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Background: Sickle cell disease (SCD) disrupts oxygen transport due to the abnormal shape and rigidity of red blood cells, leading to hemolysis. Hemolysis, a major co-morbidity in SCD, is indicated by elevated levels of lactate dehydrogenase (LDH). Arginine depletion, which is essential for nitric oxide (NO) synthesis, contributes to various complications in SCD. L-arginine supplementation may increase NO levels and reduce oxidative stress. Research on its benefits in SCD, which is prevalent in sub-Saharan Africa, is limited. This study evaluates the effect of arginine supplementation on LDH levels in patients with steady state SCD., Methods: In a retrospective study, we evaluated the effect of arginine supplementation on LDH levels in a cohort of 31 patients. We divided the study into three phases: pre-HU treatment, HU treatment, and combined HU and arginine supplementation., Results: The cohort had a median age of 12 years, ranging from 2 to 43 years. Throughout all three phases of the study, lactate dehydrogenase (LDH) levels were consistently above the established normal ranges, with elevations of 216.7%, 220.3% and 176.6% above the normative values for baseline, Phase 1 (HU) and Phase 2 (HU + Arg), respectively. Specifically, LDH levels were 649.7 ± 364.2 U/L in Baseline Phase, 661.6 ± 367 U/L in Phase 1, and 529.9 ± 346.3 U/L in Phase 2. When comparing these discrete study intervals, it is noteworthy that LDH levels were significantly lower in Phase 2 compared to the previous phases ( p  = 0.002)., Conclusion: Preliminary findings revealed a significant lower LDH levels among sickle cell patients receiving combined arginine supplementation and hydroxyurea (HU). Although these findings are promising, their credibility and applicability require further and more extensive research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Ngonde, Lukanu, Mubiala and Aloni.)

Timely detection of outbreaks is needed for poliovirus eradication, but gold standard detection in the Democratic Republic of the Congo takes 30 days (median). Direct molecular detection and nanopore sequencing (DDNS) of poliovirus in stool samples is a promising fast method. Here we report prospective testing of stool samples from suspected polio cases, and their contacts, in the Democratic Republic of the Congo between 10 August 2021 and 4 February 2022. DDNS detected polioviruses in 62/2,339 (2.7%) of samples, while gold standard combination of cell culture, quantitative PCR and Sanger sequencing detected polioviruses in 51/2,339 (2.2%) of the same samples. DDNS provided case confirmation in 7 days (median) in routine surveillance conditions. DDNS enabled confirmation of three serotype 2 circulating vaccine-derived poliovirus outbreaks 23 days (mean) earlier (range 6-30 days) than the gold standard method. The mean sequence similarity between sequences obtained by the two methods was 99.98%. Our data confirm the feasibility of implementing DDNS in a national poliovirus laboratory., (© 2023. The Author(s).)

Human Mpox cases are increasingly reported in Africa, with the highest burden in the Democratic Republic of Congo (DRC). While case reporting on a clinical basis can overestimate infection rates, laboratory confirmation by PCR can underestimate them, especially on suboptimal samples like blood, commonly used in DRC. Here we used a Luminex-based assay to evaluate whether antibody testing can be complementary to confirm cases and to identify human transmission chains during outbreak investigations. We used left-over blood samples from 463 patients, collected during 174 outbreaks between 2013 and 2022, with corresponding Mpox and VZV PCR results. In total, 157 (33.9%) samples were orthopox-PCR positive and classified as Mpox+; 124 (26.8%) had antibodies to at least one of the three Mpox peptides. The proportion of antibody positive samples was significantly higher in Mpox positive samples (36.9%) versus negative (21.6%) ( p < 0.001). By combining PCR and serology, 66 additional patients were identified, leading to an Mpox infection rate of 48.2% (223/463) versus 33.9% when only PCR positivity is considered. Mpox infections were as such identified in 14 additional health zones and 23 additional outbreaks (111/174 (63.8% ) versus 88/174 (50.6%)). Our findings highlight the urgent need of rapid on-site diagnostics to circumvent Mpox spread.

This study analyzed the protein content of ten edible insect species (using the Dumas method), then focused on the amino acid (AA) profiles of the six major commercially relevant species using HPLC (high-pressure (or performance) liquid chromatography). The protein contents varied significantly from 46.1% to 52.9% (dry matter); the Orthoptera representative yielding both the highest protein content and the highest values in three essential amino acids (EAAs). Regarding Lepidoptera species, the protein content of Saturniidae varied more than for Notodontidae. Imbrasia ertli gave the best example of a species that could be suggested for dietary supplementation of cereal-based diets, as the sample contained the highest values in five EAAs and for the EAA index. Furthermore, first-limiting AAs in the selected insects have also been pointed out (based on a species-specific AA score), supporting that the real benefit from eating insects is correlated to a varied diet. Additionally, preliminary insights into AA distribution patterns according to taxa provided three clusters based on protein quality and should be completed further to help tailor prescriptions of dietary diets. Since the AA composition of the selected insects was close to the FAO/WHO EAA requirement pattern for preschool children and met the requirements of 40% EAAs with high ratio EAAs/NEAAs, the current study endorses reports of edible insects as nutrient-rich and sustainable protein sources.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century.

