Étude de la prévalence des maladies liées à l’eau et influences des facteurs environnementaux dans l’arrondissement de Nomgr-Masson : cas du quartier Tanghin (Ouagadougou-Burkina Faso)

Les maladies liées à l’eau font partie des maladies infectieuses les plus préoccupantes observées au sein des populations des pays en développement. L’objectif de ce travail est d’étudier la contribution des maladies liées à l’eau aux dix principales causes de consultations à Tanghin et les facteurs de risques comportementaux et environnementaux qui y contribuent. La méthodologie s’articule autour d’une enquête géographique, de l’analyse microbiologique et physico-chimique des eaux et d’une enquête ménage. Les maladies liées à l’eau occupent plus de 40% des dix principales causes de consultation à Tanghin. Le paludisme est la maladie la plus répandue, suivie de la fièvre typhoïde et la dysenterie. Les eaux de puits sont toutes contaminées par les coliformes totaux et thermotolérants. Le niveau d’assainissement du quartier est très bas et permet d’observer de nombreux dépotoirs sauvages même aux abords de point d’eau. La gestion de l’eau de consommation n’est également pas convenable. Cela a pour effet une forte exposition de la population aux risques sanitaires liés à l’eau. 9.2% de la population estime avoir été infectés par les maladies liées à l’eau au cours de l’année. Une action urgente en matière d’assainissement et gestion de l’eau dans les ménages est donc à entreprendre. Mots clés : maladies liées à l’eau, pollution microbiologique, assainissement, Tanghin, Burkina Fas

Apport de la télédétection à la cartographie de l’évolution spatio-temporelle de la dynamique de l’occupation du sol dans la région des Lacs (Centre de la Côte d’Ivoire)

L’objectif de cet article est la cartographie de l’évolution spatio-temporelle de l’occupation du sol dans la région des Lacs (Côte d’Ivoire) à partir des données de télédétection (images Landsat TM et ETM+) sur une période de 16 ans (1986-2002) d’une part, et l’impact de cette occupation sur les coefficients de rétention d’autre part. Une analyse diachronique des données satellitaires a été réalisée et l’approche de la classification supervisée à partir des compositions colorées des bandes a été retenue en vue de la discrimination des classes. Les précisions globales obtenues pour les images classifiées sont de 88,47% (1986) et de 90,46% (2002). Les indices de Kappa sont de 85,84% (1986) et 88 % (2002). L’étude de la dynamique spatio-temporelle de l’occupation du sol de 1986 à 2002 fait apparaitre des taux moyens annuels calculés de régression pour les plans d’eau de -0,164, les cultures irriguées -0,231 et la savane -1,063. On observe parallèlement une progression des classes forêt (0,287), cultures (0,473) et sols nus ou dégradés (0,699). Les coefficients de rétention calculés sont faibles. En conséquence, cette étude montre que la zone d’étude est marquée par une forte anthropisation et une dégradation des conditions pluviométriques qui ont fortement affecté le mode d’occupation du sol.Mots-clés : télédétection, dynamique, occupation du sol, région des Lacs, Côte d’Ivoire

Global urban environmental change drives adaptation in white clover.

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery.

INTRODUCTION: Postoperative morbidity and mortality in older patients with comorbidities undergoing gastrointestinal surgery are a major burden on healthcare systems. Infections after surgery are common in such patients, prolonging hospitalisation and reducing postoperative short-term and long-term survival. Optimal management of perioperative intravenous fluids and inotropic drugs may reduce infection rates and improve outcomes from surgery. Previous small trials of cardiac-output-guided haemodynamic therapy algorithms suggested a modest reduction in postoperative morbidity. A large definitive trial is needed to confirm or refute this and inform widespread clinical practice. METHODS: The Optimisation of Perioperative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is a multicentre, international, parallel group, open, randomised controlled trial. 2502 high-risk patients undergoing major elective gastrointestinal surgery will be randomly allocated in a 1:1 ratio using minimisation to minimally invasive cardiac output monitoring to guide protocolised administration of intravenous fluid combined with low-dose inotrope infusion, or usual care. The trial intervention will be carried out during and for 4 hours after surgery. The primary outcome is postoperative infection of Clavien-Dindo grade II or higher within 30 days of randomisation. Participants and those delivering the intervention will not be blinded to treatment allocation; however, outcome assessors will be blinded when feasible. Participant recruitment started in January 2017 and is scheduled to last 3 years, within 50 hospitals worldwide. ETHICS/DISSEMINATION: The OPTIMISE II trial has been approved by the UK National Research Ethics Service and has been approved by responsible ethics committees in all participating countries. The findings will be disseminated through publication in a widely accessible peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: ISRCTN39653756.The OPTIMISE II trial is supported by Edwards Lifesciences (Irvine, CA) and the UK National Institute for Health Research through RMP’s NIHR Professorship