Effects of maternal nicotine on breastfeeding infants.

OBJECTIVE To assess scientific evidence about the effects of maternal nicotine on infant by an integrative review. DATA SOURCES Studies published in Portuguese, English and Spanish, from 1990 to 2009, with abstracts available in the Latin American Health Sciences Literature (Lilacs) and Medical Literature Analysis and Retrieval System On-Line (Medline) databases. The descriptors were: "breastfeeding", "lactation" and "smoking". DATA SYNTHESIS The main identified effects of nicotine on infants were: changes in sleep and wakefulness patterns; reduction of iodine supply; hystopathological damage on liver and lung; intracellular oxidative damage; reduction of pancreatic ß cells; and decreased glucose tolerance. CONCLUSIONS It is recommended to inform mothers about harmful chemicals contained in cigarettes that can be secreted into breast milk. They should be strongly encouraged to stop smoking during lactation.

Effects of maternal nicotine on breastfeeding infants / Efecto de la nicotina en el nino en amamantacion / Efeitos da nicotina materna na crianca em amamentacao

OBJECTIVE To assess scientific evidence about the effects of maternal nicotine on infant by an integrative review. DATA SOURCES Studies published in Portuguese, English and Spanish, from 1990 to 2009, with abstracts available in the Latin American Health Sciences Literature (Lilacs) and Medical Literature Analysis and Retrieval System On-Line (Medline) databases. The descriptors were: "breastfeeding", "lactation" and "smoking". DATA SYNTHESIS The main identified effects of nicotine on infants were: changes in sleep and wakefulness patterns; reduction of iodine supply; hystopathological damage on liver and lung; intracellular oxidative damage; reduction of pancreatic ß cells; and decreased glucose tolerance. CONCLUSIONS It is recommended to inform mothers about harmful chemicals contained in cigarettes that can be secreted into breast milk. They should be strongly encouraged to stop smoking during lactation. .

OBJETIVO Evaluar las evidencias científicas sobre efectos de la nicotina materna en el niño en amamantación, a partir de una revisión integrativa. FUENTES DE DATOS Artículos publicados en portugués, inglés y español, de 1990 a 2009, con resúmenes disponibles en las bases Literatura Latinoamericana en Ciencias de la Salud (Lilacs) y Medical Literature Analysis and Retrieval System On-Line (Medline). Se utilizaron los descriptores: "lactancia materna", "lactancia" y "tabaquismo". SÍNTESIS DE LOS DATOS Los principales efectos de la nicotina encontrados fueron alteraciones en los estándares de sueño y vigilia; reducción de la oferta de yodo; daños histopatológicos en el hígado y en los pulmones; daños oxidativos intracelulares; reducción de células ß del páncreas y reducción de la tolerancia a la glucosa. CONCLUSIONES Se recomienda que las madres sean informadas sobre los productos químicos perjudiciales contenidos en los cigarrillos, que pasan para el bebé mediante la lactancia materna, debiendo ser fuertemente motivadas a no fumar durante la gestación y lactancia. .

OBJETIVO Avaliar as evidências científicas sobre efeitos da nicotina materna na criança em amamentação, a partir de uma revisão integrativa. FONTES DE DADOS Artigos publicados em português, inglês e espanhol, de 1990 a 2009, com resumos disponíveis nas bases Literatura Latino-Americana em Ciências da Saúde (Lilacs) e Medical Literature Analysis and Retrieval System On-Line (Medline). Utilizaram-se os descritores: "aleitamento materno", "lactação" e "tabagismo". SÍNTESE DOS DADOS Os principais efeitos da nicotina encontrados para a criança foram alterações nos padrões de sono e vigília; redução da oferta de iodo; danos histopatológicos no fígado e no pulmão; danos oxidativos intracelulares; redução de células β do pâncreas; e diminuição da tolerância à glicose. CONCLUSÕES Recomenda-se que as mães sejam informadas sobre os produtos químicos prejudiciais contidos no cigarro, os quais passam para o bebê por meio do leite materno, devendo ser fortemente encorajadas a não fumar durante a lactação. .

[Human African trypanosomiasis in Ivory Coast: biological characteristics after treatment. 812 cases treated in the Daloa focus (Ivory Coast)]. / Trypanosomose humaine africaine en Côte d'Ivoire: caractéristiques biologiques après traitement. A propos de 812 cas traités dans le foyer de Daloa (Côte d'Ivoire).

