Completeness of information in electronic compared with paper-based patients’ records in a maternity setting in Dakar, Senegal

Background: Evaluate the consistency of information in paper-based records when registered in parallel with an electronic medical record.Methods: The study was performed at PMSHC in Dakar Senegal. From the end of year 2016, patients’ files were recorded on both paper-based and electronically. Additionally, previous records were electronically registered. To investigate the completeness of records before and after the electronic recording system has been implemented, information about some maternal and fetal/neonatal characteristics were assessed. When the variable was recorded, the system returned 1, unrecorded variables were coded as 0. We then calculated, for each variable, the unrecorded rate before 2017 and after that date. The study period extended from 2011 to June 2019, a nearly ten-year period. Data were extracted from E-perinatal to MS excel 2019 then SPSS 25 software. Frequencies of unrecorded variables were compared with chi-squared test at a level of significance of 5%.Results: A total of 48,270 unique patients’ records were identified during the eight-year period.  Among the study population, data for patients’ age, address and parity were available most of the time before and after 2017 (0.5% missing data versus 0.3% for age and 2.6% versus 1.3% for home address and from 0.3% to 0.0% for parity). However, phone number, maternal weight, maternal height, last menstrual period and blood group were found to be missing up to 96% before 2017. From 2017, these rates experienced a sudden decrease at a significant level: from 82.4% to 27.8% for phone number, from 96% to 56.3% for maternal weight and from 60.1% to 21.3% for blood group. Regarding newborns’ data, it was found that fetal height, head circumference and chest circumference were missing up to just under 25% before 2017. After that date, their completeness improved and flattened under 5%.Conclusions: Structured and computerized files reduce missing data. There is an urgent need the Ministry of health provides hospitals and health care providers with guidelines that describes the standardized information that should be gathered and shared in health and care records

Profil epidemiologique de l’epilepsie chez des patients atteints de troubles du spectre de l’autisme: Etude de 45 cas a Dakar (Senegal)

Description: Troubles du spectre de l’autisme (TSA) et épilepsie peuvent coexister chez une même personne constituant des facteurs de mauvais pronostic bilatéraux. Objectif:  Décrire les éléments sociodémographiques de patients atteints de TSA et étudier les aspects clinico-paracliniques et évolutifs des épilepsies chez ces patients. Patients et Méthodes:  Etude transversale et descriptive au service pédopsychiatrique du CHNU Fann, avec analyse des dossiers, via un questionnaire standardisé, de tous les patients suivis entre Janvier 2004 et Septembre 2018 pour TSA avec ou sans épilepsie. Résultats:  Quarante-cinq patients avec TSA colligés, avec une fréquence de l’épilepsie de 37,8%. L’épilepsie avait débuté avant l’âge de 5 ans dans 94% des cas. Les crises étaient généralisées (58,8%), essentiellement motrices tonico-cloniques (80%), ou focales (35,3%), avec une fréquence de 2 crises/jour à 1 crise/semaine. L’EEG de veille et sommeil montrait des anomalies majoritairement frontales dans 60%, et centro-pariétales dans 26,6% des cas. L’imagerie cérébrale était normale dans 93,9% des cas, et les potentiels évoqués auditifs (PEA) normaux dans 87,2% des cas. La prise en charge était multidisciplinaire pour les TSA (neuropsychologique, psychomotrice, orthophonique) et médicale, essentiellement (82,4%) en monothérapie pour l’épilepsie. Les médicaments antiépileptiques utilisés étaient le valproate de sodium (58,8%) et le phénobarbital (17,6). Le niveau d’instruction était bas avec 40% de non-scolarisés et 55,6% au primaire. Seuls 6,7% étaient autonomes et 20 patients nécessitaient une aide quasi-constante. Conclusion: La prévalence de l’épilepsie chez les patients atteints de TSA varie suivant les études. Une prise en charge globale et multidisciplinaire de l’épilepsie et des TSA améliore les troubles de comportement.   English Title: Epidemiologic profile of epilepsy in patients with autism spectrum disorders: study of 45 cases in Dakar (Senegal) Description: Autism spectrum disorders (ASD) and epilepsy can coexist in the same person, which are factors of bilateral poor prognosis. Purpose: To describe the socio-demographic profile of ASD patients and to study the clinical, paraclinical and evolutive aspects of epilepsy among them. Patients and methods: We did a cross-sectional and descriptive study in the department of child psychiatry of Fann university hospital in Dakar. We analyzed patients’ files followed between January 2004 and September 2018 for autism’s spectrum disorders with or without epilepsy. We used a standardized survey with several items. Results: Forty-five patients with ASD were collected, with an epileptic frequency of 37.8%. Epilepsy had started before the age of 5 years in 94% of cases. Seizures were generalized (58.8%), mainly tonico-clonic (80%), or focal (35.3%), with a frequency of 2 seizures per day to 1 seizure per week. The awake and sleep EEG showed abnormalities mostly in frontal area in 60%, and centro-parietal in 26.6%. Brain imaging was normal in 93.9%, and auditory evoked potential (AEP) normal in 87.2%. Management was multidisciplinary for ASD (neuropsychological, psychomotor, speech therapy) and medical, mainly (82.4%) monotherapy for epilepsy. The main molecules were: sodium valproate (58.8%) and phenobarbital (17.6). The level of education was low with 40% of students out of school and 55.6% in primary school. Only 6.7% were self-reliant and 20 patients needed almost constant assistance. Conclusion: The prevalence of epilepsy in patients with ASD varies according to the studies. The global and multidisciplinary management of epilepsy and ASD improves behavioral disorders

