Cholera outbreaks in sub-Saharan Africa during 2010-2019: a descriptive analysis

Background: Cholera remains a public health threat but is inequitably distributed across sub-Saharan Africa. Lack of standardized reporting and inconsistent outbreak definitions limit our understanding of cholera outbreak epidemiology. Methods: From a database of cholera incidence and mortality, we extracted data from sub-Saharan Africa and reconstructed outbreaks of suspected cholera starting in January 2010 to December 2019 based on location-specific average weekly incidence rate thresholds. We then described the distribution of key outbreak metrics. Results: We identified 999 suspected cholera outbreaks in 744 regions across 25 sub-Saharan African countries. The outbreak periods accounted for 1.8 billion person-months (2% of the total during this period) from January 2010 to January 2020. Among 692 outbreaks reported from second-level administrative units (e.g., districts), the median attack rate was 0.8 per 1000 people (interquartile range (IQR), 0.3-2.4 per 1000), the median epidemic duration was 13 weeks (IQR, 8-19), and the median early outbreak reproductive number was 1.8 (range, 1.1-3.5). Larger attack rates were associated with longer times to outbreak peak, longer epidemic durations, and lower case fatality risks. Conclusions: This study provides a baseline from which the progress toward cholera control and essential statistics to inform outbreak management in sub-Saharan Africa can be monitored

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Les envenimations ophidiennes dans une clinique privee « Néné » de kati et revue de la litterature

Objectif: Rapporter 5 observations cliniques de morsures de serpent chez des sujets admis en milieu de soins et faire une revue de la littérature. Méthodologie: Nous avons effectué une analyse d’une série de 5 dossiers médicaux de patients admis pour morsures de serpents. Résultats: Les patients de notre série étaient d’un âge moyen de 24,8 ans avec des extrêmes de 11 ans (observation 4) et 44 ans (observation 5). Un seul cas était de sexe féminin (observation 3). Les circonstances d’expositions étaient les travaux champêtres pour 2 cas, le ramassage de bois (2 cas) et la promenade nocturne pour 1 cas. Les sites de morsures étaient majoritairement le membre inferieur (4 cas). Un patient avait le site de morsure sur le pouce du doigt (observation 4). L’étape initiale de la prise en charge a été effectuée par le traditherapeutique dans tous les cas. Les délais de consultations ont été de 48 heures (2cas) 72 heures (2 cas) et de 12 heures chez 1 cas. Le syndrome hémorragique a été noté dans la majorité des cas à l’admission (4 patients) et le délabrement musculaire dans 1 cas (observation 5). Ils ont tous bénéficié de sérothérapie antivenimeux. L’évolution fut favorable pour l’ensemble des patients. Conclusion: les cas de morsures de serpent sont de plus en plus rencontrés au cours de nos activités de soins. Une meilleure connaissance et la maitrise des bonnes pratiques de la prise en charge des envenimations ophidiennes permettraient une amélioration du pronostic des cas. Mots clés: Morsures, Serpents, Sérum antivenimeux, Mali English Title: The ophidian envenomations in a private clinique “Néné”area in Kati and review of literature English Abstract Objectif: to report 5 clinical observations of snakebite in subjects admitted to healthcare settings and review literature. Methods: We performed an analysis of a series of medical records of patients for snakebite. Results: The patients in our series were of an average age of 24.8 years with extremes of 11 years (case 4) and 44 years (cases 5). Only one was female (case 3). The exposure circumstances were field work concerning 2 cases, wood collection (2 cases) and night walk for 1 case. The bite sites were mainly on the lower limb (4 cases). For 1 patient this site located on the thumb (case). In all cases, the initial step of consultation was effect to the traditional therapy pratician. They consult in the health structures only after failure of the traditional treatment thus at the stage of complications whose management remains uncertain and burdened with heavy. The consultations delay were 48 hours (2 cases), 72 hours (2 cases) and 12 hours in one 1 case. Hemorragic syndrome has been reported in the majority of cases at admission (4 patients) and muscle decay in one case (case 5). All of ours patients received antivenom serotherapy. Evolution was favorable for all patients. Conclusion: Snake bites are also encountered in our care structures. A better knowledge and mastery of good rules for taking care ophidian envenomations would improve the prognosis of cases. Keywords: Bites, Serpents, Antivenous Serum, Mal