The treatment and post therapeutic follow up of patients diagnosed with HAT are important for HAT control. A longitudinal survey was implemented in the focus of Daloa (Côte d'Ivoire). A total of 812 patients infected with Trypanosoma brucei gambiense in meningoencephalitic stage and treated with melarsoprol were included, this study pointed out the biological characteristics of patients after treatment. The relapse occurs between 1 and 24 months after treatment. It is essentially neurological, and characterised by the presence in the CSF of antibodies, by the increase of cell count compared with value immediately after treatment, or by the presence of trypanosomes. The cure can be confirmed from 18 months after treatment, and is characterised by the absence of antibodies and trypanosomes in the CSF, by a normal cell count and a normal proteinorachy. Biological scares were recorded on some of the patients after 18 months of follow up, but no relapse occurred among them.

[Geographic distribution of trypanosomiasis treated in Ivory Coast from 1993 to 2000]. / Distribution géographique des trypanosomés pris en charge en Côte d'Ivoire de 1993 à 2000.

Human African Trypanosomosis (HAT, or sleeping sickness) caused by Trypanosoma brucei gambiense develops chronically in Côte d'Ivoire. From 1993 to 2000, a total of 1616 patients were taken in charge in the three treatment centres of the country, which means an average of 202 patients a year. The patients came from two main areas in the Centre West of the country in the Marahoué region: the districts of Sinfra, South of Bouaflé, and Bonon, West of Bouaflé. In the Centre West and in the South East of the country (Aboisso-Ayamé), patients are still struck by the disease, although these foci are less active. The remaining foci seem to be controlled, although no active survey has been carried out. The areas where the greatest number of patients were recorded are the ones where rental crops are located (cocoa and coffee mainly) and where rural activities tend to bring humans and tsetse flies in contact. In this study, are figured the number of treated patients, the endemic and risk areas. It will help to design control strategies and decision makers to know where priority control programs should be implemented.

Measurement of cardiac troponins.

The cardiac troponins form part of the regulatory mechanism for muscle contraction. Specific cardiac isoforms of cardiac troponin T and cardiac troponin I exist and commercially available immunoassay systems have been developed for their measurement. A large number of clinical and analytical studies have been performed and the measurement of cardiac troponins is now considered the 'gold standard' biochemical test for diagnosis of myocardial damage. There have been advances in understanding the development and structure of troponins and their degradation following myocardial cell necrosis. This has contributed to the understanding of the problems with current assays. Greater clinical use has also highlighted areas of analytical and clinical confusion. The assays are reviewed based on manufacturers' information, current published material as well as the authors' in-house experience.

Plasma arginine levels and the response to inhaled nitric oxide in neonates.

Inhaled nitric oxide (iNO) can be an effective vasodilator in pulmonary hypertension of the newborn (PHN). The aim of this study was to determine whether differences in arginine levels, from which endogenous NO is produced, explain the variability in response to NO and whether the arginine levels were lower in term and preterm infants with PHN than in infants without PHN (controls). We prospectively studied 30 infants (17 born preterm) with clinically diagnosed PHN and treated with iNO and 22 controls (14 born preterm). Three NO levels (10, 20, 40 ppm) were administered to the PHN infants to identify that associated with maximum oxygenation. Twenty-seven infants with PHN improved following iNO and had lower arginine levels than those infants who did not respond to iNO (p < 0. 05). No significant relationship, however, was noted between the arginine levels and either the magnitude of change in the oxygenation index in response to iNO or the NO level associated with maximum oxygenation. The median plasma arginine level prior to iNO of the PHN infants was 12.5 (range 2-53) mu mol/l, but not significantly lower than that of the controls (median 24, range 3-82 mu mol/l). We conclude that differences in plasma arginine levels are unlikely to explain the variation in response to iNO and that, although arginine levels tended to be lower in infants with PHN, this is not a consistent finding in either the term or preterm infants.

Argininosuccinate lyase: a new autoantigen in liver disease.

