Profil épidémiologique de l’insuffisance rénale chronique terminale dans la région de Sfax

Introduction: L'insuffisance rénale chronique terminaleest un véritable problème mondial de Santé publique. En Tunisie, le coût de la prise en charge des patients dialysés pour l'année 2011 a dépassé les 90 millions de dinars (37000 Euro), soit près de 5% des dépenses globales de santé. Une meilleure connaissance du profil épidémiologique de l'insuffisance rénale chronique terminale va contribuer à l'élaboration et à l'évaluation des stratégies sanitaires visant à améliorer la prévention et la prise en charge de cette maladie. L'objectif de notre travail est de décrire le profil épidémiologique des cas incidents dans le gouvernorat de Sfax sur une période de 10 ans. Méthodes: Il s'agit d'une étude descriptive rétrospective allant de Janvier 2003 à Décembre 2012. Nous avons inclus les cas incidents d'insuffisance rénale chronique terminale dans le gouvernorat de Sfax. Résultats: Le diagnostic d'insuffisance rénale chronique terminale a été porté à 1708 cas. Il s'agit de 957 hommes et 751 femmes (sex-ratio = 1,27). L'âge moyen était de 58,4ans [10-100ans]. L'étude de l'évolution de l'âge moyen durant la période étudiée a montré une tendance vers la hausse avec un indice de corrélation positive (0,749) et p = 0,006. La principale néphropathie causale était la néphropathie diabétique (21,5%), avec une augmentation significative de sa fréquence d'une année à l'autre (un coefficient de corrélation positive (0,770) avec p = 0,009). L'hémodialyse était la technique de dialyse de choix, entreprise chez 96% des patients. Conclusion: Un registre national reste indispensable afin de mieux comprendre le profil épidémiologique de l'insuffisance rénale chronique terminale en Tunisie et de pouvoir améliorer sa prise en charge

A year of genomic surveillance reveals how the SARS-CoV-2 pandemic unfolded in Africa.

The progression of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in Africa has so far been heterogeneous, and the full impact is not yet well understood. In this study, we describe the genomic epidemiology using a dataset of 8746 genomes from 33 African countries and two overseas territories. We show that the epidemics in most countries were initiated by importations predominantly from Europe, which diminished after the early introduction of international travel restrictions. As the pandemic progressed, ongoing transmission in many countries and increasing mobility led to the emergence and spread within the continent of many variants of concern and interest, such as B.1.351, B.1.525, A.23.1, and C.1.1. Although distorted by low sampling numbers and blind spots, the findings highlight that Africa must not be left behind in the global pandemic response, otherwise it could become a source for new variants

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

Surveillance of Baladi Goat Feeding Behavior in Response to a Mediterranean Natural Rangeland Evolution

International audienceThe Lebanese Baladi goat dairy production sector suffers from food availability problems due to the dependence on natural rangelands and the scarcity of crop residues and forage pastures, leading to lower production. Thus, the nutritional values of the pastures were evaluated in an observational study where 48 Baladi lactating goats were selected and kept within a farm in Qâa er Rîm located in the region of Zahleh, Lebanon. Animal responses in feeding behavior were measured on four different circuits of natural rangelands (NR1, NR2, NR3, and NR4) surrounding the farm site, during a period of ≈75 d (from April to mid-June). Observations and measures consisted of evaluating the rangeland's botanical composition, selective feeding and analysis of forage nutritional values, recording of daily foraging dynamic, and estimation of daily intake. Natural rangelands revealed a large botanical diversity that changed according to season and altitude: From NR1 to NR4, as summer season advanced and animals were moved to higher altitudes, bushes increased, whereas grasses retreated. In parallel, mean diet nutritional value decreased; dry matter (DM) content increased, as well as acid detergent fiber and neutral detergent fiber contents, while crude protein levels decreased. The animals, however, adapted their feeding dynamics on the rangelands accordingly: With the advancement of summer time, total duration of grazing day was increased in order to compensate for longer resting periods at noon and longer walking periods in higher altitudes, without a decrease in total feeding duration. On the other hand, animals were able to adjust their feeding regimen to the available plant species by increasing their daily intake of 0.56 kg/d between NR1 and NR3 and by substituting grasses with shrubby species; a shift from 25% to 28% to 53% to 54% DM in the animals’ diet. These adaptive behavioral responses explain the capacity of Baladi goats to survive in their harsh environment and even tolerate feeding perturbations

Tumoral calcinosis, calciphylaxis, hyperparathyroidism and tuberculosis in a dialysis patient

Tumoral calcinosis and calciphylaxis are uncommon but severe complications in ure-mic patients. They occur generally after long-term hemodialysis (HD) treatment explained by ad-vanced secondary hyperparathyroidism and longstanding high calcium phosphorus product (Ca × P). Other factors such granulomatous diseases may worsen the calcium phosphate homeostasis alterations. We report a young male patient treated by HD for 6 years who developed tuberculosis in addition to tumoral calcinosis and calciphylaxis

Poor prognostic factors of lupus nephritis

The occurrence of renal involvement during the clinical course of systemic lupus erythematous (SLE) is generally considered to be the most important factor influencing the prognosis in terms of morbidity and mortality. The factors influencing prognosis in lupus nephritis (LN) are variable in literature. Our aim was to determine predictive factors of poor prognosis in LN among our population. In this retrospective study, 82 cases of LN observed over 18 years were studied. There were 12 males and 70 females with a mean age of 26.9 ± 11 years. At presentation, the mean proteinuria was 3.9 ± 4 g/day; the nephrotic syndrome, hematuria, leukocyturia and renal failure were observed in 67.1%, 63.4%, 56.1% and 37.8% of cases, respectively. LN was of class I, II, III, IV and V in 4.9%, 13.4%, 23.2%, 50% and 8.5% of the cases, respectively. Fifteen patients developed end-stage renal failure and/or died. The presence of hypertension, renal failure, massive proteinuria and high activity index score of LN was associated with poor renal prognosis