[Validation of the french translated Richmond vigilance-agitation scale]. / Validation de l'échelle de vigilance-agitation de Richmond traduite en langue française.

OBJECTIVE: To test reliability of the Richmond Agitation Sedation Scale (RASS) after French translation. STUDY DESIGN: Prospective psychomotor evaluation study. PATIENTS AND METHODS: Two bilingual physicians performed the translation from English to French language. The French version was then translated to English by a bilingual non physician ("backtranslation") and compared to the original version. The translated scale was tested according to usual guidelines concerning the translation of neuropsychological evaluation tools. The French version of RASS was tested on the morning of every fifth or sixth day, and 30-min after any procedure, in 43 consecutive patients admitted to a 12-bed medical-surgical intensive care unit during two months, by a group of four observers: the principal investigator, two anaesthesiology residents and one pharmacology student. Inter-rater reliability was tested using the simple and weighted Kappa coefficients (with their 95% confidence interval). A consensual and detailed "operating instructions" guide of RASS, intended for medical and nursing staff, has been added in the Annexe section. RESULTS: Four hundred twenty measures were performed during 105 grouped observations. Reliability of the French version of RASS was substantial. Simple Kappa coefficient, testing the concordance between observers, was ranged from 0.72 (0.62-0.81) to 0.87 (0.79-0.94) and weighted Kappa coefficient from 0.95 (0.92-0.98) to 0.99 (0.98-0.99). CONCLUSIONS: The French translation of RASS was acceptable. The translated scale preserved substantial inter-rater reliability. Monitoring of vigilance status in intensive care settings can be performed with this reliable clinical tool.

[Enteric parasites and AIDS in Haiti: utility of detection and treatment of intestinal parasites in family members]. / Parasites intestinaux et sida en Haïti: faut-il déparasiter l'entourage familial?

Intestinal parasites and human immunodeficiency virus (HIV) are major health problems in Haiti. Both entities are known to interact strongly with cell-mediated immunity. The purpose of this study undertaken in Port-au-Prince, Haiti was to evaluate the risk of enteric parasite transmission between HIV-infected patients and family members. Routine examination of stool specimens for parasites was conducted in 90 HIV-infected undergoing treatment for intestinal disorders due mainly to Cryptosporidium sp. (62%) and 123 healthy family member volunteers. A stool sample preserved in 10% formalin solution was examined to detect protozoa (MIF, modified Ziehl-Neelsen stain, Uvibio fluorescence technique, Weber stain) and helminth ova (Bailenger technique). In addition to Cryptosporidium sp., 14 parasitic species were identified: 6 Rhizopoda, 3 Flagellata (including Giardia duodenalis), 1 Coccidia (Cyclospora cayetanensis), 3 Nematoda (mainly Ascaris lumbricoides) and 1 Cestoda (Hymenolepis nana). This is the first time that 5 protozoa, i.e., Blastocystis hominis, Entamoeba hartmanni, E. polecki, Chilomastix mesnili, and Enteromonas hominis, have been reported in Haiti. As expected, enteric parasites were less common in HIV-infected subjects undergoing medical treatment (11.1%) than in uninfected family members (41.5%) (p = 0.0000). Multiple intestinal parasitism (infection by 2 to 4 parasites) was observed in 19.5% of family members. The findings of this study indicate that detecting and treating intestinal parasites in subjects living in close contact with HIV-infected patients as well as informing family members of the importance of personal hygiene in Haiti are highly recommended measures to preserve the health of AIDS patients.

[Sensitization to powdered latex gloves: prevalence in hospital employees]. / Sensibilisation aux gants en latex poudrés: une prévalence élevée chez le personnel hospitalier.

INTRODUCTION: The prevalence of latex allergies in industrial countries has skyrocketed since the 1980s. Between 2.6 and 22% of hospital workers are diagnosed with latex allergy, which has been recognized as an occupational hazard in France since 1997. AIM: To assess the prevalence of latex allergy among Montpellier University Hospital Center staff. METHODS: From 1999 to 2002, we interviewed and conducted skin-prick tests on 537 hospital staff members from different departments and with different degrees of exposure to airborne latex allergens. RESULTS: Symptoms while using natural-rubber latex gloves (most often contact dermatitis) were reported by 88 (16.4%) staff members. Overall work-related allergic symptoms included rhinitis, reported by 65 (12.1%), contact urticaria by 28 (5.2%), and bronchial symptoms by 16 (1.1%). In all, sensitization to latex was identified in 7.1% of our staff, and this percentage was higher (11.3%) in units where latex gloves were used more often. Sensitization was associated with high latex exposure and atopy. CONCLUSION: This high rate of latex sensitization and the risk factors are similar to those already published. Based on this study, we have eliminated powdered latex gloves, as have many other hospitals.