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.

Background: The progress of mass, community-directed, treatment with ivermectin (CDTI) for onchocerciasis control was disrupted by severe adverse effects (SAE) in the Democratic Republic of Congo (DRC). The study aimed at determining the frequency of post-CDTI SAE as well as factors associated with the occurrence of SAE., Methods: Our retrospective study relied on SAE collection cards, as archived by the DRC Ministry of Health, and compiled for people who benefited from ivermectin treatment then further developed SAE. The study included 945 post-CDTI SAE recorded in DRC between 2003 and 2017. These cases occurred in 15 projects out of 22 projects implemented in the country. All cards were reviewed and analysed., Results: Between the years 2003 and 2017, the total average population treated was around 15,552,588 among which 945 cases of SAE were registered in DR Congo, i.e. 6 cases of SAE for 100,000 persons treated per year. 55 deaths related to post-CDTI SAE were recorded, which represents 5.8% of all cases of SAE. Non-neurological SAE were dominated by severe headaches (74.8%), myalgia (64.0%) and arthralgia (62.7%). Neurological SAE were mainly coma (94.1%), motor deficit (75.4%) and palpebral subconjunctival haemorrhages (38.8%). Factors associated with the occurrence of SAE were: male, age over 18 years old, alcohol consumption, hemp intake and the presence of loiasis. The study also highlighted weaknesses of the National Program for Onchocerciasis Control (NPOC)  in terms of awareness campaigns among the population., Conclusion: Co-endemicity of loiasis and onchocerciasis is one of the key factors responsible for the occurrence of SAE following ivermectin treatment. Mobilization of resources necessary to the appropriate management of SAE and awareness of populations are essential to achieve onchocerciasis control in DRC.

The success of community-directed treatment with Ivermectin (CDTI) depends on active community participation. We conducted a case study nested in a cross-sectional study in the Binza Ozone Health Zone (ZS) in Kinshasa, Democratic Republic of Congo, in order to investigate community's knowledges and perceptions of onchocerciasis and on all CDTI's aspects. We interviewed 106 people aged 20 and over, purposively selected, through eight individual interviews and 12 focus groups. Themes used for collecting data were drawn for the Health Belief Model and data were analyzed using a deductive thematic approach. The term onchocerciasis was unknown to participants who called it "Mbitiri", the little black fly, in their local language. This disease is seen as curse put on the sufferer by a witch and perceived as a threat because of the "Mbitiri" bites. The afflicted participants were reluctant to seek treatment and preferred traditional practitioners or healers. CDTI is considered devastating because of adverse effects of ivermectin as well as inefficient after occurrence of deaths. This explains the low level of community adhesion and participation to this strategy. Recruitment procedures for community distributors are poorly understood and awareness and health education campaigns are either non-existent or rarely carried out. Nevertheless, the latter should be regularly done.

Introduction: The establishment of the influenza sentinel surveillance system in Kinshasa, Bas Congo, Maniema, Katanga, and Kasai Provinces allowed generation of important data on the molecular epidemiology of human influenza viruses circulating in the Democratic Republic of Congo (DRC). However, some challenges still exist, including the need for extending the influenza surveillance to more provinces. This study describes the pattern of influenza virus circulating in DRC during 2015., Methodology: Nasopharyngeal swabs were collected from January to December 2015 from outpatients with influenza-like illness (ILI) and in all hospitalized patients with Severe Acute Respiratory Infection (SARI). Molecular analysis was done to determine influenza type and subtype at the National Reference Laboratory (NRL) in Kinshasa using real time reverse transcription-polymerase chain reaction (rRT-PCR). Analysis of antiviral resistance by enzyme inhibition assay and nucleotide sequencing was performed by the Collaborating center in the USA (CDC, Atlanta)., Results: Out of 2,376 nasopharyngeal swabs collected from patients, 218 (9.1%) were positive for influenza virus. Among the positive samples, 149 were characterized as influenza virus type A (Flu A), 67 as type B (Flu B) and 2 mixed infections (Flu A and B). Flu A subtypes detected were H3N2 and H1N1. The Yamagata strain of Flu B was detected among patients in the country. Individuals aged between 5 and 14 years accounted for the largest age group affected by influenza virus. All influenza viruses detected were found to be sensitive to antiviral drugs such as oseltamivar, zanamivir, peramivir and laninamivar., Conclusion: The present study documented the possible involvement of both circulation of Flu A and B viruses in human respiratory infection in certain DRC provinces during 2015. This study emphasises the need to extend the influenza surveillance to other provinces for a better understanding of the epidemiology of influenza in DRC. It is envisioned that such a system would lead to improved disease control and patient management., Competing Interests: The authors have declared that no competing interests exist.

