scholarly journals Single Versus Multiple Dose Ivermectin Regimen in Onchocerciasis-infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

2020 ◽  
Author(s):  
Michel Mandro ◽  
Alfred Dusambimana ◽  
Joseph Nelson Siewe Fodjo ◽  
Deby Mukendi ◽  
Stephen Haesendonckx ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Seizure Freedom ◽  
Republic Of Congo ◽  
Group 2 ◽  
One Year ◽  
Intent To Treat ◽  
To Receive ◽  
Group 1

Background There is anecdotal evidence that ivermectin may decrease the frequency of seizures in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy with ≥2 seizures/month were randomly allocated to receive over a one year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs (AED). Study outcomes included seizure freedom during the last four months (primary endpoint), decrease in microfilarial density, and occurrence of adverse events. A multiple logistic regression model was used to evaluate the primary outcome. Results Of the 197 OIPWE enrolled, 100 were randomized to receive ivermectin thrice, 52 twice, and 45 once. In an intent-to-treat combined analysis of data from group 1 and 2, the probability to become seizure-free for OIPWE treated with ivermectin twice per year was significantly higher than in those treated once (OR: 5.087, 95% CI: 1.378-19.749; p=0.018) and individuals who received ivermectin twice had a 4.471 (95% CI: 0.944-6.769, p=0.075) times higher odds of seizure freedom than those received ivermectin once per year. Absence of microfilariae during the last 4 months was associated with a higher probability of seizure freedom (p=0.027). Conclusions Increasing the number of ivermectin treatments per year was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures. Registration: www.clinicaltrials.gov; NCT03852303

scholarly journals Single versus Multiple Dose Ivermectin Regimen in Onchocerciasis-Infected Persons with Epilepsy Treated with Phenobarbital: A Randomized Clinical Trial in the Democratic Republic of Congo

Pathogens ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. 205 ◽  
Author(s):  
Michel Mandro ◽  
Joseph Nelson Siewe Fodjo ◽  
Alfred Dusabimana ◽  
Deby Mukendi ◽  
Steven Haesendonckx ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Seizure Frequency ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Analysis Data ◽  
Seizure Freedom ◽  
Republic Of Congo ◽  
Group 2 ◽  
One Year ◽  
Group 1

Background: There is anecdotal evidence that ivermectin may decrease seizure frequency in Onchocerca volvulus-infected persons with epilepsy (PWE). Methods: In October 2017, a 12-month clinical trial was initiated in rural Democratic Republic of Congo. PWE with onchocerciasis-associated epilepsy experiencing ≥2 seizures/month were randomly allocated to receive, over a one-year period, ivermectin once or thrice (group 1), while other onchocerciasis-infected PWE (OIPWE) were randomized to ivermectin twice or thrice (group 2). All participants also received anti-epileptic drugs. Data was analyzed using multiple logistic regression. Results: We enrolled 197 participants. In an intent-to-treat analysis (data from group 1 and 2 combined), seizure freedom was more likely among OIPWE treated with ivermectin thrice (OR: 5.087, 95% CI: 1.378–19.749; p = 0.018) and twice (OR: 2.471, 95% CI: 0.944–6.769; p = 0.075) than in those treated once. Similarly, >50% seizure reduction was more likely among those treated with ivermectin twice (OR: 4.469, 95% CI: 1.250–16.620) and thrice (OR: 2.693, 95% CI: 1.077–6.998). Absence of microfilariae during the last 4 months increased the odds of seizure freedom (p = 0.027). Conclusions: Increasing the number of ivermectin treatments was found to suppress both microfilarial density and seizure frequency in OIPWE, suggesting that O. volvulus infection plays an etiological role in causing seizures.

The Democratic Republic of Congo

2016 ◽  
Author(s):  
Arthur J. Boutellis
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Responsibility To Protect ◽  
Republic Of Congo ◽  
Un Peacekeeping ◽  
Primary Responsibility ◽  
Host Government ◽  
Intensive Approach ◽  
Peacekeeping Missions ◽  
To Receive

Authorized in the wake of the Srebrenica massacre and Rwandan genocide, the United Nations peacekeeping mission in the Democratic Republic of Congo (DRC) was the first of two UN peacekeeping missions to receive an explicit protection of civilians (POC) mandate in 2000. This chapter discusses the challenges the UN mission faced in implementing this POC mandate over 15 years of existence. It analyses how lessons from early protection crises led the mission to develop a series of innovative tools for a better peacekeeping response, up to the establishment of the Force Intervention Brigade (FIB) in 2013. This chapter concludes with some lessons including the need for a shift from a largely UN-centric and troop-intensive approach to physical protection to a greater focus on strengthening national protection capacities as part of a broader political/stabilization strategy, which encourages and empowers the host government to shoulder its primary responsibility to protect its citizens.

