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

A 14 years old woman with a giant mucinous adenocarcinoma of the ovary

The diagnosis of ovarian tumor in pediatrics is often difficult and delayed due to unspecific call signs and polymorphic imaging presentations. These tumors are rare, estimated in children at around 2.6 / 100,000 girls per year, functional lesions being excluded. Ten to 20% of them are malignant [1-2] and represent 3% of cancers in girls under the age of 15 [3]. The World Health Organization classifies these tumors into three main groups based on whether they are derived from the surface epithelium, germline cells or ovarian stroma or sex cords. Primary or secondary locations are possible in leukemias and lymphomas [4-5]. Giant ovarian cystadenocarcinomas are rarely described. The huge ovarian masses are mostly benign, but the malignancy should be ruled out by pathology exams. Giant cysts require resection by laparotomy because of compression symptoms or the risk of malignancy, but also to prevent perforation and spillage of cystic fluid into the peritoneal cavity [6]. Here we report an observation made in a 14-year-old girl who was diagnosed with a large ovarian tumor and who was found to be a malignant tumor on pathology with papillary-type mucinous cystadenocarcinoma.</jats:p

Predictive factors of Uterine Rupture

Objectives: To assess the frequency and predictive factors of uterine rupture on no-scar uterus and on scarred uterus in an intermediate level health hospital in Dakar. Method of study: This retrospective was carried out by the Philippe Maguilen Senghor Health Center in Yoff (Dakar) during the period from January 1, 2011 to December 31, 2017. It included all the women who gave birth there'' a single pregnancy after 22 weeks of amenorrhea with a longitudinal fetal presentation or admitted after childbirth. We had studied socio-demographic characteristics and risk factors for uterine rupture. The extracted data was analyzed first on Microsoft Excel 2016 and then on EPI info. Results: Over 7 years, 29,332 deliveries of single pregnancies were recorded in our structure with 54 uterine ruptures, and a frequency of 0.18%. Induction of labor was spontaneous in 47 of the patients who presented with uterine rupture; labor was artificially induced in only 7 patients, with frequencies of 0.17% and 0.36% of all uterine ruptures, respectively. Considering the risk factors of uterine rupture, 5 parameters were discriminating: multiparity (p&lt;0.0001), transfer from another health facility for admission (p&lt;0.0001), type of fetal presentation (p=0.0001), the presence of a uterine scar (p&lt;0.0001) and the age class (p&lt;0.0001). Conclusion: The rate of uterine rupture in our structure is certainly low but should call for more vigilance during labor with a focus on evacuated patients who have started their work in another structure, patients with a uterine scar and multiparous. Childbirth on a scar uterus is a reasonable option after eliminating a potential cause of obstructed labor. Keywords: Ruptured uterus; Scar uterus; Risk factors</jats:p

Management of placenta percreta. A case report

The placenta accreta designates an abnormality of the placental insertion characterized, on the anatomopathological level, by an absence of deciduous deciduous between the placenta and the myometrium. This insertion anomaly may interest all or only part of the placenta. We distinguish within this terminology the terms of - placenta accreta when the placenta is simply attached to the Myometrium. - placenta increta when the placenta invades the myometrium. - placenta percreta when the placenta enters the serosa uterine, or even the neighboring organs (bladder, peritoneum, etc.) [1]. Placentas accretas are a high-risk situation for severe postpartum hemorrhage and its inherent complications such as disseminated intravascular coagulation, hemostasis hysterectomy, surgical wounds to the ureters, bladder, multiple organ failure, or even maternal death, particularly in the case of placenta percreta [2,3]. Risk factors for placenta percreta include a history of cesarean, uterine curettage or manual removal of placenta, presence of placenta previa, endometriosis, high parity and advanced maternal age [4]. We report the case of a 30-year-old woman, IIGIIP, who had a previous cesarean section during her first pregnancy and who had a placenta percreta and who underwent hysterectomy without cystectomy and without ligation of the hypogastric arteries.</jats:p

Needs of Young African Neurosurgeons and Residents: A Cross-Sectional Study

Introduction:Africa has many untreated neurosurgical cases due to limited access to safe, affordable, and timely care. In this study, we surveyed young African neurosurgeons and trainees to identify challenges to training and practice.Methods:African trainees and residents were surveyed online by the Young Neurosurgeons Forum from April 25th to November 30th, 2018. The survey link was distributed via social media platforms and through professional society mailing lists. Univariate and bivariate data analyses were run and aP-value &amp;lt; 0.05 was considered to be statistically significant.Results:112 respondents from 20 countries participated in this study. 98 (87.5%) were male, 63 (56.3%) were from sub-Saharan Africa, and 52 (46.4%) were residents. 39 (34.8%) had regular journal club sessions at their hospital, 100 (89.3%) did not have access to cadaver dissection labs, and 62 (55.4%) had never attended a WFNS-endorsed conference. 67.0% of respondents reported limited research opportunities and 58.9% reported limited education opportunities. Lack of mentorship (P= 0.023, Phi = 0.26), lack of access to journals (P= 0.002, Phi = 0.332), and limited access to conferences (P= 0.019, Phi = 0.369) were associated with the country income category.Conclusion:This survey identified barriers to education, research, and practice among African trainees and young neurosurgeons. The findings of this study should inform future initiatives aimed at reducing the barriers faced by this group.</jats:p