Prevalence of HIV infection and high-risk activities in Haiti.

The prevalence of antibodies to human immunodeficiency virus (HIV) was determined in the relatives, friends, and sex partners of AIDS patients in Haiti and in other unrelated Haitian population groups. Among contacts of AIDS patients, HIV seroprevalence was highest among sex partners of the opposite sex (55%) and lowest among female relatives and friends (9%) of female AIDS patients. Male relatives and friends of male AIDS patients had a seroprevalence rate of 19% and also had a history of multiple heterosexual partners and frequent contact with prostitutes. The HIV seroprevalence rate among unrelated groups of Haitian adults ranged from 2% in rural healthy adults to 22% among tuberculosis patients to a high of 49% among Haitian prostitutes. This seroprevalence pattern suggests that HIV infection is widespread in Haiti and that heterosexual activity plays a major role in transmission.

The urge for an AIDS vaccine: perspectives from a developing country.

AIDS is inexorably involving all parts of the country and all strata of society, with 10% of the urban and 3% of the rural population infected with HIV. It is increasingly a disease of women and children. The major cofactors for transmission are also sexually transmitted. For most developing countries, in spite of all education efforts, the "silent epidemic" of AIDS continues. AIDS is known but not understood; counselling modifies behavior in only 10-20% of at-risk persons. Under optimal conditions, HIV discordant females have seroconversion rates of 4.7% per year and pregnancy rates of 10.4% per year. The recent political unrest in Zaire and Haiti will further enhance the spread of AIDS in these countries. Despite these difficult periods, the work can and must continue. After all, during our 10th year of collaboration with a Haitian private research group, the Haitian government and Cornell University, Haiti has known seven different political rulers. Finally, I want to make a pledge on behalf of the millions of people who face a certain death from HIV infection and AIDS and who will never make the front page of any newspaper. For these people, you can make a difference. You must give us the tools to carry on this fight. The clinical trials must be done where they are most needed: the developing countries. Vaccines represent the only viable alternative despite the recognized obstacles of viral heterogeneity, immunogenicity, and delivery.

Clinical manifestations of human immunodeficiency virus infection in Haitian children.

OBJECTIVE: This study was designed to describe the characteristics of HIV-1 infection in children in Haiti and to assess its impact on morbidity and mortality. BACKGROUND: Throughout the developing world the female-to-male ratio of HIV-1 infection approaches 1:1, leading to a tremendous burden of vertically transmitted HIV-1 infection. The frequency of transmission, progression of disease and AIDS-defining clinical illnesses are not as well-described in this setting as in the industrial world. METHODS: Children were identified as being HIV-1-seropositive from case findings among family members of individuals presenting for screening at the GHESKIO Centers in Port-au-Prince, Haiti. Children who were seronegative from the same population were also enrolled and both groups were followed at regular intervals. The clinical course and illnesses associated with HIV infection were documented. RESULTS: Rapid progression to symptomatic disease and death was seen and a battery of physical findings enabled a clinician over time to assign with high sensitivity and specificity the diagnosis of AIDS to a child. Although many findings are similar, the presentation of HIV-1 infection in Haiti differed in significant ways from observations in the industrial world. In particular signs of malnutrition, failure to thrive and tuberculosis were more common in the Haitian population. CONCLUSION: Pediatric HIV-1 infection in Haiti differs significantly from the illness in the industrial world. Early mortality poses a particular difficulty in diagnosing and ascribing mortality to HIV-1 infection.

The natural history of human immunodeficiency virus 1 infection in Haitian infants.

