2009 Pandemic Influenza A (H1N1) Virus Outbreak and Response – Rwanda, October, 2009–May, 2010

BACKGROUND: In October 2009, the first case of pandemic influenza A(H1N1)pdm09 (pH1N1) was confirmed in Kigali, Rwanda and countrywide dissemination occurred within several weeks. We describe clinical and epidemiological characteristics of this epidemic. METHODS: From October 2009 through May 2010, we undertook epidemiologic investigations and response to pH1N1. Respiratory specimens were collected from all patients meeting the WHO case definition for pH1N1, which were tested using CDC's real time RT-PCR protocol at the Rwandan National Reference Laboratory (NRL). Following documented viral transmission in the community, testing focused on clinically severe and high-risk group suspect cases. RESULTS: From October 9, 2009 through May 31, 2010, NRL tested 2,045 specimens. In total, 26% (n = 532) of specimens tested influenza positive; of these 96% (n = 510) were influenza A and 4% (n = 22) were influenza B. Of cases testing influenza A positive, 96.8% (n = 494), 3% (n = 15), and 0.2% (n = 1) were A(H1N1)pdm09, Seasonal A(H3) and Seasonal A(non-subtyped), respectively. Among laboratory-confirmed cases, 263 (53.2%) were children <15 years and 275 (52%) were female. In total, 58 (12%) cases were hospitalized with mean duration of hospitalization of 5 days (Range: 2-15 days). All cases recovered and there were no deaths. Overall, 339 (68%) confirmed cases received oseltamivir in any setting. Among all positive cases, 26.9% (143/532) were among groups known to be at high risk of influenza-associated complications, including age <5 years 23% (122/532), asthma 0.8% (4/532), cardiac disease 1.5% (8/532), pregnancy 0.6% (3/532), diabetes mellitus 0.4% (2/532), and chronic malnutrition 0.8% (4/532). CONCLUSIONS: Rwanda experienced a PH1N1 outbreak which was epidemiologically similar to PH1N1 outbreaks in the region. Unlike seasonal influenza, children <15 years were the most affected by pH1N1. Lessons learned from the outbreak response included the need to strengthen integrated disease surveillance, develop laboratory contingency plans, and evaluate the influenza sentinel surveillance system

An African Muslim Saint and his Followers in France

This paper explores the practice of Islam among a relatively understudied group of Muslim migrants in France, the Halpulaaren, some of whom have been living in France for more than three decades. Drawing on field research in Senegal, Mali and France, the author considers the contexts for Halpulaaren migration to France, including the West African background to such migration and the situation migrants face in France. The author focuses on a Halpulaaren Muslim religious leader from Senegal, Mansour Baro, who has a reputation as a living Muslim saint, and his followers in France. Tierno Mansour is one of a handful of the most esteemed leaders of the Tijaniyya Sufi order in Senegal. The appeal of this saint, who annually visits Europe, for his followers in France is examined in order to try and understand some of the ways of being Muslim in the shadow of the global city with both its promises and constraints. [Journal abstract]ASC – Publicaties niet-programma gebonde

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation &lt;92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p&lt;0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p&lt;0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Prise en charge des fistules anales au Service de Chirurgie de l’Hôpital Militaire de Ouakam : à propos d’une série de 63 observations

