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The Amazon shelf break is a key region for internal tide (IT) generation. It also shows a large seasonal variation in circulation and associated stratification. This study, based on a high-resolution model (1/36∘) explicitly forced by tide, aims to better characterize how the ITs vary between two contrasted seasons. During the season from March to July (MAMJJ) the currents and mesoscale eddies are weak while the pycnocline is shallower and stronger. From August to December (ASOND) mean currents and mesoscale eddies are strong, and the pycnocline is deeper and weaker than in MAMJJ. For both seasons, semi-diurnal M2 ITs are generated on the shelf break mainly between the 100 and 1000 m isobath in the model. South of 2∘ N, the conversion from barotropic to baroclinic tide is more efficient in MAMJJ than in ASOND. Local dissipation of the coherent M2 at the generation sites is higher in MAMJJ (30 %) than in ASOND (22 %), because higher modes are favourably generated (modes 2 and 3), making the internal wave packet more dispersive. The remaining fraction (70 %–80 %) propagates away from the generation sites and mainly dissipates locally every ∼ 100 km, which corresponds to the mode 1 reflection beams. About 13 %, 30 %, and 40 % of the M2 coherent IT dissipates at the first, second, and third beams. M2 coherent baroclinic flux propagates more northward during MAMJJ while it seems to be blocked at 6∘ N during ASOND. There is no intensified dissipation of the coherent M2 that could explain the disappearance of the coherent flux. In fact, the flux at this location becomes more incoherent because of strong interaction with the currents. This has been shown in the paper using 25 h mean snapshots of the baroclinic flux that shows branching and stronger eastward deviation of the IT when interacting with mesoscale eddies and stratification during ASOND. Finally, we evaluated sea surface height (SSH) frequency and wavenumber spectra for subtidal (f<1/28 h−1), tidal (1/28 h−1 < f<1/11 h−1), and supertidal (f>1/11 h−1) frequencies. Tidal frequencies explain most of the SSH variability for wavelengths between 250 and 70 km. Below 70 km, the SSH is mainly incoherent and supertidal. The length scale at which the SSH becomes dominated by unbalanced (non-geostrophic) IT was estimated to be around 250 km. Our results highlight the complexity of correctly predicting IT SSH in order to better observe mesoscale and sub-mesoscale eddies from existing and upcoming altimetric missions, notably the Surface Water Ocean Topography (SWOT) mission.

The aim of this study is to characterize and quantify the mesoscale dynamics off the Congo River in the Gulf of Guinea and evaluate its impact on the exchange of fresh and salty waters between the coastal and open ocean in this area. The study area, centered at the mouth of the Congo River (2°S-10°S and 3°E-13.5°E), is characterized by an intense seasonal freshwater cycle related to rainfall-driven fluvial input. We used a 1/36° resolution NEMO model configuration for the Gulf of Guinea, optimised to improve the realism the Congo River plume. Results from this configuration were validated with observations and we analyzed the year 2016. The Congo River combined with the wind forcing strongly influences the ocean circulation in the area. The river plume is associated with positive sea level height at the river mouth and strong horizontal density gradients. Moreover, the river plume stratifies the surface waters leading to a very shallow mixed layer (

