Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Connaissance indigène des procédés de production du beurre de Pentadesma butyracea Sabine au Bénin

Indigenous Knowledge on Production Processes of Pentadesma butyracea Sabine Butter in Benin. Pentadesma butyracea Sabine is a tree that produces fruits containing oleaginous seeds from which butter, similar to shea butter, is extracted. This butter, so far insufficiently known, is obtained traditionally by a poorly documented process. Based on a technological investigation in the rural area and a factorial correspondences analysis (FCA), this study contributes to a better knowledge of the traditional technology of the P. butyracea butter production in Benin. P. butyracea butter is extracted by twelve main successive unit operations. The transformers involved in the butter production belong to eight different ethnic groups. Two types of thermal pretreatments, namely cooking with water and roasting in a traditional furnace are applied to P. butyracea seeds. The influence of the ethnic group was reported, especially on the type of the thermal pretreatment applied to the seeds as well as the various unit operations of transformation implemented from fruit picking up to obtaining butter. This better knowledge will allow improving the traditional processes of the P. butyracea butter production in rural environment

Typologie Et Structure Des Populations Naturelles De Pentadesma Butyracea Dans La Zone Soudano-Guineenne Du Benin

La présente étude, conduite dans la région soudano-guinéenne du centre Bénin, a pour objectif la caractérisation écologique de Pentadesma butyracea, une espèce vulnérable au Bénin, à travers l’inventaire, la typologie et la caractérisation structurale de ses populations naturelles. Les inventaires floristiques et dendrométriques ont été faits dans cent placeaux de 500 m2, de longueur et largueur variables, dans tous les sites de forêts galeries à dominance P. butyracea. Les données collectées sont l’abondance, la richesse spécifique, la densité, la surface terrière, l’Indice Shannon et l’équitabilité de Pielou. Dans la région soudano-guinéenne du Centre Bénin, P. butyracea est présent dans 76 sites avec une abondance de 1.132 individus adultes (dbh ≥ 10 cm). Sur la base des caractéristiques écologiques des sites, cinq populations de P. butyracea ont été identifiées. Il s’agit des populations de Bassila, Koura, Manigri, Pénéssoulou et Agbassa, qui sont différentes sur le plan statistique pour chacun des paramètres écologiques à savoir la densité, la surface terrière, la richesse spécifique, l’Indice de Shannon et l’Equitabilité de Pielou (Prob. &lt; 0,001). La structure en diamètre de l’espèce dans la plupart des sites est en cloche avec une dissymétrie droite caractéristique des peuplements monospécifiques jeunes. Trois facteurs/gradients (i.e. climat, formations végétales et pression anthropique) expliquent au mieux la typologie et la structure en diamètre des cinq populations discriminées. Il est préconisé comme stratégies de protection et exploitation durables de P. butyracea dans le milieu d’étude la conservation in situ et ex situ, le respect de la législation forestière en matière de protection des forêts galeries, les essais de domestication et la sensibilisation des populations à la limitation des pressions et préservation de cette espèce vulnérable auBénin.Mots clés : Ligneux, Usage Multiple, Pentadesma butyracea, répartition géographique, structure, Bénin.The present study, conducted in the Soudano-guinean region of centre Benin, aimed to characterize the ecology of Pentadesma butyracea, a vulnerable multipurpose species in Benin Republic. All the riparian forest sites where the species was present have been inventoried to map its spatial distribution and quantify its abundance. Floristic and dendrometric relevés were done in 100 plots, each 500 m² in size, in the P. butyracea dominated riparian forest sites to assessed the flora diversity and the structure of the targeted species. In the soudano-guinean region of centre Benin, P. butyracea was present in 76 riparian forest sites with an overall abundance of 1.132 stems (dbh ≥ 10 cm). The values of trees density, basal area, species richness, Shannon diversity index and Pielou equitability index permitted to discriminated five P. butyracea populations (i.e. Bassila, Koura, Manigri, Pénéssoulou and Agbassa) that were significantly different for all the parameters used for the typology (Prob. &lt; 0,001). Three factors/gradients (i.e. climate, vegetation, anthropogenic disturbance) were the underlying factors of the typology and structure of the discriminated populations. The stem diameter structure of P. butyracea in most of the stands had a Gaussian shape with however a right-dissymmetry, characteristic of young monospecific populations. Among the strategies for sustainable protection and uses of P. butyracea in the study area we suggest to promote in situ and ex situ conservation, to enforce of the forest law regarding the protection of riparian forests, to undertake domestication trials and to raise awareness among local people as a means to reduce anthropogenic disturbance and preserve remnants populations of this vulnerable species in Benin.Keywords : Tree Species, Pentadesma butyracea, spatial distribution, structure, Benin.Article in Frenc

Structure, ecological spectra and species dominance in riparian forests from Benin (West Africa)

This paper investigates the structure of the Benin Riparian Forests (RFs) through different methods: lifeforms, phytogeographic types, diameter class distribution, basal area, and stem density. Field data was collected in 373 phytosociological relev&#233;s using the Braun-Blanquet approach. RFs displayed a physiognomy that is highly variable in terms of structural characteristics. RFs in Benin were similar to many dense tropical forests and to the West African ones in particular, in terms of phytogeographical types (higher contribution of Guineo-Congolian basin species) and life forms (high abundance of phanerophytes and lianas, high occurrence of therophytes and medium size trees, low percentage of megaphanerophytes and woody lianas). Diameter class distribution was reserve J type, while values of basal area and stem density varied from 23 to 59 m2/ha, and 253 to 785 trees/ha respectively. Species dominance, in terms of abundance and basal area (i.e. 4.4% of the tree richness contributes 48.5% of overall abundance and 57.4% of the total basal area), was a major characteristic of RFs in Benin. The most dominant and frequent tree species were Pterocarpus santalinoides, Cola laurifolia, Syzygium guineense, Dialium guineense, Berlinia grandiflora, Cynometra megalophylla, Elaeis guineensis, Diospyros mespiliformis, Uapaca togoensis and Parinari congensis. Many stands of RFs are facing various levels of structural and floristic simplification, which include transformations in vegetation physiognomy, from dense pristine stands to sparsely forested waterways banks, riparian scrub, or bare land. Measures have to be taken to conserve the structural complexity of these edaphic and topographic forest ecosystems.Keywords: riparian forests, structure, dominance, Be

Morphological variability of the tallow tree, Pentadesma butyracea Sabine (Clusiaceae), in Benin

The seeds of Pentadesma butyracea (butter tree) are exploited by rural populations in West Africa to produce butter used for consumption and as an ingredient in cosmetics and medicinal preparations. To improve our knowledge of this under-studied species, the morphological variation of the trees, fruits and seeds in 12 natural populations of Benin distributed over a gradient of climate aridity is described with 14 quantitative and 13 qualitative descriptors. Most traits, except seed shape categories, show significant differences among populations. Multivariate analyses distinguish two eco-geographical groups: trees located in the more humid southern part of the species distribution are taller and have larger fruits and seeds than trees located in the north. To disentangle the relative roles of genetic variation and phenotypic plasticity in shaping, further phenotypic studies should be performed in common garden experiments. © 2012 Springer Science+Business Media B.V.SCOPUS: ar.jinfo:eu-repo/semantics/publishe