation between the preoperative and pathological diagnoses was low in the C-PNET group (33%, P = 0.03). None of the 24 patients (23%) with metastatic disease at the time of surgery were in the C-PNET group. Furthermore, significantly more parenchyma-sparing resections (P = 0.039) and fewer enlarged resections (P = 0.019) were achieved in the C-PNET group. C-PNET group had a significantly lower node invasion rate than the S-PNET and M-PNET groups (8% vs. 41% and 24%, P = 0.004). Although median OS was comparable in all 3 groups before (P = 0.3) and after (P = 0.18) matching, higher median DFS was observed in the C-PNET group than in the other groups after matching (P = 0.038). Conclusion C-PNET was associated with a better prognosis than PNET with a solid component. The results support a wait-and-see policy in cases wherein a reliable preoperative diagnosis remains challenging.

Abstract Background Current demographic trends point towards an aging society entailing increasing occurrence and burden of neurodegenerative diseases. In this context, understanding physiological aging and its turning point into neurodegeneration is essential for the development of possible biomarkers and future therapeutics of brain disease. Methods The SENIOR study represents a longitudinal, observational study including cognitively healthy elderlies aged between 50 and 70 years old at the time of inclusion, being followed annually over 10 years. Our multimodal protocol includes structural, diffusion, functional, and sodium magnetic resonance imaging (MRI) at 3 T and 7 T, positron emission tomography (PET), blood samples, genetics, audiometry, and neuropsychological and neurological examinations as well as assessment of neuronal risk factors. Results One hundred forty-two participants (50% females) were enrolled in the SENIOR cohort with a mean age of 60 (SD 6.3) years at baseline. Baseline results with multiple regression analyses reveal that cerebral white matter lesions can be predicted by cardiovascular and cognitive risk factors and age. Cardiovascular risk factors were strongly associated with juxtacortical and periventricular lesions. Intra-subject across-test variability as a measure of neuropsychological test performance and possible cognitive marker predicts white matter volume and is significantly associated with risk profile. Division of the cohort into subjects with a higher and lower risk profile shows significant differences in intra-subject across-test variability and volumes as well as cortical thickness of brain regions of the temporal lobe. There is no difference between the lower- and higher-risk groups in amyloid load using PET data from a subset of 81 subjects. Conclusions We here describe the study protocol and baseline findings of the SENIOR observational study which aim is the establishment of integrated, multiparametric maps of normal aging and the identification of early biomarkers for neurodegeneration. We show that intra-subject across-test variability as a marker of neuropsychological test performance as well as age, gender, and combined risk factors influence neuronal decline as represented by decrease in brain volume, cortical thickness, and increase in white matter lesions. Baseline findings will be used as underlying basis for the further implications of aging and neuronal degeneration as well as examination of brain aging under different aspects of brain pathology versus physiological aging.

Abstract Background The current study aimed to evaluate the outcomes of patients with unresectable non-metastatic locally advanced pancreatic adenocarcinoma (LAPA) who did not benefit from resection considering the treatment strategy in the clinical settings. Methods Between 2010 and 2017, a total of 234 patients underwent induction chemotherapy for LAPA that could not be treated with surgery. After oncologic restaging, continuous chemotherapy or chemoradiation (CRT) was decided for patients without metastatic disease. The Kaplan–Meier method was used to determine overall survival (OS), and the Wilcoxon test to compare survival curves. Multivariate analysis was performed using the stepwise logistic regression method. Results FOLFIRINOX was the most common induction regimen (168 patients, 72%), with a median of 6 chemotherapy cycles and resulted in higher OS, compared to gemcitabine (19 vs. 16 months, hazard ratio (HR) = 1.2, 95% confidence interval: 0.86–1.6, P = .03). However, no difference was observed after adjusting for age (≤75 years) and performance status score (0–1). At restaging, 187 patients (80%) had non-metastatic disease: CRT was administered to 126 patients (67%) while chemotherapy was continued in 61 (33%). Patients who received CRT had characteristics comparable to those who continued with chemotherapy, with similar OS. They also had longer progression-free survival (median 13.3 vs. 9.6 months, HR = 1.38, 95% confidence interval: 1–1.9, P

