GRANULITISATION OF FRONTAL NAPPES IN THE KABYÈ MASSIF IN NORTHERN TOGO

The Kabyè Massif represents one of disseminated hills which marks the suture zone of the Panafrican Dahomeyides Belt in northen Togo. Coronitic structures were described in high-grade granulites composing the frontal nappes on the south-western edge of the massif. Granulitisation is investigated through petrofabric study of the frontal nappes rocks of Kabyè Massif. Two stages of granulitisation are revealed: the first one corresponds to the formation of granulites with an Opx + Pl + Cpx + Grt ± Qtz paragenesis ; the second one has a Cpx + Pl + Grt + Qtz ± Ilm mineral assemblage. The former corresponds to metamorphic recristallization of about medium-pressure to high-temperature conditions (P = 10 to 13 kbar and T = 900 with 1000°C). The latter, which developed coronitic structures, is interpretated as formed at an ultra-high-pressure and medium- to hightemperature conditions (P = 13 to 19 kbar and T = 850 to 900°C). These coronitic petro-fabrics define an anticlockwise P-T paths trajectories corresponding to the collision and the beginning of the nappes extraction during the Panafrican tectonics

GRANULITISATION OF FRONTAL NAPPES IN THE KABYÈ MASSIF IN NORTHERN TOGO

The Kabyè Massif represents one of disseminated hills which marks the suture zone of the Panafrican Dahomeyides Belt in northen Togo. Coronitic structures were described in high-grade granulites composing the frontal nappes on the south-western edge of the massif. Granulitisation is investigated through petrofabric study of the frontal nappes rocks of Kabyè Massif. Two stages of granulitisation are revealed: the first one corresponds to the formation of granulites with an Opx + Pl + Cpx + Grt ± Qtz paragenesis ; the second one has a Cpx + Pl + Grt + Qtz ± Ilm mineral assemblage. The former corresponds to metamorphic recristallization of about medium-pressure to high-temperature conditions (P = 10 to 13 kbar and T = 900 with 1000°C). The latter, which developed coronitic structures, is interpretated as formed at an ultra-high-pressure and medium- to hightemperature conditions (P = 13 to 19 kbar and T = 850 to 900°C). These coronitic petro-fabrics define an anticlockwise P-T paths trajectories corresponding to the collision and the beginning of the nappes extraction during the Panafrican tectonics

Déterminants des adhérences péritonéales dans une population féminine congolaise : étude cas-témoin: Determinants of peritoneal adhesions in a female Congolese population: a case-control study

Context and objective. Peritoneal adhesions are a major health concern worldwide. However little is known about their risk factors in sub-Saharan Africa. This study aimed to assess the determinants of peritoneal adhesions in female subjects. Methods. A case-control study, aiming to identify correlates of peritoneal adhesions, compared two groups of patients with and without adhesions after gynecological surgery in 2 hospitals of Kinshasa. Odds ratio calculation and multivariate logistic regression were used to assess the strength of associations and to identify independent determinants of peritoneal adhesions. Results. Cases (105) were compared to controls (112) and were not different regarding age (p = 0.244), parity (p = 0.380), educational level (0.061), economic status (0.481), history of miscarriages (0.546), presence or absence of keloid scar (0.233) and anti-MOMP (0.499) and anti-HSP-60 (0.230) Chlamydia trachomatis serological status. The patients with hypertrophic scar had twice as many adhesions and those with a history of laparotomy had 8 times more adhesions than the others. Women who underwent surgery for uterine leiomyoma had 2 times more adhesions. In multivariate analysis, uterine leiomyoma and history of laparotomy had emerged as major independent determinants of adhesions. Conclusion. The study highlighted uterine leiomyoma as major risk factors of adherences apart from the history of laparotomy and not chlamydia infection. Additional evidenced surveys are nned to determine relevant guidelines. Contexte and objectif. Les adhérences péritonéales sont un problème mondial majeur de santé publique. Cependant, les données sur leurs déterminants restent fragmentaires en Afrique subsaharienne. L’objectif de la présente étude était de rechercher les facteurs associés aux adhérences péritonéales chez la femme. Méthodes. Nous avons conduit une étude cas-témoin identifiant les sujets avec adhérences péritonéales parmi les opérés (au cours de laparotomie ou laparoscopie) et appariés à ceux indemnes (témoins) pour l’âge, la parité et le niveau socioéconomique aux Départements de Gynécologie et Obstétrique des Cliniques Universitaires de Kinshasa et de l’Hôpital Saint Joseph de Limete/Kinshasa, du 1er juin 2015 au 20 mars 2016. Le Odds ratio a permis de mesurer la force d’association entre la présence des adhérences et les facteurs associés. L’analyse de régression logistique multivariée a recherché les déterminants indépendants des adhérences. Le test était statistiquement significatif pour une valeur de p ‹ 0,05. Résultats. Au total, 105 cas et 112 témoins ont été inclus. Les cas et les témoins n’étaient pas différents en ce qui concerne leur âge (p=0,244), leur parité (p=0,380), leur niveau d’instruction (0,061), leur niveau économique (0,481), la présence ou non d’une chéloïde (0,233) et leur sérologie anti-MOMP (0,499) et anti-HSP-60 (0,230) du Chlamydia trachomatis. Les opérées qui avaient une cicatrice hypertrophique avaient 2 fois plus d’adhérences et celles avec antécédent de laparotomie avaient 8 fois plus d’adhérences. En plus, les opérées avec une myomatose utérine avaient 2 fois plus d’adhérences. En analyse de régression logistique multi variée, seuls la myomatose utérine actuelle ou dans le passé et l’antécédent de laparotomie avaient émergé comme facteurs majeurs indépendants associés aux adhérences péritonéales et multipliant respectivement le risque par 7,75 et 2,2. Conclusion. L’étude illustre la valeur prédictive des adhérences de la myomatose utérine en dehors de l’antécédent de laparotomie et non de l’infection à Chlamydia. Des études ultérieures sont nécessaires en vue d’établir des recommandations adéquates