Very little is known on mesoscale dynamics in the northern Gulf of Guinea, off West Africa. The purpose of our work is to quantify these mesoscale eddies dynamics in this region (0°N-7°N, 10°W-10°E) and their impact on the near-surface ocean and particularly in the coastal upwelling along the northern coast between 2°W and 2°E. We used a regional simulation of the NEMO model at 1/36° resolution of the year 2016 with daily outputs, validated with in situ and satellite data. On average, four cyclonic and four anticyclonic eddies were detected per day with a mean radius of 75 km and 72 km, respectively. Their lifetime is of the order of few days to a month with associated sea level anomaly from 0.5 cm to more than 1cm. The largest eddies with a relatively long life span are located between 2°N and 4°N, east of Cape Palmas (Ivory Coast) and Cape Three Points (Ghana). We then focused on the July-August-September upwelling period, during which we detected a cyclonic eddy east of the Cape of Three Points, from mid-July to mid-August 2016 with an average radius of 75 km. This cyclone is quasi-stationary and is located in the core of coastal upwelling.Using a heat budget, we show that this eddy has an influence on sea surface temperature (SST) with a double effect. It expands offshore the upwelled cold and salty waters from July 14 to 24, then from July 25 until the dissipation of the cyclone, it weakens this upwelling by advection of warm offshore waters towards the coast, which mix with the upwelling cold waters and warm them.A lagrangian study shows that the eddy waters come from the coastal upwelling, then mix with warmer offshore waters and later are transported eastward by the Guinea Current.In conclusion, this study demonstrates the key role of eddies in SST intra-seasonal variability in the northern Gulf of Guinea.Keywords : Gulf of Guinea, Modeling, Eddy, Coastal upwelling, Lagrangian simulation.

The ocean kinetic energy is dominated by mesoscale eddies, which are quasi-circular structures with typical horizontal scales of 10 to 100 km and vertical extension of hundreds meters. the mesoscale eddies play significant roles in the transport and redistribution of water masses with their physical and biogeochemical properties throughout ocean. In this study, we used 8 years of satellite altimetry data, combined with sea surface temperature (SST), sea surface salinity (SSS), latent and sensible heat fluxes (LHF and SHF) and precipitation data, to investigate how mesoscale eddies impact on air-sea heat and fresh water exchange in the tropical Atlantic ocean (TAO). We show that an important fraction of eddies exhibit inverse SST anomalies, and that eddy-induced LHF and SHF anomalies are quasi-linearly proportional to SST anomalies. Moreover, eddies contribute to ~10 – 25 % of the total heat flux variability. However, no direct link has been observed between heat flux and precipitation anomalies over eddies in the TAO. Nevertheless, beneath the Intertropical Convergence Zone (ITCZ), significant correlation were found, suggesting that eddies may modulate both heat and freshwater fluxes in this region. Relative to SSS anomalies within eddies, their variability represents up to 30% of the total variability. In addition, beneath the ITCZ, freshwater fluxes would play an important role in their variability. However, oceanic processes such as horizontal and vertical advection and mixing are suspected to play a key role in the SSS variability at mesoscale beneath the ITCZ. To better understand the role of such processes, numerical modeling studies are needed for future investigations.

Objectives Congenital adrenal hyperplasia (CAH) remains one of the most challenging endocrine disorders to diagnose, manage, and treat, especially in Africa where there is lack of neonatal screening program, and limited access to care. Data on biomolecular anomaly are sparse, therefore type of mutations are unknown, increasing management challenges and genetic counseling. The present study aims to describe clinical, biomolecular aspects of a group of Cameroonian patients. Methods We did an observational retrospective study at the pediatric endocrinology unit of the Mother and Child Centre of the Chantal Biya Foundation in Yaounde from May 2013 to December 2019, including all patients diagnosed with CAH. Results We consecutively included 31 patients aged less than 21 years, diagnosed CAH. Median age at diagnosis was 1.71 years (IQR 0.08–2.57 years). Abnormal genitalia was the main complain in 48.4%(n=15). The most prevalent genetic anomaly found in our study population (n=24) was on CYP11, found in 16 patients (66.6%) followed by CYP21A2 mutation found in 8 patients. Homozygous mutation of p.Q356X was found in half of patients with 11 hydroxylase deficiency. This mutation was mostly found in people from semi-Bantu tribes, declared non consanguineous. Conclusions 11 hydroxylase deficiency is the most prevalent form of CAH found in this group of Cameroonian children.

