Bell’s palsy in pregnancy as a prodromal sign of preeclampsia: A report of three cases, pregnancy outcome, and literature review

Bell’s palsy is a less common neurological disorder in the general population. Its occurrence during pregnancy can be used as a predictor of adverse obstetric outcomes including preeclampsia and its complications. We report cases of three pregnant women from Botswana who presented with Bell’s palsy in the third trimester coexisting with preeclampsia and multiple complications. One of the patient was a case of maternal near-miss with multiple life threating complications including stage 3 acute kidney injury (AKI) and required hemodialysis. The second and third patients developed Bell`s palsy and preeclampsia at term, management of preeclampsia commenced with immediate delivery resulting in good maternal and neonatal outcome. In all the three patients preeclampsia and Bell`s palsy completely resolved post-delivery. Therefore, new onset Bell’s palsy in pregnancy may be used as a prodromal sign of preeclampsia. Such patients deserve close follow up for preeclampsia or gestational hypertension for a better obstetric outcome. La paralysie de Bell est un trouble neurologique moins fréquent dans la population générale. Son apparition pendant la grossesse peut être utilisée comme un prédicteur d'issues obstétricales défavorables, y compris la prééclampsie et ses complications. Nous rapportons les cas de trois femmes enceintes du Botswana qui ont présenté une paralysie de Bell au troisième trimestre coexistant avec une prééclampsie et de multiples complications. L'un des patients était un cas de quasi-accident maternel avec de multiples complications potentiellement mortelles, notamment une insuffisance rénale aiguë (IRA) de stade 3 et une hémodialyse nécessaire. Les deuxième et troisième patientes ont développé une paralysie de Bell et une prééclampsie à terme, la prise en charge de la prééclampsie a commencé avec l'accouchement immédiat, ce qui a donné de bons résultats maternels et néonatals. Chez les trois patientes, la prééclampsie et la paralysie de Bell ont complètement disparu après l'accouchement. Par conséquent, une nouvelle paralysie de Bell pendant la grossesse peut être utilisée comme signe prodromique de prééclampsie. Ces patientes méritent un suivi rapproché de la prééclampsie ou de l'hypertension gestationnelle pour un meilleur résultat obstétrica

Semi-Dwarf Tef Lines for High Seed Yield and Lodging Tolerance in Central Ethiopia

