Université de Kisangani

Populations of forest trees exhibit large temporal fluctuations, but little is known about the synchrony of these fluctuations across space, including their sign, magnitude, causes and characteristic scales. These have important implications for metapopulation persistence and theoretical community ecology. Using data from permanent forest plots spanning local, regional and global spatial scales, we measured spatial synchrony in tree population growth rates over sub-decadal and decadal timescales and explored the relationship of synchrony to geographical distance. Synchrony was high at local scales of less than 1 km, with estimated Pearson correlations of approximately 0.6–0.8 between species’ population growth rates across pairs of quadrats. Synchrony decayed by approximately 17–44% with each order of magnitude increase in distance but was still detectably positive at distances of 100 km and beyond. Dispersal cannot explain observed large-scale synchrony because typical seed dispersal distances (<100 m) are far too short to couple the dynamics of distant forests on decadal timescales. We attribute the observed synchrony in forest dynamics primarily to the effect of spatially synchronous environmental drivers (the Moran effect), in particular climate, although pests, pathogens and anthropogenic drivers may play a role for some species.

Objectives Chest computed tomography (CT) plays a crucial role in evaluating patients with coronavirus disease 2019 (COVID-19) pneumonia. This study aimed to assess the association between initial chest CT findings and mortality in adult inpatients with COVID-19 in the city of Goma, North Kivu province, the Democratic Republic of the Congo. Materials and Methods This was a multicenter retrospective study of patients hospitalized in Goma with COVID-19 pneumonia who underwent chest CT from January 1, 2021, to December 31, 2022. For each patient included, two experienced radiologists independently reviewed the initial chest CT. A multivariate logistic regression was performed to identify chest CT findings associated with mortality at the 5% significance level. Results Of 76 patients included in the study, 26 (34.2%) died. The degree of lung parenchymal involvement >25% (adjusted odds ratio [aOR] = 16.27 [3.30–80.16]) and the presence of consolidations (aOR = 3.33 [1.00–11.47]) were predictive of mortality with an area under the receiver operating characteristic curve of 0.8392. Sensitivity was 73.08%, specificity was 82%, positive predictive value was 67.86%, and negative predictive value was 85.42%. Conclusion Lung involvement >25% and consolidations on chest CT appear to predict death in adult inpatients with COVID-19 pneumonia.

Banana Wilt caused by Xanthomonas vasicola pv. musacearum (Xvm), has emerged as a significant threat to food security in eastern Democratic Republic of Congo (Kivu). Currently, the only means of combatting this biotic constraint is through best agricultural practices. The aim of this study was to evaluate the effectiveness of medicinal plants used in the Kivu provinces in inhibiting Xvm. Three in vitro experiments were conducted at laboratories of Uganda's National Agriculture Research Organization (NARO) and the International Institute of Tropical Agriculture (IITA) in South Kivu. The bacterial samples were collected from infected field-grown banana plants in South Kivu and isolated on Yeast Extract Peptone Agar (YPGA). Pure Xvm colonies were used for identification via i) Polymerase Chain Reaction (PCR) with specific primers and, ii) greenhouse inoculation trials. A completely randomized design was used for the three inhibition tests (1) on Mueller Hinton Agar (MHA) using disc diffusion with 10 plant extracts; (2) in liquid YPG Broth using 10 plant extracts; and (3) on MHA using disc diffusion with 19 plant extracts. The first two trials used plant extracts diluted in petroleum ether, while the third trial used 19 plant extracts diluted in methanol. After maceration, filtration, and solvent evaporation, 10 mg of extract was diluted in 80 µl of distilled water + 10 µl of Dimethylsulfoxide (DMSO). Ten µl of this solution was impregnated on perforated discs of Whatman filter paper. Zingiber officinale (ginger) and Ricinus communis (castor) were the most effective plant extracts in suppressing Xvm. Of the thirteen plant species identified as effective against the pathogen, the Myrtaceae and Euphorbiaceae families were the most represented. Based on these results, evaluating the effectiveness of the most promising plant extracts in disinfecting the metal blades of garden tools is recommended. In addition, various phytochemical groups present in plant extracts could be evaluated for their effectiveness in suppressing Xvm, especially phenols and tannins.