Abstract Background Systemic sclerosis (SSc) is a severe and highly heterogeneous disease. The modified Rodnan skin score (mRSS) is a widely used tool for the assessment of the extent and degree of skin thickness. This study aimed to identify the classes of patients with early similar skin thickening trajectories without any a priori assumptions and study their associations with organ involvement and survival. Methods From the French SSc national cohort, patients with a disease duration of less than 2 years at inclusion and with at least 2 mRSS available within the first 4 years of follow-up were enrolled. Classes of patients with similar mRSS trajectories were identified based on a latent class mixed model. The clinical characteristics and survival rate were compared between the obtained classes. Results A total of 198 patients fulfilled the inclusion criteria, with a total of 641 mRSS available. The median disease duration and follow-up were 0.8 (interquartile range 0.4; 1.2) and 6.3 (3.8; 8.9) years, respectively. Individual trajectories of mRSS were highly heterogeneous between patients. Models with 1–6 latent classes of trajectories were sequentially assessed, and the 5-class model represented the best fit to data. Each class was characterized by a unique global trajectory of mRSS. The median disease duration did not differ significantly between classes. Baseline organ involvement was more frequent in classes with significant change over time (classes 2–5) than in class 1 (low baseline mRSS without significant change over time). Using Cox regression, we observed a progressively increasing risk of death from classes 1 to 5. Conclusions Early identification of clinical phenotype based on skin thickening trajectories could predict morbi-mortality in SSc. This study suggested that mRSS trajectories characterization might be pivotal for clinical practice and future trial designs.

On évoquera d’abord les caractères originaux de la gastronomie chinoise et d’abord la multiplicité des plats servis ensemble sur la table, éventuellement en plusieurs actes, comme dans le grand service à la française d’avant le XIXe siècle, mais comme aussi dans toutes les grandes cuisines du monde, en particulier l’ottomane, la marocaine, la juive ashkénaze, la russe, l’indienne, et, plus près de la chine, la coréenne, la japonaise ou la thaïlandaise. Toutes les saveurs doivent être mises en valeur, mais sans ordre particulier : salé, sucré, amer, acide, piquant, sans oublier la fadeur qui est essentielle. Le seul semblant d’ordre est l’habitude de servir en premier des plats froids. Ce chatoiement de saveurs, couleurs et consistances, les allers et retours constants d’un plat à un autre par les convives qui composent leur repas selon leur bon plaisir rendent très difficile, sinon impossible, la recherche d’une « harmonie gustative » entre les mets et les boissons d’accompagnement telle que l’ont imaginée et la cultivent les Français depuis deux siècles. L’accompagnement liquide d’un repas chinois peut être unique ou mêler diverses boissons telles qu’eau fraîche ou chaude, thé, « vin » jaune chinois, liqueurs fortes, bière et, depuis peu de temps, vin de raisin (putaoju). On abordera l’histoire du vin de raisin en Chine et l’explosion récente de sa consommation, de sa production locale et de son importation, surtout dans sa version rouge, compte tenu du prestige de cette couleur en Chine. Il va de soi que les habitudes gustatives françaises sont une construction culturelle et que nul ne saurait jeter l’opprobre sur celles des Chinois. Cette communication a seulement pour but de suggérer quelques pistes de réflexion aux gastronomes chinois qui, comme tous les amateurs éclairés de bonne chère, aiment découvrir de nouvelles saveurs, être étonnés et participer à l’évolution d’un art qu’ils ont porté au fil des siècles à l’un des plus hauts niveaux du monde. Comme toute expression culturelle, celle-ci ne saurait être figée ; elle doit se renouveler et emprunter à bon escient à l’extérieur et assimiler ces apports sans tomber dans les effets de mode et les provocations gratuites. On évoquera, en particulier, l’intérêt de marier la cuisine chinoise avec les vins blancs les plus divers servis rafraîchis (secs tranquilles ou effervescents, moelleux, liquoreux ou, surtout, oxydatifs), mais aussi avec les vins doux naturels. On suggérera l’intérêt de tenter l’innovation d’une organisation de repas chinois en séquences mieux personnalisées sur le plan gustatif, seul moyen d’imaginer des alliances intéressantes, ce que certains importateurs ont tenté, comme la maison Krug en Champagne, par exemple.

