Allanblackia floribunda: a new oil tree crop for Africa: amenability to grafting

Three Allanblackia species (A. floribunda, A. stuhlmannii and A. parviflora) with high nutritive, medicinal, cosmetic and economic values are currently being domesticated as new oil tree crops. Allanblackia seeds contain a hard white fat consisting mostly of stearic (52-58%) and oleic (39-49%) acids. This unusual fatty acid content has the right properties for many different food and cosmetic products making them commercially interesting. Vegetative propagation studies on A. floribunda, which grows naturally in the moist forest of Cameroon and Nigeria, were initiated aimed at evaluating its amenability to grafting. Scions were grafted onto 18 month old rootstocks of A. floribunda using side tongue, top cleft, side veneer, whip-and-tongue methods under nursery conditions in Cameroon. In parallel, side tongue and inverted 'T' budding methods were also tested in situ on young A. floribunda wildings growing under semi-deciduous and evergreen tree covers. In addition, the effects of protecting side tongue new grafts with non perforated translucent plastic, perforated translucent plastic and aluminium foil were assessed. Under nursery conditions, side tongue grafts were significantly more successful (80.0 +/- A 6.3%), than grafts of side veneer (52.5 +/- A 7.9%), top cleft (55.0 +/- A 7.9%) and whip and tongue (50.0 +/- A 7.9%). The success of side tongue graft was further increased (86.7 +/- A 6.2%) under the shade of evergreen trees when protected by non perforated translucent plastic. These results indicate the potential for in situ grafting and 'top working' to promote cultivation of more productive germplasm of Allanblackia within multifunctional agricultural systems

Thoracotomies à l’Hôpital General de Douala : Indications et résultats

Introduction : La thoracotomie est une procédure chirurgicale majeure pouvant être conduite dans un contexte d’urgence ou électif. Celle-ci peut avoir diverses indications et comme tout acte chirurgical conduire à de nombreuses complications avec un taux de mortalité relativement élevé dans notre contexte où le plateau technique est souvent limité. Objectif : Le but de notre étude était de déterminer les indications et les résultats des thoracotomies à l’hôpital général de Douala entre 2006 et 2017. Patients et Méthode : Il s’agissait d’une étude rétrospective qui s’est déroulée dans le service de chirurgie de l’hôpital général de Douala dans la période allant du 1er Janvier 2006 au 31 Décembre 2017. Au total 35 dossiers de patients ayant bénéficié d’une thoracotomie ont été inclus. Résultats : Les principales indications retrouvées étaient les traumatismes thoraciques avec 37 % de cas suivies de la persistance du canal artériel 14 % et les séquelles de tuberculose 11 %. Les complications étaient retrouvées dans 17 % des cas (n=5) avec comme principale complication l’empyème avec 11% de cas. Le taux de mortalité était de 6 %.Conclusion : Au terme de notre étude, nous avons observé que les indications de thoracotomies étaient aussi bien traumatiques que non traumatiques avec une légère prédominance pour les indications traumatiques. Le taux de mortalité bien qu’acceptable était non négligeable. Mots clés : Thoracotomie, indications, complications, Douala English title: Thoracotomies at Douala General Hospital: Indications and resultsIntroduction: thoracotomy is a major surgical procedure that can be done in the context of an emergency or as elective. It can have diverse indication and like every other surgical act, has numerous complications with a relatively high mortality rate in limited technical facilities settings. Objective: The aim of our study was to determine the indication and results of thoracotomies at the Douala General Hospital between 2006 and 2017. Patients and Methods: We conducted a retrospective study in the surgical unit of the Douala General Hospital. The file of 37 patients who underwent thoracotomy between 1st January 2006 to the 31st of December 2017 were included Results: The main indication found were thoracic trauma with 37% of cases, following patient by ductus arteriosus closure 14% and tuberculosis sequels (11%). Complications were found in 17% of the case (n = 5) with main complication being empyema. The mortality rate was of 6%. Conclusion: The present study showed that the indication for thoracotomy could be traumatic as well as not traumatic with a predominance of traumatic indications. The mortality rate was 6%. Keywords : Thoracotomy, indication, complications, Doual

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when >= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%). CPGs appropriately recommend covering more than 90% of all the potential pathogens causing CAP, with the exception of patients enrolled from Germany, Pakistan, and Croatia. The 2019 ATS/IDSA CPGs appropriately recommend covering 93.6% of the cases compared with 90.3% of the ERS CPGs (p < 0.01). S. pneumoniae remains the most common pathogen in patients hospitalized with CAP. Multinational CPG recommendations for patients with CAP seem to appropriately cover the most common pathogens and should be strongly encouraged for the management of CAP patients.info:eu-repo/semantics/publishedVersio

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia

Objective: Streptococcus pneumoniae is the most frequent bacterial pathogen isolated in subjects with Community-acquired pneumonia (CAP) worldwide. Limited data are available regarding the current global burden and risk factors associated with drug-resistant Streptococcus pneumoniae (DRSP) in CAP subjects. We assessed the multinational prevalence and risk factors for DRSP-CAP in a multinational point-prevalence study. Design: The prevalence of DRSP-CAP was assessed by identification of DRSP in blood or respiratory samples among adults hospitalized with CAP in 54 countries. Prevalence and risk factors were compared among subjects that had microbiological testing and antibiotic susceptibility data. Multivariate logistic regressions were used to identify risk factors independently associated with DRSP-CAP. Results: 3,193 subjects were included in the study. The global prevalence of DRSP-CAP was 1.3% and continental prevalence rates were 7.0% in Africa, 1.2% in Asia, and 1.0% in South America, Europe, and North America, respectively. Macrolide resistance was most frequently identified in subjects with DRSP-CAP (0.6%) followed by penicillin resistance (0.5%). Subjects in Africa were more likely to have DRSP-CAP (OR: 7.6; 95% CI: 3.34-15.35, p < 0.001) when compared to centres representing other continents. Conclusions: This multinational point-prevalence study found a low global prevalence of DRSP-CAP that may impact guideline development and antimicrobial policies. Published by Elsevier Ltd on behalf of The British Infection Association