Armed Conflicts, HIV Testing, HIV Prevalence, and High-Risk Sexual Behaviors: An Epidemiologic Analysis

Armed conflicts have a wide array of consequences on health and behavior possibly serving a role in the spread of HIV, yet there is limited research on the quantitative association between armed conflicts and HIV. To address this gap in the literature, we evaluated the effect of armed conflicts on HIV testing, HIV prevalence, and high-risk sexual behaviors, using Demographic and Health Surveys data from 11 countries in Sub-Saharan Africa (years 2010 to 2018) and the Armed Conflict Location & Event Data. We hypothesized that armed conflicts, measured using number of conflict days, fatalities, or distance to nearest conflict, would be associated with reduced likelihoods of HIV testing, higher likelihoods of HIV prevalence, and higher occurrences of high-risk sexual behaviors. We developed three specific aims to 1) compare HIV testing, HIV prevalence, HIV knowledge and attitudes, and high-risk sexual behaviors between conflict and non-conflict areas, 2) determine the association between armed conflicts, HIV testing, and HIV prevalence and 3) determine the association between armed conflicts and high-risk sexual behaviors. We utilized a cross-sectional ecologic study, descriptive statistics such as maps, plots and two-sample T tests for the first aim and generalized linear mixed effects models with spatial random effects while adjusting for common confounders for subsequent aims. For these analyses, we used data from 168 administrative regions. Of these, 79 experienced conflict with an average of 87 days spent in conflict and 200 fatalities. In Aim 1, we found significantly lower HIV prevalence, stigma, previous HIV testing, and HIV knowledge in conflict areas. In Aim 2, armed conflicts were significantly associated with lower rates of HIV prevalence but not with previous HIV testing. In Aim 3, number of days and fatalities were significantly associated with increased rates of high-risk sexual behaviors but close proximity to an area of conflict was significantly associated with lower rates of high-risk sexual behaviors. Our findings illustrate that the relationship between armed conflicts and HIV measures is complex and is influenced by conflict duration, intensity, and proximity. Future studies should consider accounting for temporality and utilizing different populations exposed to higher intensity conflicts

Gestational diabetes and endothelial function: impact of gestational insulin resistance on reactive hyperhemia index

Our aim was to characterize endothelial function in gestational diabetes by evaluating the reactive hyperemia index (RHI, LnRHI). A prospective, descriptive and comparative study was conducted on a population of pregnant women aged over 20 and under 36, located in the gestational age group 24-38th week of amenorrhea. They were divided into two groups. Group 1 (G1): group of pregnancies without diabetes, consists of pregnant women with no risk factor for gestational diabetes and with normal fasting blood glucose. Group 2 (G2): group of pregnancies with diabetes, includes pregnancies whose oral glucose tolerance tests (OGTT) came back positive. Anthropo-physiological parameters (age, weight, height, blood pressure (PA) and biochemical parameters (glycemia, insulinemia, HOMA-IR, cholesterol, triglycerides) were measured. RHI and LnRHI were determined at Endopat 2000. The two groups were matched for age, weight, heart rate (HR) and blood pressure (BP). Levels of glucose (G1:0.76±0.11; G2:1.11±0.11; p˂0.0001), insulin (G1:7.67±4.35; G2:22.9±3.75; p˂0.0001), HOMA-IR (G1:1.51±0.97; G2:6.29±1.23; p˂0.0001), total cholesterol (G1:1±0.81; G2:2.49±0.74; p=0.002), HDL cholesterol (G1:0.45±0.23; G2: 0.8±0.19; p=0.004, LDL cholesterol (G1:0.42±0.54; G2:1.39±0.6; p=0.004), triglycerides (G1:0.65±0.49; G2:1.48±0.27; p=0.0018), were significantly higher in the diabetic group. Both RHI and LnRHI were negatively correlated with HOMA-IR (respectively, r=-0.8931, p<0.0001; r=-0.8938; p<0.0001). HOMA-IR index was independently associated with levels of RHI and LnRHI (respectively r²=0.797; p<0.0001); (r²=0.804; p<0.0001)). Thus, gestational insulin resistance would be associated with a change in endothelial function such as a decrease in endothelium-dependent vasodilatation reflecting endothelial dysfunction, hence an increase in cardiovascular risk

Insulin resistance and arterial stiffness: impact of gestational diabetes on pulse wave velocity

