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

Motivation à enseigner : enquête auprès des participants du diplôme inter-universitaire en pédagogie médicale de la Faculté de médecine et de pharmacie de Marrakech

Contexte :  La nécessité de former les cliniciens-enseignants à la pédagogie médicale est universellement reconnue. Or, la motivation à entamer et poursuivre un programme formel de développement professoral en pédagogie médicale a été peu étudiée. Une connaissance plus fine des déterminants de la motivation des enseignants à se former à la pédagogie permettrait de mieux soutenir les efforts d’amélioration de la formation des professionnels de la santé. Objectif : Mettre en évidence des sources de motivation des cliniciens-enseignants qui choisissent de poursuivre le diplôme inter-universitaire (DIU) en pédagogie médicale. Méthodes : Quatre-vingts des 110 (72 %) enseignants ayant suivi une formation professorale en pédagogie médicale dans le cadre du DIU ont complété le questionnaire de l’échelle de motivation en éducation adapté aux études universitaires de Vallerand et al. (ÉMÉ-U 28), élaboré en lien avec la théorie de l’auto-détermination. Résultats : Au regard des mesures rapportées, la motivation autonome est plus élevée que la motivation contrôlée. Une très grande majorité des participants indiquent souhaiter poursuivre des études avancées pour le plaisir de découvrir des choses jamais vues auparavant et une majorité significative pour approfondir leurs connaissances en pédagogie médicale. La plupart d’entre eux se sont engagés dans le DIU pour le plaisir et pour la satisfaction personnelle liée à la recherche de l’excellence dans leur profession. Seul un tiers des participants justifie l’inscription au DIU de pédagogie par des éléments externes de motivation, liés à la contrepartie espérée de pouvoir décrocher la titularisation et l’agrégation plus tard. Conclusion : Cette étude contribue à la compréhension de la dynamique motivationnelle qui pousse des cliniciens à initier un processus de formation professorale afin de devenir des cliniciens-enseignants

Factors associated with psychological burden of breast cancer in women in Morocco: cross‑sectional study

Abstract Background Depression and anxiety are among the psychological diagnoses impacting individuals diagnosed with breast cancer. This study aims to estimate the prevalence, as well as the predictors, of anxiety and depression in women with breast cancer. Materials and methods This was a cross-sectional, multi-center study conducted over an eight-month period among women with breast cancer in oncology centers in southern Morocco. Anxiety and depression were assessed using the validated Moroccan dialectal version of the Hospital Anxiety and Depression Scale (HADs). To identify the predictors of anxiety and depression in the study population. Multiple linear regression analyses were performed, including variables for which univariate analyses were significant with a p < 0.05 value. Statistical analyses were performed using Jamovi software version 2.2.3. Results A total of 230 participant responses were collected. The prevalence of anxiety and depression was 77.4% and 62.6%, respectively. Multiple linear regression analysis revealed the following factors increased anxiety: being younger than 50 years old, not having studied beyond elementary school, having children aged between 10 and 18 and having TNM stage III and IV. The following factors decreased anxiety in patients with breast cancer: good physical functioning (Karnofsky score), satisfaction with social support and financial support. Regarding depression, the following factors decreased depression: good physical functioning (Karnofsky score), a minimum of 2.5 h per week of physical activity, active occupational status, satisfaction with social support and financial support. In contrast, the recurrence of breast cancer was an associated factor with increased depression. Conclusion The prevalence of anxiety and depression in women with breast cancer is very high in our context. Therefore, routine screening tests for depression and anxiety as well as psychosocial management care are necessary for patients with breast cancer in Morocco

Epidémiologie et facteurs de risque des anomalies de fermeture du tube neural: données marocaines