Study Objectives: The screening of anti-Human Immunodeficiency Virus antibodies is mandatory in every blood donor admitted to the Blood Bank of Kinshasa University Clinics since 1984. However, no compiled data are available to date. The objective of this study was to establish the trend, prevalence, viral co-infections, and determinants of Human Immunodeficiency anti-Virus serology in blood donors admitted between 2003-2006 and 2008-2013., Patients and Methods: A retrospective analysis was carried out at University Kinshasa Clinics, using blood donors' records during 2003-2006 and 2008-2013. The prevalence of the human immunodeficiency virus per year, age, sex and type of blood donors were estimated. Independent predictors of human immunodeficiency virus seropositivity were also identified., Results: Out of 26,341 blood donors, 2.2% (n=576/26,341) were seropositive for Human Immunodeficiency Virus. Age<25 years (OR=1.7; 95% CI: 1.4-2; P<0.0001) and Hepatitis C virus seropositivity (OR=3; 95% CI; 1.8-4.9; P<0.001) emerged as independent predictors of Human Immunodeficiency Virus seropositivity., Conclusion: This study shows a strong association between the Human Immunodeficiency Virus and hepatitis C and younger age respectively. Further studies are needed to ensure safety of Blood donation in Democratic Republic of Congo., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Objectives: To study the prevalence and risk markers of diabetes mellitus and intermediate hyperglycaemia (IH) in Kisantu, a semirural town in Bas-Congo province, The Democratic Republic of Congo., Design: A cross-sectional population-based survey., Settings: A modified WHO STEPwise strategy was used. Capillary glycaemia was measured for fasting plasma glucose and 2-h-postload glucose. Both WHO/IDF (International Diabetes Federation) 2006 and American Diabetes Association (ADA) 2003 diagnostic criteria for diabetes and IH were used., Participants: 1898 subjects aged ≥ 20 years., Results: Response rate was 93.7%. Complete data were available for 1759 subjects (86.9%). Crude and standardised (for Doll and UN population) prevalence of diabetes were 4.8% and 4.0-4.2%. Crude IH prevalence was 5.8% (WHO/IDF) and 14.2% (ADA). Independent risk markers for diabetes (p<0.01) were male (OR 2.5), age 50-69 years (OR 2.6), family history (OR 3.5), waist (OR 4.1) and alcohol consumption (OR 0.36). In receiver operating characteristic (ROC) analysis, prediction of diabetes was slightly better by waist than body mass index (BMI). IH defined according to WHO/IDF was associated with BMI (OR 2.6, p<0.001). IH defined according to ADA was associated (p<0.05) with waist (OR 1.4), education level (OR 1.6), BMI (OR 2.4) and physical activity (OR 0.7)., Conclusions: Current prevalence of diabetes in DR Congo exceeds IDF projections for 2030. The lower glucose threshold used by ADA almost triples impaired fasting glucose prevalence compared to WHO/IDF criteria. The high proportion of disorders of glycaemia made up by IH suggests the early stages of a diabetes epidemic.

Aim: To determine the prevalence and determinants of microalbuminuria and macroalbuminuria in type 1 Congolese diabetics aged less than 30 years., Methods: Cross sectional study (june-july 2008) at the Primary Health Care Center Boyambi in Kinshasa, The Democratic Republic of the Congo. HbA(1c) and urine albumin excretion (UAE) were measured by an enzyme immunoassay method. Determinants of microalbuminuria and macroalbuminuria were assessed by logistic regression., Results: One hundred and eighty-one type 1 diabetics (female gender: 61.3%) were included in this study. They were aged 19.1+/-5.8 years and were diabetics for 57.6+/-45.1 months. HbA(1c) was superior or equal to 10% in 88%, between 7 and 10% in 4% and inferior to 7% in 8%. Prevalence of microalbuminuria and macroalbuminuria was 21.9% and 7.3%, respectively. Diabetes duration superior to 5 years (OR: 4.1; 95% CI [1.9-8.4]), age superior to 18 years (OR: 2.9 [1.3-6.2]) and HbA(1c) superior to 10% (OR: 2.6 [1.1-6.4]) were independent determinants of pathological UAE., Conclusion: Microalbuminuria and even macroalbuminuria are very frequent in type 1 Congolese diabetics aged above or equal to 30 years, especially in those aged above 18 years and diabetics for more than 5 years. Improving diabetes control and treating microalbuminuria is urgently needed to prevent renal insufficiency among children and young adults with type 1 diabetes of The Democratic Republic of the Congo.

Administered alone, calcium entry blockers (CEB) are effective antihypertensive agents in the aged, and their blood pressure lowering action is similar to that of other antihypertensive drugs. CEB may be regarded as alternatives to diuretics in the elderly, and they should be used instead of diuretics when these are contraindicated. The effectiveness of CEB might be explained by some characteristics of old age, such as elevated mean blood pressure, reduced plasma renin activity, blunted sympathetic activity, altered drug pharmacokinetics and so forth. CEB appear to have a favourable metabolic profile and to be as safe in the elderly as in younger patients. The beneficial effects of CEB on mortality, morbidity and quality of life in geriatric hypertension still need to be established.