The initial COVID-19 vaccinations were created and distributed to the general population in 2020 thanks to emergency authorization and conditional approval. Consequently, numerous countries followed the process that is currently a global campaign. Taking into account the fact that people are being vaccinated, there are concerns about the effectiveness of that medical solution. Actually, this study is the first one focusing on how the number of vaccinated people might influence the spread of the pandemic in the world. From the Global Change Data Lab "Our World in Data", we were able to get data sets about the number of new cases and vaccinated people. This study is a longitudinal one from 14/12/2020 to 21/03/2021. In addition, we computed Generalized log-Linear Model on count time series (Negative Binomial distribution due to over dispersion in data) and implemented validation tests to confirm the robustness of our results. The findings revealed that when the number of vaccinated people increases by one new vaccination on a given day, the number of new cases decreases significantly two days after by one. The influence is not notable on the same day of vaccination. Authorities should increase the vaccination campaign to control well the pandemic. That solution has effectively started to reduce the spread of COVID-19 in the world.

Introduction: In black Africa, connectivites have been for a long time a source of diagnostic erraticity because of their clinical polymorphism. This study aims to determine the therapeutic itinerary of patients followed for connectivitis in the Internal Medicine Department of the CNHU HKM of Cotonou. Methodology: This is a cross-sectional study that included patients followed for connectivitis in the HKM-Cotonou Internal Medicine Department from January 2010 to October 2018. Results: Out of 3600 patients hospitalized in the study period, 21 had connectivitis, i.e. a hospital frequency of 0.58%. Of the 21 patients collected, 18 met the inclusion criteria. The mean age was 40 (±11) years old and the youngest was of 21 and the oldest 58. The sex ratio was 17.9. The “Fon” ethnic group was the most represented (33.3%) and 15 (83.3%) subjects were Christians. Systemic lupus erythematosus was the most frequent connectivitis (55.6%). The average time of consultation was 38 months. Witchcraft was the most incriminating cause (78%). Ten (55.5%) patients had resorted to self-medication as their first choice of treatment, 5 (27.8%) to traditional medicine treatment and 3 (16.7%) to prayer for healing. The reasons for the first choice of treatment were satisfaction (44.4%), financial problems (27.8%), trivialization of the disease (16.7%), and advice from family and friends (11.1%). The consultation at the CNHU followed a referral from a first contact health structure (61%) or an initiative of the patient (27.8%). Conclusion: Connectivitis is a source of diagnostic error in our context. Awareness must be raised among patients for an early consultation at the first symptoms.

The first cases of SARS-CoV-2 were diagnosed in BENIN in early March 2020. Measures have been instituted to control its spread, including barrier measures. The objective of this study is to determine the effectiveness of self-application of these measures among hospital staff at CNHU-HKM. Methods: This is a case-control study conducted from July 1, 2020 to January 1, 2021 on the risk factors of COVID-19 contamination. Included were any CNHU-HKM staff who underwent PCR testing for COVID-19 at the CNHU-HKM triage center during the study period. Data were collected using a survey form administered to respondents. Data analysis was performed with R 4.1.0 software. Results: A total of 141 patients were included in the study. The mean age was 35.5 (±11.1) years. The sex ratio (M/F) was 1.87. Fon and Mina ethnic groups were the most represented (74.5%). Workers older than 50 years were more likely to be exposed to COVID-19 (OR=4.83). Nurses in contact with patients (87.2% of the study population) had a higher risk of contamination (OR=3.6), compared to administrative staff. The FFP2 mask was a protective factor (OR=0.35) as well as long-term chemoprophylaxis with chloroquine (OR=0.44). Conclusion: Health care workers are at high risk of contamination by COVID-19. Barrier measures and chloroquine chemoprophylaxis are indeed mandatory in controlling the spread of the pandemic.