Abstract In the MITICA (Mother‐to‐Infant TransmIssion of microbiota in Central‐Africa) study, 48 mothers and their 50 infants were followed from delivery to 6 months between December 2017 and June 2019 in Bangui (Central‐African Republic). Blood tests and stool analyses were performed in mothers at delivery, and their offspring at birth, 11 weeks and 25 weeks. Stool cultures were performed in specific growth media for Salmonella, Shigella, E. coli, Campylobacter, Enerobacter, Vibrio cholerae, Citrobacter and Klebsiella, as well as rotavirus, yeasts and parasitological exams. The median vitamin C levels in mothers at delivery were 15.3 μmol/L (inter‐quartile‐range [IQR] 6.2–27.8 μmol/L). In infants, the median vitamin C levels at birth were 35.2 μmol/L (IQR 16.5–63.9 μmol/L). At 11 and 25 weeks, the median vitamin C levels were 41.5 μmol/L (IQR 18.7–71.6 μmol/L) and 18.2 μmol/L (IQR 2.3–46.6 μmol/L), respectively. Hypovitaminosis C was defined as seric vitamin C levels

Objectives: Drugs for Neglected Diseases initiative (DNDi) has identified three chemical lead series, the nitroimidazoles, benzoxaboroles and aminopyrazoles, as innovative treatments for visceral leishmaniasis. The leads discovered using phenotypic screening, were optimised following disease- and compound-specific criteria. Several leads of each series were progressed and preclinical drug candidates have been nominated. Here we evaluate the efficacy of the lead compounds of each of these three chemical classes in in vitro and in vivo models of cutaneous leishmaniasis. Methods: The in vitro activity of fifty-five compounds was evaluated against the intracellular amastigotes of L. major, L. aethiopica, L. amazonensis, L. panamensis, L. mexicana and L. tropica. The drugs demonstrating potent activity (EC50

Abstract Background Rheumatoid arthritis (RA) is associated with a 5 to 10 years reduction in life expectancy due to premature atherosclerosis. This reduction is the consequence of traditional cardiovascular risk factors (TCRF) as well as systemic inflammation. The aim of the present study was to describe the prevalence and factors associated with subclinical atherosclerosis in RA at the University Hospital of Kinshasa (UHK). Methods Patients with a diagnosis of RA based on the 2010 ACR/EULAR criteria were included in this cross-sectional study from 1 June 2014 to 31 May 2015 at the UHK. RA disease activity was measured using the DAS28-ESR. Active RA was defined by a DAS 28 > 2.6. Severe RA was defined by the presence of extra-articular manifestation, joint erosions on X-rays or HAQ ≥0.5. An assessment of subclinical atherosclerosis was performed by the measurement of the carotid intima-media thickness (cIMT) using two-dimensional ultrasonography. Subclinical atherosclerosis was defined by a cIMT ≥0.9 mm. A diagnosis of atheroma plaque was retained when the cIMT was ≥1.5 mm. The association between subclinical atherosclerosis and potential risk factors was modeled using logistic regression analysis. Results We recruited 75 patients. The average age was 51.8 ± 14.6 years, with a sex ratio F/M of 4. The prevalence of subclinical atherosclerosis was 32%. In logistic regression being a woman of ≥55 years old (aOR 10.6, 95% CI [2.087–53.82], p = 0.028), DAS28-ESR > 2.6 (aOR 3.5,95% CI [1.55–10.38], p = 0.044), severe RA (aOR 32.6,95% CI [1.761–60.37],p = 0.035), high blood pressure (aOR 22.4,95% CI [5.04–99.41], p = 0.005) and obesity (aOR 32.3, 95% CI [2.606–40.73], p = 0.026) emerged as factors associated with subclinical atherosclerosis. Conclusion Subclinical atherosclerosis is common in RA patients attending the UHK. It appears to be associated with RA disease activity and severity apart from traditional cardiovascular risk factors. These results suggest that early management of subclinical atherosclerosis targeting remaining RA disease activity and cardiovascular risk factors could slow down progression to clinical cardiovascular disease.

