The effect of medical therapy on IOP control in Ghana

Background: To investigate IOP control following twelve months of continuous medical therapy in Ghana.Methods: This retrospective case series included 163 glaucoma patients diagnosed at a referral eye center between 1996 and 2006. Information collected included age, gender, IOP at presentation, six months and oneyear post treatment and types of anti-glaucoma medications prescribed. Optimal IOP control was defined according to results from the Advanced Glaucoma Intervention Study (AGIS), which demonstrated arrest of visual field progression in patients with IOP < 18 mmHg at all visitations: Level 1 (post-treatment IOP . 21 mmHg); Level 2 (. 18 mmHg) and level 3 (. 16mmHg). The principal outcome measure was the achievement of IOP <18 mmHg at six months and twelve month visitations.Results: One hundred sixty three patients were analyzed. These included 68 males (41.7%) and 95 females (58.3%). The mean age was 57}16  (median 59 years; range 7 . 95 years). There was no significant difference in age (p=0.35) or mean IOP (p=0.08) between genders. The mean pre-treated IOP of 31.9}8.9 mmHg significantly decreased to 21.3}6.6  mmHg at 6 months (p=0.001), with 57.4% of eyes at Level 1 IOP control, 25.3% at Level 2 and 15.4% at Level 3 and decreased further at 12 months to 20.7}6.9 mmHg (p=0.48) with 69.7% of eyes at Level 1, 34.4% at Level 2, and 12.4% at Level 3.Conclusions: Current medical regimen is insufficient to reduce IOP to target levels as defined in the Advanced Glaucoma Intervention Study.Keywords: Glaucoma, POAG, IOP, Ghana, intraocular pressur

Comparison of Primary Open Angle Glaucoma Patients in Rural and Urban Ghana

Purpose: To compare the clinical features of glaucoma patients who present at a rural hospital in North Eastern Ghana and an urban hospital in the capital city of Accra.Methods: This is a multi-center retrospective case series involving records of newly diagnosed glaucoma patients with emphasis on primary open angle glaucoma (POAG). Information collected included basic demographic data, intraocular pressures and optic disc measurements.Results: A total of 949 patients (437 rural; 512 urban; 1868 eyes) were included. Rural vs. urban comparisons, respectively: mean age, 53.2 ± 16.3 vs. 54.5 ± 16.4 years; male: female ratio, 3:2 vs. 1:1; POAG, 78.1% vs. 50.6%; POAG suspect, 10.3% vs. 41.9%; IOP, 39.2 ± 7.1 vs. 31.8 ± 7.3 mmHg; bilateral blindness, 34.1% vs. 17.5%; uniocular blindness, 52.2% vs. 32.9%. Females at the rural hospital were twice as likely to present blind in at least one eye (OR 2.04, CI 1.36 - 3.07, p<0.001).Conclusions: Patients with POAG at the rural hospital present with more advanced disease characteristics.Keywords: glaucoma, open angle,Ghana, Urban, rura