This paper looks into the MaxEnt model in a trial to comprehend the ecological and environmental conditions that propagate and drive the spread of Ebola Virus Disease in Africa. We use the MaxEnt model to assess risk determinants associated with the occurrence and distribution of EVD, taking into account non-correlated variables such as neighborhood mean temperature, rainfall, and human population density. Our findings indicate that among the factors that significantly shape the geographical distribution of EVD risk are human population density, annual rainfall, temperature variability, and seasonality. The model used is both reliable and accurate (the average value for training AUC was 0.987); it can be used as a valuable approach for the prediction of infectious disease outbreaks. High-risk areas are primarily identified in the western and central regions of Africa, with some of the others in the east also vulnerable. This further calls for specified public health interventions and enhanced surveillance in specified hotspots, contributing to global efforts to predict and mitigate risks associated with EVD outbreaks more adequately. The findings further support that it remains imperative to conduct additional research, including socio-economic and cultural variables, to enhance the understanding of how environmental factors contribute to the emergence and transmission of Ebola.

Meeting rising quality standards while at the same time addressing climate challenges will make the commercial cultivation of Robusta coffee increasingly difficult. Whereas breeding new varieties may be an important part of the solution, such efforts for Robusta lag behind, with much of its genetic diversity still unexplored. By screening existing field genebanks to identify accessions with desirable traits, breeding programs can be significantly facilitated. This study quantifies the morphological diversity and agronomic potential of 70 genotypes from the INERA Coffee Collection in Yangambi, Democratic Republic of the Congo. We measured 29 traits, comprising vegetative, reproductive, tree architecture, and yield traits. Classification models were applied to establish whether these traits could accurately classify genotypes based on their background. Furthermore, the agronomic potential and green bean quality of the genotypes were studied. While significant variation in morphological traits was observed, no combination of traits could reliably predict the genetic background of different genotypes. Genotypes with promising traits for green beans were identified in both ‘Lula’ and ‘Lula’ – Wild hybrids, while promising yield traits were found in ‘Lula’ – Congolese subgroup A hybrids. Additionally, certain ‘Lula’ – Wild hybrids showed low specific leaf area and stomatal density, indicating potential fitness advantages in dry environments, warranting further study. Our findings highlight the agronomic potential of underexplored Robusta coffee genotypes from the Democratic Republic of the Congo and indicate the need for further screening to maximize their value.

Background Promoting the use of insecticide-treated mosquito nets (ITNs) is one of the main strategies for reducing malaria-related morbidity. An innovative activity-based contracting (ABC) approach has been implemented in Kwilu Province, Democratic Republic of Congo to optimize ITN mass distribution campaigns, with payments based on contractually defined programmatic outcomes for key campaign activities following independent verification of results. Methods This internal evaluation was carried out using a mixed methods approach combining qualitative and quantitative document and content analysis from a series of three workshops: validation workshops for campaign results at provincial level for the 2021 and 2022 campaigns; internal evaluation workshop for the Kwilu campaign as part of the ABC approach organized by “Santé pour tous en milieu rural” (SANRU) with its sub-contractors; and national campaign evaluation workshop organized by the National Malaria Control Program. Results The pilot campaign with the ABC approach in Kwilu has demonstrated better results than campaigns conducted using the standard, non-ABC, approach: better household coverage (99.9% vs. 97.3%) and improved compliance with ITN allocation to households based on the household size (98. 9% vs. 84.7%); lower loss of ITNs (0.3% vs. 0.5%) with immediate penalties for lost ITNs in the province under the ABC approach; shorter campaign lead times (14 vs. 28 weeks from the start of training to the launch of distribution). This last point is crucial, as it is likely to generate efficiencies and contribute to ensuring timely ITN replacement campaigns. Conclusion The challenges encountered and the lessons learned in the implementation of the pilot ABC approach in Kwilu could guide future distribution campaigns in the DRC and other African countries that would like to engage in distribution campaigns based on performance-based incentive contracts.