OBJECTIVES: The current study followed HIV-infected women through pregnancy and their infants through the first 2 years of life to determine the rate of vertical transmission of HIV infection from Haitian women, factors in maternal health and obstetrical history that might influence such transmission and the natural history of HIV infection in their affected offspring. STUDY DESIGN: The medical histories of 81 infants born of HIV-infected women and of a control group of 88 infants born to uninfected women were documented with close clinical and serologic follow-up. In addition to standard tests for persistence of HIV antibodies, the use of acid-dissociated p24 assays enabled us to assign some additional infants to the HIV-infected cohort. RESULTS: Transmission could be documented in 27% of infants born to HIV-infected women. Excess early deaths occurred in infants of HIV-infected women in Port-au-Prince with 60% of infected infants dead by 6 months of age. This is a more accelerated mortality than that in a group of 42 HIV-infected infants born of Haitian mothers living in Miami where 10% were dead at 6 months. Clinically, in 6 of 19 deaths in HIV-infected children in Haiti, failure to thrive and gastroenteritis lead to a systemic infection manifested as meningitis, sepsis or pneumonia as the immediate cause of death. CONCLUSIONS: Early mortality attributable to perinatally acquired AIDS was identified in Haiti. The comparison of data from Miami and Port-au-Prince suggests that environmental exposures in developing countries may be more operative in this early mortality than viral strain or maternal host factors, both of which might be expected to be similar between the two groups of Haitian ethnicity.

Precise measurement of the b-quark fragmentation function in Z0 boson decays

We have developed a new technique for inclusive reconstruction of the energy of B hadrons. The excellent efficiency and resolution of this technique allow us to make the most precise determination of the b-quark fragmentation function, using e(+)e(-)-->Z0 decays recorded in the SLAC Large Detector experiment. We compared our measurement with the predictions of a number of fragmentation models. We excluded several of these models and measured the average scaled energy of weakly decaying B hadrons to be = 0.714+/-0. 005(stat)+/-0.007(syst)+/-0.002 (model dependence).

First direct measurement of the parity-violating coupling of the Z0 to the s quark

We present the first direct measurement of A(s), the parity-violating coupling of the Z0 boson to the strange quark, using approximately 550 000 e(+)e(-)-->Z0-->hadrons events recorded by the SLC Large Detector with a polarized e(-) beam. We tagged Z0-->s&smacr; events by the absence of B or D hadrons and the presence in each hemisphere of a high momentum K+/- or K(0)(s). Fitting the polar angle distributions of the strangeness-signed thrust axis gave A(s) = 0.895+/-0.066(stat)+/-0.062(syst). The analyzing power and uu+d&dmacr; background were constrained using the data, greatly reducing any model dependence.

Cryptosporidiosis in Haitian children.

We used a modified acid-fast stain to detect Cryptosporidium oocysts in unconcentrated stools from 824 Haitian children less than 2 years of age with acute diarrhea. Oocysts were identified in stools from 17.5% of 291 children seen at a rural dispensary and in 16.3% of stools from 533 children in an urban hospital. Children with cryptosporidiosis were identified throughout a 22-month period from October 1982 to July 1984, without seasonal predilection. Cryptosporidiosis was twice as common in infants greater than 6 months of age than in younger infants. Cryptosporidium oocysts were rarely found in stools of infants receiving only breast milk. The clinical presentation of children with cryptosporidiosis was similar to other patients with diarrhea who did not have cryptosporidiosis. No asymptomatic Cryptosporidium infections were detected among 71 family members of 31 children with cryptosporidiosis. Three of the 71 family members less than 3 years of age were found to have diarrhea and Cryptosporidium oocysts. In follow-up studies of 31 patients, oocysts persisted in stools for a mean of 14 days (range 5-31 days). Duration of oocyst excretion was directly correlated with duration of diarrhea. These findings suggest that Cryptosporidium is an important cause of acute self-limited diarrheal illness to Haitian children.

Pruritic skin lesions. A common initial presentation of acquired immunodeficiency syndrome.

During July 1983 to December 1984, we observed that 62 (46%) of 134 Haitian patients with acquired immunodeficiency syndrome had intensely pruritic eruptions for which neither specific causative nor categoric diagnoses could be established. These lesions were a presenting manifestation of acquired immunodeficiency syndrome in 79% of the patients and appeared a mean of 8 months before the diagnosis of either Kaposi's sarcoma or opportunistic infection. Lesions included erythematous round macules, papules, or nodules that first appeared on the extensor surface of the arms, but subsequently involved the legs, trunk, and face. Histologically, the lesions were characterized by varying degrees of mixed (predominantly eosinophilic) perivascular and perifollicular inflammatory cell infiltrates of the dermis. The lesions did not respond to any therapeutic regimens used and usually persisted throughout the acquired immunodeficiency syndrome illness. Demographic and laboratory data did not distinguish these patients from those without pruritic skin lesions.