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

Prevalence of anti-malarial resistance genes in Dakar, Senegal from 2013 ă to 2014

International audienceBackground: To determine the impact of the introduction of ă artemisinin-based combination therapy (ACT) on parasite susceptibility, ă a molecular surveillance for antimalarial drug resistance was conducted ă on local isolates from the Hopital Principal de Dakar between November ă 2013 and January 2014 and between August 2014 and December 2014. ă Methods: The prevalence of genetic polymorphisms in antimalarial ă resistance genes (pfcrt, pfmdr1, pfdhfr and pfdhps) was evaluated in 103 ă isolates. ă Results: The chloroquine-resistant haplotypes CVIET and CVMET were ă identified in 31.4 and 3.9 % of the isolates, respectively. The ă frequency of the pfcrt K76T mutation was increased from 29.3 % in ă 2013-2014 to 43.2 % in 2014. The pfmdr1 N86Y and Y184F mutations were ă identified in 6.1 and 53.5 % of the isolates, respectively. The pfdhfr ă triple mutant (S108N, N51I and C59R) was detected in the majority of the ă isolates (82.3 %). The prevalence of quadruple mutants (pfdhfr S108N, ă N51I, C59R and pfdhps A437G) was 40.4 %. One isolate (1.1 %) harboured ă the pfdhps mutations A437G and K540E and the pfdhfr mutations S108N, ă N51I and C59R. ă Conclusions: Despite a decline in the prevalence of chloroquine ă resistance due to the official withdrawal of the drug and to the ă introduction of ACT, the spread of resistance to chloroquine has ă continued. Furthermore, susceptibility to amodiaquine may be decreased ă as a result of cross-resistance. The frequency of the pfmdr1 mutation ă N86Y declined while the Y184F mutation increased in prevalence, ă suggesting that selective pressure is acting on pfmdr1, leading to a ă high prevalence of mutations in these isolates and the lack of specific ă mutations. The 50.5 % prevalence of the pfmdr1 polymorphisms N86Y and ă Y184F suggests a decrease in lumefantrine susceptibility. Based on these ă results, intensive surveillance of ACT partner drugs must be conducted ă regularly in Senegal

Absence of association between polymorphisms in the K13 gene and the presence of Plasmodium falciparum parasites at day 3 after treatment with artemisinin derivatives in Senegal