Tef [ Eragrostis tef (Zucc.) Trotter] is the major cereal crop in the Horn of Africa, especially in Ethiopia where it is a staple food for over 60% of its 90 million population. The crop performs better than other cereal crops under extreme environmental conditions. The grain of tef is not only nutritious but also gluten-free, the cause for celiac disease, which affects humans world wide. The objective of this study was to evaluate the morpho-agronomic performance of newly developed semi-dwarf tef genotypes for grain yield and yield related agronomic traits under diverse environmental conditions. Twenty-four tef lines were evaluated, along with one local and three standard checks, at three locations in the Central Ethiopia. The mean squares due to genotypes, locations and genotype by location interactions were highly significant (P<0.01) for all the studied traits. Three genotypes, namely RIL- 91, RIL-244 and RIL-11, gave the highest seed yield, ranging between 4.4 to 4.7 t ha-1, compared to the popular and widely cultivated tef variety called Quncho which gave 4.2 t ha-1. Genotypic and phenotypic coefficients of variations ranged from 0.002 to 173.9% and from 0.004 to 255.9%, respectively. The highest genetic advance (20.2 cm) and heritability estimates (86.7%) were obtained for plant height indicating that selection for this trait can be made easily. Grain yield showed significant and positive genotypic association with plant height, whole culm and second culm internode length, second culm internode diameter, number of spikelet per panicle and shoot biomass yield. Cluster analysis grouped the genotypes into six distinct classes. The first five principal components with eigenvalues greater than one accounted for 85% of the total variation. Generally, this study identified tef genotypes with better grain yield and reasonable lodging tolerance for further evaluation and eventual release to the farming communities.Tef [ Eragrostis tef (Zucc.) Trotter] est une\ua0culture majeure de c\ue9r\ue9ale dans la corne de l\u2019Afrique, particuli\ue8rement en Ethiopie o\uf9 elle est un aliment de base pour plus de 60% de son 90\ua0million de population. La culture performe mieux que d\u2019autres cultures c\ue9r\ue9ali\ue8res dans des conditions environnementales extr\ueames. Les grains du tef ne sont pas seulement nutritifs mais aussi ne contiennent pas de gluten, la cause des maladies des c\ue9r\ue9ales, qui affectent les hommes dans le monde. L\u2019objectif de cette \ue9tude \ue9tait d\u2019\ue9valuer la performance morpho-agronomique des g\ue9notypes semi-nain de tef nouvellement d\ue9velopp\ue9s pour le rendement en grain et les composantes du rendement sous diverses conditions environnementales. Vingt-quatre lign\ue9es de tef \ue9taient \ue9valu\ue9es, ensemble avec un local et trois contr\uf4les standards, dans trois locations dans la r\ue9gion centrale de l\u2019Ethiopie. Les carr\ue9es moyens dus aux g\ue9notypes, locations et aux interactions entre le g\ue9notype et l\u2019environnement \ue9taient hautement significatifs (P<0.01) pour tous les traits \ue9tudi\ue9s. Trois g\ue9notypes, nomm\ue9s RIL-91, RIL-244 and RIL-11, ont donn\ue9 les rendements les plus \ue9lev\ue9s en grain variant de 4,4 \ue0 4,7 t ha-1, compar\ue9s \ue0 la vari\ue9t\ue9 de tef populaire et largement cultiv\ue9e appel\ue9e Ounho qui a donn\ue9 4,2 t ha-1. Les coefficients de variation g\ue9notypique et ph\ue9notypique ont vari\ue9 de 0,002 \ue0 173,9% et de 0,004 \ue0 255,9%, respectivement. La plus grande avanc\ue9e g\ue9notypique (20,2 cm) et les estimations d\u2019h\ue9ritabilit\ue9 (86,7%) \ue9taient obtenues pour la taille de la plante montrant que la s\ue9lection pour ce trait peut \ueatre faite plus t\uf4t. Le rendement en grain a montr\ue9 une association significative et positive avec la taille de la plante, la longueur de l\u2019entre-n\u153ud au niveau de la canne int\ue9grale et la seconde canne, le diam\ue8tre de la seconde canne de l\u2019entre-n\u153ud, le nombre d\u2019\ue9pillet par panicule et le rendement en biomasse de la tige. L\u2019analyse en class a group\ue9 les g\ue9notypes en six classes distinctes. Les cinq premi\ue8res composantes principales avec des valeurs propres sup\ue9rieures \ue0 un ont pris en compte 85% de la variation totale. En g\ue9n\ue9rale, cette \ue9tude a identifi\ue9 des g\ue9notypes de tef avec des meilleurs rendements en grains et de tol\ue9rance raisonnable \ue0 la verse pour davantage \ue9valuation et \ue9ventuelle lib\ue9ration aux communaut\ue9s paysannes

Technology generation to dissemination:lessons learned from the tef improvement project

Indigenous crops also known as orphan crops are key contributors to food security, which is becoming increasingly vulnerable with the current trend of population growth and climate change. They have the major advantage that they fit well into the general socio-economic and ecological context of developing world agriculture. However, most indigenous crops did not benefit from the Green Revolution, which dramatically increased the yield of major crops such as wheat and rice. Here, we describe the Tef Improvement Project, which employs both conventional- and molecular-breeding techniques to improve tef\u2014an orphan crop important to the food security in the Horn of Africa, a region of the world with recurring devastating famines. We have established an efficient pipeline to bring improved tef lines from the laboratory to the farmers of Ethiopia. Of critical importance to the long-term success of this project is the cooperation among participants in Ethiopia and Switzerland, including donors, policy makers, research institutions, and farmers. Together, European and African scientists have developed a pipeline using breeding and genomic tools to improve the orphan crop tef and bring new cultivars to the farmers in Ethiopia. We highlight a new variety, Tesfa, developed in this pipeline and possessing a novel and desirable combination of traits. Tesfa\u2019s recent approval for release illustrates the success of the project and marks a milestone as it is the first variety (of many in the pipeline) to be released

Intensifying Maize Production Under Climate Change Scenarios in Central West Burkina Faso