Abstract Objective To determine the effect of clinical status (weight variation and performance status [PS]) at diagnosis and during induction treatment on resectability and overall survival (OS) rates in patients with borderline resectable (BRPC) or locally advanced pancreatic cancer (LAPC). Methods From 2005 to 2017, 454 consecutive patients were diagnosed with LAPC or BRPC. We evaluated the PS (0–1 or 2–3), body mass index at diagnosis, and weight loss (WL) > 5% at initial staging and after induction treatment and separated continuous weight loss (CWL) from weight stabilization. Results A total of 294 patients (64.8%) presented with WL, and 57 patients (12.6%) presented with a PS of 2–3. At restaging, 60 patients (13.2%) presented with CWL. Independent factors that poorly influenced the OS were a PS of 2–3 at diagnosis (P < .01), CWL at restaging (P < .01), and absence of resection (P < .01). Factors independently impeding resection were LAPC (P < .01), PS > 1 at diagnosis (P < .01), and CWL (P = .01). In total, 142 patients (31.3%) underwent pancreatectomy. Independent factors that poorly influenced the OS in the resected group were PS > 0 at diagnosis (P = .01) and obesity (P < .01). For the 312 unresected cancer patients (68.7%), CWL (P < .01) was identified as an independent factor that poorly influenced the OS. Conclusion Clinical parameters that are easy to measure and monitor are independent factors of poor prognosis. The variation of weight during the induction treatment, more than WL at diagnosis, significantly precluded resection and was an independent factor of shorter OS in unresected patients.

In the absence of drugs to treat or prevent COVID-19, drug repurposing can be a valuable strategy. Despite a substantial number of clinical trials, drug repurposing did not deliver on its promise. While success was observed with some repurposed drugs (e.g., remdesivir, dexamethasone, tocilizumab, baricitinib), others failed to show clinical efficacy. One reason is the lack of clear translational processes based on adequate preclinical profiling before clinical evaluation. Combined with limitations of existing in vitro and in vivo models, there is a need for a systematic approach to urgent antiviral drug development in the context of a global pandemic. We implemented a methodology to test repurposed and experimental drugs to generate robust preclinical evidence for further clinical development. This translational drug development platform comprises in vitro, ex vivo, and in vivo models of SARS-CoV-2, along with pharmacokinetic modeling and simulation approaches to evaluate exposure levels in plasma and target organs. Here, we provide examples of identified repurposed antiviral drugs tested within our multidisciplinary collaboration to highlight lessons learned in urgent antiviral drug development during the COVID-19 pandemic. Our data confirm the importance of assessing in vitro and in vivo potency in multiple assays to boost the translatability of pre-clinical data. The value of pharmacokinetic modeling and simulations for compound prioritization is also discussed. We advocate the need for a standardized translational drug development platform for mild-to-moderate COVID-19 to generate preclinical evidence in support of clinical trials. We propose clear prerequisites for progression of drug candidates for repurposing into clinical trials. Further research is needed to gain a deeper understanding of the scope and limitations of the presented translational drug development platform.

