BACKGROUND & AIMS: BACKGROUND:Human African trypanosomiasis (sleeping sickness), an endemic disease, is currently reemerging in Africa with an estimated incidence of 45,000 new cases per year. It is caused by Trypanosoma brucei subspecies and transmitted by day-biting tsetse flies. PATIENTS AND METHODS:We report a case of West African trypanosomiasis due to Trypanosoma brucei gambiense involving a Frenchman living in Libreville, Gabon. The patient presented with fever and polyadenopathies as well as two skin ulcerations highly suggestive of trypanosomiasis. Microscopic examination of cutaneous and peripheral blood smears confirmed the diagnosis of haemolymphatic infection with T. b. gambiense with trypanosomal chancres. Examination of the cerebrospinal fluid was normal. The patient was successfully treated with pentamidine isethionate. CONCLUSIONS:Recognition of cutaneous manifestations may allow a rapid diagnosis of African trypanosomiasis that is essential for timely and efficient treatment and survival.

背景与目标： 背景：人类锥虫病（昏睡病）是一种地方性疾病，目前正在非洲重新流行，估计每年发生45,000例新病例。它是由布鲁氏锥虫亚种引起的，并且是由叮咬的采采蝇传播的。
病人和方法：我们报告了一例西非锥虫病，该病例是由法国人居住在加蓬利伯维尔的布鲁氏锥虫引起的。该患者出现发烧，多腺病以及两次皮肤溃疡，强烈提示锥虫病。皮肤和外周血涂片的显微镜检查证实了T. b的血淋巴感染的诊断。甘菊与锥虫性小结。脑脊液检查正常。该患者已成功使用喷他is乙羟乙磺酸盐治疗。
结论：认识到皮肤表现可能可以快速诊断非洲锥虫病，这对于及时有效的治疗和生存至关重要。

BACKGROUND & AIMS: The efficacy of a 3-day clindamycin-quinine regimen to treat clinical malaria attacks was investigated in 256 children from western Gabon. Treatment was well tolerated by all of the children and its efficacy was higher than 97% by day 20. Thus this 3-day clindamycin-quinine regimen might constitute a potential alternative to chloroquine for treating clinical malarial attacks in children from Gabon.

背景与目标： 在来自加蓬西部的256名儿童中研究了为期3天的克林霉素-奎宁方案治疗临床疟疾的疗效。所有儿童对这种疗法的耐受性都很好，到20天时其疗效已超过97％。因此，这种3天的克林霉素-奎宁方案可能替代氯喹，用于治疗加蓬儿童的临床疟疾。

BACKGROUND & AIMS: :In this study, we characterize the diversity and estimated infection levels of gastrointestinal parasites circulating in two galago species, Galago demidoff and G. thomasi in two sites situated in the Southeastern forests of Gabon. Our study reveals that eleven parasites including nine helminthes (Ascaris spp., Ankylostoma spp., Dicrocoelium spp., Gongylonema spp., Oesophagostomum spp., Lemuricola spp., Strongyloides spp. Trichostrongylus spp. and Trichuris spp.) and two protozoans (Balantidium spp. and Entamoeba spp.) may infect Galago spp. with high infection rates. The results show that: a very similar parasite spectrum is found in both host species; all the taxa identified were previously observed in other Primate species and/or Man. They also show that age, gender and forest type may influence infection rates and/or parasite diversity found in a particular host and/or geographic area.

背景与目标： ：在这项研究中，我们描述了在加蓬东南森林中两个地点的两个加拉戈物种加拉戈·德米多夫和托马斯·G。thomasi中循环的胃肠道寄生虫的多样性和估计的感染水平。我们的研究揭示了11种寄生虫，其中包括9种蠕虫（A虫属，脚突动物属，双囊纲属，弓形纲属，食管造口菌属，Lemuricola属，Strongyloides属，Trichostrongylus spp。和Trichustrongylus spp。和Trichustrongylus spp。和Trichustrongylus spp。和Trichustrongylus spp。和Trichustrongylus spp。（三毛）。菌和Entamoeba菌）可能会感染Galago菌。感染率很高。结果表明：在两种寄主物种中都发现了非常相似的寄生虫谱；先前在其他灵长类和/或人类中观察到的所有分类单元。他们还表明年龄，性别和森林类型可能会影响在特定宿主和/或地理区域中发现的感染率和/或寄生虫多样性。

