Systemic phenotype of sarcoidosis associated with radiological stages. Analysis of 1230 patients.

BACKGROUND: To analyze the association between Scadding radiological stages of sarcoidosis at diagnosis and the disease phenotype (epidemiology, clinical presentation and extrathoracic involvement) in one of the largest cohorts of patients with sarcoidosis reported from southern Europe. METHODS: The SARCOGEAS-Study Group includes a multicenter database of consecutive patients diagnosed with sarcoidosis according to the WASOG 1999 criteria. Extrathoracic disease at diagnosis was defined according to the 2014 instrument and the clusters proposed by Schupp et al. RESULTS: We analyzed 1230 patients (712 female, mean age 47 yrs.) who showed the following Scadding radiologic stages at diagnosis: stage 0 (n = 98), stage I (n = 395), stage II (n = 500), stage III (n = 195) and stage IV (n = 42). Women were overrepresented in patients presenting with extrathoracic/extrapulmonary disease, while the diagnosis was made at younger ages in patients presenting with BHL, and at older ages in those presenting with pulmonary fibrosis (q values <0.05). Multivariable adjusted analysis showed that patients presenting with pulmonary involvement (especially those with stages II and III) had a lower frequency of concomitant systemic involvement in some specific extrathoracic clusters (cutaneous-adenopathic/musculoskeletal, ENT and neuro-ocular/OCCC) but a higher frequency for others (hepatosplenic), in comparison with patients with extrapulmonary involvement (stages 0 and I). The presence of either BHL or fibrotic lesions did not influence the systemic phenotype of patients with pulmonary involvement. CONCLUSIONS: The key determinant associated with a differentiated systemic phenotype of sarcoidosis at diagnosis was interstitial pulmonary involvement rather than the individual Scadding radiological stage.

Reducing spatial variability of soybean response to rhizobia inoculants in farms of variable soil fertility in Siaya County of western Kenya.

Soybean grain yields in sub-Saharan Africa have remained at approximately 50% below those attained in South America despite numerous efforts. A study was conducted in Siaya County (western Kenya) involving 107 farms with soils of different fertility status. The main objective was to test combinations of two inoculants (Legumefix and Biofix) and nutrient sources (Minjingu and Sympal) to raise soybean grain yields. Inoculation used Legumefix or Biofix with and without Minjingu or Sympal in a factorial design. There was soil acidity and a widespread deficiency of potassium, nitrogen, and phosphorus. Inoculation and nutrient source led to increases in nodulation and nodule occupancy. For grain yields the response varied from nil in some sites to high increases in others. Highest grain yields (3000-4000 kg ha-1) were obtained with Legumefix + Sympal (12% of the farmers testing it). The formulation of the nutrient source was important to meet other nutrient deficiencies in most of the soils. Farmers using Legumefix + Sympal require yield increases of 35% for profitability (Value cost ratio of 3) while farmers using Minjingu + inoculant require a yield increase of at least 68%. Inoculants used alone were most profitable but this is advisable only when farmers are too resource constrained to afford fertilizer. For sustainable yields Legumefix + Sympal or Biofix + Sympal were recommended.

Looking back and moving forward: 50 years of soil and soil fertility management research in sub-Saharan Africa.

Low and declining soil fertility has been recognized for a long time as a major impediment to intensifying agriculture in sub-Saharan Africa (SSA). Consequently, from the inception of international agricultural research, centres operating in SSA have had a research programme focusing on soil and soil fertility management, including the International Institute of Tropical Agriculture (IITA). The scope, content, and approaches of soil and soil fertility management research have changed over the past decades in response to lessons learnt and internal and external drivers and this paper uses IITA as a case study to document and analyse the consequences of strategic decisions taken on technology development, validation, and ultimately uptake by smallholder farmers in SSA. After an initial section describing the external environment within which soil and soil fertility management research is operating, various dimensions of this research area are covered: (i) 'strategic research', 'Research for Development', partnerships, and balancing acts, (ii) changing role of characterization due to the expansion in geographical scope and shift from soils to farms and livelihoods, (iii) technology development: changes in vision, content, and scale of intervention, (iv) technology validation and delivery to farming communities, and (v) impact and feedback to the technology development and validation process. Each of the above sections follows a chronological approach, covering the last five decades (from the late 1960s till today). The paper ends with a number of lessons learnt which could be considered for future initiatives aiming at developing and delivering improved soil and soil fertility management practices to smallholder farming communities in SSA.