Context and Objective: Cardiovascular diseases are the leading cause of mortality in patients. In this context, proprotein convertase subtilisin/kexin type 9 (PCSK9) appears to be the new biomarker identified as interfering in lipid homeostasis. This study aimed to investigate the association between PCSK9, dyslipidemia, and future risk of cardiovascular events in a population of black Africans. Methods: A cross-sectional study was conducted between August 2016 and July 2020 in six hemodialysis centers in the city of Kinshasa, Democratic Republic of the Congo. Serum PCSK9 was measured by ELISA; lipid levels of 251 chronic kidney disease grade 5 (CKD G5) hemodialysis patients and the Framingham predictive instrument were used for predicting cardiac events. Results: Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were significantly increased in the tertile with the highest PCSK9. By contrast, high-density lipoprotein cholesterol (HDL-c) was significantly decreased in the same tertile. A strong positive and significant correlation was found between PCSK9 and TC, TG, and LDL-c. Negative and significant correlation was observed between PCSK9 and HDL-c. The levels of PCSK9, smoking, overweight, and atherogenic dyslipidemia were associated with future risks for cardiovascular events in univariate analysis. After adjustment, all these variables persisted as independent determinants of future risk for cardiovascular events. The probability of having a cardiovascular event in this population was independently associated with PCSK9 levels. Compared to the patients in the lowest PCSK9 tertile, patients with PCSK9 levels in the middle (aOR 5.9, 95% CI 2.06–17.3, P

INTRODUCTION: The spread of enterobacteria producing broad-spectrum beta-lactamases (ESBL) is a global public health-problem. In a study carried in 2003-2005 at the Pasteur Institute in Bangui, 450 enterobacteria were identified in clinical isolates, of which 17 were ESBL (prevalence: 3.78%). The aim of this study was to update this data. METHODS: from May 2018 to April 2019, a total of 941 enterobacteria were isolated and identified under identical conditions of recruitment and with the same techniques used in the previous study: phenotypic identification using Api 20E strips (biomérieux SA, Marcy-l´Etoile, France) and antimicrobial drug susceptibility using the disk diffusion method (Bio-Rad antibiotic discs, Marnes la Coquette, France). Resistance genes were identified by PCR and sequencing. RESULTS: from May 2018 to April 2019, a total of 941 enterobacteria were isolated of which 478 were ESBL, thus amounting to a prevalence of 50.80%. The genetic profiles of the bla CTX-M resistance genes exhibited the emergence of the CTX-M28 variant (CTX-M1 group) and variants of the M2 and M9 groups. There was also a notable increase, from 35 to 64%, in the ESBL with a bla SHV gene. CONCLUSION: this study documents a 13 fold increase in the prevalence of ESBL derived from clinical isolates of the bacteriology laboratory of the Institut Pasteur in Bangui, by comparing its data with that of the publication by Frank et al. 2006. Together with this increase a significant diversification of the circulating CTX-M resistance genes was noticed.

Objective Early identification of atherosclerosis using a non-invasive tool like ankle–brachial index (ABI) could help reduce the risk for cardiovascular disease among long-term hemodialysis patients. The study objective was to assess the frequency and impact of abnormal ABI as a marker of subclinical peripheral artery disease (PAD) in chronic hemodialysis patients. Methods This was a historic cohort study of kidney failure patients on long-term hemodialysis for at least 6 months. The ABI, measured with two oscillometric blood pressure devices simultaneously, was used to assess subclinical atherosclerosis of low limb extremities. Abnormal ABI was defined as ABI 1.3 (PAD present). Survival was defined as time to death. Independent factors associated with abnormal ABI were assessed using multiple logistic regression analysis. Kaplan–Meier method (log-rank test) was used to compare cumulative survival between the two groups; a P value

France is a nation, a cultural and political construct which has aggregated diverse territories around the core of the Ile-de-France over a period of a millennium. It has always been divided between centrifugal and centripetal forces, between the concern to respect regional diversity and the state and geographic centralization of which Paris is the powerful symbol. The opening onto three seas and oceans and its position as European finisterre, as well as its Roman and Christian heritage, made France an extroverted country, open to multiple external influences and eager to shine in Europe and in the world.

