Determinants of the Ophthalmological Follow-Up of Sickle Cell Patients at the National Center of Research and Care for Sickle Cell Patients in Lome-Togo

Objectives: To assess the factors influencing the ophthalmological follow-up of sickle cell patients in Togo. Materials and Methods: The national center of research and care for sickle cell patients (CNRSD) served as study setting. It was a descriptive and analytical study by interview over a three-month period from December 01, 2020 to March 02, 2021. Was included in the study, any patient with sickle cell disease genotype SS or SC, age ≥ 17 years, regularly followed at the CNRSD and having accepted the interview by a survey sheet. Excluded were patients with sickle cell trait genotype AS or AC or with a disability that prevented them from being interviewed. Results: Two hundred and fifty (250) patients with sickle cell disease were interviewed. The mean age was 29.1 years ± 11.12 years [17 years;67 years] and the sex ratio = 0.52. Nine patients over ten (9/10) attended at least secondary school. The jobless represented 25.60% of the total population followed respectively by students and laborers in 20.40% and 16% of cases. Twenty-four percent (24%) of patients were followed up in ophthalmology department. Statistically, there was no significant relationship between level of education (p = 0.4083), occupation (p = 0.6441) and knowledge of the ocular complications of sickle cell disease. Statistically, there was a significant relationship between knowledge of the ocular complications of sickle cell disease and compliance with ophthalmological follow-up (p = 0.0009). Conclusion: The knowledge of eye disorders related to sickle cell disease by patients with sickle cell disease improves their ophthalmological follow-up. Greater awareness on eye disorders related to sickle cell disease by medical staff towards patients with sickle cell disease would improve ophthalmological follow-up. .

Influence of individual tree characteristics,spatial structure and logging history on tree-related microhabitat occurrence in North American hardwood forests

Background:Tree-related microhabitats(hereafter,"TreMs")are key components of forest biodiversity but they are still poorly known in North American hardwood forests.The spatial patterns of living trees bearing TreMs(hereafter,"TreM-trees")also remain to be determined.As logging practices can lead to a loss of TreM-trees and of their associated biodiversity,it is essential to identify the factors explaining TreM occurrence to better integrate them into forest management.We therefore inventoried TreMs in 40.5-ha survey strips in northern hardwood forests in Quebec,Canada,while recording the spatial location of each tree.Two strips were located in unmanaged oldgrowth forests,and 2 were in forests managed under selection cutting.All 4 stands were dominated by sugar maple(Acer saccharum Marsh.)and American beech(Fagus grandifolia Ehrn.).Beech bark disease,an exotic pathology,was observed in all the strips.Results:Large diameter at breast height and low tree vigor were the main characteristics explaining the presence of TreMs at the tree scale.TreM-trees presented slight spatial aggregation patterns.These aggregates,however,were not well-defined and were generally constituted by a large number of trees bearing few different types of TreMs.Two TreM classes(broken branch or top and woodpecker lodge)also presented a spatial aggregation.Logging practices had no significant effect on TreM occurrence.Beech bark disease increased the frequency of senescent beeches.The impact of this pathology on TreMs was however mitigated by the small size of infected trees and probably by the short time elapsed since its appearance.Conclusion:The factors explaining the presence and abundance of TreMs on trees has so far been little studied in North American hardwood forests.Our results highlight that TreM-tree characteristics in the surveyed forests are consistent with those of previous studies conducted in other forest types and regions(e.g.,Europe or Northwestern America).To our knowledge,this study is also the first to identify a spatial aggregation of TreM-trees and of specific TreM classes.It will be nevertheless necessary to determine whether the small impact of logging activities we observed results from current or past management practices.

Access to Antibiotics through Prescription and Non-Prescription Media in Private Pharmacies in Lomé, Togo