BACKGROUND & AIMS: :Plasma lipoprotein(a) (Lp(a)) is a quantitative trait associated with atherothrombotic disease in European and Asian populations. Lp(a) concentrations vary widely within and between populations, with Africans exhibiting on average two- to threefold higher Lp(a) levels and a different distribution compared to Europeans. The apo(a) gene locus on chromosome 6q26-27 (LPA, MIM 152200) has been identified as the major quantitative trait locus (QTL) for Lp(a) concentrations in Europeans and populations of African descent (North American and South African Blacks) but data on autochthonous Black Africans are lacking.Here, we have analysed Lp(a) plasma concentrations, apo(a) isoforms in plasma and four polymorphisms in the LPA gene in 31 African families with 54 children from Gabon. Weighted midparent-offspring regression estimated a heritability h2=0.76. The correlation of Lp(a) levels associated with LPA alleles identical by descent (IBD) resulted in a heritability estimate of 0.801. Our data demonstrate that Lp(a) concentrations are highly heritable in a Central African population without admixture and high Lp(a) (median 43 mg/dl). LPA is the major QTL, explaining most or all of the heritability of Lp(a) in this population.

背景与目标： ：血浆脂蛋白（a）（Lp（a））是与欧洲和亚洲人群中的动脉粥样硬化血栓形成疾病相关的定量性状。 Lp（a）浓度在人群内部和人群之间差异很大，与欧洲人相比，非洲人的Lp（a）水平平均高出2到3倍，分布也有所不同。染色体6q26-27（LPA，MIM 152200）上的apo（a）基因基因座已被确定为欧洲人和非洲人后裔（北美和南非黑人）Lp（a）浓度的主要定量性状基因座（QTL） ），但缺乏有关当地黑人非洲人的数据。在此，我们分析了31个非洲家庭（有54名加蓬儿童）的血浆Lp（a）血浆浓度，血浆apo（a）亚型以及LPA基因的四个多态性。加权的中父母-后代回归估计遗传力h2 = 0.76。与血统相同的LPA等位基因相关的Lp（a）水平的相关性（IBD）导致遗传度估计为0.801。我们的数据表明，Lp（a）的浓度在没有混合和高Lp（a）（中值43 mg / dl）的中非人群中是高度可遗传的。 LPA是主要的QTL，解释了该人群Lp（a）的大部分或全部遗传力。

BACKGROUND & AIMS: :Deep-sea mussels of the genus Bathymodiolus (Bivalvia: Mytilidae) harbor symbiotic bacteria in their gills and are among the dominant invertebrate species at cold seeps and hydrothermal vents. An undescribed Bathymodiolus species was collected at a depth of 3,150 m in a newly discovered cold seep area on the southeast Atlantic margin, close to the Zaire channel. Transmission electron microscopy, comparative 16S rRNA analysis, and fluorescence in situ hybridization indicated that this Bathymodiolus sp. lives in a dual symbiosis with sulfide- and methane-oxidizing bacteria. A distinct distribution pattern of the symbiotic bacteria in the gill epithelium was observed, with the thiotrophic symbiont dominating the apical region and the methanotrophic symbiont more abundant in the basal region of the bacteriocytes. No variations in this distribution pattern or in the relative abundances of the two symbionts were observed in mussels collected from three different mussel beds with methane concentrations ranging from 0.7 to 33.7 microM. The 16S rRNA sequence of the methanotrophic symbiont is most closely related to those of known methanotrophic symbionts from other bathymodiolid mussels. Surprisingly, the thiotrophic Bathymodiolus sp. 16S rRNA sequence does not fall into the monophyletic group of sequences from thiotrophic symbionts of all other Bathymodiolus hosts. While these mussel species all come from vents, this study describes the first thiotrophic sequence from a seep mussel and shows that it is most closely related (99% sequence identity) to an environmental clone sequence obtained from a hydrothermal plume near Japan.

背景与目标： ：Bathymodiolus（Bivalvia：Mytilidae）属的深海贻贝在其g中带有共生细菌，并且在冷渗漏和热液喷口处是主要的无脊椎动物。在3,150 m的深度处，在东南大西洋边缘的一个新发现的冷渗漏区（靠近扎伊尔河道），收集了一个未描述的比目鱼种类。透射电镜，比较16S rRNA分析和荧光原位杂交表明，该比毛菌属。生活在与硫化物和甲烷氧化细菌的双重共生中。观察到the共生细菌在the上皮细胞中有明显的分布模式，其中硫营养型共生菌占根尖区，而甲烷营养型共生菌在细菌细胞的基底区更丰富。在从三个不同的贻贝床收集的贻贝中，甲烷浓度范围为0.7至33.7 microM的贻贝中，未观察到这种分布模式或两个共生体的相对丰度的变化。甲烷营养共生体的16S rRNA序列与已知的其他营养双歧贻贝的甲烷营养共生体的16S rRNA序列最密切相关。出人意料的是，硫营养型Bathymodiolus sp。 16S rRNA序列不属于所有其他嗜水梭菌宿主的硫营养共生体的单系序列。虽然这些贻贝物种全部来自通风孔，但这项研究描述了渗水贻贝的第一个硫营养序列，并表明它与从日本附近的热液羽流获得的环境克隆序列最密切相关（99％序列同一性）。