Radiochimiotherapie des cancers oto-rhinolaryngologiques dans un service de reference au Mali: Radiochemotherapy of otorhinolaryngological cancers in a referral service in Mali

Objectif: - le but de l’étude était d’évaluer le résultat de la radiothérapie des cancers oto-rhino laryngologiques.Patients et méthode: - il s’agissait d’une étude rétrospective au service de radiothérapie de l’hôpital du Mali durant une période allant d’avril 2014 à novembre 2018.Résultats: - L’âge médian était de 47 ans (18 à 76 ans). L’antécédent de tabagisme chronique a été retrouvé dans 45% (n= 09) des cas, et l’intoxication alcoolo tabagique dans 35% (n= 07) des cas. Le signe révélateur était la dysphonie dans 40% (n=08), la dyspnée dans 25% (n=05) et les adénopathies cervicales dans 20% (n=04). La tumeur était localisée dans la cavité buccale et l’oropharynx dans 40% (n=08), le larynx dans 35% (n=07) et le cavum dans 25% (n=05). Les patients ont été classés selon la classification TNM 6eme édition en T3-T4 dans 65% (n=13) des cas, T1-T2 dans 35% (n=07) des cas. La chimiothérapie néo adjuvante a été administrée chez 85% (n= 17) des patients. La radiothérapie externe au photon 6MV a été administrée chez tous les patients à la dose de 70Gy en raison de 5 séances de 2 Gy par semaine. L’évaluation après radiothérapie a objectivé 35% (n= 7) de rémissions complètes, 25% (n= 5) de récidives locales, 20% (n= 4) de métastases à distance et 20% (n= 4) dedécès.Conclusion: - Le pronostic des cancers oto-rhino laryngologiques est classiquement mauvais. La radiothérapie externe améliore le control local et lasurvie de ces cancers.ABSTRACTPurpose: - The aim of this study was to evaluate the result of radiotherapy for otolaryngological cancers.Patients and method: - It was a retrospective study in the radiotherapy department of Mali hospital during a period from April 2014 to November 2018.Results: - The median age was 47 years (18 to 76 years). A history of chronic smoking was found in 45% (n = 09) of cases. Tobacco alcohol intoxication in 35% (n = 07) of cases. The telltale sign was dysphonia in 40% (n = 08), dyspnea in 25% (n = 05) and cervical lymphadenopathy in 20% (n = 04). The tumor was located in the oral cavity and oropharynx in 40% (n = 08), the larynx in 35% (n = 07) and the nasopharynx in 25% (n = 05. The patients were classified according to the TNM classification 6th edition in T3-T4 in 65% (n = 13) of the cases, T1- T2 in 35% (n = 07) of the cases. Neoadjuvant chemotherapy was administered in 85% (n = 17) of patients. . External beam radiation therapy with 6MV photonwas administered to all patients at a dose of 70Gy due to 5 sessions of 2 Gy per week. The evaluation after radiotherapy objectified 35% (n = 7) of complete remissions, 25% (n = 5) of local recurrences, 20% (n = 4) of distant metastases and 20% (n = 4) of death.Conclusion: - The prognosis for otolaryngological cancers is classically poor. External radiotherapy improves local control and survival of these cancers

Antibiotiques et résistance bactérienne : pistes d'actions pour ancrer les progrès de 2020

International audienceL'année 2020 a bouleversé les comportements du quotidien, en raison de la pandémie de COVID-19 et des confinements et gestes barrières à adopter pour limiter sa propagation. Ces modifications ont contribué à limiter la transmission des autres infections ; elles ont aussi impacté le recours aux soins et la prise en charge de certaines pathologies en santé humaine