Background Radiculomedullary lesions represent a significant public health issue, with their epidemiological, clinical, and therapeutic characteristics varying depending on whether they are of traumatic or non-traumatic origin. The aim of this study was to compare clinical, therapeutic, and postoperative aspects between traumatic radiculomedullary lesions (TRML) and non-traumatic radiculomedullary lesions (NTRML). Methods This was a prospective cohort study conducted from 2020 to 2023 involving patients suffering from radiculomedullary lesions operated at the Department of Neurosurgery, University Teaching Hospital of Kinshasa. In addition to socio-demographic characteristics, the two patient groups - traumatic and non-traumatic - were compared based on clinical, therapeutic, and postoperative aspects using the American Spinal Injury Association (ASIA) and Spinal Cord Independence Measures (SCIM III) scores. Results We included 153 patients, with 73 traumatic cases (47.7%) and 80 non-traumatic cases (52.3%). TRMLs were predominantly caused by road traffic accidents (34%) and falls (11%), while NTRMLs were mainly due to disc herniations (22.2%) and tuberculosis (13.7%). The mean age for TRMLs was 35.4 ±12.8 years with a sex ratio of 3.5, compared to 50.7±15.9 years and a sex ratio of 1.1 for NTRMLs. TRMLs were more frequently located in the cervical region (32.8%) and the thoracolumbar junction (40%), whereas NTRMLs predominantly affected the thoracic (22.5%) and lumbar (63.7%) regions. Patients with NTRMLs had more incomplete lesions (98.7%) and better SCIM III scores at admission compared to TRMLs (p ˂ 0.001). TRMLs had more complete deficits 42 (57.3%) vs 1 (1.3%). Both groups significantly improved their ASIA and SCIM III scores postoperatively (p ˂ 0.001) but in a similar manner (Diff-in-diff: ASIA, p=0.955; SCIM, p=0.967). TRMLs developed more complications than NTRMLs (p˂0,001). Only five patients (11.6%) with ASIA A progressed to higher grades, and all remained dependent (SCIM III score ˂50). The average hospital stay was 89.2 ±74.2 days for TRMLs and 57.5±52.9 days for NTRMLs (p˂0.001). Conclusion This study revealed that TRMLs frequently affect young male individuals and are often located in the cervical region and thoracolumbar junction. In contrast, NTRMLs affect older individuals without gender preference and are usually found in the thoracic and lumbar regions. TRMLs often lead to complete deficits, pressure sores, urinary infections, and longer hospital stays compared to NTRMLs. Both patient groups showed significant postoperative improvement with no significant difference between them. However, patients with complete deficits showed less improvement in both groups.

Objective This study aimed to assess the effect of sildenafil citrate and estradiol valerate as adjuvant therapy during ovarian stimulation cycles with clomiphene citrate in patients with unexplained infertility in Kisangani. Method A double-blind, randomized controlled trial was conducted for two years at two specialized health facilities in Kisangani (University Clinics of Kisangani and “Clinique des Anges Kisangani”). The population included 148 patients, 74 of whom were on clomiphene citrate + sildenafil citrate (CCSC) regimens and 74 of whom were on clomiphene citrate + estradiol valerate (CCEV) regimens for three months. The primary indicator was the conception rate, with secondary outcomes encompassing endometrial thickness, appearance and vascularity, the number of mature follicles and ovulation rate. Results The two groups were comparable in terms of sociodemographic and clinical characteristics. The mean duration of attempting to conceive was 4.39 years versus 4.36 years (P = 0.839), while the mean AFC was 11.51 versus 11.46 (P = 0.831), in the CCSC group versus CCEV group respectively. Secondary infertility was the most frequent diagnosis in each of the two groups. The biochemical pregnancy rate was comparable between the two groups (P = 0.385), while the clinical pregnancy rate was significantly higher in the CCSC group versus CCEV group (P = 0.04). Both perifollicular flow and the ovulation rate were significantly higher in the CCSC group versus the CCEV group (P = 0.006 and P = 0.002 respectively). However, endometrial vascularity/thickness, and the number of Graafian follicles were not significantly different between the two groups. Conclusion As an adjuvant, sildenafil increases the rate of clinical pregnancy more than does estradiol in patients with unexplained infertility undergoing ovarian stimulation with clomiphene citrate. Study registration PACTR 202,310,849,449,401 (Pan African Clinical Trials Registry).

