Residual mother-to-child transmission of HIV in Burkina Faso

Background: Burkina Faso is one of the countries in West Africa most affected by the HIV/AIDS pandemic, despite the implementation of a mother-to-child HIV transmission prevention program as a strategy to reduce the risk of vertical transmission of the disease.Objective: To assess the current risk of mother-to-child transmission of HIV in Burkina Faso.Materials and methods: A prospective study was conducted between December 2014 and July 2016, in the 13 health regions of Burkina Faso. Women who were screened HIV-positive during a prenatal consultation were followed until delivery. Their babies received dry blood spot (DBS) at birth, at week 6 and at 1year, to screen for HIV.Results: Overall, 186 pregnant women were included in the study, with a mean age of 29.17±6.13 years. Of their children, 430 DBS actually received a PCR test, giving a 91.1% PCR implementation rate. After analyses, 6 (1.3%) babies were identified as carriers of HIV1. The newborn’s serological status was associated with delivery pattern (p=0.000), the administration of antiretroviral drugs to the mother after delivery (p=0.0064), the administration of Nevirapine to the newborn at birth (p=0.022), the use of contraceptive methods after delivery (p=0.028) and the presence of breast affections/infections since delivery (p=0.013).Conclusion: The results of our study are encouraging and demonstrate the effectiveness of interventions in the mother-tochild prevention program (PMTCT) for HIV-positive pregnant women can be improved through early initiation of triple therapy in early pregnancy and improved adherence to antiretroviral (ARV) therapy.Keywords: Burkina Faso, HIV/AIDS, mother-to-child transmission, antiretroviral drugs, pregnant wome

La cryptococcose neuro-méningée au Mali

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 ± 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between 1 and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains

A Global Network of Science and Technology Advice in Foreign Ministries

This paper is a product of the International Dialogue on Science and Technology Advice in Foreign Ministries (Vienna Dialogue) in October 2016, involving more than twenty nations and several international organisations. The event was a key step to further develop the Foreign Minister Science and Technology Advisor Network (FMSTAN), growing from an initial group of five nations. The Vienna Dialogue was convened by the Fletcher School of Law and Diplomacy, Tufts University, and the International Institute for Applied Systems Analysis (IIASA) at the Vienna headquarters of IIASA, bringing together diplomats from foreign ministries to consider the value of evidence for informed decision-making by nations with regard to issues, impacts and resources within, across and beyond national boundaries. The evidence comes from the natural and social sciences with engineering and medicine as well as other areas of technology. By building common interests among nations, science is a tool of diplomacy, promoting cooperation and preventing conflict in our world. Science diplomacy was discussed as an international, interdisciplinary and inclusive process to help balance national interests and common interests in view of urgencies today and across generations in our globally-interconnected civilization

Autoantibodies against type I IFNs in patients with life-threatening COVID-19

Interindividual clinical variability in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is vast. We report that at least 101 of 987 patients with life-threatening coronavirus disease 2019 (COVID-19) pneumonia had neutralizing immunoglobulin G (IgG) autoantibodies (auto-Abs) against interferon-w (IFN-w) (13 patients), against the 13 types of IFN-a (36), or against both (52) at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs. The auto-Abs neutralize the ability of the corresponding type I IFNs to block SARS-CoV-2 infection in vitro. These auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only 4 of 1227 healthy individuals. Patients with auto-Abs were aged 25 to 87 years and 95 of the 101 were men. A B cell autoimmune phenocopy of inborn errors of type I IFN immunity accounts for life-threatening COVID-19 pneumonia in at least 2.6% of women and 12.5% of men

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries