La décennie 1980 marque un tournant dans l'intégration de l'Afrique subsaharienne dans l'économie des drogues illicites. Terre de passage pour les produits illicites venant des continents asiatique et sud-américain et à destination de l'Europe et de l'Amérique du Nord, l'Afrique en devient également une terre de production, principalement de cannabis, et un marché de consommation. Le développement de la production, du trafic et de la consommation illicites de cannabis s'y inscrit dans un contexte économique dégradé. La chute des prix des matières premières et les politiques de libéralisation des filières ne touchent pas seulement le secteur agricole qui se met en quête de cultures alternatives : le commerce et le transport pâtissent aussi de cette dégradation économique. À la différence des 122 Hérodote, n°112, La Découverte, 1 er trimestre 2004. 1. Des études agro-économiques auprès des producteurs ont été menées en Gambie, au Sénégal,
ObjectivesThe clinical outcomes of the Beta (B.1.351) variant of concern (VOC) of the SARS-CoV-2 virus remain poorly understood. In early 2021, northeastern France experienced an outbreak of Beta that was not observed elsewhere. This outbreak slightly preceded and then overlapped with a second outbreak of the better understood VOC Alpha (B.1.1.7) in the region. This situation allowed us to contemporaneously compare Alpha and Beta in terms of the characteristics, management, and outcomes of critically ill patients.MethodsA multicenter prospective cohort study was conducted on all consecutive adult patients who had laboratory confirmed SARS CoV-2 infection, underwent variant screening, and were admitted to one of four intensive care units (ICU) for acute respiratory failure between January 9th and May 15th, 2021. Primary outcome was 60-day mortality. Differences between Alpha and Beta in terms of other outcomes, patient variables, management, and vaccination characteristics were also explored by univariate analysis. The factors that associated with 60-day death in Alpha- and Beta-infected patients were examined with logistic regression analysis.ResultsIn total, 333 patients (median age, 63 years; 68% male) were enrolled. Of these, 174 and 159 had Alpha and Beta, respectively. The two groups did not differ significantly in terms of 60-day mortality (19 vs. 23%), 28-day mortality (17 vs. 20%), need for mechanical ventilation (60 vs. 61%), mechanical ventilation duration (14 vs. 15 days), other management variables, patient demographic variables, comorbidities, or clinical variables on ICU admission. The vast majority of patients were unvaccinated (94%). The remaining 18 patients had received a partial vaccine course and 2 were fully vaccinated. The vaccinated patients were equally likely to have Alpha and Beta.ConclusionsBeta did not differ from Alpha in terms of patient characteristics, management, or outcomes in critically ill patients.Trial RegistrationClinicalTrials.gov, identifier: NCT04906850.
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