International audience

Purpose Urethral fistula and dehiscence are common after hypospadias surgery. Preoperative androgens have been considered to reduce these complications although this consideration is not evidence-based. Dermatologists have reported the benefits of topical estrogens on skin healing. We investigated whether the preoperative use of topical promestriene could reduce healing complications in hypospadias surgery. Our primary objective was to demonstrate a reduction of healing complications with promestriene vs placebo. Impact on reoperations and other complications, clinical tolerance, bone growth, and biological systemic effects of the treatment were also considered. Methods We conducted a prospective, randomized, placebo-controlled, double-blind, parallel group trial between 2011 and 2015 in 4 French centers. One-stage transverse preputial island flap urethroplasty (onlay urethroplasty) was selected for severe hypospadias. Promestriene or placebo was applied on the penis for 2 months prior to surgery. The primary outcome was the presence of postoperative urethral fistula or dehiscence in the first year postsurgery. For safety reasons, hormonal and anatomical screenings were performed. Results Out of 241 patients who received surgery, 122 patients were randomized to receive placebo, and 119 patients received promestriene. The primary outcome was unavailable for 11 patients. Healing complications were assessed at 16.4% (19/116) in the placebo vs 14.9% (17/114) in the promestriene arm, and the odds ratio adjusted on center was 0.93 (95% confidence interval 0.45-1.94), P = 0.86. Conclusions and relevance Although we observed an overall lower risk of complications compared to previous publications, postsurgery complications were not different between promestriene and placebo, because of a lack of power of the study or the inefficacy of promestriene.

Introduction According to the current classification of the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society for Pediatric Endocrinology (ESPE) of Disorders of Sex Development (DSD), etiologies vary around the world. Ethnic or genetic diversity probably explains this variability. We therefore conducted the present study on etiologies of DSDs in a country from central Africa. Methods We carried out an observational retrospective study at the Pediatric Endocrinology Unit of the Mother and Child Centre of the Chantal Biya Foundation in Yaounde, Cameroon from May 2013 to December 2019. All patients diagnosed with a DSD were included, and incomplete files excluded. Results We included 80 patients diagnosed with DSD during the study period. The 46,XX DSD were the most frequent in our study population (n = 41, 51.25%), with congenital adrenal hyperplasia (CAH) as the main diagnosis. The 46,XY DSD accounted for 33.75% and sex chromosome DSD group represented 15% of the study population. Conclusions DSDs are not an exceptional diagnosis in a Sub-Saharan context. 46,XX DSD are the most prevalent diagnosis in our setting. The diagnosis of all these affections is late compared to other centers, justifying advocacy for neonatal screening of DSDs in our context.

Introduction: Patients with Systemic Lupus Erythematosus (SLE) are seen late in specialized medical consultation in Benin. The objective of this work was to assess general practitioners’ knowledge in Cotonou about SLE. Materials and Methods: This work was a cross-sectional study that was led in the city of Cotonou from July 1 to September 30, 2017. In the study population, we have general practitioners who practice in the city. Data collection was set in response to a self-questionnaire. Result: The survey involved 209 general practitioners. The average age was 27.5 years with a minimum of 22 and a maximum of 34. Most of them practiced in private clinics. Besides, 17 doctors (8.1%) reported that they never heard of lupus. Among the 192 remaining, only one had an average knowledge of lupus, while the others had insufficient knowledge. Conclusion: From this study, we got that SLE is still little known by the general practitioner. Increasing the knowledge of general practitioners’ knowledge of lupus is compulsory to improve the screening rate.

Background: FOXL2 is the gene involved in blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES). There have been few single case reports of growth hormone deficiency (GHD) with this syndrome, and Foxl2 is known to be involved in pituitary development in mice. Our aim was to analyze the prevalence of FOXL2 gene alteration in a series of patients with congenital hypopituitarism and eyelid anomalies. Methods: FOXL2 was analyzed in 10 patients with hypopituitarism (ranging from isolated GHD to complete pituitary hormone deficiency) and eyelid anomalies (typical BPES in 4 patients and milder anomalies in 6 patients). In patients with an FOXL2 mutation, we ruled out other possible molecular explanations by analyzing a panel of 20 genes known to be associated with hypopituitarism, and a candidate gene approach was used for patients without an FOXL2mutation. Results: Three patients had an FOXL2mutation. All 3 had typical BPES. Their pituitary phenotype varied from GHD to complete pituitary hormone deficiency and their pituitary morphology ranged from normal to an interrupted pituitary stalk. No mutations were found in genes previously associated with hypopituitarism. Conclusion: Our study shows that some patients with BPES have hypopituitarism with no molecular explanation other than FOXL2 mutation. This points toward an involvement of FOXL2 in human pituitary development.