ACTUALISATION STRUCTURALE DE L’AQUIFÈRE DU PALÉOCÈNE DANS LE BASSIN CÔTIER DU TOGO

Groundwater is one of the main sources of drinking water to the population living in the coastal sedimentary basin of Togo. Faced with the depletion and pollution of the most accessible aquifer of the Continental terminal, it is important to find alternatives groundwater resources, exploring the potential of the deep aquifers that are little exploited this day. This study aims to improve knowledge of one of these deep aquifers and particularly the Paleocene aquifer. The Paleocene aquifer is a confined aquifer and this study focuses on its configuration, its location and its structure, based on the systematic inventory of wells and stratigraphy. Thus geological sections of North-South and West-East directions have allowed knowing the extent and geometry of this aquifer, as well as the nature of the reservoir and wall rocks. They also show that the sedimentary formations of coastal basin are organized in a monocline series dipping toward south. Different results were represented as isopach map of the reservoir and isohypse maps of upper confining bed and lower confining one. As the others formations of the basin, the wall rocks take on an air of an inclined plane towards the Atlantic Ocean. The upper confining bed elevations range from 20 m in the northern part of the basin, at -380 in the Southeast. Those of lower confining bed in the same sectors are 0 in NW and -20m in NE at -420 m in the South. This morphology of the aquifer is related to the NNW-SSE direction of extension faults that affected the crystalline basement at the opening of the Atlantic Ocean. Estimates of the reservoir thickness are between 6m to more than 50 m and are influenced by the base sands

Diagnosis of paediatric TB using Xpert® MTB/RIF Ultra on fresh respiratory samples.

OBJECTIVE: To evaluate the diagnostic accuracy of Xpert® MTB/RIF Ultra (Ultra) on fresh respiratory samples for the diagnosis of pulmonary TB (PTB) in children.METHODS: Between July 2017 and December 2019, children with presumed TB were prospectively enrolled at clinical sites in three African countries. Children were assessed using history, physical examination and chest X-ray. Sputum or gastric aspirate samples were analysed using Ultra and culture. The diagnostic accuracy of Ultra was calculated against culture as the reference standard.RESULTS: In total, 547children were included. The median age was 4.7 years, 77 (14.1%) were HIV infected and 77 (14.1%) had bacteriologically confirmed TB. Ultra detected an additional 20 cases in the group of children with negative culture results. The sensitivity of Ultra was 66.3% (95% CI 47-82), and the specificity was 95.4% (95% CI 89-99) when assessed against culture as the reference standard.CONCLUSION: Despite the improved performance of Ultra as compared to Xpert as was previously reported, its sensitivity remains sub-optimal for the detection of TB in children. Ultra detected additional 20 cases which otherwise could not have been detected by culture alone, suggesting that the latter is an imperfect reference standard

Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents

<p>Abstract</p> <p>Background</p> <p>Even though electronic prescribing systems are widely advocated as one of the most effective means of improving patient safety, they may also introduce new risks that are not immediately obvious. Through the study of specific incidents related to the processes involved in the administration of medication, we sought to find out if the prescribing system had unintended consequences in creating new errors. The focus of this study was a large acute hospital in the Midlands in the United Kingdom, which implemented a Prescribing, Information and Communication System (PICS).</p> <p>Methods</p> <p>This exploratory study was based on a survey of routinely collected medication incidents over five months. Data were independently reviewed by two of the investigators with a clinical pharmacology and nursing background respectively, and grouped into broad types: sociotechnical incidents (related to human interactions with the system) and non-sociotechnical incidents. Sociotechnical incidents were distinguished from the others because they occurred at the point where the system and the professional intersected and would not have occurred in the absence of the system. The day of the week and time of day that an incident occurred were tested using univariable and multivariable analyses. We acknowledge the limitations of conducting analyses of data extracted from incident reports as it is widely recognised that most medication errors are not reported and may contain inaccurate data. Interpretation of results must therefore be tentative.</p> <p>Results</p> <p>Out of a total of 485 incidents, a modest 15% (n = 73) were distinguished as sociotechnical issues and thus may be unique to hospitals that have such systems in place. These incidents were further analysed and subdivided into categories in order to identify aspects of the context which gave rise to adverse situations and possible risks to patient safety. The analysis of sociotechnical incidents by time of day and day of week indicated a trend for increased proportions of these types of incidents occurring on Sundays.</p> <p>Conclusion</p> <p>Introducing an electronic prescribing system has the potential to give rise to new types of risks to patient safety. Being aware of these types of errors is important to the clinical and technical implementers of such systems in order to, where possible, design out unintended problems, highlight training requirements, and revise clinical practice protocols.</p