La phase chronique de l’infection cryptoglandulaire du canal anal se traduit classiquement par un écoulement anal purulent résistant aux antibiotiques et toujours récidivant. L’évolution de la suppuration se fait le plus souvent vers la traversée de l’appareil sphinctérien à un niveau plus ou moins haut. Elle favorise les récidives et peut compromettre la continence anale lors de l’exérèse chirurgicale. La cure par fistulectomie et ligature élastique reste une procédure d’actualité dans notre contexte. Pour ce faire, une étude rétrospective descriptive ayant colligée 63 cas de fistules anales à l’hôpital militaire de Ouakam était menée et les aspects épidémiologiques et thérapeutiques analysés. Notre série était composée de 52 hommes et 11 femmes soit un sex ratio de 5/1. L’âge moyen était de 38 ans avec des extrêmes de 21 ans et 62 ans. Le motif de consultation était un écoulement anal purulent et récidivant dans 100% des cas. La fistule anale était associée à des hémorroïdes de grade 2 et grade 3 dans 11 cas et 7cas respectivement. L’orifice externe était situé dans le quadrant postérieur dans 48 cas soit 76%, dans le quadrant antérieur dans 12 cas soit 19%. Il était situé de part et d’autre de la ligne médiane dans 2 cas. L’orifice externe se situait à moins de 3 cm de la marge anale dans 52 cas soit 82%. La fistule était trans-sphinctérienne dans 73%. Une fistulectomie et une ligature élastique serrée étaient réalisées chez 53 patients soit 84% présentant une fistule trans-sphincterienne. Un drainage au séton était réalisé chez 6 patients. La fistule était sous cutanée chez 4 patients et une fistulectomie simple réalisée sans ligature élastique. Des complications étaient notées chez 7 patients. Il s’agit d’incontinence au gaz chez 4 patients sans incontinence fécale et une récidive de la fistule chez 3 patients. Une cicatrisation complète de la fistule était obtenue à court terme dans 98%. Cinquante et un patients étaient suivis et 12 patients perdus de vue après 6mois de suivi. Aucune récidive n’était notée. Pour conclure, la fistulectomie et la ligature élastique serrée demeure une procédure intéressante dans les fistules trans-sphincteriennes. L’identification du trajet fistuleux par un cathétérisme doux, atraumatique, et la chute spontanée de l’élastique en postopératoire sont essentielles. Les récidives sont rares et l’impact sur la continence minime.Mots clés : Anus, fistule cryptoglandulaire, sphincter anal, séton.English AbstractThe chronic phase of the cryptoglandular infection of the anal canal usually results in a purulent anal flow resistant to antibiotics and always recurring. The evolution of suppuration is most often directed towards the crossing of the sphincter to a more or less high level. It promotes recurrences and may compromise anal continence during the surgical procedure. The cure by fistulectomy and elastic ligature remains a topical procedure in our context. A retrospective and descriptive study of 63 cases of anal fistula at Ouakam military hospital was carried out and the epidemiological and therapeutic aspects analyzed. Our series was composed of 52 men and 11 women, a sex ratio of 5/1. The average age was 38 years with extremes of 21 years and 62 years. Patients complaint for purulent and recurrent anal flow in 100% of the cases. Anal fistula was associated with grade 2 and grade 3 hemorrhoids in 11 cases and 7 cases respectively. The external orifice was located in the posterior quadrant in 48 cases, ie 76%, in the anterior quadrant in 12 cases, ie 19%. It was located on either side of the median line in 2 cases. The external orifice was less than 3 cm from the anal margin in 52 cases, or 82%. The fistula was transsphincteric in 73%. Fistulectomy and tight elastic ligation were performed in 53 patients, ie 84% with transsphincteric fistula. Seton drainage was performed in 6 patients. The fistula was subcutaneous in 4 patients and a simple fistulectomy performed without elastic ligature. Complications were noted in 7 patients. These included gas incontinence in 4 patients without fecal incontinence and fistula recurrence in 3 patients. Complete fistula healing was obtained in the short term in 98%. Fifty-one patients were followed up and 12 patients lost to follow-up after 6 months of followup. No recurrence was noted. To conclude, fistulectomy and tight elastic ligation remains an interesting procedure in transsphincter fistulae. The identification of the fistulous tract by a soft, atraumatic catheterization and the spontaneous fall of the elastic in postoperative period are essential. Recurrences are rare and the impact on continence minimal.Keywords : Anus, cryptoglandular fistula, anal sphincter, seto