Introduction: The progressive ageing of the population from southern Sahara is leading to an increase in health needs among the elderly. The purpose of this study was to output an overview about the reasons why the elderly come for consultation in the internal medicine department of the HKM-NHUC in Cotonou. Methodology: This was a retrospective, descriptive, and analytical study, which included all patients aged 65 years and over, who came for the first time for consultation in the Internal Medicine Department of the CNHU-HKM between January 1st and December 31st, 2017. Results: Among the 680 new patients received in internal Medicine consultations during the study period, 118 people were aged 65 and over, representing a hospital frequency of 17.35%. The sex ratio was 0.9 with a mean age of 73 ± 7 years. Hypertension was the main comorbidity of the patients (69%). Cough (11.3%) and low back pain (8.2%) dominated the reasons for consultation. The three main nosological groups of pathologies were, in descending order, diseases of the osteo-articular system (17.5%), diseases of the respiratory system (16.5%) and diseases of the circulatory system (12.4%). Pneumonia (11.3%) and lumbosacral spondylarthrosis (10.3%) were the most frequent pathologies in patients whose health needs remain quite varied. Conclusion: The elderly become gradually an important part of the population in southern Sahara. A better understanding of the health needs of this category of the population is necessary to deal effectively with the health challenges that will accompany this phenomenon.

Disorders of isolated mineralocorticoid deficiency causing potentially life-threatening salt-wasting crisis early in life have been associated with gene variants of aldosterone biosynthesis or resistance, but in some patients no such variants are found. WNT/β-catenin signaling is crucial for differentiation and maintenance of the aldosterone producing adrenal zona glomerulosa (zG). We describe a highly consanguineous family with multiple perinatal deaths or infants presenting at birth with failure to thrive, severe salt-wasting crises associated with isolated hypoaldosteronism, nail anomalies, short stature, and deafness. Whole exome sequencing revealed a homozygous splice variant in the R-SPONDIN receptor LGR4 gene (c.618-1G>C) regulating WNT signaling. The resulting transcripts affected protein function and stability, and resulted in loss of Wnt/β-catenin signaling in vitro. The impact of LGR4 inactivation was analyzed by adrenal cortex specific ablation of Lgr4, using Lgr4Flox/Flox mated with Sf1:Cre mice. Inactivation of Lgr4 within the adrenal cortex in the mouse model caused decreased WNT signaling, aberrant zonation with deficient zG and reduced aldosterone production. Thus, human LGR4 mutations establish a direct link between LGR4 inactivation and decreased canonical WNT signaling with abnormal zG differentiation and endocrine function. Therefore, variants in WNT signaling and its regulators should systematically be considered in familial hyperreninemic hypoaldosteronism.

International audience; Waves propagate in a free-surface ocean due to compressibility and gravity (and surface tension at much smaller scale). Analytical solutions have long been derived independently for acoustic and gravity waves, i.e., acoustic waves or internal-gravity rays in an unbounded ocean, surface-gravity waves in a free-surface-ocean, and acoustic or internal modes in a bounded ocean. In the present study, capillarity waves and earth-rotation are neglected and a simple, unified model based on inner and boundary dispersion relations is derived for waves propagating in a compressible, stratified, free-surface ocean. Wave solutions are identified and visually analyzed in phase-space. Taylor developments are then carried out with respect to small parameters describing stratification and compressibility and are compared with numerical approximations of the intersection of inner and boundary dispersion surfaces. Finally, the model recovers the known approximations for swell, long-surface waves, internal-gravity rays, internal modes, acoustic waves or acoustic modes, and also provides modification of these solutions due to stratification and compressibility.