Rocaglates as dual-targeting agents for experimental cerebral malaria

Cerebral malaria (CM) is a severe and rapidly progressing complication of infection by Plasmodium parasites that is associated with high rates of mortality and morbidity. Treatment options are currently few, and intervention with artemisinin (Art) has limited efficacy, a problem that is compounded by the emergence of resistance to Art in Plasmodium parasites. Rocaglates are a class of natural products derived from plants of the Aglaia genus that have been shown to interfere with eukaryotic initiation factor 4A (eIF4A), ultimately blocking initiation of protein synthesis. Here, we show that the rocaglate CR-1-31B perturbs association of Plasmodium falciparum eIF4A (PfeIF4A) with RNA. CR-1-31B shows potent prophylactic and therapeutic antiplasmodial activity in vivo in mouse models of infection with Plasmodium berghei (CM) and Plasmodium chabaudi (blood-stage malaria), and can also block replication of different clinical isolates of P. falciparum in human erythrocytes infected ex vivo, including drug-resistant P. falciparum isolates. In vivo, a single dosing of CR-1-31B in P. berghei-infected animals is sufficient to provide protection against lethality. CR-1-31B is shown to dampen expression of the early proinflammatory response in myeloid cells in vitro and dampens the inflammatory response in vivo in P. berghei-infected mice. The dual activity of CR-1-31B as an antiplasmodial and as an inhibitor of the inflammatory response in myeloid cells should prove extremely valuable for therapeutic intervention in human cases of CM.We thank Susan Gauthier, Genevieve Perreault, and Patrick Senechal for technical assistance. This work was supported by a research grant (to P.G.) from the Canadian Institutes of Health Research (CIHR) (Foundation Grant). J.P. and P.G. are supported by a James McGill Professorship salary award. D.L. is supported by fellowships from the Fonds de recherche sante Quebec, the CIHR Neuroinflammation training program. J.P. is supported by CIHR Research Grant FDN-148366. M.S. is supported by a CIHR Foundation grant. J.A.P. is supported by NIH Grant R35 GM118173. Work at the Boston University Center for Molecular Discovery is supported by Grant R24 GM111625. K.C.K. was supported by a CIHR Foundation Grant and the Canada Research Chair program. (Canadian Institutes of Health Research (CIHR); James McGill Professorship salary award; Fonds de recherche sante Quebec; CIHR Neuroinflammation training program; FDN-148366 - CIHR Research Grant; CIHR Foundation grant; R35 GM118173 - NIH; Canada Research Chair program; R24 GM111625

C5 deficiency and C5a or C5aR blockade protects against cerebral malaria

Experimental infection of mice with Plasmodium berghei ANKA (PbA) provides a powerful model to define genetic determinants that regulate the development of cerebral malaria (CM). Based on the hypothesis that excessive activation of the complement system may confer susceptibility to CM, we investigated the role of C5/C5a in the development of CM. We show a spectrum of susceptibility to PbA in a panel of inbred mice; all CM-susceptible mice examined were found to be C5 sufficient, whereas all C5-deficient strains were resistant to CM. Transfer of the C5-defective allele from an A/J (CM resistant) onto a C57BL/6 (CM-susceptible) genetic background in a congenic strain conferred increased resistance to CM; conversely, transfer of the C5-sufficient allele from the C57BL/6 onto the A/J background recapitulated the CM-susceptible phenotype. The role of C5 was further explored in B10.D2 mice, which are identical for all loci other than C5. C5-deficient B10.D2 mice were protected from CM, whereas C5-sufficient B10.D2 mice were susceptible. Antibody blockade of C5a or C5a receptor (C5aR) rescued susceptible mice from CM. In vitro studies showed that C5a-potentiated cytokine secretion induced by the malaria product P. falciparum glycosylphosphatidylinositol and C5aR blockade abrogated these amplified responses. These data provide evidence implicating C5/C5a in the pathogenesis of CM

Community-Centered Responses to Ebola in Urban Liberia: The View from Below

The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia.In this study the authors analyzed data from the 2014 Ebola outbreak in Monrovia and Montserrado County, Liberia. The data were collected for the purposes of program design and evaluation by the World Health Organization (WHO) and the Government of Liberia (GOL), in order to identify: (1) local knowledge about EVD, (2) local responses to the outbreak, and (3) community based innovations to contain the virus. At the time of data collection, the international Ebola response had little insight into how much local Liberian communities knew about Ebola, and how communities managed the epidemic when they could not get access to care due to widespread hospital and clinic closures. Methods included 15 focus group discussions with community leaders from areas with active Ebola cases. Participants were asked about best practices and what they were currently doing to manage EVD in their respective communities, with the goal of developing conceptual models of local responses informed by local narratives. Findings reveal that communities responded to the outbreak in numerous ways that both supported and discouraged formal efforts to contain the spread of the disease. This research will inform global health policy for both this, and future, epidemic and pandemic responses

Diagnostic de Begomovirus associes aux systemes de cultures a base du manioc (Manihot esculenta Crantz) par la PCR (Polymerase Chain Reaction) au Togo