Objectives: The present study was conducted to describe and analyze antibiotic demands via prescription and non-prescription media received in private pharmacies in Lomé. Methods: A cross-sectional study was conducted in 26 private pharmacies in Lomé (Togo) from August to October 2013. The study was based on a survey conducted with a standardized questionnaire to collect data representing the daily activity of the pharmacies. Data on prescription documents, non-prescription media, patients’ and prescribers’ identification, and antibiotics requested were collected and analyzed. Key findings: During the study period, 596 antibiotic prescriptions were collected. Various prescription and non-prescription media permitted available antibiotic access in private pharmacies. Seventy-nine percent (79%) of the received orders contained one antibiotic. All categories of health care professionals were found among antibiotic prescribers. Prescribers were not identifiable in 40.2% of all prescription tools received for antibiotics demand. Forty-four percent (44%) of antibiotic orders were supported by a prescription. The study found that many people ordering antibiotic (61%) were not the direct users. Some elements of prescription compliance were mentioned at the rate of 82%, 44.7% and 59% (date, prescribers’ identity and qualification), 3/4 of the prescription material (patients’ identity and sex), more than 87% (accuracy of the dosage), 79.7% (oral route of administration) and less than 1/3 (duration of treatment). The results also indicated that Beta-lactams (41%), quinolones (17%), and 5-nitroimidazoles (15%) were the most prescribed classes of antibiotics. Conclusions: The study revealed that more than half of the antibiotics orders, received in pharmacies were non-compliant. This calls for an awareness of healthcare workers and populations on the rational use of antibiotics. Access to antibiotics should be further controlled (prescription dispensing), community should ban other media of obtaining antibiotics without a prescription and avoid particularly antimicrobial self-medication.

Correlation between Asymptomatic Bacteriuria and HIV-1 Viral Load Level and CD4 Count in Pregnant Women on Antiretroviral Therapy in N’djamena (Chad)

A cross-sectional study was conducted at the “Centre de l’Appui Psycho-Médico-Social (APMS)” which is a centre for Psychological and Medical Support in N'Djamena (Chad) from January to March 2014. The aim of this study was to evaluate the correlation between asymptomatic bacteriuria (ASB) and viral load level and CD4 count in seventy-six (76) HIV-1 infected pregnant women on antiretroviral therapy (ART). Urine culture and bacteria identification were performed by using a chromogenic culture medium (UriselectR4). T CD4+ lymphocytes count and viral load measurement were done respectively on PIMATM test and Abbott m2000 RealTime HIV-1. In this study, 25 (32.9%) pregnant women were carrying ASB and major bacteria;Escherichia coli and Streptococcus agalactiae known to cause neonatal meningitis to newborns were identified. Bacteria were isolated mainly in women with CD4 lymphocytes 3log (70%) (19/25). Besides the prevention of mother to child transmission of HIV, which remains a goal, it is important to prevent also the transmission of other microorganisms causing neonatal infections. Our findings support the needs to do bacteriological analysis of urine in every HIV-infected pregnant woman at least in late pregnancy.

Ciprofloxacin Sensitivity of <i>Staphylococcus</i>Strains Isolated at the Sylvanus Olympio University Hospital, Togo

Background: Staphylococcal infections are managed by hygiene measures and usage of antibiotics. The first-line treatment refers to beta-lactamins. However, the emergence of beta-lactamin resistant staphylococcal strains has been reported, as demonstrated by a study conducted in Lomé University Teaching Hospital, Bacteriology Laboratory (2001) on 742 Staphylococcus aureus strains which revealed 67.00% of them where methicillin resistant. In this setting of emergent methicillin-resistant strains, the second-line treatments are prescribed by clinicians without antibiograms. Fluoroquinolones are the first preference molecules used for second-line treatment because of their efficacy and affordability. We want to contribute to setting monitoring and alert-making tools for drug prescribers. Thus we conducted this study, aiming to determine the frequency of S. aureus and coagulase-negative staphylococci (CNS) strains isolation in different types of biologic samples, and to investigate the link between methicillin resistance and ciprofloxacin resistance. Methods: We conducted this study from January 2006 through Jun 2010. The Microbiology Laboratory Service collected and analyzed samples for diagnostic purpose from inpatients and outpatients consulted in the hospital. We collected and analyzed de-identified data on these patients to form laboratory records. Bacteriological analyses in which ciprofloxacin have not been tested were excluded. Results: Over the 1108 staphylococal strains isolated from various biological samples processed, 751 were Staphylococcus aureus and 357 were coagulase-negative staphylococci. The strains sensitivity profile is for all isolates. The majority of germs were S. aureus and 20% of them were ciprofloxacin-resistant. The probability of a patient who has an infection caused by S. aureus increases his stay in high-risk settings such as intensive care unit, surgical intervention, extended hospitalization, use of a catheter. The use of broad-spectrum antibiotics increases the risk of multidrug-resistant strains. Conclusion: This study highlights the recurring issue of over consumption of antibiotics in nowadays medical treatments. There is a need to raise awareness about the rational use of antibiotics in general and fluoroquinolones particularly.

