Qualite de vie des Patients ayant une Gonarthrose a Brazzavile, Congo

Objective: To evaluate the quality of life in patients with knee osteoarthritis. Patients and Methods: Cross-sectional, descriptive and analytical study, conducted in two steps in the Department of Rheumatology at the University Hospital of Brazzaville. The first step made it possible to collect data of patients diagnosed as having knee osteoarthritis according to the ACR criteria of 1986 and followed up from January 1st, 2013 to December 31st, 2017. After informed consent was obtained, the second step consisted in measuring the quality of life of patients using a specific quality-of-life questionnaire for knee and hip osteoarthritis OAKHQOL (OsteoArthritis of Knee Hip Quality Of Life). It took place from May 2nd to November 2nd, 2018 (6 months). Results: We included in this study 103 women and 16 men (sex ratio F / H of 6/1). The average age was 56.1 ± 9 years (range 27 to 77 years). The mean evolution time was 5.1 ± 3.6 years. The knee osteoarthritis moderately impaired the overall quality of life of patients. The most affected dimensions were physical activity and pain, with respectively 51.3% and 42.9% of patients between 25 and 50. Mean scores for additional items were 35.3 +/- 24.4, respectively, (n = 84) for employment, 36.2 +/- 20.8 (n = 61) for relationship with the partner and 39.4 +/- 27.2 (n = 61) for sexuality. Conclusion: Knee osteoarthritis affects the overall quality of life of patients, especially in the physical activity and pain dimensions.Objectif : Evaluer la qualité de vie des patients ayant une gonarthrose. Patients et Méthodes: Etude transversale, descriptive, menée dans le Service de Rhumatologie du CHU de Brazzaville, en deux étapes. La première a permis de colliger les dossiers des patients diagnostiqués selon les critères de l’ACR de 1986 et suivis pour une gonarthrose du 1 er janvier 2013 au 31 décembre 2017.La seconde consistait, après consentement éclairé, en la mesure de la qualité de vie à l’aide du questionnaire Arthrose des Membres Inférieurs et Qualité de vie (AMIQUAL) des patients identifiés. Elle s’est déroulée du 02 mai au 02 novembre 2018 (6 mois). Résultats : Nous avons inclus 103 femmes et 16 hommes (sexe ratio H/F de 1/6). L’âge moyen était de 56,1 +/- 9 ans (extrêmes 27 à 77 ans). La durée moyenne d’évolution était de 5,1 +/- 3,6 ans. La gonarthrose altérait de façon modérée la qualité de vie globale des patients. Les dimensions les plus touchées étaient les activités physiques et la douleur, avec respectivement 51,3% et 42,9% des patients compris entre 25 et 50. Les scores moyens des items indépendants étaient respectivement de 35,3 +/- 24,4 (n=84) pour la dimension activité professionnelle, 36,2 +/- 20,8 (n=61) pour la relation de couple et 39,4+/-27,2 (n=61) pour la sexualité. Conclusion : la gonarthrose affecte la qualité de vie globale des patients notamment dans les dimensions activités physiques et douleur

Rifampicin and clarithromycin (extended release) versus rifampicin and streptomycin for limited Buruli ulcer lesions: a randomised, open-label, non-inferiority phase 3 trial.