Introduction: les anomalies de fermeture du tube neural sont des défauts congénitaux de la formation du système nerveux central. L'incidence varie entre 3 et 40 cas pour 10000 dans le monde. Il existe des facteurs de risque de survenue de cette affection. La prévention reste un élément important dans la prise en charge. L'objectif de ceete étude est d'étudier les paramètres sociodémographiques, maternels, obstétricaux et néonatals des anomalies de fermeture du tube neural et analyser les facteurs de risque responsables dans notre contexte. Méthodes: étude prospective cas-témoin sur 4 ans. Ont été recrutés tous les cas portant une malformation du tube neural isolée ou associée à d'autres malformations. Les données maternelles, obstétricales et néonatales ont été enregistrées. L'analyse statistique était réalisée par le biais d'un logiciel de statistiques SPSS version 17.0 pour Windows. Résultats: soixante huit cas ont été inclus. Quatre-vingts cinq pour cent des malformations étaient isolées. L'anencéphalie était l'anomalie la plus retrouvée (67 %). L'âge maternel moyen était 31,03±7,50 ans. La consanguinité parentale était notée dans 9 cas. Un niveau socio-économique bas et un non suivi des grossesses ont été rapportés dans 29 % des cas. L'étude a retrouvé des antécédents de mort-nés et de morts néonatales dans 4 % des cas. La consommation de Fenugrec était significativement associée aux malformations du tube neural et a été retrouvée dans 8 cas contre 1 cas dans le groupe sain. La voie haute d'accouchement était utilisée dans 29 % des cas. L'âge gestationnel moyen était de 35,55±4,16 semaines d'aménorrhée. Il n'y avait pas de prédominance de sexe. On avait noté une relation significative entre les malformations du tube neural et l'avènement d'une asphyxie périnatale, 15 cas présentaient un apgar à 0 à la première minute et 12 cas un apgar inférieur à 7 à la cinquième minute. Conclusion: le bas niveau socio-économique, le non suivi des grossesses et la consommation maternelle de fenugrec en période gestationnelle étaient des facteurs prédictifs de développement d'anomalies du tube neural dans notre contexte.The Pan African Medical Journal 2015;2

Prevalence and associated factors of self-medication in worldwide pregnant women: systematic review and meta-analysis

Abstract Background Self-medication during pregnancy is of great interest. The use of drugs during pregnancy requires a careful reflection on the benefits to the mother and the risks to the fetus. Selecting a drug or drugs for treating pregnant women can be difficult for clinicians owing to the various pharmacokinetic and physiological changes encountered during pregnancy. This systematic review and meta-analysis aimed to estimate the pooled prevalence of self-medication and associated factors among women during pregnancy. Methods Searches were carried out at PubMed, Science Direct, Web of Science, and Google Scholar. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulated and analyzed qualitatively and quantitatively through meta-analysis. Results The overall prevalence of self-medication among pregnant women was 44.50% (95% CI: 38.92–50.23). Subgroup analyses showed differences in self-medication prevalence influenced by region, county income, and study design. The Heterogeneity, assessed by the statistical test I2 varied from 96 to 99% and was statistically significant. The result of this funnel plot showed that the funnel plot was symmetry with p-value = 0.36, and there is no publication bias. Conclusion The results obtained from this study showed that the prevalence of self-medication among pregnant women is relatively high. This requires effective measures and interventions to reduce self-medication. Trial registration ID =  CRD42022312333

The Influence of Heavy Metals and Trace Elements on Comatose Patients with Severe Traumatic Brain Injury in the First Week of Admission

Purpose. The aim of this study is to investigate the possible role of heavy metals (lead and cadmium) and imbalance of trace elements (chromium, iron, zinc, copper, and manganese) in death among patients with severe traumatic brain injury. Material and Methods. A case-control study was conducted with 64 comatose patients with severe TBI, in the Department of Anesthesiology and Reanimation, Ibn Sina University Hospital and Hospital of Specialties in Rabat, Morocco; 22 healthy volunteers were recruited in Blood Transfusion Center of Rabat. Blood samples were collected from TBI patients, in the first week (3h after admission and each 48h during one week) and from healthy volunteers one time. Concentration of heavy metals and trace elements in serum was determined by electrochemical atomic absorption spectrometry. Statistical analysis was performed using Statistical software (SPSS) and the cases and controls were compared using the Mann–Whitney U test and Student’s t-test for cadmium according to gender and final evolution. A P-value <0.05 was considered to be statistically significant. Results. Our data showed that the difference of heavy metals concentration (lead and cadmium) between patients and healthy subjects was not statistically significant. However, the difference of some trace elements concentration (iron, copper, chromium, and selenium) between patients and healthy subjects was statistically significant. According to the final evolution, the concentration of manganese was higher in dead patients and statistically significant (p = 0.04) for heavy metals; the concentration of lead was not statistically significant while the concentration in cadmium was statistically significant (p = 0.004). By sex, lead and cadmium were statistically significant, respectively p = 0.02, p = 0.001, and cadmium was higher in women, while lead was higher in men. Conclusion. Among all studied heavy metals (lead and cadmium) and trace elements (iron, zinc, copper, selenium, chromium, and manganese), manganese and cadmium may play a role in the death of patients from severe traumatic brain injury