Prevalence of Soil-Transmitted Helminths and Intestinal Protozoa among School Children in Lome, Togo

Background: Significant morbidity in children is associated with infectious diseases especially soil-transmitted helminth (STH) infections which are prevalent in sub-Saharan African countries. The objective of this study is to estimate the prevalence of STH and intestinal protozoa among schoolchildren in Lomé, Togo. Patients and Methods: In November 2013, in each of the five districts of the Lomé-commune region, thirty pupils per level of the third, fourth, fifth and sixth grades of five primary schools were included. Each child submitted a single stool sample that was analyzed by the Kato-Katz method for STH. In addition, stool samples of school children selected in third and sixth grades were examined by direct visualization using saline and Lugol’s stain for intestinal protozoa. Results: A total of 2944 children were enrolled at 25 schools. The overall prevalence of STH at schools was 5.0% (range 1.5% to 8.6%), was higher in boys than girls, and increased with age and grade. Hookworm was the most prevalent species (3.4% of children surveyed). Intestinal protozoa were found in 52.2% (765/1465) of children tested and commensal amoebae represented 22.7% of these protozoa identified. Entamoeba histolytica/dispar/moshkovskii and Giardia intestinalis were identified in 2.3% and 11.5% of children, respectively. Co-infestation was noted in 1.35% of children with intestinal helminths and 12.2% of children with protozoa. Conclusion: Although a high prevalence of intestinal protozoa was found in our study, the majority were non-pathogenic protozoa and the low prevalence of STH among school-age children in Lomé-commune region confirms that mass drug administration (MDA) is not needed. Children should receive additional education on best hygiene practices.

HIV-1 Viral Load and CD4 Assessment in HIV-1 Infected Pregnant Women Supported as Part of PMTCT in N’Djamena, Chad

In Sub-Saharan Africa, HIV affects lots of women of childbearing age;without prevention they can transmit the virus to their child. A cross-sectional study was conducted in the center of Psycho Medico-Social Support (APMS) in N’Djamena, Chad from January 2014 to March 2015. Our sampling concerned HIV-1 infected pregnant women followed up for PMTCT and their newborn. CD4+ lymphocytes and HIV-1 viral load were tested respectively with PIMATM and Abbott m2000 Real Time in mothers. Early infant diagnosis of HIV-1 was done in Children using PCR tool (Abbott m2000 Real Time). Pregnant women included in the study had a median age of 25 years (IQR, 22 - 30 years). Most of them (75.6%) (34/45), were under combination ART (TDF + 3TC or FTC + EFV). The median duration on ART was 4 month (IQR [3 - 5 months]). Nevirapine syrup was administrated to newborns as prophylaxis at least for the first six weeks of life until EID was done. At ART initiation, mothers’ LTCD4+ median was 249 cells/mm3 (IQR: 95 - 674 cells/mm3). After a median duration of 4 months on ART, LTCD4+ median was 530 cells/mm3 (IQR [263 - 1220 cells/mm3]). Viral load assessment in mothers showed that 15.5% (7/45) were undetectable, 75.6% (34/45) were detectable with a VL < 3log copies/ml and 8.8% (4/45) at virologic failure (VL > 3log copies/ ml). Four (11.4%) of 35 children included were tested positive at EID for HIV-1. Antiretroviral treatment management in pregnant women can improve their health and reduce the risk of MTCT. Availability of virologic monitoring in routine is essential for pregnant women in resources limited setting for preventing HIV transmission to their new-born and keep them alive.

Lichen-Spruce Woodland Early Indicators of Ecological Resilience Following Silvicultural Disturbances in Québec’s Closed-Crown Forest Zone