'You give us rangoli, we give you talk': using an art-based activity to elicit data from a seldom heard group

<p>Abstract</p> <p>Background</p> <p>The exclusion from health research of groups most affected by poor health is an issue not only of poor science, but also of ethics and social justice. Even if exclusion is inadvertent and unplanned, policy makers will be uninformed by the data and experiences of these groups. The effect on the allocation of resources is likely to be an exacerbation of health inequalities.</p> <p>Discussion</p> <p>We subject to critical analysis the notion that certain groups, by virtue of sharing a particular identity, are inaccessible to researchers - a phenomenon often problematically referred to as 'hard to reach'. We use the term 'seldom heard' to move the emphasis from a perceived innate characteristic of these groups to a consideration of the methods we choose as researchers. Drawing on a study exploring the intersections of faith, culture, health and food, we describe a process of recruitment, data collection and analysis in which we sought to overcome barriers to participation. As we were interested in the voices of South Asian women, many of whom are largely invisible in public life, we adopted an approach to data collection which was culturally in tune with the women's lives and values. A collaborative activity mirroring food preparation provided a focus for talk and created an environment conducive to data collection. We discuss the importance of what we term 'shoe leather research' which involves visiting the local area, meeting potential gatekeepers, and attending public events in order to develop our profile as researchers in the community. We examine issues of ethics, data quality, management and analysis which were raised by our choice of method.</p> <p>Summary</p> <p>In order to work towards a more theoretical understanding of how material, social and cultural factors are connected and influence each other in ways that have effects on health, researchers must attend to the quality of the data they collect to generate finely grained and contextually relevant findings. This in turn will inform the design of culturally sensitive health care services. To achieve this, researchers need to consider methods of recruitment; the makeup of the research team; issues of gender, faith and culture; and data quality, management and analysis.</p

Diagnostic accuracy of a three-gene Mycobacterium tuberculosis host response cartridge using fingerstick blood for childhood tuberculosis: a multicentre prospective study in low-income and middle-income countries

BACKGROUND: Childhood tuberculosis remains a major cause of morbidity and mortality in part due to missed diagnosis. Diagnostic methods with enhanced sensitivity using easy-to-obtain specimens are needed. We aimed to assess the diagnostic accuracy of the Cepheid Mycobacterium tuberculosis Host Response prototype cartridge (MTB-HR), a candidate test measuring a three-gene transcriptomic signature from fingerstick blood, in children with presumptive tuberculosis disease. METHODS: RaPaed-TB was a prospective diagnostic accuracy study conducted at four sites in African countries (Malawi, Mozambique, South Africa, and Tanzania) and one site in India. Children younger than 15 years with presumptive pulmonary or extrapulmonary tuberculosis were enrolled between Jan 21, 2019, and June 30, 2021. MTB-HR was performed at baseline and at 1 month in all children and was repeated at 3 months and 6 months in children on tuberculosis treatment. Accuracy was compared with tuberculosis status based on standardised microbiological, radiological, and clinical data. FINDINGS: 5313 potentially eligible children were screened, of whom 975 were eligible. 784 children had MTB-HR test results, of whom 639 had a diagnostic classification and were included in the analysis. MTB-HR differentiated children with culture-confirmed tuberculosis from those with unlikely tuberculosis with a sensitivity of 59·8% (95% CI 50·8–68·4). Using any microbiological confirmation (culture, Xpert MTB/RIF Ultra, or both), sensitivity was 41·6% (34·7–48·7), and using a composite clinical reference standard, sensitivity was 29·6% (25·4–34·2). Specificity for all three reference standards was 90·3% (95% CI 85·5–94·0). Performance was similar in different age groups and by malnutrition status. Among children living with HIV, accuracy against the strict reference standard tended to be lower (sensitivity 50·0%, 15·7–84·3) compared with those without HIV (61·0%, 51·6–69·9), although the difference did not reach statistical significance. Combining baseline MTB-HR result with one Ultra result identified 71·2% of children with microbiologically confirmed tuberculosis. INTERPRETATION: MTB-HR showed promising diagnostic accuracy for culture-confirmed tuberculosis in this large, geographically diverse, paediatric cohort and hard-to-diagnose subgroups. FUNDING: European and Developing Countries Clinical Trials Partnership, UK Medical Research Council, Swedish International Development Cooperation Agency, Bundesministerium für Bildung und Forschung; German Center for Infection Research (DZIF)