L’une des conséquences de la propagation des biotypes très polyphages de Bemisia tabaci, est probablement l’émergence de nouvelles espèces de Begomovirus associées aux changements climatiques. Cette étude a été initiée pour identifier ces agents pathogènes au sein des systèmes de cultures à base du manioc à travers tout le Togo afin d’avoir plus d’information sur les Begomovirus émergents. Ainsi des échantillons foliaires de manioc, de dix plantes associées au manioc en cultures mixtes et de diverses plantes sauvages collectés durant la période de 2013-2016, ont été soumis à un diagnostic PCR pour la détection des Begomovirus de façon générale et plus spécifiquement pour l’identification des Begomovirus de la mosaïque du manioc. À cet effet cinq couples d’amorces spécifiques ciblant le gène de la CP des Begomovirus ont été utilisés notamment JSP001/JSP002, JSP001/JSP003, JSP012/JSP013, ICMV-F2/ICMV-R2 et AC1048/AV494. Les résultats ont montré la présence effective de Begomovirus dans les cinq régions économiques du Togo. Avec l’amorce AC1048/AV494 des Begomovirus ont été identifié dans 50 % (soja), 26,31 % (piment), 19,15 % (manioc), 13,63 % (tomate), 9,09 % (corète potagère), et 5 % (plantes sauvages). Deux espèces de Begomovirus de la mosaïque du manioc ACMV et EACMV ont également été identifiées. Le taux d’incidence individuel de ACMV est de 36,17 % sur le manioc et celui de EACMV est de 20,21 % sur le manioc et 10.53 % sur le piment. C’est la première fois que des Begomovirus sont détectés dans des échantillons de la corète potagère et EACMV sur le piment au Togo. Cette étude contribuera à l’avancé des connaissances sur les maladies induites par des Begomovirus transmis par les mouches blanches, Bemisia tabaci.Mots clés:  Begomovirus, Bemisia tabaci, diagnostic, manioc, PCR, systèmeEnglish Title: Diagnosis of Begomoviruses associated with cassava  (Manihot esculenta Crantz)-based cropping systems by  PCR (Polymerase Chain Reaction) in TogoEnglish AbstractOne of the consequences of the spread of highly polyphagous Bemisia tabaci biotypes is probably the emergence of new begomovirus species associated with climate change. This study is conducted to identify theses pathogen agents within cassava based cropping systems throughout Togo in order to get more information about emerged begomoviruses. Thus, Foliar samples of cassava, ten intercropped plants with cassava in fields and various wild plants collected during the period 2013-2016 are submitted to PCR diagnosis for the detection of begomoviruses in general and more specifically for the detection of cassava mosaic begomoviruses. For this purpose, five specific primer pairs targeting begomoviruses CP gene were used, in particular JSP001/JSP002, JSP001/JSP003, JSP012/JSP013, ICMV-F2/ICMV-R2 and AC1048/AV494. Results showed the effective presence of begomoviruses in the five economic regions of Togo. With AC1048/AV494 primers begomoviruses are found in 50 % (soybean), 26.31 % (pepper), 19.15 % (cassava), 13.63 % (tomato), 9.09 % (jute), and 5 % (wild plants). Two species of cassava mosaic begomoviruses ACMV and EACMV are also identified. The individual incidence rate for ACMV is 36.17 % in cassava and EACMV is 20.21 % in cassava and 10.53 % in pepper. This is the first report of begomoviruses in jute samples and EACMV in pepper in Togo. This study will contribute to the advancement of knowledge on begomoviruses-induced diseases transmitted by whiteflies, Bemisia tabaci.Keywords: Begomovirus, Bemisia tabaci, diagnosis, cassava, PCR, syste

Evaluation du systeme d’information hospitalier integre HopitalOS au Centre Hospitalier Prefectoral de Notse, et a la Clinique Nathanaël de Lome