Anti-liver cytosol 1 autoantibody (LC1) characterizes a severe form of autoimmune hepatitis (AIH), staining the cytoplasm of periportal hepatocytes and targeting an unidentified 60-kD liver cytosolic antigen. To identify its target, we used high-titre anti-LCI+ sera from two patients with AIH to screen 18 cytoplasm enzymes with periportal location by double immunodiffusion (DDI). Both sera gave a broad precipitin line against human liver cytosol, suggesting that they may recognize two distinct antigens, a possibility confirmed by the appearance of two precipitin lines when DDI conditions were optimized (0.8% agarose and 3% polyethylene glycol (PEG)). Experiments by DDI and Western blot (WB) identified a liver cytosolic autoantigen of 50 kD, different from LC1, giving a line of identity with argininosuccinate lyase (ASL). Reactivity to ASL was then investigated by DDI and WB in 57 patients with AIH, 17 with primary biliary cirrhosis (PBC), 15 with chronic hepatitis B virus (HBV) infection, 13 with alphal-antitrypsin deficiency, 17 with Wilson's disease, 18 with extrahepatic autoimmune disorders, and in 48 healthy controls. Anti-ASL was found in 16% of AIH and 23% of PBC patients by DDI and in 14% of AIH, 23% of PBC and 20% of HBV patients by WB. No argininosuccinate was present in the urine of four anti-ASL+ patients tested, excluding an inhibition of enzymatic activity by anti-ASL. The addition of anti-ASL+ serum to human fibroblast cultures induced a significant increase in ASL activity. ASL is a new autoantigen in liver disease and its clinical relevance warrants further investigation.

Prevalence of neurological disorders in Haute-Vienne department (Limousin region-France).

The Limousin region had at present one of the largest elderly populations in France and in Europe. To determine the frequency of certain neurological disorders in the elderly, a neuroepidemiological survey was conducted in 1986-1987 on a representative sample of the population in Haute-Vienne (the most population-dense department in the Limousin region). This study used a WHO protocol which was first introduced at the beginning of the 1980s. It had been previously tested in France on a pilot population in 1984. The prevalences of the principal neurological disorders encountered per 100,000 inhabitants were as follows: nonmigraine headache 5,059, migraine 4,270, epilepsy 788, completed stroke 1,445, transient ischemic attacks 657, neuropathy 1,642, Parkinson's disease 328, and dementia 197.

Amino acid concentrations in human embryological fluids.

The concentrations of amino acids in samples of coelomic fluid (n = 15), amniotic fluid (n = 9) and maternal serum (n = 15) obtained from normal pregnancies between 7 and 12 weeks of gestation were measured using reversed-phase chromatography with pre-column derivatization. The total molar concentration of the 18 amino acids measured was 2.3 times higher in coelomic fluid than in maternal serum. All amino acids except serine and tryptophan were present in significantly higher concentrations in coelomic fluid than in maternal serum. Significant correlations between maternal serum and coelomic fluid were only found for proline, tyrosine, and tryptophan, suggesting that levels of the other amino acids are mainly influenced by placental synthesis and do not directly depend on maternal amino acid metabolism. Levels of all amino acids were significantly higher in coelomic fluid compared to amniotic fluid. Compared to maternal serum, the amniotic fluid contained significantly higher levels of arginine, lysine, alanine and tyrosine and lower levels of serine, glutamine and tryptophan. The total molar amino acid concentration decreased significantly with gestational age in both coelomic fluid and maternal serum. These results suggest that amino acids accumulate in coelomic fluid to support the metabolism of the secondary yolk sac, and that the exocoelomic cavity is the reservoir for most nutrients needed by the embryo and early fetus in the first trimester of human pregnancy.

Prevalence of headache in a representative sample of the population in a French department (Haute-Vienne-Limousin).

In 1986-1987, a neuroepidemiologic survey was undertaken to study the prevalence of the most frequently encountered neurologic disorders, and in particular headache, in a representative sample of the population in the Haute-Vienne Department (Limousin). A door-to-door survey was made using a protocol developed by the W.H.O. at the beginning of the 1980's. The calculated prevalences (according to Poisson's distribution) per 100,000 inhabitants were 5,059 for nonmigraine headache, and 4,270 for migraine headache. This disorder preferentially affected young adults and essentially involved females. It was the most frequently encountered disorder (50%) during the different surveys of similar methodology.

[EEG and treatment with Arsobal in human African trypanosomiasis]. / EEG et traitement par l'arsobal dans la trypanosomiase humaine africaine.