Two new African minnow species, Enteromius cerinus sp. nov. and Enteromius ruforum sp. nov., are described for science from the Angadiko River, a left‐bank sub‐affluent of first order of the Nepoko River, draining the north‐eastern part of the Okapi Wildlife Reserve (OWR). Both new species belong to the group of Enteromius for which the last unbranched dorsal‐fin ray is flexible and underrated. Within this morphological group, both are most similar to Enteromius kamolondoensis, especially in life colour pattern characteristics. However, Enteromius cerinus sp. nov. differs from E. kamolondoensis by its low number of circumpeduncular scales, 10–11 (vs. 12), low maximum body depth, 22.8%–25.7% standard length (Ls) (vs. 26.1%–30.0%), and long anterior and posterior barbel lengths, 32.6%–35.3% head length (LH) (vs. 23.6%–27.2%) and 41.6%–43.9% LH (vs. 30.3%–34.9%), respectively. Further, E. ruforum sp. nov. is also easily distinguished from E. kamolondoensis by its high maximum body depth, 30.6%–33.3% Ls (vs. 26.1%–30.0%), and small, isometric, eye diameter, 26.2%–28.0% LH (vs. 29.1%–31.9%). A barcoding study (mtDNA, cytochrome oxidase subunit I [COI]) revealed that specimens of both new species form lineages well differentiated from those of other available species. As such, (i) E. cerinus sp. nov. diverges from E. kamolondoensis by a K2P genetic distance (GD) of 10.3% and (ii) E. ruforum sp. nov. by a K2P GD of 11.2%. To the present day, the fish fauna of the left‐bank sub‐affluents of the Nepoko River, in general, remains poorly known or undocumented. Unfortunately, at the same time, multiple anthropogenic impacts are affecting this fauna, such as (i) the destruction of habitats along the river banks for agriculture and fishing and (ii) the use of illegal fishing practices, such as fishing with plant‐based ichthyotoxins during ecopage, which is combined with dam building. As a result of the demographic growth, this ecopage results in overfishing and thus is threatening both new species in particular, but all other co‐occurring fish species as well. Both new species, E. cerinus sp. nov. and E. ruforum sp. nov., should thus be considered Vulnerable (VU) according to IUCN criterion D2. It is therefore hoped that their discovery highlights the urgent need for a better protection and further in situ exploration of the reserve's freshwater (fish) biodiversity, in general, and that of those small sub‐affluents, in particular.

Introduction HIV self-testing represents a convenient and confidential option for HIV testing—the present study aimed to assess the acceptability of blood versus saliva self-tests among key populations in Kisangani. Methods This study was an analytical cross-sectional study. Our sample size was 363 subjects. After obtaining their consent, we administered a questionnaire to participants. We asked participants to choose between blood and saliva self-testing. We defined the acceptability of the self-test (saliva or blood) as the intention to use the self-test using a 5-point Likert scale. Descriptive statistics were described by estimating proportions for categorical variables and means with standard deviations for symmetrically distributed quantitative variables. The variable of interest was the acceptability of self-testing, which was dichotomized (Very Likely/Unlikely). The corresponding endpoint was the proportion of participants accepting the self-test in HIV screening. A bivariate analysis was performed to determine factors related to the acceptability of the self-test, using Pearson’s Chi-square (χ2) and ANOVA followed by 2-to-2 multiple comparisons (Bonferroni) for comparison of means and proportions. A progressive stepwise logistic regression model at the 5% threshold included variables with a bi-variate association. Results The acceptability of the blood self-test was 71.6% compared to 28.4% for the saliva self-test. Factors associated with acceptability of the self-test were higher level of education aOR CI95%: 1.5(0.4–5.5) p = 0.006; non-use of condoms with casual partners aOR CI95%: 2.8(1.4-5) p = 0.003; knowledge of the type of self-test aOR CI95%:2.4(1.02–5.65) p = 0.043 and the obstacle to acceptability of the self-test was non-availability of the self-test aOR CI 95%: 18.9(6.5–54.9) p < 0.0001. Conclusion Our study showed that key populations in Kisangani preferred blood self-testing over saliva self-testing. Blood self-tests must be made available to key population groups, as this would improve access to testing for these populations, thus boosting the first UNAIDS target 95.