Combination of poor soil fertility and climate change and variability is the biggest obstacle to agricultural productivity in Sub-Saharan Africa. While each of these factors requires different promising adaptive and climate-resilient options, it is important to be able to disaggregate their effects. This can be accomplished with ordinary agronomic trials for soil fertility and climate year-to-year variability, but not for long-term climate change effects. In turn, by using climate historical records and scenario outputs from climate models to run dynamic models for crop growth and yield, it is possible to test the performance of crop management options in the past but also anticipate their performance under future climate change or variability. Nowadays, the overwhelming importance given to the use of crop models is motivated by the need of predicting crop production under future climate change, and outputs from running crop models may serve for devising climate risk adaptation strategies. In this study we predicted yield of one maize variety named Massongo for the time periods 1980–2010 (historical) and 2021–2050 (2030s, near future) across agronomic practices including the fertilizer input rates recommended by the national extension services (28 kg N, 20 kg P, and 13 kg K ha−1). The performance of the crop model DSSAT 4.6 for maize was first evaluated using on-farm experimental data that encompassed two seasons in the Sudano-Sahelian zone in six contrasting sites of Central West Burkina Faso. The efficiency of the crop model was evidenced by reliable simulations of total aboveground biomass and yields after calibration and validation. The root-mean-square error (RMSE) of the entire dataset for grain yield was 643 kg ha−1 and 2010 kg ha−1 for total aboveground biomass. Three regional climate change projections for Central West Burkina Faso indicate a decrease in rainfall during the growing period of maize. All the three scenarios project that the decrease in rainfall is to the tune of 3–9% in the 2030s under RCP4.5 in contrast to climate scenarios produced by the regional climate model GCM ICHEC-EC-Earth which predicted an increase of rainfall of 25% under RCP8.5. Simulations using the CERES-DSSAT model reveal that maize yields without fertilizer show the same trend as with fertilizer in response to climate change projections across RCPs. Under RCP4.5 with output from the climate model ICHEC-EC-Earth, yield can slightly increase compared to the historical baseline on average by less than 5%. In contrast, under RCP8.5, yield is increased by 13–22% with the two other climate models in fertilized and non-fertilized plots, respectively. Nevertheless, the average maize yield will stay below 2000 kg ha−1 under non-fertilized plots in RCP4.5 and with recommended mineral fertilizer rates regardless of the RCP scenarios produced by ICHEC-EC-Earth. Giving the fact that soil fertility improvement alone cannot compensate for the adverse impact of future climate on agricultural production particularly in case of high rainfall predicted by ICHEC-EC-Earth, it is recommended to combine various agricultural techniques and practices to improve uptake of nitrogen and to reduce nitrogen leaching such as the splitting of fertilizer applications, low-release nitrogen fertilizers, agroforestry, and any other soil and water conservation practices

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Magnitude of cytopenias among HIV‑infected children in Bahir Dar, northwest Ethiopia: a comparison of HAART-naïve and HAART‑experienced children

Yakob Gebregziabher Tsegay,1,* Agerie Tadele,2 Zelalem Addis,3 Agersew Alemu,4 Mulugeta Melku2,* 1Bahir Dar Regional Health Research Laboratory Center, Bahir Dar, 2Department of Hematology and Immunohematology, 3Department of Medical Microbiology, 4Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia *These authors contributed equally to this work Background: AIDS, caused by HIV, is a multisystem disease that affects hematopoiesis. The aim of this study was to assess cytopenias among HIV-infected children who had a follow-up at Felege Hiwot Referral Hospital, Bahir Dar, northwest Ethiopia. Methods: An institution-based cross-sectional study was conducted between April and May 2013. Systematic random sampling method was used to select the study participants. Descriptive statistics, independent t-test as well as chi-square and logistic regression were used for analysis. A p-value <0.05 was considered as statistically significant. Results: A total of 224 children (112 highly active antiretroviral therapy [HAART]-naïve and 112 HAART-experienced) participated in the study. The magnitude of anemia, thrombocytopenia, neutropenia, leukopenia and pancytopenia among HAART-naïve HIV-infected children were 30.4%, 9.8%, 8%, 4.5% and 1.8%, respectively. The overall prevalence of anemia, neutropenia, thrombocytopenia, leukopenia and pancytopenia were 29.5%, 8.9%, 8%, 4.5% and 1.4%, respectively. Cluster of differentiation-4 percentage and mean corpuscular volume were significantly different between HAART-experienced and HAART-naïve children. Being of younger age and severely immunosuppressed were risk factors of anemia. Conclusion: Anemia was the most common cytopenia, followed by neutropenia. Severe immunosuppression and younger age were significantly associated with anemia. Therefore, emphasis should be given for investigation and management of cytopenias in HIV-infected children, particularly for those who are immunosuppressed and of younger age. Keywords: anemia, children, cytopenia, HAART, HIV, leukopenia, neutropenia, pancytopenia, thrombocytopeni