Background: Gestational diabetes is an intolerance of glucose with the first appearance during the pregnancy. This hyperglycaemia status, because of the pre-existing insulin-resistance, constitute a favourable land of arterial stiffness. The aim of this study is to determine the impact of non obese gestational diabetes on arterial stiffness by measuring the pulse wave velocity (PWV).Methods: We recruited 60 pregnant women aged from 20 to 35 years old. They were between twentieth four and thirtieth five weeks of gestational age. Subjects were divided into two groups: the first group (G1), considered as control group, included 25 normoglycemic pregnant subjects without any history of illness or risk factors of gestational diabetes; the second group (G2) included 35 women with Gestational Diabetes Mellitus (GDM). All pregnant women had not history of smoking, were not taking decoction or medicine, which could disturb pregnancy evolution. Anthropo-physiological and biochemical parameters studied, were: age, body mass index (BMI), blood pressure (BP), triglyceride, cholesterol and HOMA-IR index. The PWV between finger and toe (PWVft) was measured by pOpmètre®.Results: The two groups are matched by age (G1:28±4ans; G2:29±3ans) and BMI (G1:25.6±1.27; G2:26.9±1.3). Blood pressure (BP) values are in normal interval (systolic BP: [110-132mmHg]; diastolic BP: [63-87mmHg]; mean BP: [79-103mmHg]). Total cholesterol (G1:0.95±0.08;G2:2.4±0.7; p˂0.0001), HDL cholesterol (G1:0.44±0.02; G2:0.76±0.2; p˂0.0001, LDL cholesterol (G1:0.40±0.05; G2:1.3±0.5; p˂0.0001), triglyceride (G1:0.57±0.45; G2:1.6±0.4;p˂0.0001), HOMA.IR (G1:1.31±1.05; G2:7.4±1.07; p˂0.01), PWVft (G1:5.99±1.23; G2:10.3±1.9; p˂0.0001) are significantly higher in diabetic group. PWVft is positively correlate to HOMA-IR index, total cholesterol, LDL cholesterol and triglycerides (r=0.3348, p=0.032; r=0.5275, p˂0.0001; r=0.4855,p˂0.0001; r=0.5581, p˂0.0001respectively).Conclusions: Gestational diabetes might induce an increase of pulse wave velocity expressing increment of arterial stiffness. This last constitute an early underlying cardiovascular risk.

L’éléphantiasis vulvo-clitoridien: à propos d’un nouveau cas

L'éléphantiasis vulvo-clitoridien d'origine filarienne est une affection très rare. Nous rapportons un nouveau cas chez une femme de 33 ans suivie dans un service de Maladies Infectieuses pour filariose lymphatique. Elle avait une masse vulvo-clitoridienne qui évoluait depuis plus de 10 ans. Une résection clitoridienne et une plastie vulvaire a été réalisée. Les résultats fonctionnels et esthétiques étaient satisfaisants.Key words: Eléphantiasis, filariose, vulvo-clitoridie

The Effect of Travel Burden on Depression and Anxiety in African American Women Living with Systemic Lupus

The United States has a deficit of rheumatology specialists. This leads to an increased burden in accessing care for patients requiring specialized care. Given that most rheumatologists are located in urban centers at large hospitals, many lupus patients must travel long distances for routine appointments. The present work aims to determine whether travel burden is associated with increased levels of depression and anxiety among these patients. Data for this study were collected from baseline visits of patients participating in a lupus study at MUSC. A travel/economic burden survey was assessed as well as the 8-item Patient Health Questionnaire (PHQ-8) and the 7-item Generalized Anxiety Disorder (GAD-7) survey as measures of depression and anxiety, respectively. Linear regression models were used to assess the relationship between travel burden and depression and anxiety. Frequency of healthcare visits was significantly associated with increased depression (β = 1.3, p = 0.02). Significant relationships were identified between anxiety and requiring time off from work for healthcare appointments (β = 4, p = 0.02), and anxiety and perceived difficulty in traveling to primary care providers (β = 3.1, p = 0.04). Results from this study provide evidence that travel burden can have an effect on lupus patients’ anxiety and depression levels

Effects of lenten fasting on body composition and biochemical parameters

Background: The catholic lenten fasting is the period of 40 days of fasting that precedes Easter. It is one of religious fasting less documented in the scientific literature. Thus the aim of our study was to evaluate the evolution of anthropometric and body composition and biochemical profile during Catholic lenten fasting.Methods: We conducted a prospective study, which took place during the period between one week before at the end of lenten fasting. Eleven fasters (4 women and 7 men), aged between 18 and 59 years were included in present study. Anthropometric, body composition parameters and biochemical profile were evaluated one week before, at 15th day and at the end of Lenten fasting.Results: Weight, body mass index (BMI) and visceral fat decreased significantly at the end of Lenten fasting. Lipid profile changed significantly during this fasting period. Total cholesterol (TC), low density lipoprotein – cholesterol (LDL-C) and triglycerides decreased significantly with fasting. High density lipoprotein – cholesterol (HDL-C) was remained unchanged during this fasting period while TC/HDL ratio was significantly decreased at the end of Lent.Conclusions: Present study showed that the fasting of Lent seems to have beneficial effects on reducing cardiovascular risk factors. Further studies are required to better understand the physiological mechanisms involved for a therapeutic use

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century