Lichen woodlands (LW) located in the closed-crown boreal forest are not a successional stage moving towards a closed black spruce feathermoss stand (FM), but an alternative stable state, due to their previous forest history, and the occurrence of LWs located nearby closed-crown FM stands. Therefore, afforestation in those LWs through site preparation and plantation could shift back LW into FM stands. We implemented an experimental design with different combinations of silvicultural treatments in both site types (LW, FM). We monitored the evolution of plant diversity and the physiology of three bio-indicators (Picea mariana, Kalmia angustifolia, Rhododendron groenlandicum) in different microsites created by the silvicultural treatments. The return to the initial composition was noticed only two years after treatments, especially in the LW stands, thus indicating a higher level of early ecosystem resilience in LWs compared to FM stands. Mean species cover, especially in the FM stands, decreased the most in the skid trails created by logging, probably due to a lack of acclimation of bryophytes to open stand conditions. Conversely, ericaceous shrubs and lichens found in the LWs were already acclimated to open stand conditions, which give to LWs a restructuring advantage compared to FM plant communities after silvicultural treatments. Overall, FM and LW short-term resilience was similar, indicating equally efficient ecosystem reorganization in both stands. The comparable early resilience in managed LW and FM stands, in terms of plant biodiversity, contradicts the presumed fragility of LW stands, especially in this case where LWs are assumed to be an alternative stable state created by compound disturbances. Silvicultural treatments maintained the functional group diversity in LWs, a key element for ecosystem resilience. Therefore, this study support the idea that plantation following site preparation in LWs could be a valuable management strategy to reach several objectives, such as increasing forest carbon sinks.

喜马拉雅山不同森林群落主要树种叶片元素性状与生物量之间的关系

植物需要多种基本元素调节并保持其特定比例以维持生长发育,叶片元素含量反映了植物的功能及其对环境的适应性.然而,在森林海拔梯度上,我们对于资源获取、光合作用和生长相关的叶片元素如何调节森林生物量仍知之甚少.本研究在喜马拉雅山干城章嘉峰地区沿热带森林(海拔80m)至高山树线(海拔4200m)设置海拔梯度样带,每间隔海拔100m设置一个样点,对116个树种的1859个个体测定了叶片中10种元素(C、N、P、K、Ca、Mg、Zn、Fe、Cu和Mn)的含量,通过计算叶片元素含量的群落加权平均值(反映优势物种的性状优势度,表征质量比效应)和功能离散度(反映物种在生态位空间内的聚集或者离散程度,表征互补效应),探究叶片元素含量及其离散程度沿海拔梯度分异特征,解析其对森林群落生物量的影响.研究结果表明,较强的叶片元素质量比效应和较弱的互补效应有利于森林群落生物量的积累.叶片元素性状多样性与海拔的共同作用对生物量的解释量(解释方差:52.2%)高于元素性状多样性的解释量(解释方差:0.05%~21%).海拔调节了树种性状多样性在生物量积累中的作用,互补效应在低海拔和高海拔地区对生物量的影响分别体现为积极和消极作用,这表明海拔和互补效应之间也存在交互作用.此外,海拔和质量比效应的交互作用对海拔梯度上生物量的影响也存在异质性.本研究表明,不同森林群落生物量的积累可能受到由海拔调控的性状多样性的影响.尽管较高的性状分异不利于生物量的积累,但能增强高海拔地区树种对胁迫环境的适应性.

Linking leaf elemental traits to biomass across forest biomes in the Himalayas

Plants require a number of essential elements in different proportions for ensuring their growth and development.The elemental concentrations in leaves reflect the functions and adaptations of plants under specific environmental conditions.However,less is known about how the spectrum of leaf elements associated with resource acquisition,photosynthesis and growth regulates forest biomass along broad elevational gradients.We examined the influence of leaf element distribution and diversity on forest biomass by analyzing ten elements(C,N,P,K,Ca,Mg,Zn,Fe,Cu,and Mn)in tree communities situated every 100 meters along an extensive elevation gradient,ranging from the tropical forest(80 meters above sea level)to the alpine treeline(4200 meters above sea level)in the Kangchenjunga Landscape in eastern Nepal Himalayas.We calculated communityweighted averages(reflecting dominant traits governing biomass,i.e.,mass-ratio effect)and functional divergence(reflecting increased trait variety,i.e.,complementarity effect)for leaf elements in a total of 1,859 trees representing 116 species.An increasing mass-ratio effect and decreasing complementarity in leaf elements enhance forest biomass accumulation.A combination of elements together with elevation explains biomass(52.2%of the variance)better than individual elemental trait diversity(0.05%to 21%of the variance).Elevation modulates trait diversity among plant species in biomass accumulation.Complementarity promotes biomass at lower elevations,but reduces biomass at higher elevations,demonstrating an interaction between elevation and complementarity.The interaction between elevation and mass-ratio effect produces heterogeneous effects on biomass along the elevation gradient.Our research indicates that biomass accumulation can be disproportionately affected by elevation due to interactions among trait diversities across vegetation zones.While higher trait variation enhances the adaptation of species to environmental changes,it reduces biomass accumulation,especially at higher elevations.