Introduction : L’installation du premier système d’information intégré dans un centre de santé public au Togo, dénommé HopitalOS a été faite au centre hospitalier préfectoral de Notsè en décembre 2016, puis à la clinique Nathanaël de Lomé en janvier 2018. Depuis son implémentation dans ces centres, aucune étude n’avait encore été faite pour apprécier son efficacité. Ce travail a permis de combler ce vide. Méthode : Il s’est agi d’une étude transversale descriptive, dont la collecte des données s’était déroulée du 20 juillet à 31 août 2018, et qui a porté sur l’évaluation du système HopitalOS au centre hospitalier préfectoral de Notsè et à la clinique Nathanaël de Lomé. Les données ont été collectées grâce à des fiches d’enquête remplies par les utilisateurs et interrogeant sur l’ergonomie du système, leur point de vue par rapport au système et l’accessibilité aux produits pharmaceutiques et aux examens paracliniques en temps réel. Résultats : Au total, 25 utilisateurs avaient répondu aux questionnaires, tous ont trouvé le système utile, 92% l’ont trouvé facile d’utilisation, 96% convivial et 76% ont trouvé le temps d’accès acceptable. Tous les utilisateurs ont trouvé que le système leur permettait de garder la traçabilité des patients ; 92% des utilisateurs étaient favorables au déploiement de nouvelles fonctionnalités et à la généralisation du système à tout leur centre. Conclusion : Ce travail nous a permis de mettre en évidence l’importance du système d’information intégré pour un pays en voie de développement comme le Togo. Le système intégrait bien les données du patient, et avait une bonne ergonomie. Les utilisateurs avaient un point de vue globalement positif sur le système. Le système permet une accessibilité en temps réel aux informations sur les produits pharmaceutiques et les examens de laboratoire.  English title: Evaluation of the integrated hospital information system HopitalOS at Centre Hospitalier Prefectoral of Notse, and at the Clinique Nathanaël in Lome Abstract Introduction: The constantly evolving growth of medical knowledge makes hospital information systems increasingly necessary for better medical data processing. The implementation of the first integrated information system in a public health center in Togo, named HopitalOS, was made at centre hospitalier préfectoral of Notsè in December 2016, then at Clinique Nathanaël in January 2018. Since its implementation in those centers, no studies had been conducted to describe this system and assess its effectiveness. This work filled this gap. Method: It was a descriptive cross-sectional study, whose data collection took place from July 20 to August 31, 2018, and which focused on evaluation of the HopitalOS system at centre hospitalier préfectoral of Notsè and Clinique Nathanaël in Lomé. Data was collected with questionnaires filled in by users and asking questions about the ergonomics of the system, their point of view about the system and the accessibility to pharmaceutical and paraclinical exams in real time. Results: In total, 25 users answered the questionnaires, all found the system useful, 92% of users found it easy to use, 96% of users found it user-friendly, and 76% of users found the access time acceptable. All users found that the system allowed them to keep patient traceability. Conclusion: This work allowed us to highlight the importance of the integrated information system for a developing country like Togo. The system integrated well the data of the patient, and has good ergonomics. Users had a generally positive view about the system. The system provides realtime accessibility to information on pharmaceuticals and laboratory tests. Key words: Hospital information system; Medical informatics; HopitalOS ; Togo

Acute and Sub-chronic (28-day) Oral Toxicity Studies of Hydroalcohol Leaf Extract of Ageratum conyzoides L (Asteraceae)

Purpose: Ageratum conyzoides is an annual herbaceous plant commonly used in African traditional medicine as a purgative, antipyretic, anti-ulcer and wound dressing agent. The objective of this study was to investigate the acute and sub-chronic toxicity of A. conyzoides leaves in Wistar rats. Methods: In the acute test, the limit test dose of 5000 mg/kg was administered to Wistar rats and then observed individually 1 h post-dosing, and at least once daily for 14 days. Sub-chronic toxicity was evaluated after administering daily oral doses of 500 and 1000 mg/kg body wt., for 28 days to the rats, Biochemical and haematological assessments as well as body and relative organ weights of the rats were carried out Results: The limit dose of 5000 mg/kg did not cause any mortality or signs of acute toxicity in the rats tested during the observation period. In the sub-chronic tests, the results did not show any treatment– related abnormalities in terms of haematological and biochemical parameters. However, urea was significantly (p < 0.05) lower in the group treated with 500 mg/kg of A. conyzoides extract. The weekly body and organ weight of the rats showed no significant differences between the control and the rats treated with the extract except for liver where there was a significant increase (p < 0.05) in rats that received 1000 mg/kg, i.e., 3 ± 0.2 g as against 2.5 ± 0.1 g for the control. Conclusion: Our results suggest that the hydroalcohol extract of A. conyzoides is relatively safe when administered orally in rats