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

STRESS MOTHER EXPERIENCE FOR PREMATURE BIRTH

The main objective of this study is to approach the experience of these mothers in our Moroccan context by focusing on the analysis of the socio-cultural impact. The secondary objective is to determine the risk factors associated with feelings of psychological difficulties.&#x0D; This study was conducted at the Souissi Maternity Hospital in Rabat over the six months. We chose to conduct a survey of Moroccan women who gave birth to premature alive. Preterm birth was defined as any birth prior to 37 weeks of amenorrhea (SA). This is a prospective, descriptive and analytical study. 100 parturients were included in our study.&#x0D; The collection of information has been on the second day of delivery. Two groups of women were subsequently identified:&#x0D; &#x0D; group A with one or two light feelings (absent or mild psychological difficulty)&#x0D; group B with 3 or 4 medium or strong feelings (medium to strong psychological difficulty).&#x0D; &#x0D; We analyzed two groups to determine the risk factors associated with psychological difficulties.&#x0D; In univariate analysis, we examined the association of each of maternal and neonatal characteristics with both groups A and B.&#x0D; Nine factors were significantly associated with moderate or intense psychological difficulty.&#x0D; A high level of instruction, well-monitored pregnancy, presence of a pathological obstetrical history and cesarean delivery, all these factors accentuate the intensity of the feelings experienced.&#x0D; In parallel, a weight greater than or equal to 1500 g birth of the child, transfer the baby in neonatal medicine lessen these feelings.&#x0D; In multivariate analysis and after adjusting for factors studied, only the presence of pathological factors obstetrical history and the place of the child in the parental project are significant and therefore correlated with average or intense psychological difficulty.&#x0D; We have indeed found that prematurity inscribed the child and his mother in a difficult context. This would affect preterm rupture of the mother / child bond. After that other questions have emerged. Given that self-efficacy is rooted in the failures and successes encountered previously, it would have been interesting to consider primiparity of the mother, and the support of the father at birth and after, when returning home because it would play a leading role and would have a positive impact on the mother's psyche.</jats:p

Leukemia B Lymphoblastic Lymphoma in a Child: With t (9.22) and Hyperdiploidy

Introduction: Non-Hodgkin's lymphoblastic B lymphoma with lymph node location is exceptional in children. Unlike acute lymphoblastic leukemia, which is the first cancer in children around the age of 3 with a favorable prognosis with a survival of 5 years in 90%. Observation: child, 15 years old. The hospital admission examination showed a febrile patient (40°C), bilateral cervical and inguinal polyadenopathies, the absence of hepatosplenomegaly. The hemogram at entry found bicytopenia made up of angerogenic anemia and thrombocytopenia. On the haematological level, there has been an evolution towards pancytopenia. A lymph node biopsy showed medullary infiltration with lymphoma cells of phenotype B. The karyotype found hyper diploidy with t (9.22). The patient was put on corticosteroid therapy, hyperhydration and (Allopurinol) followed by COP type chemotherapy (Cyclophosphamide, Oncovin, Prednisone) with good tolerance. A year later the patient presented with a feverish peak (40°C). Only a hematological relapse in the form of acute leukemia. Therapeutically, it was decided to re-induce the patient according to the GRAALL catch-up protocol (Idarubicin-Aracytine) and to propose it for an allograft of bone marrow, but unfortunately the patient died. Conclusion: Lymphoblastic lymphoma / Acute lymphoblastic leukemia B, associated with t (9; 22) and hyperdiploidy in children is an exceptional hemopathy and has a negative diagnosis.</jats:p

Application of Chitosan in Bone and Dental Engineering

Chitosan is a deacetylated polysaccharide from chitin, the natural biopolymer primarily found in shells of marine crustaceans and fungi cell walls. Upon deacetylation, the protonation of free amino groups of the d-glucosamine residues of chitosan turns it into a polycation, which can easily interact with DNA, proteins, lipids, or negatively charged synthetic polymers. This positive-charged characteristic of chitosan not only increases its solubility, biodegradability, and biocompatibility, but also directly contributes to the muco-adhesion, hemostasis, and antimicrobial properties of chitosan. Combined with its low-cost and economic nature, chitosan has been extensively studied and widely used in biopharmaceutical and biomedical applications for several decades. In this review, we summarize the current chitosan-based applications for bone and dental engineering. Combining chitosan-based scaffolds with other nature or synthetic polymers and biomaterials induces their mechanical properties and bioactivities, as well as promoting osteogenesis. Incorporating the bioactive molecules into these biocomposite scaffolds accelerates new bone regeneration and enhances neovascularization in vivo.</jats:p