BACKGROUND & AIMS: OBJECTIVES:To assess the relationship between the presence of DHFR and DHPS mutations in Plasmodium falciparum, parasite in vitro resistance, and in vivo efficacy of sulfadoxine-pyrimethamine (SP) treatment. PATIENTS AND METHODS:Measurement of SP treatment efficacy in malaria-infected children in Gabon was combined with in vitro tests of susceptibility to pyrimethamine and cycloguanil, and molecular genotyping at several DHFR and DHPS loci of parasites isolated before treatment. DHFR was studied at codons 108, 51, and 59, whereas DHPS gene was typed at positions 436, 437, 540 and 581. RESULTS:SP treatment was effective in 86% of children by day 28. Seventy-five percent of isolates were in vitro resistant to pyrimethamine and 65.5% to cycloguanil. No mutation was detected at codons 540 and 581 of the DHPS gene. Most isolates (71.8%) presented with the triple mutant DHFR genotype, whereas 64.3% combined at least three DHFR and one DHPS mutations. The increase in the number of DHFR mutations was associated with an increase in in vitro resistance to pyrimethamine and cycloguanil; three DHFR mutations conferred pyrimethamine and to a lesser extent cycloguanil resistance. Treatment failures only occurred with isolates presenting at least two DHFR mutations (S108N and C59R) and one DHPS mutation (S436A or A437G), but SP treatment of infections with such parasites gave treatment success in 82.0% of children. CONCLUSIONS:DHFR mutations that lead to high-level in vitro resistance to pyrimethamine plus 1-2 DHPS mutations are not sufficient to induce in vivo failure of SP treatment in young children from Gabon.

背景与目标： 目的：评估恶性疟原虫中DHFR和DHPS突变的存在，寄生虫的体外抗药性以及磺胺多辛-乙胺嘧啶（SP）治疗的体内疗效之间的关系。
病人和方法：结合加蓬疟原虫的体外测试，对乙胺嘧啶和环鸟嘌呤的敏感性以及在治疗前分离出的几个寄生虫的DHFR和DHPS位点的分子基因分型，结合SP治疗效果的测量。 DHFR在密码子108、51和59上进行了研究，而DHPS基因在436、437、540和581位进行分型。
结果：到28天，SP治疗对86％的儿童有效。75％的分离株对乙胺嘧啶具有体外抗药性，对环鸟嘌呤有65.5％的抗药性。在DHPS基因的密码子540和581处未检测到突变。大多数分离株（71.8％）表现出三重突变DHFR基因型，而64.3％结合了至少三个DHFR和一个DHPS突变。 DHFR突变数目的增加与体外对乙胺嘧啶和环鸟嘌呤的抗性增加有关。三个DHFR突变赋予了乙胺嘧啶，并在较小程度上赋予了环鸟嘌呤耐药性。只有出现至少两个DHFR突变（S108N和C59R）和一个DHPS突变（S436A或A437G）的分离株才发生治疗失败，但是SP感染这种寄生虫的感染使82.0％的儿童获得治疗成功。
结论：导致高水平的体外对乙胺嘧啶抗性的DHFR突变加上1-2 DHPS突变不足以诱发加蓬幼儿SP治疗的体内失败。

BACKGROUND & AIMS: :In order to minimize risks of pathogen transmission with the development of ecotourism in Gabon, a seasonal inventory has been performed in five contrasted biotopes in Ivindo (INP) and Moukalaba-Doudou (MDNP) National Parks. A total of 10,033 hematophagous flies were captured. The Glossinidae, with six different species identified, was the most abundant group and constitutes about 60% of the captured flies compared to the Stomoxys (6 species also identified) and Tabanidae with 28% and 12%, respectively. The Glossinidae showed a higher rate of capture in primary forest and in research camps. In INP, the Stomoxys showed a higher rate of capture in secondary forest and at village borders, whereas in MDNP the Stomoxys were captured more in the savannah area. Thus, each fly group seemed to reach maximum abundance in different habitats. The Glossinidae were more abundant in primary forest and near research camps while Stomoxys were more abundant in secondary forest and savannah. The Tabanidae did not show a clear habitat preference.