Treatment of newly diagnosed and relapsed acute promyelocytic leukemia with intravenous liposomal all-transretinoic acid

Blood ◽  
2001 ◽  
Vol 97 (1) ◽  
pp. 73-80 ◽  
Author(s):  
Dan Douer ◽  
Elihu Estey ◽  
Sergio Santillana ◽  
John M. Bennett ◽  
Gabriel Lopez-Bernstein ◽  
...  
Keyword(s):  
Acute Promyelocytic Leukemia ◽  
Retinoic Acid Receptor ◽  
Promyelocytic Leukemia ◽  
Newly Diagnosed ◽  
Resistant Disease ◽  
Polymerase Chain ◽  
Group 2 ◽  
One Year ◽  
Intent To Treat ◽  
Group 1

Abstract A novel intravenous liposomal formulation of all-transretinoic acid (ATRA) was evaluated in 69 patients with acute promyelocytic leukemia (APL): 32 new diagnoses, 35 relapses, and 2 oral ATRA failures. Liposomal ATRA (90 mg/m2) was administered every other day until complete remission (CR) or a maximum of 56 days. Treatment following CR was liposomal ATRA with or without chemotherapy. In an intent-to-treat (ITT) analysis of all patients, CR rates were 62%, 70%, and 20% in newly diagnosed, group 1 first relapses (ATRA naive or off oral ATRA more than or equal to 1 year), or group 2 relapses (second or subsequent relapse or first relapses off oral ATRA less than 1 year), respectively. In 56 evaluable patients (receiving 4 or more doses), CR rates for the same groups were 87% (20 of 23), 78% (14 of 18), and 23% (3 of 13). Remission failure in newly diagnosed patients was not from resistant disease. Several patients in CR became polymerase chain reaction (PCR) negative for promyelocytic leukemia/retinoic acid receptor-alpha (PML/RARα) after liposomal ATRA alone. Toxicity was generally mild, most commonly headaches (67.5%). Eighteen patients (26%) had ATRA syndrome develop during induction. One-year survival of ITT patients was 62%, 56%, and 20% for newly diagnosed, group 1, and group 2, respectively. The medium duration of CR has not yet been reached and was 18 and 5.5 months in the same groups. These results demonstrate that liposomal ATRA is effective in inducing CR in newly diagnosed or group 1 APL patients. It provides a reliable dosage of ATRA for patients with APL unable to swallow or absorb medications and can induce molecular remissions without chemotherapy.

scholarly journals Status competition in Africa: Explaining the Rwandan–Ugandan clashes in the Democratic Republic of Congo

2018 ◽  
Vol 118 (472) ◽  
pp. 509-530 ◽  
Author(s):  
Henning Tamm
Keyword(s):  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
World Politics ◽  
Social Psychological ◽  
Republic Of Congo ◽  
Status Competition ◽  
Regional Newspapers ◽  
Ruling Elites ◽  
One Year ◽  
Social Psychological Perspective

Abstract Yoweri Museveni’s rebels seized power in Uganda in 1986, with Rwandan refugees making up roughly a quarter of his troops. These refugees then took power in Rwanda in 1994 with support from Museveni’s regime. Subsequently, between 1999 and 2000, the Rwandan and Ugandan comrades-in-arms turned on each other in a series of deadly clashes in the Democratic Republic of Congo, a country they had invaded together only one year earlier. What explains these fratricidal clashes? This article contends that a social–psychological perspective focused on status competition between the Rwandan and Ugandan ruling elites provides the most compelling answer. Long treated as ‘boys’, the new Rwandan rulers strove to enhance their social status vis-à-vis the Ugandans, seeking first equality and then regional superiority. Economic disputes over Congo’s natural resources at times complemented this struggle for status but cannot explain all of its phases. The article draws on interviews with senior Rwandan, Ugandan, and former Congolese rebel officials, and triangulates them with statements given to national and regional newspapers at the time of the clashes. More broadly, it builds on the recently revitalized study of status competition in world politics and makes a case for integrating research on inter-African relations.

Efficacy and safety of malarial prophylaxis with mefloquine during pregnancy in Kisangani, Democratic Republic of Congo: a randomized clinical trial

2021 ◽  
Author(s):  
Noël Labama Otuli ◽  
Roland Marini Djang’eing’a ◽  
Joris Losimba Likwela ◽  
Jean‐Didier Bosenge Nguma ◽  
Mike‐Antoine Maindo Alongo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Efficacy And Safety ◽  
Republic Of Congo
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