International audience; Nokoué Lagoon in the South of Benin is a large intermittent coastal water body in West Africa, which supports one of the largest inland fisheries of the region. The seasonal and interannual variability of its salinity was studied, based on 3 years of monthly surveys (Dec 2017-Dec 2020). This dataset allows us to identify fine-scale salinity structures and to better understand the salinization/desalinization processes at seasonal scales. During the rainy season from May to November, under the influence of large freshwater inflows from the rivers on its northern shores, the lagoon desalinizes to a salinity of zero in October-November. During the dry season from December to April, under the effect of the ocean tide, Nokoué lagoon becomes progressively saltier, reaching typical salinities of ~25 in April. On average, the Nokoué lagoon is saltier in its southwestern part and fresher towards the river's mouths. Vertical salinity stratification is largest in December at the beginning of the main dry season. The lagoon displays a very marked interannual variation with mean surface (bottom, respectively) salinity of 25 (25) in April 2018 and 2020, respectively, against 16 (18) in April 2019. In the absence of river inflow data, a box model shows that the average salinity of the lagoon is very sensitive to small changes in river inflow (or discharge), with observed interannual differences in salinity induced by small variations of 10-15 m 3 s-1 in inflow during the dry season. During the salinization phase, the model suggests that ~30% of the seawater entering the lagoon during flood-tides remains trapped and enhances the Nokoué lagoon salinity. This model also indicates that a complete desalinization of the lagoon occurs for river inflow greater than ~50-60 m 3 s-1. The general mixing time scale of the lagoon is of 30-40 days.

International audience;  At their generation site, 50% of observed eddies have non-significant isopycnal temperature/salinity (θ/S) anomalies in the TAO.  On density-coordinates, both CEs and AEs can exhibit significant positive, negative or non-significant isopycnal θ/S anomalies.  We discuss the relationship between isopycnal θ/S and PV anomalies and how they can inform us on their generation mechanisms.

Context: P450 oxidoreductase (POR) is required for the activities of steroid-metabolizing cytochrome P450 enzymes in the endoplasmic reticulum. POR deficiency (PORD) is a form of congenital adrenal hyperplasia. Objective and Aim: Enzymatic and structural analysis of a novel L374H POR mutation from a patient with 46,XX disorder of sexual development. Design, Setting, Patient, and Intervention: The patient was a 46,XX girl with nonconsanguineous Turkish parents. She had virilized external genitalia at birth, a uterus and ovaries, and no sign of Antley-Bixler syndrome. The initial diagnosis was CYP21A2 deficiency with no mutations in CYP21A2, but POR mutations were found. Functional testing was done after producing recombinant POR proteins for analyzing enzymatic and structural properties. Main Outcome: Novel mutations were causing severe loss of POR activities for metabolism of steroids and small molecules. Results: The L374H mutation reduced activities by 80% in cytochrome c, 97% in thiazolyl blue tetrazolium bromide, and 86% in ferricyanide reduction assays. The catalytic efficiency of the 17 α-hydroxylation of progesterone and the 17,20-lyase reaction of 17-OH pregnenolone was decreased by 87 and 90%, respectively; 21-hydroxylation of progesterone was decreased by 96%, and androstenedione aromatization was decreased by 90%. Analysis of the mutant structure by molecular dynamics simulations revealed structural instability. Flavin release and fast proteolysis assays showed that the L374H mutant is less stable than wild-type POR, confirming the bioinformatics prediction. Conclusions: This is the first report of a mutation causing PORD by affecting protein stability that causes severe reduction in POR activities. Detailed characterization of individual mutations in POR is required for understanding novel molecular mechanisms causing PORD.

The study concerns the water level (WL) evolution in lagoons under the influence of tides and river fluxes. We derive new approximate analytical solutions of the Stigebrandt (1980) equations and apply them to the Nokoué Lagoon (Benin), a large tropical coastal lagoon fed by substantial river input.