背景与目标： ：为了在加蓬进行生态旅游的过程中将病原体传播的风险降到最低，已在伊文多（INP）和穆卡巴拉巴-杜杜（MDNP）国家公园的五个形成鲜明对比的生物群落中进行了季节性调查。总共捕获了10,033个食血蝇。识别出六个不同物种的鹰嘴豆科是最丰富的一类，占被捕获苍蝇的约60％，而Stomoxys（也鉴定出六个物种）和Tabanidae分别占28％和12％。 loss科在原始森林和研究营地中的捕获率更高。在INP中，Stomoxys在次生森林和村庄边界的捕获率更高，而在MDNP中，Stomoxys在大草原地区的捕获率更高。因此，每个苍蝇群似乎在不同的生境中达到最大的丰度。在原始森林和研究营地附近，牛舌科更为丰富，而次生森林和大草原中的Stomoxys则更为丰富。 an科没有明显的栖息地偏好。

BACKGROUND & AIMS: Plasmodium falciparum malaria continues to threaten human populations in the tropics and travellers in endemic areas. Drug resistance of the parasite is a major problem in treating this devastating disease. In a prospective trial we investigated the in vitro sensitivity of Plasmodium falciparum to chloroquine, quinine and mefloquine in the Albert Schweitzer Hospital in Lambaréné, Gabon every second year from 1992 to 1998. We used the standard WHO in vitro sensitivity assay. Parasite sensitivity to quinine and mefloquine remained stable over the years. However, parasite resistance to chloroquine decreased highly significantly with the change in local malaria treatment policy. In 1992, 100% of parasite isolates showed resistance to chloroquine, whereas in 1998 only 45% were found resistant.

背景与目标： 恶性疟原虫疟疾继续威胁热带地区的人口和流行地区的旅行者。寄生虫的耐药性是治疗这种破坏性疾病的主要问题。在一项前瞻性试验中，我们从1992年至1998年每隔第二年在加蓬Lambaréné的Albert Schweitzer医院调查了恶性疟原虫对氯喹，奎宁和甲氟喹的体外敏感性。我们使用了标准的WHO体外敏感性测定。这些年来，寄生虫对奎宁和甲氟喹的敏感性保持稳定。但是，随着当地疟疾治疗政策的改变，对氯喹的寄生虫抵抗力大大降低。在1992年，100％的寄生虫分离株显示出对氯喹的抗药性，而在1998年，发现只有45％的抗药性。

BACKGROUND & AIMS: :A new species of quill mites (Syringophilidae) Syringophiloidus plocei sp. nov. parasitizing Ploceus cucullatus (St. Muller) (type host), P. aurantius (Vieillot) and P. nigerrimus (Vieillot) (Ploceidae: Passeriformes) in Gabon is described using external morphology and DNA barcode data (the mitochondrial cytochrome c oxidase subunit I sequences (COI) and D1-D3 region of the nuclear 28S rRNA gene). Females of S. plocei sp. nov. differ from S. pseudonigritae Glowska, Dragun-Damian and Dabert, 2012 by the length of setae ag3 190-230 (vs 145-160). The genetic distances (K2P) between COI haplotypes of S. plocei sp. nov. individuals (from P. cucullatus, P. nigerrimus and P. aurantius) and S. pseudonigritae ranges from 13.1-13.7%.

背景与目标： ：一种新的纤毛螨（Syringophilidae）Syringophiloidus plocei sp。十一月使用外部形态学和DNA条码数据（线粒体细胞色素C氧化酶亚基I）描述了加蓬寄生的小古怪Ploceus cucullatus（圣穆勒）（宿主类型），金黄色葡萄球菌（Vieillot）和黑假单胞菌（Vieillot）（Ploceidae：Passeriformes）。序列（COI）和28S rRNA核基因的D1-D3区）。 S. plocei sp。的雌性。十一月与set。ag3 190-230（vs 145-160）的长度不同，与S. pseudonigritae Glowska，Dragun-Damian和Dabert，2012年有所不同。 S. plocei sp。COI单倍型之间的遗传距离（K2P）。十一月个体（来自P. cucullatus，P。nigerrimus和P. aurantius）和S. pseudonigritae的比例为13.1-13.7％。

BACKGROUND & AIMS: BACKGROUND:Malaria remains a major public health problem, due largely to emergence and widespread P. falciparum drug resistance. WHO recommends artemisinine combination based therapy (ACT) to overcome P. falciparum drug resistance, but reports of declining ACT efficacy have been published. A thorough understanding of the molecular bases of P. falciparum resistance to existing drugs is therefore needed. The aims of this study were to analyze the in vitro sensitivity of P. falciparum field isolates from Franceville, Gabon, to chloroquine (CQ), mefloquine (MF), dihydroartemisinine (DHA) and monodesethylamodiaquine (MDAQ), and to investigate polymorphisms associated with drug resistance. METHODS:We conducted a cross-sectional study of 53 field isolates. Field isolates sensitivity to CQ, MF, DHA and MDAQ was assessed using the colorimetric DELI test. The Pfmdr1 codons 86 and 1246, Pfcrt (haplotype codon 72 to 76) and the PfATPAse6 codons 110 and 2694 were analysed by PCR-RFLP. Associations between drug sensitivity and parasite gene polymorphisms were evaluated with the Chi square test, and routine hematological parameters were analyzed with Fisher's exact test implemented with Epinfo software. In all statistical tests, significance was assumed at p<0.05. RESULTS:A total of 46 P. falciparum isolates were successfully cultured in vitro and their sensitivity was tested. The proportions of isolates resistant to CQ, MF and MDAQ were 43.5%, 23.4% and 56.5%, respectively. Some isolates (23.9%) had DHA IC50 values higher than 10 nM. The median IC50 values were 71.67 (interquartile range (IQR, 1-438.2), 6.59 (IQR, 0.08-96), 64.79 (IQR, 0.09-448) and 6.45 nM (IQR, 0.09-23) for CQ, MF, MDAQ and DHA, respectively. The strongest correlation between diminished DHA sensitivity and MF resistance was observed (r2=0.73), followed by correlation between diminished DHA sensitivity and CQ resistance. Cross-resistance between CQ and MF was also observed. The prevalence of the 86Y and 1246Y mutations in Pfmdr1, 76T in Pfcrt, and 110A and 2694T in PfATPase6 was respectively 42% and 17.1%, 97.8%, and 0% and 22.2%. CONCLUSION:These high levels of antimalarial drug resistance in Franceville, Gabon, call for reinforced surveillance of drug efficacy.

背景与目标： 背景：疟疾仍然是主要的公共卫生问题，这主要是由于恶性疟原虫耐药性的出现和广泛存在。世卫组织建议以青蒿素为基础的联合疗法（ACT）来克服恶性疟原虫的耐药性，但已发表了有关ACT疗效下降的报道。因此，需要彻底了解恶性疟原虫对现有药物的抗性的分子基础。这项研究的目的是分析来自法国弗朗斯维尔，加蓬的恶性疟原虫野外分离株对氯喹（CQ），甲氟喹（MF），双氢青蒿素（DHA）和单去甲二甲基喹（MDAQ）的体外敏感性，并研究与之相关的多态性。耐药性。
方法：我们对53个野外分离株进行了横断面研究。使用比色DELI测试评估了现场分离株对CQ，MF，DHA和MDAQ的敏感性。通过PCR-RFLP分析了Pfmdr1密码子86和1246，Pfcrt（单倍型密码子72至76）和PfATPAse6密码子110和2694。用卡方检验评估药物敏感性和寄生虫基因多态性之间的关联，并使用Epinfo软件实施的Fisher精确检验分析常规血液学参数。在所有统计检验中，显着性假设为p <0.05。
结果：共成功分离出46株恶性疟原虫分离株，并对其敏感性进行了测试。抗CQ，MF和MDAQ的分离株比例分别为43.5％，23.4％和56.5％。一些分离株（23.9％）的DHA IC50值高于10 nM。对于CQ，MF和MDAQ，IC50的中间值分别为71.67（四分位间距（IQR，1-438.2），6.59（IQR，0.08-96），64.79（IQR，0.09-448）和6.45 nM（IQR，0.09-23）分别观察到DHA和DHA灵敏度降低之间的最强相关性（r2 = 0.73），其次是DHA灵敏度降低与CQ电阻之间的相关性，还观察到CQ和MF之间的交叉抗性，86Y的患病率Pfmdr1，Pfcrt中的76T和PfATPase6中的110A和2694T的1246Y和1246Y突变分别为42％和17.1％，97.8％，0％和22.2％。
结论：在加蓬弗朗斯维尔，这些高水平的抗疟药耐药性要求加强对药物疗效的监测。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVE:Epilepsy is a major public health issue in low- and middle-income countries, where the availability and accessibility of quality treatment remain important issues, the severity of which may be aggravated by poor quality antiepileptic drugs (AEDs). The primary objective of this study was to measure the quality of AEDs in rural and urban areas in 3 African countries. METHODS:This cross-sectional study was carried out in Gabon, Kenya, and Madagascar. Both official and unofficial supply chains in urban and rural areas were investigated. Samples of oral AEDs were collected in areas where a patient could buy or obtain them. Pharmacological analytical procedures and Medicine Quality Assessment Reporting Guidelines were used to assess quality. RESULTS:In total, 102 batches, representing 3782 units of AEDs, were sampled. Overall, 32.3% of the tablets were of poor quality, but no significant difference was observed across sites: 26.5% in Gabon, 37.0% in Kenya, and 34.1% in Madagascar (P = .7). The highest proportions of substandard medications were found in the carbamazepine (38.7%; 95% confidence interval [CI] 21.8-57.8) and phenytoin (83.3%; 95% CI 35.8-99.5) batches, which were mainly flawed by their failure to dissolve. Sodium valproate was the AED with the poorest quality (32.1%; 95% CI 15.8-42.3). The phenobarbital (94.1%; 95% CI 80.3-99.2) and diazepam (100.0%) batches were of better quality. The prevalence of substandard quality medications increased in samples supplied by public facilities (odds ratio [OR] 9.9; 95% CI 1.2-84.1; P < .04) and manufacturers located in China (OR 119.8; 95% CI 8.7-1651.9; P < .001). The prevalence of AEDs of bad quality increased when they were stored improperly (OR 5.4; 95% CI 1.2-24.1; P < .03). SIGNIFICANCE:No counterfeiting was observed. However, inadequate AED storage conditions are likely to lead to ineffective and possibly dangerous AEDs, even when good-quality AEDs are initially imported.