Coffee processing involves various steps, from harvest to the storage of dried green coffee beans, each of which can significantly affect the beans' chemical composition and sensory qualities. Yet, a comprehensive evaluation that includes the coffee's genetic background and chemical, sensory, and biological aspects is still uncommon for Robusta coffee. Four Robusta ( C. canephora ) genotypes from the Democratic Republic of the Congo were subjected to five different coffee processing methods: Strip-picked, unsorted, sundried cherries; Overripe, sorted, sundried cherries; ripe, sorted, sundried (Natural) cherries; ripe, sorted, Pulped, sundried parchment; and ripe, sorted, wet fermented (Washed), sundried parchment were processed separately. The resulting green beans underwent sensory descriptive cupping, seed germination tests, and metabolite profiling using LC-HRMS. The Pulped and Washed methods produced coffees with higher sensory attributes scores, while the Overripe method was associated with the sensory ‘potato taste’ defect. Washed coffee was characterized by smooth, fruity, cocoa notes, and was negatively correlated with rough mouthfeel, tobacco, and leather flavors. The Pulped and Washed method had significantly higher germination success after four months of storage. The processing method influenced caffeine concentration in green beans, depending on the genotype, while trigonelline levels varied significantly between genotypes but not between processing methods. The grouping of the metabolite profiles of roasted coffee and green beans was consistent with their genetic background rather than the processing method. Overall, we demonstrate that genotype plays a significant role in mediating the outcomes of different processing methods.

The largest tropical peatland complex in the Cuvette Centrale is marked by persistent knowledge gaps. We assessed recent peat forest disturbances and their direct drivers from 2019 to 2021 in Cuvette Centrale, spanning the Republic of Congo (ROC) and the Democratic Republic of Congo (DRC). Utilizing peatland maps and Radar for Detecting Deforestation alert data, we analyzed spatial and temporal patterns of disturbances. Further, we examined 2267 randomly sampled peat forest disturbance events through visual interpretation of monthly Planet and Sentinel 2A data to identify direct drivers. Our findings revealed that between 2019 and 2021, about 91% of disturbances occurred in DRC, with hotspots concentrated in the northwest Sud-Ubangi district. Disturbances predominantly followed a sharp seasonal pattern, recurring during the first half of each year with temporal hotspots emerging between February and May, closely associated with smallholder agriculture activities. Smallholder agriculture accounted for over 88% of disturbances in Cuvette Centrale, representing a leading role both in ROC (∼77%) and DRC (∼89%). While small-scale logging contributed 7% to the disturbances in the region, it constituted an important driver (18%) in the ROC. Other drivers included floods, roads, and settlements. Approximately 77% of disturbances occurred outside managed forest concessions in Cuvette Centrale, with 40% extending into protected areas. About 90% of disturbances were concentrated within 1 km of peat forest edges and ∼76% of the disturbances occurred within 5 km of road or river networks. The insights underscore the crucial need for effective peat forest conservation strategies in Cuvette Centrale and can inform national policies targeting peatland protection, aligning with commitments in the Brazzaville Declaration and the Paris Agreement. Further, our findings on direct driver assessment could serve as a reference dataset for machine learning models to automate the visual interpretation and upscale the assessment across the entire region.