France is a nation, a cultural and political construct which has aggregated diverse territories around the core of the Ile-de-France over a period of a millennium. It has always been divided between centrifugal and centripetal forces, between the concern to respect regional diversity and the state and geographic centralization of which Paris is the powerful symbol. The opening onto three seas and oceans and its position as European finisterre, as well as its Roman and Christian heritage, made France an extroverted country, open to multiple external influences and eager to shine in Europe and in the world.

We analyzed data from the 2015 and 2016 meningitis epidemic seasons in Central African Republic as part of the national disease surveillance. Of 80 tested specimens, 66 belonged to meningococcal serogroup W. Further analysis found that 97.7% of 44 isolates belonged to the hyperinvasive clonal complex sequence type 11.

Various attempts have recently been undertaken to put the historical knowledge produced on Franco-Maghreb relations within the reach of the general public, especially students at school. The Museum of France and Algeria History in Montpellier was one of the most ambitious. Rephrasing a project initially focused on the memory expectations of the French in Algeria, he mobilized dozens of professionals of heritage and French and Algerian researchers to try to propose a common path in the history of the two countries. It was less a question of confronting multiple and divergent memories than of inviting the bearers of these to submit to a duty of history in order to enter into a dialogue.But in June 2014, the new mayor of Montpellier suddenly decided to stop the museum project, under pressure of Algerianist associations particularly. For several months, this decision provoked a very lively and wide public debate. The paper, written by the former chairman of the museum’s scientific committee, recalls the genesis and development of the project and questions the reasons both structural and short-term, local and national, which have weighed on its abandonment. Conversely, the strong reaction of academic and cultural circles also led to validating the interest of the undertaking, as evidenced by the survival of certain aspects of the project and the attempt of the Head of State to relaunch it in 2016. The lesson that remains from this experience is that the crossed history of France and the Maghreb is more than ever necessary, but can hardly find a place in memory politics with ambiguous objectives.

Abstract Background To determine predictive factors of postoperative pancreatic fistula (POPF) in patients undergoing enucleation (EN). Methods From 2005 to 2017, 47 patients underwent EN and had magnetic resonance imaging available for precise analysis of tumor location. Three pancreatic zones were delimited by the right side of the portal vein and the main pancreatic head duct (zone #3 comprising the lower head parenchyma and the uncinate process). Results The mortality and morbidity rates were 0% and 62%, respectively. POPF occurred in 23 patients (49%) and was graded as B or C (severe) in 15 patients (32%). Four patients (8.5%) developed a postoperative hemorrhage, and 5 patients (11%) needed a reintervention. In univariate and multivariate analyses, the pancreatic zone was the unique predictive factor of overall (P = .048) or severe POPF (P = .05). We did not observe any difference in postoperative courses when comparing the EN achieved in zones #1 and #2. We noted a longer operative duration (P = .016), higher overall (P = .017) and severe POPF (P = .01) rates, and longer hospital stays (P = .04) when comparing the EN achieved in zone #3 versus that in zones #1 and #2. Patients who underwent EN in zone #3 had a relative risk of developing a severe POPF of 3.22 compared with patients who underwent EN in the two other pancreatic zones. Conclusion Our study identifies the lower head parenchyma and the uncinate process as a high-risk zone of severe POPF after EN. Patients with planned EN in this zone could be selected and benefit from preoperative and/or intraoperative techniques to reduce the severe POPF rate.

Hepatic hemangioma is the most common benign hepatic tumor, and most of them are small in size and asymptomatic. Giant hepatic hemangiomas are uncommon, but pedunculated giant hemangiomas are even rarer and often difficult to diagnose because of their exophytic development. We report here on a 48-year-old man with a symptomatic pedunculated giant hepatic hemangioma and hepatic angiomatosis, mimicking a gastric gastrointestinal stromal tumor with liver metastases. The preoperative diagnosis was suspected on imaging including CT scan and MRI. The patient was successfully operated (left hepatic lobectomy), without any complication, and the pathological analysis confirmed the diagnosis. We reviewed the English literature, and to our knowledge, our case represents the largest case reported so far when compared with the 19 other informative cases.