背景与目标： 目的：癫痫病是低收入和中等收入国家的主要公共卫生问题，在这些国家，优质治疗的可获得性和可及性仍然是重要问题，劣质抗癫痫药物（AED）可能会加重其严重性。这项研究的主要目的是测量3个非洲国家农村和城市地区AED的质量。
方法：这项横断面研究在加蓬，肯尼亚和马达加斯加进行。对城市和农村地区的官方和非正式供应链进行了调查。在患者可以购买或获得的地方收集口服AED的样品。使用药理分析程序和《药物质量评估报告指南》评估质量。
结果：总共采样了102批次，代表了3782单位的AED。总体而言，有32.3％的药片质量较差，但在各个站点之间均未观察到明显差异：加蓬为26.5％，肯尼亚为37.0％，马达加斯加为34.1％（P = 0.7）。在卡马西平（38.7％; 95％置信区间[CI] 21.8-57.8）和苯妥英钠（83.3％; 95％CI 35.8-99.5）批次中发现不合格药物的比例最高，其主要缺陷在于无法溶解。丙戊酸钠是质量最差的AED（32.1％; 95％CI 15.8-42.3）。苯巴比妥（94.1％; 95％CI 80.3-99.2）和地西epa（100.0％）批次的质量较好。在公共设施（比值比[OR] 9.9; 95％CI 1.2-84.1; P <.04）和位于中国的制造商提供的样品中，不合格质量药物的流行率有所增加（OR 119.8; 95％CI 8.7-1651.9; P <.001）。如果储存不当，劣质AED的患病率会增加（OR 5.4; 95％CI 1.2-24.1; P <.03）。
意义：未发现伪造。但是，即使最初进口的是优质AED，AED的储存条件不足也可能导致AED失效，甚至可能导致危险。