BACKGROUND: Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS: We did an open-label, non-inferiority, randomised (1:1 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter. The trial was open label, and neither the investigators who took measurements of the lesions nor the attending doctors were masked to treatment assignment. The primary clinical endpoint was lesion healing (ie, full epithelialisation or stable scar) without recurrence at 52 weeks after start of antimicrobial therapy. The primary endpoint and safety were assessed in the intention-to-treat population. A sample size of 332 participants was calculated to detect inferiority of RC8 by a margin of 12%. This study was registered with ClinicalTrials.gov, NCT01659437. FINDINGS: Between Jan 1, 2013, and Dec 31, 2017, participants were recruited to the trial. We stopped recruitment after 310 participants. Median age of participants was 14 years (IQR 10-29) and 153 (52%) were female. 297 patients had PCR-confirmed Buruli ulcer; 151 (51%) were assigned to RS8 treatment, and 146 (49%) received oral RC8 treatment. In the RS8 group, lesions healed in 144 (95%, 95% CI 91 to 98) of 151 patients, whereas lesions healed in 140 (96%, 91 to 99) of 146 patients in the RC8 group. The difference in proportion, -0·5% (-5·2 to 4·2), was not significantly greater than zero (p=0·59), showing that RC8 treatment is non-inferior to RS8 treatment for lesion healing at 52 weeks. Treatment-related adverse events were recorded in 20 (13%) patients receiving RS8 and in nine (7%) patients receiving RC8. Most adverse events were grade 1-2, but one (1%) patient receiving RS8 developed serious ototoxicity and ended treatment after 6 weeks. No patients needed surgical resection. Four patients (two in each study group) had skin grafts. INTERPRETATION: Fully oral RC8 regimen was non-inferior to RS8 for treatment of early, limited Buruli ulcer and was associated with fewer adverse events. Therefore, we propose that fully oral RC8 should be the preferred therapy for early, limited lesions of Buruli ulcer. FUNDING: WHO with additional support from MAP International, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac

Community intervention for child tuberculosis active contact investigation and management : study protocol for a parallel cluster randomized controlled trial

Background There are major gaps in the management of pediatric tuberculosis (TB) contact investigation for rapid identification of active tuberculosis and initiation of preventive therapy. This study aims to evaluate the impact of a community-based intervention as compared to facility-based model for the management of children in contact with bacteriologically confirmed pulmonary TB adults in low-resource high-burden settings. Methods/design This multicenter parallel open-label cluster randomized controlled trial is composed of three phases: I, baseline phase in which retrospective data are collected, quality of data recording in facility registers is checked, and expected acceptability and feasibility of the intervention is assessed; II, intervention phase with enrolment of index cases and contact cases in either facility- or community-based models; and III, explanatory phase including endpoint data analysis, cost-effectiveness analysis, and post-intervention acceptability assessment by healthcare providers and beneficiaries. The study uses both quantitative and qualitative analysis methods. The community-based intervention includes identification and screening of all household contacts, referral of contacts with TB-suggestive symptoms to the facility for investigation, and household initiation of preventive therapy with follow-up of eligible child contacts by community healthcare workers, i.e., all young (< 5 years) child contacts or older (5–14 years) child contacts living with HIV, and with no evidence of TB disease. Twenty clusters representing TB diagnostic and treatment facilities with their catchment areas are randomized in a 1:1 ratio to either the community-based intervention arm or the facility-based standard of care arm in Cameroon and Uganda. Randomization was stratified by country and constrained on the number of index cases per cluster. The primary endpoint is the proportion of eligible child contacts who initiate and complete the preventive therapy. The sample size is of 1500 child contacts to identify a 10% difference between the arms with the assumption that 60% of children will complete the preventive therapy in the standard of care arm. Discussion This study will provide evidence of the impact of a community-based intervention on household child contact screening and management of TB preventive therapy in order to improve care and prevention of childhood TB in low-resource high-burden settings. Trial registration ClinicalTrials.gov NCT03832023. Registered on 6 February 201

Ten-year attrition and antiretroviral therapy response among HIV-positive adults: a sex-based cohort analysis from eight West African countries