Home care for antibiotic therapy in the management of maternal-fetal infection: Action research example

Introduction- Given the progress in medical care in neonatology, the development of neonatal medicine evaluation techniques and management of difficulties in our Moroccan context, the need to increase the alternative structures for complete hospitalization (CH) in this discipline, is clear. Purpose- Assess the economic and neonatal outcomes of neonatal infection in case of further outpatient care. Material and methods- This is a prospective, single-center including newborns hospitalized for infection between 1 January 2011 and 31 December 2013. Exclusion criteria were respiratory distress, birth defects, direct admission neonatal resuscitation. Results- 1060 neonates were included. The parturients had a preterm rupture of membranes PRM in 70% of cases. We had found a tinted amniotic fluid in 23% of cases. Mothers had chorioamnionitis in 20% of cases. We noted the presence of vaginal discharge with vaginal itching in 18% of cases. of mictional burns were found in 10% of cases. Breast laboratory tests (urinalysis, vaginal swabs, blood cultures, CRP) was positive in 3% of cases the mean birth weight was 3300.20 grams +/- 600. The average age was +/- 1.4 days 0.45. Thirty percent of the children were exclusively breastfed. 80% of patients were asymptomatic at admission. The clinical signs were found mainly respiratory distress. Mean CRP was 35,12mg / L +/- 3.5. The average duration of the PRM was 9.66 +/- 57.7 hours. The examination at the end of treatment was without abnormalities in 89.2% of cases. CRP control was below 6 mg / l in 48% of cases. The evolution of life on day 28 was favorable in 100% of cases. The average length of hospital treatment was 2.87 +/- 1.145 days; the average duration of treatment as outpatients was 2.74 +/- 1.31 days. 100% of newborns received treatment by parenteral perfusion according the protocol of the center. The average number of hospital days per patient spared protocol averaged 3.21 +/- 0.78 days. The average amount saved per patient was 82.65 +/- 5.51 Euros. Total amount saved over three years was 83,000 Euros. Conclusion- The partial hospitalization seems possible for infected newborns without aggravating their illness. It also contributes significantly to the health economy.</jats:p

IS THE DIVERTICULARPAPILLA A FACTOR IN THE FAILURE OF CANULATION OF THE COMMON BILE DUCT IN BILIARY STONES PATHOLOGY?

Introduction: Duodenaldiverticulumiscommon (6-20%). Thesemaybe a difficulty in cannulation of the common bile duct and are more frequentassociatedwithbiliary stones. Objectives: To calculate the prevalence of juxta-papillarydiverticulum in patients withbiliary stones and to evaluate the influence of juxtapillarydiverticulum on the success rate of the cannulation of the CBD in biliary stones pathology. Patients and MethodsA prospspectivestudythat lead from April 2002 to september 2020. Wereincluded 1011 patients whobenefited of a ERCP for CBD stones. The presence or absence of a juxta-papillarydiverticulumwasnoted. Wecompared the success rate of cannulation of the common bile duct in patients with a juxta-papillarydiverticulum (Group I) versus patients withoutdiverticularpapillae (group II). ResultsThe meanage of the patients was 58 ± 14 yearswith 605 women and 406 men (sex ratio M / F: 0.67). Patients withdiverticularpapillae (group I) accounted for 9.1% of the patients enrolled (93 patients). Group II had 918patients (90.8%). The success rate of the cannulation of CBD was 92.3% in group II versus 87.1% in group I (p: 0.04). The overall rate of early complications was 6% in group II versus 7.4% in group I (p = 0.11). Conclusion The presence of a juxta-papillarydiverticulumappears to significantlydecrease the success rate of CBD cannulation in biliary stones pathologywithoutincreasing the risk of early complications. However, prospective studieswith large series are stillnecessary to confirmthese.</jats:p