BACKGROUND & AIMS: INTRODUCTION:As antiretroviral treatment (ART) continues to expand in resource-limited countries, the emergence of HIV drug resistance mutations (DRMs) is challenging in these settings. In Gabon (central Africa), no study has yet reported the virological effectiveness of initial ART given through routine HIV care. METHODS:Following the World Health Organization (WHO) recommendations, a cross-sectional study with a one-time HIV-1 RNA viral load (VL) measurement was conducted in Gabon to assess virological failure (VF) defined by a VL result ≥1000 copies/ml and DRMs among adult patients living with non-B HIV-1 strains and receiving first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy for at least 12 months. Risk factors associated with VF and DRMs were assessed. RESULTS:Between March 2010 and March 2011, a total of 375 patients were consecutively enrolled from two decentralized (one semirural and one rural) HIV care centres. Median time on ART was 33.6 months (range, 12-107). Overall, the rate of VF was 41.3% (36.4-46.4). Among viremic patients, 56.7% (80/141) had at least one DRM and 37.6% had dual-class resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and NNRTIs. The most frequent DRMs were K103N/S (46.1%) and M184V/I (37.6%). Thymidine analogue mutations were found in 10.6%. Independent risk factors associated with VF were being followed up at the semirural centre (P=0.033), having experienced unstructured treatment interruptions (P=0.0044), and having low CD4+ counts at enrolment (P<0.0001). A longer time on ART (P=0.0008) and being followed up at the rural centre (P=0.021) were risk factors for DRMs. CONCLUSIONS:This is the first study conducted in Gabon providing VF rates and DRM patterns in adult patients receiving first-line ART. In sub-Saharan Africa, where NNRTI-based regimens are recommended as the standard for first-line ART, strengthening virological monitoring together with preventing unplanned treatment interruptions are a global public health priority.

背景与目标： 简介：随着抗逆转录病毒治疗（ART）在资源有限的国家/地区继续扩大，在这些情况下，HIV耐药性突变（DRM）的出现是具有挑战性的。在加蓬（中部非洲），尚无研究报道通过常规HIV护理进行初始抗病毒治疗的病毒学效果。
方法：按照世界卫生组织（WHO）的建议，在加蓬进行了一项一次性HIV-1 RNA病毒载量（VL）测量的横断面研究，以评估由VL结果≥1000定义的病毒学衰竭（VF）感染非B HIV-1株并接受基于一线非核苷逆转录酶抑制剂（NNRTI）的抗逆转录病毒治疗的成年患者至少12个月的拷贝数/毫升和DRMs。评估与VF和DRM相关的危险因素。
结果：从2010年3月至2011年3月，共有375名患者从两个分散的（一个半农村和一个农村）HIV护理中心入组。 ART的中位时间为33.6个月（范围12-107）。总体而言，VF率为41.3％（36.4-46.4）。在病毒血症患者中，有56.7％（80/141）的患者至少有一种DRM，而37.6％的患者对核苷类逆转录酶抑制剂（NRTIs）和NNRTIs具有双重耐药性。最常见的DRM是K103N / S（46.1％）和M184V / I（37.6％）。发现胸苷类似物突变为10.6％。在半农村中心随访与VF相关的独立危险因素（P = 0.033），经历非结构性治疗中断（P = 0.0044），入组时CD4计数低（P <0.0001）。接受抗逆转录病毒治疗的时间较长（P = 0.0008），而在农村中心进行随访（P = 0.021）则是DRM的危险因素。
结论：这是在加蓬进行的第一项研究，旨在为接受一线抗病毒治疗的成年患者提供VF率和DRM模式。在撒哈拉以南非洲，基于NNRTI的治疗方案被推荐作为一线抗病毒治疗的标准，加强病毒学监测以及防止计划外的治疗中断是全球公共卫生的重点。

BACKGROUND & AIMS: BACKGROUND:The recommendation of artemisinin combination therapy (ACT) as first-line treatment for uncomplicated falciparum malaria is supported by a plethora of high quality clinical trials. However, their recommendation for the treatment of mixed-species malaria and the large-scale use for the treatment of non-falciparum malaria in endemic regions is based on anecdotal rather than systematic clinical evidence. METHODS:This study prospectively observed the efficacy of artemether-lumefantrine for the treatment of uncomplicated non-falciparum or mixed-species malaria in two routine district hospitals in the Central African country of Gabon. RESULTS:Forty patients suffering from uncomplicated Plasmodium malariae, Plasmodium ovale or mixed-species malaria (including Plasmodium falciparum) presenting at the hospital received artemether-lumefantrine treatment and were followed up. All evaluable patients (n=38) showed an adequate clinical and parasitological response on Day 28 after oral treatment with artemether-lumefantrine (95% confidence interval: 0.91,1). All adverse events were of mild to moderate intensity and completely resolved by the end of study. CONCLUSIONS:This first systematic assessment of artemether-lumefantrine treatment for P. malariae, P. ovale and mixed-species malaria demonstrated a high cure rate of 100% and a favourable tolerability profile, and thus lends support to the practice of treating non-falciparum or mixed-species malaria, or all cases of malaria without definite species differentiation, with artemether-lumefantrine in Gabon. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT00725777.