Objectives Epilepsy is a chronic neurological disease that is highly susceptible to a variety of mental health problems due to its enormous biological, social, and psychological burdens. The purpose of this study was to determine the prevalence and identify risk factors for common mental disorders (CMDs) in people with epilepsy (PWEs) in Goma, in the Democratic Republic of the Congo (DRC). Material and Methods This is an analytical cross-sectional study conducted at the Neuropsychiatric Hospital Center in Goma (DRC) from March to April 2022, involving 302 PWEs. A questionnaire was administered to collect socio-demographic data, personal and family history, clinical features, and management of epilepsy. CMDs were assessed using the self-report questionnaire-20. Bivariate analysis was performed, followed by multivariate analysis, and variables with P < 0.05 in the final model were considered as risk factors associated with CMDs. Results The study included 302 PWEs, of which 56.9% were men, and the mean age was 28.4 ± 11.0 years. CMDs were present in 39.1% of the participants. The presence of CMDs was significantly associated with having five or more seizures in the month preceding the survey (adjusted odds ratio [aOR] = 3.8; 95% confidence interval [CI]: 1.7–8.3) and having medical co-morbidities (aOR = 3.1; 95% CI: 1.5–6.4). Conclusion The prevalence of CMDs in PWEs was high (39.1%), suggesting that this is a public health issue. Therefore, early detection and recognition of CMD symptoms should be a routine activity when managing PWEs.

Key Clinical Message The use of negative pressure therapy in the management of gunshot wound have a favorable outcome, NPT is easy to build, accelerates wound budding, reduces patient's stay in hospital and its low cost. It showed reassuring results in the management of wound with soft tissue lost, comparatively to other dressing. Abstract Wounds due to gunshot injuries are common in east of Republic Democratic of Congo and its management should be well known by surgeons and other health practitioners. Reconstruction is possible with simple surgeries using skin grafts and negative pressure therapy (NPT). In this study, we present our results of wounds treatment after gunshot injury with a simple non‐surgical procedure using NPT. We present four patients with soft tissue losses caused by gunshot injury. These patients underwent an average of four to eight sessions of vacuum dressing, the length of hospital stay was decrease and soft tissue losses were reconstructed using at the end skin grafts.

Type II odontoid fracture, classified by Anderson and D’Alonzo, is the most common traumatic injury to the odontoid process. Surgical management of this lesion is particularly challenging in underresourced countries. This study aims to report the preliminary experience of the Kinshasa University Teaching Hospital in Kinshasa, Democratic Republic of the Congo, particularly using adaptive techniques. Three patients, aged 22, 30, and 32 years, respectively, were admitted to the neurosurgery department with Anderson and D'Alonzo type II odontoid fractures as confirmed by CT scan imaging. The first two patients underwent anterior odontoid fixation using a non-cannulated orthopaedic screw with an image intensifier. In the third case, partial resection of the C1 posterior arch was performed, followed by immobilisation using a rigid Philadelphia neck brace. Postoperative follow-up in all three cases was uneventful, and neurological outcomes were satisfactory. Odontoid surgery remains challenging for developing countries. The use of a non-cannulated orthopaedic screw for anterior fixation and posterior spinal cord decompression via partial resection of the C1 posterior arch, followed by external cervical immobilisation with a rigid neck brace for neglected fractures, could be effective alternatives to conventional surgical techniques. However, randomised multicentre studies are required to confirm the efficacy and safety of these techniques.

Background Infertility affects millions of couples worldwide and regions with high fertility rates are the most affected. This study aims to determine the prevalence of infertility in couples in Kisangani, identify the aetiological factors involved, and assess the responsibility of partners. Methods A cross-sectional study was conducted in seven health facilities in the city of Kisangani following a two-month campaign of free gynaecological consultations. The ratios were subjected to a Pearson's chi-square test or Exact Fisher with a significance level of p < 0.05. Results Of the 1,434 patients who consulted us for a gynaecological problem, 697 (48.61%) were infertile. Factors associated to infertility were polygamous relationship (p-value = 0.0000), first sexual intercourse before the age of 18 (p-value = 0.0000), having unprotected sex with a non-regular partner in the previous six months (p-value = 0.0047), history of treated genital tract infections in the previous six months (p-value = 0.0106) and history of abdominal-pelvic surgery (p-value = 0.0000). Among female causes of infertility, ovarian factors associated with primary infertility (p-value = 0.0172) represented 43.21% of cases, with PCOS as the major factor (31.74%). Uterine factors represented 19.69% of cases, with fibroid as the major factor (18.75%). Tubal factors represented 64.63% of cases, with bilateral obstruction (p-value = 0.0115) and bilateral hydrosalpinx (Exact Fisher = 0.0385) associated with secondary infertility. 53.54% of patients had bacterial vaginosis and 43.4% of them had antisperm antibody. Chlamydia Trachomatis was associated to secondary infertility (p-value = 0.0419). Among male, 44.55% of them had a sperm abdomality wich was in association to primary infertility (p-value = 0.0129). Oligospermia was the most prevalent (21.03%) and associated to primary infertility (p-value = 0.0113). Regarding partner responsibility, women was solely responsible in 25.23% of cases and men in 18.16%. Both partners were responsible in 29.06% of cases and in 27.53% of cases, the cause of infertility remained unexplained. Conclusion Infertility represents a significant public health concern in Kisangani, with approximately one-quarter of cases remaining unexplained. Given the high prevalence of bacterial vaginosis and anti-sperm antibodies, it is imperative to conduct studies to ascertain whether there is a correlation between these factors and unexplained infertility.