EEG in patients suffering form HAT at the meningoencephalitis stage displays the characteristic features of the disease. Now since most of the patients are treated at an early stage, the majority of the EEG are normal or with mild abnormalities. Where abnormalities occur, they present a diminished background activity interrupted by bursts of synchronous and generalised polymorphic delta waves at 1.2 c/s. A strict correlation frequently exists between severity of clinical symptoms and the degree of EEG abnormality. These EEG abnormalities disappears very often, after the first period of the treatment by melarsoprol. EEG seems useful to follow the course of the patients treated by melarsoprol.

[Hemiplegic forms of human African trypanosomiasis]. / Formes hémiplégiques de la trypanosomiase humaine africaine.

Hemiplegic forms of human African trypanosomiasis are unusual. From 1963 to 1987, 14 cases have been reported in the literature. One may be mistakenly led to look for a space-occupying lesion when clinical features include hemiplegia, vascular shift from median line during arteriography, focal EEG anomalies and intracranial hypertension. The discussion on diagnosis also covers subacute or chronic meningo encephalitis (tuberculosis syphilis or fungal infection). CT scanner findings suggest the association of a massive demyelination of centrum semiovale, with cerebral oedema.

[A neuro-epidemiologic survey in a Limousin town]. / Enquête neuro-épidémiologique dans un bourg du Limousin.

One characteristic of the Limousin district is the raised average age of its population. Given the growing average age found in France and the ensuing potential problems, it was thought useful to undertake a neuro-epidemiological study of the distribution of neurological diseases in this region. The initial step involved checking the techniques to be used and the form of questionnaire relevant to this type of study. Following W.H.O. recommendations, the total population of one small town was surveyed, and the distribution of various neurological ailments was thus measured (headaches, migraine, cluster headaches: 12.73 p. 100, transient ischemic attack: 1.89 p. 100, stroke: 1.36 p. 100, epilepsy: 1.68 p. 100. Parkinson's disease 1.47 p. 100, dementia: 0.31 p. 100, misc: 0.84 p. 100). These figures were compared with the results from similar pilot projects carried out elsewhere around the world. The results obtained in this preliminary study enabled us to perfect the methods, and to perform a more extensive survey of a representative cross section of the Limousin population. This larger study will be published later.

Treatment of human late stage gambiense trypanosomiasis with alpha-difluoromethylornithine (eflornithine): efficacy and tolerance in 14 cases in Côte d'Ivoire.

alpha-Difluoromethylornithine (DFMO; eflornithine), an inhibitor of polyamine biosynthesis, was used to treat 14 patients with late stage gambiense sleeping sickness, 12 cases having been previously treated with and considered refractory to melarsoprol. alpha-Difluoromethylornithine was administered intravenously at a dose of 400 mg/kg/day for 14 days followed by oral treatment, 300 mg/kg/day, for 21-28 days. In all patients treatment was associated with rapid disappearance of trypanosomes from body fluids (in several cases within 24 hr) and decreased cerebrospinal fluid white blood cell counts. In all but one patient, who died of a pulmonary infection during treatment, alpha-difluoromethylornithine produced a dramatic reversal of clinical signs and symptoms of the disease. Determination of drug concentrations in serum and cerebrospinal fluid of 5 patients demonstrated that alpha-difluoromethylornithine diffuses into the central nervous system with cerebrospinal fluid levels representing up to 51% of corresponding serum concentrations. Diarrhea, abdominal pain, and anemia were the most frequent side effects associated with therapy, but were reversible and did not necessitate discontinuation of treatment. Four patients have been followed for more than 2 years post-treatment without evidence of relapse.

Human African trypanosomiasis (T.b. gambiense): a study of 16 fatal cases of sleeping sickness with some observations on acute reactive arsenical encephalopathy.

The principal clinical and pathological findings in 16 fatal cases of human African trypanosomiasis caused by T.b. Gambiense are described. The changes in the brain took the form of a non-specific lymphoplasmacytic meningo-encephalitis of varying intensity. Other features included morular cells, diffuse microglial hyperplasia, and large reactive astrocytes in the white matter. Carditis was identified in 10 cases. Acute reactive arsenical encephalopathy appeared to be the principal cause of death in 10 patients. Convulsions figured prominently in this type of encephalopathy in seven patients and were sufficiently severe to produce hypoxic brain damage. In three cases of acute reactive arsenical encephalopathy the structural changes in the brain were those of acute haemorrhagic leucoencephalopathy.