.
National Tuberculosis Reference Laboratories (NTRLs) are central to tuberculosis (TB) control programs. Between 2018 and 2024, the Republic of Congo, a country of 6 million inhabitants, achieved a transformative strengthening of its TB diagnostic system, coordinated by the NTRL. Strategic investments, supported mainly by international partners, enabled a substantial decentralization of services, expanding the diagnostic network from 38 to 113 diagnostic and testing centers and increasing GeneXpert sites from 3 to 31. The expansion of the diagnostic network and specimen referral system was associated with a reduced structural gap in diagnostic coverage by extending access to GeneXpert testing to a larger number of peripheral and previously underserved centers. Critically, the establishment of a BSL-3 laboratory and the deployment of advanced assays like Xpert MTB/XDR ended the reliance on overseas testing by introducing in-country capacity for multidrug-resistant and pre-extensively drug-resistant TB detection. These systemic improvements were associated with significant positive outcomes, including an annual molecular testing surging from 11,609 in 2022 to over 27,000 in 2024 and bacteriological confirmation rates rising from 34 to 73%. This comprehensive laboratory systems strengthening, which also facilitated cross-programmatic initiatives like HIV and Mpox testing integration, underscores how sustained investment in infrastructure, logistics, and quality management is fundamental to improving case detection, surveillance, and progress toward the WHO End TB Strategy milestones.
Objectives: Liver function abnormalities during tuberculosis (TB) treatment can indicate anti-TB drug-induced liver injury (ATLI), a serious adverse event. Therefore, this study aims to evaluate transaminase levels in a cohort of patients with TB undergoing treatment. It also assesses the prevalence and severity of ATLI. Methods: We conducted a cross-sectional study of 235 patients with TB during the intensive phase (2 months) of treatment to assess liver function. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured, and hepatotoxicity was graded according to the World Health Organization/common terminology criteria for adverse events criteria. HIV was screened according to the national algorithm, and hepatitis B was assessed serologically. Results: Median ALT and AST levels varied by age, sex, and HIV status. Males had higher ALT (19.2 vs 15.3 IU/l; P = 0.009) and AST (28.1 vs 24.0 IU/l; P = 0.009) levels than females. Levels increased with age (P <0.05) and were higher in patients positive for HIV (ALT 25 vs 17.7 IU/l, AST 33 vs 27 IU/l; P <0.05). No differences were observed according to hepatitis B status. Overall, 53 (22.6%) patients had elevated transaminases, mostly mild (92.5%), whereas 7.5% experienced ATLI. Conclusion: Hepatotoxicity was common at 2 months of TB treatment and was associated with male sex, older age, and HIV co-infection. These findings highlight the importance of regular liver function monitoring in these patient groups during treatment.
Abstract Background Lower urinary tract symptoms (LUTS) are common. They impair quality of life (QoL) and productivity. Objective To evaluate the impact of LUTS on QoL, work productivity, and daily activities. Methods This was an analytical cross-sectional study. LUTS were assessed via the IPSS score, QoL was assessed via the IPSS-QoL item, and the WPAI-LUTS questionnaire was used to evaluate absenteeism, presenteeism, overall work productivity impairment, and impairment of non-work daily activity. Adjusted linear regression was used to determine the relationships among the three parameters. Results A total of 344 participants were included, with a mean age of 62 (SD: 9) years. Workers represented 64.2% (private sector 47.1%, public sector 49.8%). The mean IPSS was 9 (7.1), and the IPSS-QoL was 3 (2.2). The mean absenteeism, presenteeism, overall work productivity impairment, and activity impairment scores were 4%, 10.4%, 12.7%, and 13.2%, respectively. After adjustment, IPSS was associated with IPSS-QoL (βa = 0.192; p < 0.001), particularly for storage symptoms (βa = 0.238; p < 0.001), as well as with all WPAI-LUTS domains (βa = 0.73 to 1.76; p < 0.001). Conclusion LUTS are associated with impaired QoL, reduced work productivity, and limitations in daily activities among men aged 40 years and older.
We establish a cosymplectic counterpart of Banyaga’s theorem by proving that the group of weakly Hamiltonian diffeomorphisms, Ham_η ,ω(M) , is simple on any closed cosymplectic manifold. A key structural result, derived from Lie group theory, provides the foundation for our argument: the Reeb flow on any closed cosymplectic manifold is always periodic. This property, in turn, forces the associated flux group to be discrete. Building on this discrete invariant, we develop the essential fragmentation and transitivity principles needed to prove perfectness and simplicity. Beyond this algebraic framework, we recover Li’s result realizing closed cosymplectic manifolds as symplectic mapping tori, and we establish a Liouville-type integrability theorem for Hamiltonian systems invariant under the Reeb flow, producing (n+1) -dimensional invariant tori. Finally, we characterize the commutator subgroup of the full cosymplectomorphism group as Ham_η ,ω(M) .
Compared to other species, the extent of human cooperation is unparalleled. Such cooperation is coordinated between community members via social norms. Developmental research has demonstrated that very young children are sensitive to social norms, and that social norms are internalized by middle childhood. Most research on social norm acquisition has focused on norms that modulate intra-group cooperation. Yet around the world, multi-ethnic communities also cooperate, and this cooperation is often shaped by distinct inter-group social norms. In the present study, we investigated whether intra-ethnic and inter-ethnic social norm acquisition follows the same, or distinct, developmental trajectories. Specifically, we worked with BaYaka foragers and Bandongo fisher-farmers who inhabit multi-ethnic villages in the Republic of the Congo. In these villages, inter-ethnic cooperation is regulated by sharing norms. Based on our ethnographic knowledge of the participating communities, we predicted that children's intra-ethnic sharing choices would match those of adults at an earlier age than their inter-ethnic sharing choices. To test this prediction, children (5-17 years) and adults (17 + years) participated in a modified Dictator Game to investigate the developmental trajectories of children's intra- and inter-ethnic sharing choices. Contrary to our prediction, both intra- and inter-ethnic sharing norms were acquired in middle childhood. Interviews with adult participants suggested that intra- and inter-ethnic sharing norms are acquired from multiple sources, including parents and peers. Further, Bandongo adults primarily reported learning sharing norms via Instruction, whereas BaYaka adults primarily reported learning via Observation/Imitation. These cross-cultural differences may reflect variation in norm complexity. Together, these findings suggest that when social contexts regularly expose children to out-group collaboration, inter-ethnic norms are acquired at similar timelines to intra-ethnic ones, as part of children's broader cooperative repertoire.
