Analyse Ecosystémique Et Enjeux De La Conservation De Bonobo Réintroduits Dans La Réserve Communautaire Ekolo Ya Bonobo A Basankusu

Cette recherche consiste à évaluer d’une part l’importance de la conservation de bonobo et d’autres part, à étudier l’utilité de cette dernière au regard de la préservation de la biodiversité générale, et aux espèces endémiques rares prêtes d’être exterminer qui leurs donnent la chance de se régénérer dans la tranquillité au sein de leur écosystème naturel. Au second lieu, nous avions étudié le rôle écosystémique des forêts, qui nous procure des biens et services pour la survie merveilleuse. Pour plus de détaille concernant les types de forêts que caractérisent le massif forestier de la réserve, d’après les études, nous trouvons ces quatre composants types de forêts faisant d’elle un caractère exceptionnel sur le plan écologique, et avec une diversité floristique énorme, prédominée par le Gilbertiodendron dewevrei, suivi d’Alchornea cordifolia, Picralima nitida, Raphia sese et autres types. D’autre part, nous avons méticuleusement étudié ses diversités fauniques, qui lui donnent une valeur écologique très importante sur le plan faune dont on cite : Cercopithecus sp, Céphalophus sp, Potamochoerus porcus, Pan paniscus qui était réintroduit dans ladite forêt et autres espèces faisant d’elle un cheptel important. Pour ce qui concerne les atouts sociaux, nous avions analysé toutes les activités alternatives faites par les amis de Bonobo, au bénéfice de la communauté locale au regard de la conservation qui se passe dans leur entité. Nous n’avions pas manqué de parler sur les risques anthropocentriques que parcours la communauté riveraine de Basankusu face à cette espèce réintroduite qui peut occasionnée des dégâts matériels graves à la communauté 

Nifurtimox plus Eflornithine for Late-Stage Sleeping Sickness in Uganda: A Case Series

African sleeping sickness (Human African Trypanosomiasis, or HAT), due to the parasite Trypanosoma brucei gambiense, threatens millions across remote and conflict-affected regions of sub-Saharan Africa, and causes about 15 000 reported cases every year. Untreated HAT progresses from stage 1 (infection of the blood and lymph) to stage 2 (invasion of the central nervous system), and ultimately death. Drugs for stage 2 are few. The historical mainstay, melarsoprol, is highly toxic and inefficacious in some areas due to parasite resistance. Eflornithine is the only viable alternative, already established as safe and efficacious, but difficult to administer and at risk of resistance if used in monotherapy. This paper reports on a series of 48 Ugandan patients treated with a novel combination of nifurtimox (a drug registered for Chagas disease) and eflornithine, 17 as part of a terminated trial, and 31 in a subsequent case series study. Despite the low sample size, findings are promising: no cases of treatment failure, no treatment terminations, and no HAT- or treatment-related deaths. Nifurtimox plus eflornithine may be the best treatment hope for stage 2 HAT patients in the next decade, while new drugs are developed. A larger, multi-centric trial of the combination is ongoing

Oral fexinidazole for stage 1 or early stage 2 African Trypanosoma brucei gambiense trypanosomiasis: a prospective, multicentre, open-label, cohort study

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

Pregnancy Outcomes among Patients with Sickle Cell Disease in Brazzaville

Introduction. Sickle cell disease (SCD) is one of the most common genetic diseases in the world. It combines, in its homozygous form, chronic hemolytic anemia, vasoocclusive complications, and susceptibility to infections. It is well known that the combination of pregnancy and sickle cell disease promotes the occurrence of complications that are sometimes fatal for the mother and/or the fetus. Objective. The objective of the current study was to compare pregnancy outcomes among women with SCD with those of women without the diagnosis of SCD. Materials and methods. It was a case-control study carried out in four maternity hospitals in Brazzaville in 2 years (July 2017–June 2019). It concerned 65 parturients with SS homozygous SCD. The mode of childbirth and maternal and perinatal morbidity and mortality were compared with those of 130 non-sickle cell pregnant women. Results. The average age was 27 years for SCD women and 31 years for non-SCD women. The average gestational age at delivery was 35 weeks for SCD women and 38 weeks for non-SCD women. From the logistic regression analysis using the comparison group as the reference group, there was excessive risk in SCD compared to non-SCD of infection (29.3% vs. 4.6%, OR = 21.7, 95% CI [7.6–62.7]; p=0.001), cesarean (63% vs. 35.4%, OR = 3.1, 95% CI [1.6–5.7]; p=0.001), prematurity (75.4% vs. 30.8%, OR = 8, 95% CI [3.0–23.2]; p=0.001), low birth weight (52.3% vs. 16.1%, OR = 4.7, 95% CI [2.4–9.4]; p=0.001), neonatal requiring admission to the intensive care unit (40.3% vs. 17.5%, OR = 3.2, 95% CI [1.6–6.3]; p=0.01), and neonatal death (21.5% vs. 4.8%, OR = 4.3, 95% CI [1.5–12.2]; p=0.01). Conclusion. The risk of pregnancy in patients with homozygous sickle cell anemia remains high, on both the maternal and fetal sides.</jats:p

Pregnancy Outcomes among Patients with Sickle Cell Disease in Brazzaville

Introduction. Sickle cell disease (SCD) is one of the most common genetic diseases in the world. It combines, in its homozygous form, chronic hemolytic anemia, vasoocclusive complications, and susceptibility to infections. It is well known that the combination of pregnancy and sickle cell disease promotes the occurrence of complications that are sometimes fatal for the mother and/or the fetus. Objective. The objective of the current study was to compare pregnancy outcomes among women with SCD with those of women without the diagnosis of SCD. Materials and methods. It was a case-control study carried out in four maternity hospitals in Brazzaville in 2 years (July 2017–June 2019). It concerned 65 parturients with SS homozygous SCD. The mode of childbirth and maternal and perinatal morbidity and mortality were compared with those of 130 non-sickle cell pregnant women. Results. The average age was 27 years for SCD women and 31 years for non-SCD women. The average gestational age at delivery was 35 weeks for SCD women and 38 weeks for non-SCD women. From the logistic regression analysis using the comparison group as the reference group, there was excessive risk in SCD compared to non-SCD of infection (29.3% vs. 4.6%, OR = 21.7, 95% CI [7.6–62.7]; p=0.001), cesarean (63% vs. 35.4%, OR = 3.1, 95% CI [1.6–5.7]; p=0.001), prematurity (75.4% vs. 30.8%, OR = 8, 95% CI [3.0–23.2]; p=0.001), low birth weight (52.3% vs. 16.1%, OR = 4.7, 95% CI [2.4–9.4]; p=0.001), neonatal requiring admission to the intensive care unit (40.3% vs. 17.5%, OR = 3.2, 95% CI [1.6–6.3]; p=0.01), and neonatal death (21.5% vs. 4.8%, OR = 4.3, 95% CI [1.5–12.2]; p=0.01). Conclusion. The risk of pregnancy in patients with homozygous sickle cell anemia remains high, on both the maternal and fetal sides