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

Traitement medicamenteux de l’insuffisance cardiaque de l’adulte dans les centres Hospitaliers Universitaires De Lome

Introduction : L’insuffisance cardiaque estune pathologie grave qui constitue l’un des motifs de consultation et d’hospitalisation dans les services de cardiologie des centres hospitaliers et universitaires de Lomé au Togo. Elle constitue le mode évolutif le plus fréquent de la plupart des cardiopathies. Dans notre pays, l’absence de travaux antérieurs sur l’insuffisance cardiaque nous a incité à entreprendre cetteétude en vue de faire le point sur notre attitude vis-à-vis de cette pathologie dans nos services de cardiologie. Objectifs : Les objectifs de l’étude étaient de déterminer la fréquence hospitalière de l’insuffisance cardiaque et d’évaluer sa prise en charge thérapeutique.Matériel et méthode : Il s’agissait d’une étude rétrospective sur une période de 12 mois (du premier janvier au 31 décembre 2004). Elle est réalisée dans les services de cardiologie des CHU de Lomé et aporté sur 104 dossiers des patients hospitalisés pour insuffisance cardiaque. Les données épidémiologiques, cliniques, paracliniques, thérapeutiques et évolutives sont relevées des dossiers surune fiche d’enquête. Elles sont ensuite analysées dans le logiciel EPI-INFO 6.0 de CDC Atlanta.Résultats : L’insuffisance cardiaque représentait 16,3% des hospitalisations. L’âge moyen de la population d’étude était de 59,8 ans avec une prédominance masculine (sex–ratio=1,48). Les cardiomyopathies (85,7%), les valvulopathies (68%) et l’HTA (59,6%) étaient les étiologies les plus fréquentes. L’insuffisance cardiaque globale était le tableau clinique le plus fréquent. Les IEC, diurétiques, anti-aldostérones et la digoxine sont prescrits respectivement dans 61,5 %, 97,4 % 9,6 % et51,9 % des cas. Les bêtabloquants ne faisaient pas encore partie du traitement de l’insuffisance cardiaque dans les services.Conclusion : Affection fréquente à Lomé, la prise en charge de  l’insuffisance cardiaque n’est pas encore conforme aux référentiels scientifiques.Introduction: Heart failure is a severe disease which accounts for a substantial portion of consultationand hospitalization in the cardiological department of Tokoin Teaching Hospital of Lome in Togo. It’sfrequently a principal complication of virtually all forms of heart disease. In our country, the lack ofinformation about heart failure had urged to this study in order to sum up our practice in the department.Objective: The aim of our study was to determine the hospital frequency of heart failure and to evaluateits management.Method: It was a retrospective study carried out from 1st January to 31st March 2004 . It had concerned 104records of in-patients. Epidemiological, clinical, laboratory findings and management aspects werestudied. Data were analysed with Epi Info 6.0 of CDC Atlanta database.Results: Heart failure had been found in 11.8% of in-patients during the period of study. The mean agewas 59.8 years with a male predominance (male-female ratio = 1.48).Cardiomyopathies (85.7%), valvular heart disease (68%) and arterial hypertension (59.6) were the mostfrequent causes. ACE inhibitors, diuretics, antialdosterone and cardiac glycoside were respectivelyprescribed in 61.5%, 97.4%, 9.6% and 51.9%. Beta-blockers were not introduced in the management ofin-patients.Conclusion: Heart failure is a frequent disease in Lome. Its management may be completed according tothe newer international scientific standards.

Insuffisance cardiaque de l’adulte dans les centres hospitaliers universitaires de Lome

Introduction: Heart failure is a severe disease which accounts for a substantial portion of consultation and hospitalization in the cardiological department of Tokoin Teaching Hospital of Lome in Togo. It represents an issue of public health in our African environment.In our country, the lack of information about heart failure had urged to this study in order to sum up our practice in the department.Objective: The aim of our study was to determine the hospital frequency of adult’s heart failure and to evaluate its diagnostic management.Method: It was a retrospective study carried out from 1st January to 31st March 2004 in the cardiological department of Tokoin and Campus Teaching Hospital of Lome in Togo.. It had concerned 104 records of inpatients. Epidemiological, physical examination, laboratory findings including chest roentgenogram, electrocardiogram and echocardiogram aspects were studied. Data were analysed with Epi Info 6.0 of CDC Atlanta database.Results: Heart failure had been found in 11.8% of in-patients during the period of study. The mean age was 59.8 years with a bracket ranged from 28 to 87 years. There was a male predominance with malefemaleratio of 1.48. Exertional dyspnea (75%), pulmonary rales (62.5%), edema (60.6%) were the main symptoms found. The rate of laboratory explorations achievement is very low due to the financial straits.Cardiomyopathies (85.7%), valvular heart disease (68%) and arterial hypertension (59.6) were the most frequent causes.Conclusion: Heart failure is a frequent disease in Lome. Effort may be done to better its management

Interaction of the Double-Strand Break Repair Kinase DNA-PK and Estrogen Receptor-α

Here we show that, upon estrogen stimulation, DNA-dependent protein kinase (DNA-PK) forms a complex with estrogen receptor-α in a breast cancer cell line (MELN). Inhibition of DNA-PK by siRNA technology demonstrated that estrogen-induced ERα activation and cell cycle progression is, at least, partially dependent on DNA-PK