Although the mammalian cerebral cortex is most often described as a hexalaminar structure, there are cortical areas (primary motor cortex) and species (elephants, cetaceans, and hippopotami), where a cytoarchitecturally indistinct, or absent, layer 4 is noted. Thalamocortical projections from the core, or first order, thalamic system terminate primarily in layers 4/inner 3. We explored the termination sites of core thalamocortical projections in cortical areas and in species where there is no cytoarchitecturally distinct layer 4 using the immunolocalization of vesicular glutamate transporter 2, a known marker of core thalamocortical axon terminals, in 31 mammal species spanning the eutherian radiation. Several variations from the canonical cortical column outline of layer 4 and core thalamocortical inputs were noted. In shrews/microchiropterans, layer 4 was present, but many core thalamocortical projections terminated in layer 1 in addition to layers 4 and inner 3. In primate primary visual cortex, the sublaminated layer 4 was associated with a specialized core thalamocortical projection pattern. In primate primary motor cortex, no cytoarchitecturally distinct layer 4 was evident and the core thalamocortical projections terminated throughout layer 3. In the African elephant, cetaceans, and river hippopotamus, no cytoarchitecturally distinct layer 4 was observed and core thalamocortical projections terminated primarily in inner layer 3 and less densely in outer layer 3. These findings are contextualized in terms of cortical processing, perception, and the evolutionary trajectory leading to an indistinct or absent cortical layer 4.

Background: Both sildenafil and estradiol are seen to improve endometrial thickness in patients with infertility who are undergoing clomiphene induction cycles. However, the correlation between endometrial thickness and pregnancy rate is debatable. This study investigated the effect of adding oral sildenafil to clomiphene citrate (CC), compared to adding estradiol valerate, on the uterine biophysical profile (Applebaum score) and pregnancy rate. Methods: This was a double-blinded, randomized controlled trial conducted in Kisangani in the Democratic Republic of the Congo from October 1, 2021, to October 31, 2023. Patients with unexplained infertility were randomly assigned to one of two groups: the interventional, which was given CC (2 x 50 mg/day from day 3 to day 7 of the menstrual cycle) + sildenafil (2 x 25 mg/day orally from day 8 to day 12) or (ii) the control group, which was given CC (similar dosage as the intervention group) + EV (2 x 2 mg/day orally from day 8 to day 12), for a maximum of three cycles. Applebaum scores and clinical pregnancy rates were measured. Results: Patients in the sildenafil and EV groups were similar in mean age (29.04 versus 28.89 years). Of the 74 patients enrolled in each group, 71 in the sildenafil group and 72 in the EV group received treatment and were followed to completion. The Applebaum scores were significantly higher in the sildenafil group than in the EV group (17.05 versus 15.14, respectively, P=0.000). In the sildenafil group, the clinical pregnancy rate was also significantly higher, at 28.92% versus 20.83% in the EV group (P = 0.04). Conclusion: As compared to EV, the oral addition of sildenafil to CC is associated with a good Applebaum score and a high rate of clinical pregnancy in patients with unexplained infertility.