INTRODUCTION: Sex differences have already been reported in sub-Saharan Africa for attrition and immunological response after antiretroviral therapy (ART) initiation, but follow-up was usually limited to the first two to three years after ART initiation. We evaluated sex differences on the same outcomes in the 10 years following ART initiation in West African adults. METHODS: We used cohort data of patients included in the IeDEA West Africa collaboration, who initiated ART between 2002 and 2014. We modelled no-follow-up and 10-year attrition risks, and immunological response by sex using logistic regression analysis, survival analysis with random effect and linear mixed models respectively. RESULTS: A total of 71,283 patients (65.8% women) contributed to 310,007 person-years of follow-up in 16 clinics in eight West African countries. The cumulative attrition incidence at 10-year after ART initiation reached 75% and 68% for men and women respectively. Being male was associated with an increased risk of no follow-up after starting ART (5.1% vs. 4.0%, adjusted Odds Ratio: 1.25 [95% CI: 1.15 to 1.35]) and of 10-year attrition throughout the 10-year period following ART initiation: adjusted Hazard Ratios were 1.22 [95% CI: 1.17 to 1.27], 1.08 [95% CI: 1.04 to 1.12] and 1.04 [95% CI: 1.01 to 1.08] during year 1, years 2 to 4 and 5 to 10 respectively. A better immunological response was achieved by women than men: monthly CD4 gain was 30.2 and 28.3 cells/mL in the first four months and 2.6 and 1.9 cells/μL thereafter. Ultimately, women reached the average threshold of 500 CD4 cells/μL in their sixth year of follow-up, whereas men failed to reach it even at the end of the 10-year follow-up period. The proportion of patients reaching the threshold was much higher in women than in men after 10 years since ART initiation (65% vs. 44%). CONCLUSIONS: In West Africa, attrition is unacceptably high in both sexes. Men are more vulnerable than women on both attrition and immunological response to ART in the 10 years following ART initiation. Innovative tracing strategies that are sex-adapted are needed for patients in care to monitor attrition, detect early high-risk groups so that they can stay in care with a durably controlled infection

Feasibility of a randomized clinical trial evaluating a community intervention for household tuberculosis child contact management in Cameroon and Uganda

Background One of the main barriers of the management of household tuberculosis child contacts is the necessity for parents to bring healthy children to the facility. We assessed the feasibility of a community intervention for tuberculosis (TB) household child contact management and the conditions for its evaluation in a cluster randomized controlled trial in Cameroon and Uganda. Methods We assessed three dimensions of feasibility using a mixed method approach: (1) recruitment capability using retrospective aggregated data from facility registers; (2) acceptability of the intervention using focus group discussions with TB patients and in-depth interviews with healthcare providers and community leaders; and (3) adaptation, integration, and resources of the intervention in existing TB services using a survey and discussions with stakeholders. Results Reaching the sample size is feasible in all clusters in 15 months with the condition of regrouping 2 facilities in the same cluster in Uganda due to decentralization of TB services. Community health worker (CHW) selection and training and simplified tools for contact screening, tolerability, and adherence of preventive therapy were key elements for the implementation of the community intervention. Healthcare providers and patients found the intervention of child contact investigations and TB preventive treatment management in the household acceptable in both countries due to its benefits (competing priorities, transport cost) as compared to facility-based management. TB stigma was present, but not a barrier for the community intervention. Visit schedule and team conduct were identified as key facilitators for the intervention. Conclusions This study shows that evaluating a community intervention for TB child contact management in a cluster randomized trial is feasible in Cameroon and Uganda. Trial registration Clini calTr ials. gov NCT03832023. Registered on February 6th 2019

Effects of sweet potato feathery mottle virus, sweet potato chlorotic stunt virus and their co-infection on sweet potato yield in Western Burkina Faso

To determine the effects of sweet potato feathery mottle virus (SPFMV), Sweet potato chlorotic stunt virus (SPCSV) and their co-infection on sweet potato yield, twelve sweet potato varieties were assessed in a hotspot area in Western Burkina Faso. The experiment was carried out in a randomized complete-block design with the twelve varieties in three replications. Data were collected on plant growth parameters, plant virus symptoms and yield parameters. Additional testing for selected sweet potato viruses was done using a nitrocellulose membrane enzyme-linked immunosorbent assay (NCM-ELISA) and RT-PCR. SPFMV and SPCSV were the viruses detected in this study. Varieties Djakani and Ligri were virus-free and had the highest average yields out of twelve sweet potato varieties assessed. Field monitoring indicated that 58% of plants were found to be virus-infected. The results suggest that severe symptoms were associated with sweet potato virus disease (SPVD) and yield reduction. However, the interaction of SPCSV with other viruses, which may result in synergistic negative effects on sweet potato yield and quality, needs further research