Pancreatic ductal adenocarcinoma (PDAC) is a complex disease and its underlying epigenomic heterogeneity is not fully understood. Here, the authors utilize patient-derived PDAC xenografts to define the epigenomic landscape of PDAC, highlighting chromatin states linked to differing disease aggressiveness and survival.

Cardiovascular disease (CVD) risk in type 2 diabetes mellitus (T2DM) increases with the development of albuminuria and is related in part to dyslipidemia. The present analysis assessed lipid profile and patterns of dyslipidemia in T2DM patients according to albuminuria status. This was a post hoc analysis of data from 181 T2DM patients seen at a tertiary health-care hospital and enrolled in a cross-sectional study of albuminuria status. Abnormal albuminuria was defined as microalbuminuria [albumin to creatinine ratio (ACR) 30-299.9 mg/g] or macro-albuminuria (ACR ≥300 mg/g). Atherogenic dyslipidemia was defined as triglycerides (TGs) ≥150 mg/dL and/or high-density lipoprotein-cholesterol (HDL-c)

Preclinical models based on patient-derived xenografts have remarkable specificity in distinguishing transformed human tumor cells from non-transformed murine stromal cells computationally. We obtained 29 pancreatic ductal adenocarcinoma (PDAC) xenografts from either resectable or non-resectable patients (surgery and endoscopic ultrasound-guided fine-needle aspirate, respectively). Extensive multiomic profiling revealed two subtypes with distinct clinical outcomes. These subtypes uncovered specific alterations in DNA methylation and transcription as well as in signaling pathways involved in tumor-stromal cross-talk. The analysis of these pathways indicates therapeutic opportunities for targeting both compartments and their interactions. In particular, we show that inhibiting NPC1L1 with Ezetimibe, a clinically available drug, might be an efficient approach for treating pancreatic cancers. These findings uncover the complex and diverse interplay between PDAC tumors and the stroma and demonstrate the pivotal role of xenografts for drug discovery and relevance to PDAC.

Abstract Background Pancreatic carcinoma is one of the most lethal human cancers. In patients with resectable tumors, surgery followed by adjuvant chemotherapy is the only curative treatment. However, the 5-year survival is 20%. Because of a strong metastatic propensity, neoadjuvant chemotherapy is being tested in randomized clinical trials. In this context, improving the selection of patients for immediate surgery or neoadjuvant chemotherapy is crucial, and high-throughput molecular analyses may help; the present study aims to address this. Methods Clinicopathological and gene expression data of 695 pancreatic carcinoma samples were collected from nine datasets and supervised analysis was applied to search for a gene expression signature predictive for overall survival (OS) in the 601 informative operated patients. The signature was identified in a learning set of patients and tested for its robustness in a large independent validation set. Results Supervised analysis identified 1400 genes differentially expressed between two selected patient groups in the learning set, namely 17 long-term survivors (LTS; ≥ 36 months after surgery) and 22 short-term survivors (STS; dead of disease between 2 and 6 months after surgery). From these, a 25-gene prognostic classifier was developed, which identified two classes (“STS-like” and “LTS-like”) in the independent validation set (n = 562), with a 25% (95% CI 18–33) and 48% (95% CI 42–54) 2-year OS (P = 4.33 × 10–9), respectively. Importantly, the prognostic value of this classifier was independent from both clinicopathological prognostic features and molecular subtypes in multivariate analysis, and existed in each of the nine datasets separately. The generation of 100,000 random gene signatures by a resampling scheme showed the non-random nature of our prognostic classifier. Conclusion This study, the largest prognostic study of gene expression profiles in pancreatic carcinoma, reports a 25-gene signature associated with post-operative OS independently of classical factors and molecular subtypes. This classifier may help select patients with resectable disease for either immediate surgery (the LTS-like class) or neoadjuvant chemotherapy (the STS-like class). Its assessment in the current prospective trials of adjuvant and neoadjuvant chemotherapy trials is warranted, as well as the functional analysis of the classifier genes, which may provide new therapeutic targets.