Introduction With global cesarean section rates rising, there’s concern about increase in obstetric vesico-uterine fistula (OVUF). Very little is known about this anatomoclinical entity of obstetric fistula in Africa in general and in DRC in particular. Our purpose was to describe the epidemiological, clinical, and therapeutic aspects of OVUF in the Democratic Republic of the Congo (DRC). Methods This was a descriptive cross-sectional study. Data were collected from patients who presented with OVUF across seven provinces of the DRC (North Kivu, Haut-Uélé, Kasai Central, Kwilu, Maniema, Nord-Ubangi and Sankuru) from January 2017 to December 2022. Study variables were epidemiological, clinical, and therapeutic features. Results Of 1,267 patients presenting with obstetric fistulas, 355 (28.0%) had OVUF. The mean age was 32.9 ± 11.6 years, 80.6% of patients (286/355) lived in rural areas, and the majority had a low level of education (40% no formal education, 30.1% primary school, 28.7% secondary school). In total, 64.8% of patients were primiparous (230/355) and in all (100%) cases, OVUF was caused iatrogenically during cesarean delivery. Majority (76.3%) of patients laboured for one day or less (mean duration 1.0 ± 0.5 days) before giving birth, and the fetus died in 58.3% of cases. In 35.8% of cases, the fistula had lasted more than 10 years (mean age 10.1 ± 10.0 years) before repair. A proportion of 88.2% (n = 313) of OVUF was isolated while 11.3% (n = 40) was associated with a uretero-vaginal fistula. In 82.8% (n = 294) of cases the OVUF was single. The average fistula size was 2.4 ± 1.0 cm (range: 0.5 and 5.5 cm) and 274 (77.2%) fistulas measured between 1.5 and 3 cm, with 14.9% (n = 53) of them larger than 3 cm. Fibrosis was present in 65.1% of cases, cervical involvement was absent in 97.7% and post-operative complications were absent in 94.4%. In all cases, the OVUF was surgically repaired abdominally with a success rate of 97.5% (346/355). Conclusion The proportion of OVUF is relatively high in the DRC. Most affected patients were young, under-educated, primiparous women living in rural areas. Cesarean section was the sole identified cause of OVUF which was isolated, single, without fibrosis, in majority of cases. Abdominal repair of OVUF was very effective, with good results in almost all cases. Teaching young doctors working mainly in remote areas how to perform safe cesarean section is needed to reduce incidence of OVUF in DRC.

Objective This study aimed to assess the effect of sildenafil citrate and estradiol valerate as adjuvant therapy during ovarian stimulation cycles with clomiphene citrate in patients with unexplained infertility to update infertility management guidelines in Kisangani. Method A double-blind, randomized controlled trial was conducted for two years (from October 1, 2021, to October 31, 2023). The population included 148 patients, 74 of whom were on clomiphene citrate + sildenafil citrate (CCSC) regimens and 74 of whom were on clomiphene citrate + estradiol valerate (CCEV) regimens for three months. The primary indicator was the conception rate, with secondary outcomes encompassing endometrial thickness, appearance and vascularity, the number of mature follicles and ovulation rate. Results Perifollicular flow was predominantly high-grade (P = 0.002), and the ovulation rate and clinical pregnancy rate were greater (P = 0.006) in the CCSC group than in the CCEV group. However, biochemical pregnancy rate, endometrial vascularity/thickness, and the number of Graafian follicles were not significantly different. The two groups were comparable in terms of sociodemographic and clinical characteristics. The mean duration of attempting to conceive was 4.39 years versus 4.36 years, and the mean AFC was 11.51 versus 11.46, respectively, in the CCSC versus CCEV groups. Secondary infertility was the most frequent type in each of the two participant assignment groups. Conclusion As an adjuvant, sildenafil increases the rate of clinical pregnancy more than does estradiol in patients with unexplained infertility undergoing ovarian stimulation with clomiphene citrate. However, both sildenafil citrate and estradiol valerate can protect the endometrium from the harmful antiestrogenic effects of clomiphene. Study registration: PACTR 202310849449401 ( Pan African Clinical Trials Registry)