International audienceIn 2006, the Senegalese National Malaria Control Programme recommended artemisinin-based combination therapy as first-line treatment for uncomplicated malaria. In addition, intravenous (i.v.) injection of artesunate and artemether has gradually replaced quinine for the treatment of severe malaria. Mutations in the propeller domain of the Kelch 13 gene (K13-propeller, PF3D71343700), such as Y493H, R539T, I543T and C580Y, were recently associated with in vivo and in vitro resistance to artemisinin in Southeast Asia. However, these mutations were not identified in Africa. In total, 181 isolates of Plasmodium falciparum from 161 patients from Dakar, Senegal, were collected between August 2015 and January 2016. The K13-propeller gene of the isolates was sequenced. A search for non-synonymous mutations in the propeller region of K13 was performed in the 181 isolates collected from Dakar from 2015 to 2016. Three synonymous mutations were detected (D464D, C469C and R471R). Of 119 patients treated with i.v. artesunate or intramuscular artemether followed by artemether/lumefantrine, 9 patients were still parasitaemic on Day 3. Parasites from these nine patients were wild-type for K13-propeller. None of the polymorphisms known to be involved in artemisinin resistance in Asia were detected. These results suggest that K13 is not the best predictive marker for artemisinin resistance in Africa. More isolates from clinical failure cases or patients with delayed parasite clearance after treatment with artemisinin derivatives are necessary to identify new molecular markers. (C) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved

Absence of Association between Polymorphisms in the RING E3 Ubiquitin Protein Ligase Gene and Ex Vivo Susceptibility to Conventional Antimalarial Drugs in Plasmodium falciparum Isolates from Dakar, Senegal

International audienceThe RING E3 ubiquitin protein ligase is crucial for facilitating the transfer of ubiquitin. The only polymorphism identified in the E3 ubiquitin protein ligase gene was the D113N mutation (62.5%) but was not significantly associated with the 50% inhibitory concentration (IC50) of conventional antimalarial drugs. However, some mutated isolates (D113N) present a trend of reduced susceptibility to piperaquine (P = 0.0938). To evaluate the association of D113N polymorphism with susceptibility to antimalarials, more isolates are necessary

Absence of association between polymorphisms in the pfcoronin and pfk13 genes and the presence of Plasmodium falciparum parasites after treatment with artemisinin derivatives in Senegal

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Association between Polymorphisms in the Pfmdr6 Gene and Ex Vivo Susceptibility to Quinine in Plasmodium falciparum Parasites from Dakar, Senegal

International audiencePolymorphisms and the overexpression of transporter genes, especially of the ATP-binding cassette superfamily, have been involved in antimalarial drug resistance. The objective of this study was to use 77 Senegalese Plasmodium falciparum isolates to evaluate the association between the number of Asn residues in the polymorphic microsatellite region of the Plasmodium falciparum multidrug resistance 6 gene (Pfmdr6) and the ex vivo susceptibility to antimalarials. A significant association was observed between the presence of 7 or 9 Asn repeats and reduced susceptibility to quinine

Ex vivo activity of Proveblue, a methylene blue, against field isolates of Plasmodium falciparum in Dakar, Senegal from 2013-2015

International audienceResistance to most antimalarial drugs has spread from Southeast Asia to Africa. Accordingly, new therapies to use with artemisinin-based combination therapy (triple ACT) are urgently needed. Proveblue, a methylene blue preparation, was found to exhibit antimalarial activity against Plasmodium falciparum strains in vitro. Proveblue has synergistic effects when used in combination with dihydroartemisinin, and has been shown to significantly reduce or prevent cerebral malaria in mice. The objectives of the current study were to evaluate the in vitro baseline susceptibility of clinical field isolates to Proveblue, compare its activity with that of other standard antimalarial drugs and define the patterns of cross-susceptibility between Proveblue and conventional antimalarial drugs. The Proveblue IC50 of 76 P. falciparum isolates ranged from 0.5 nM to 135.1 nM, with a mean of 8.1 nM[ 95% confidence interval, 6.4-10.3]. Proveblue was found to be more active against P. falciparum parasites than chloroquine, quinine, monodesethylamodiaquine, mefloquine, piperaquine, doxycycline (P < 0.001) and lumefantrine (P = 0.014). Proveblue was as active as pyronaridine (P = 0.927), but was less active than dihydroartemisinin and artesunate (P < 0.001). The only significant cross-susceptibilities found were between Proveblue and dihydroartemisinin (r(2) = 0.195, P = 0.0001), artesunate (r(2) = 0.187, P = 0.0002) and piperaquine (r(2) = 0.063, P = 0.029). The present study clearly demonstrates the potential of Proveblue as an effective therapeutic agent against P. falciparum. In this context, the use of Proveblue as part of the triple ACT treatment for multidrug-resistant malaria warrants further investigation. (C) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved

Modulation of in vitro antimalarial responses by polymorphisms in Plasmodium falciparum ABC transporters (pfmdr1 and pfmdr5)

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