背景与目标： 背景：青蒿素联合治疗（ACT）推荐作为无并发症恶性疟疾的一线治疗方法得到了众多高质量临床试验的支持。但是，他们对混合物种疟疾的治疗以及在流行地区大规模使用非恶性疟疾治疗的建议是基于轶事而非系统的临床证据。
方法：本研究前瞻性地观察了中非国家加蓬的两家常规地区医院使用蒿甲醚-氟美特林治疗非复杂性非恶性疟或混合种疟疾的疗效。
结果：在医院就诊的40例患有单纯性疟原虫，卵形疟原虫或混合物种疟疾（包括恶性疟原虫）的患者接受了蒿甲醚-氟美汀治疗并得到了随访。所有可评估的患者（n = 38）在口服蒿甲醚-氟美汀治疗后第28天表现出足够的临床和寄生虫学反应（95％置信区间：0.91,1）。所有不良事件的强度均为轻度至中度，并在研究结束之前完全解决。
结论：首次对蒿甲醚-黄麻黄素治疗疟原虫，卵形疟原虫和混合物种疟疾的系统评价显示出100％的高治愈率和良好的耐受性，因此为治疗非恶性疟原虫的实践提供了支持或混合物种疟疾，或所有没有明确物种分化的疟疾病例，在加蓬都带有蒿甲醚-荧光粉。
试用注册：ClinicalTrials.gov标识符：NCT00725777。

BACKGROUND & AIMS: BACKGROUND:Helminths and malaria are among the most prevalent infectious diseases in the world. They both occur in tropical area where they often affect the same populations. There are studies suggesting an effect of helminths on malariometric indices. For example, malaria attacks as well as disease severity has been shown to be influenced by a concurrent chronic helminth infection. However, there are also studies that show no effect of concurrent helminth infections on malarial outcomes. To start addressing this issue, the effect of chronic Schistosoma haematobium infection on both the innate and adaptive immune response of Plasmodium falciparum-infected subjects was assessed in an area endemic for both these infections in Gabon. METHOD:Subjects infected with S. haematobium and or P. falciparum, as well as a control group with neither of these infections, were recruited. For innate immune response, heparinized blood was obtained and cultured for 24 hours with a panel of TLR ligands. For adaptive immune response, PBMC was isolated and stimulated with SEB for 72 hours. Cytokines and chemokines were measured in supernatants using a multiplex beads array immunoassay. Principal Component analysis was used to assess pattern of cytokine and chemokine responses representing the innate and adaptive components of the immune system. RESULTS:Overall it was observed that the presence of P. falciparum infection was marked by an increase in innate and adaptive immune responsiveness while S. haematobium infection was characterized by an increased chemokine profile, with at the same time, lower pro inflammatory markers. When the study subjects were split into single infected and co-infected groups no effect of S. haematobium on the immune response of P. falciparum infected subjects was observed, neither for the innate nor for the adaptive component of the immune response. CONCLUSION:This study provides original information on the cellular immune response of S. haematobium and/or P. falciparum in infected subjects. It rules out an effect of S. haematobium on the cytokine profile of subjects co-infected with P. falciparum.

背景与目标： 背景：蠕虫和疟疾是世界上最流行的传染病。它们都发生在热带地区，经常影响相同的种群。有研究表明，蠕虫对疟疾测度指数有影响。例如，疟疾发作和疾病严重程度已显示受并发慢性蠕虫感染的影响。但是，也有研究显示并发蠕虫感染对疟疾预后没有影响。为了开始解决这个问题，在加蓬流行的地区评估了慢性血吸虫血吸虫感染对恶性疟原虫感染对象的先天性和适应性免疫反应的影响。
方法：招募感染了链球菌和/或恶性疟原虫的受试者，以及没有感染的对照组。对于先天免疫应答，获得肝素化的血液，并与一组TLR配体一起培养24小时。为了适应性免疫反应，分离PBMC并用SEB刺激72小时。使用多重磁珠阵列免疫测定法测量上清液中的细胞因子和趋化因子。主成分分析用于评估代表免疫系统先天性和适应性成分的细胞因子和趋化因子反应的模式。
结果：总的来说，观察到恶性疟原虫感染的存在以先天性和适应性免疫应答的增加为特征，而沙门氏菌感染以趋化因子谱增加为特征，同时促炎性标志物较低。当将研究对象分为单个感染和共感染组时，无论是天生的还是免疫应答的适应性成分，都没有观察到血球链球菌对恶性疟原虫感染对象的免疫反应的影响。
结论：本研究提供了有关感染对象中血红球菌和/或恶性疟原虫细胞免疫反应的原始信息。它排除了血球链球菌对与恶性疟原虫共感染的受试者的细胞因子谱的影响。