[Accuracy of videokeratographic quantitative criteria for detection of keratoconus suspects in families with keratoconus]. / Efficience des critères vidéokératographiques quantitatifs dans l'analyse familiale de patients atteints de kératocône.

AIM: We statistically assessed the videokeratographic data obtained from families with keratoconus in order to determine reliable criteria for detecting keratoconus suspects. MATERIAL AND METHODS: Fourteen keratoconus patients from 12 families were enlisted. We investigated 55 relatives (110 eyes). Standard videokeratographic data were obtained by screening 30 individuals (60 eyes) with clinically normal eyes, with no history of ocular disorders, contact lens wear, or keratoconus individuals in their family. Videokeratographic qualitative and quantitative analyses were performed on every subject. The videokeratographic threshold values obtained from the control group were used as a reference. RESULTS: Two criteria based on the Klyce/Maeda indices proved their statistical significance in detecting keratoconus suspects. When considering the significant criteria ascertained by the statistical analysis, building pedigrees favored the autosomal dominant mode of inheritance. Two of the pedigrees corresponded to either a recessive mode of transmission or the potential occurrence of a de novo mutation. CONCLUSION: We have determined videokeratographic criteria of statistical significance for detecting keratoconus suspects. The knowledge of the status of each member of families with keratoconus is a prerequisite to performing genetic linkage analyses, which may allow a precise locus linked with this disorder to be refined.

[Clinical study and prevalence of fetal alcohol syndrome in medico-social institutions of the Reunion Island]. / Etude clinique et prévalence du syndrome d'alcoolisation foetale pris en charge dans les établissements médicosociaux de l'île de la Réunion.

BACKGROUND: Fetal alcohol syndrome (FAS) is a major problem in the Reunion Island and the Public Health Authorities decided to determine its prevalence in their medico-social centers on 31 December 1996. MATERIAL AND METHODS: A questionnaire was established to identify affected patients in the 20 medico-social centers in charge of 1320 children. Eighty-eight children were selected and 87 could be analyzed. RESULTS: Sixty-four of 87 (76.3%) were FAS and 23 of 87 (23.7%) had closely alcohol-related diseases. The prevalence was between 7.1 and 14.1% and lower than expected from available data. CONCLUSION: The study allowed to precise the social and familial factors predisposing to alcohol addiction during pregnancy. A TV prevention message will be broadcasted after this study.

System size, energy, and centrality dependence of pseudorapidity distributions of charged particles in relativistic heavy-ion collisions.

We present the first measurements of the pseudorapidity distribution of primary charged particles in Cu+Cu collisions as a function of collision centrality and energy, sqrt[s_{NN}]=22.4, 62.4, and 200 GeV, over a wide range of pseudorapidity, using the PHOBOS detector. A comparison of Cu+Cu and Au+Au results shows that the total number of produced charged particles and the rough shape (height and width) of the pseudorapidity distributions are determined by the number of nucleon participants. More detailed studies reveal that a more precise matching of the shape of the Cu+Cu and Au+Au pseudorapidity distributions over the full range of pseudorapidity occurs for the same N{part}/2A rather than the same N_{part}. In other words, it is the collision geometry rather than just the number of nucleon participants that drives the detailed shape of the pseudorapidity distribution and its centrality dependence at RHIC energies.

Resting energy expenditure and fuel metabolism following laparoscopic adjustable gastric banding in severely obese women: relationships with excess weight lost.

BACKGROUND: Although adjustable gastric banding is increasingly proposed for massively obese patients, little is known about the modifications of resting metabolic rate and substrate oxidation or about metabolic determinants of weight loss following this type of bariatric surgery. OBJECTIVES: To evaluate the relationships between excess weight loss, resting metabolic rate (RMR) and substrate oxidation, and to identify metabolic predictive factors of weight loss after adjustable gastric banding. SUBJECTS: Seventy-three obese nondiabetic women aged 39.1+/-10.4 years (18.4-64.8). DESIGN: Resting metabolic rate and substrate oxidation (indirect calorimetry), body composition (bio-impedance), lipid profile and insulin sensitivity indexes were assessed before and after (13.3+/-6.0 months, range 6.0-31.1) adjustable gastric banding. Patients were classified according to postsurgery time: group A (6-12 months, n=39); group B (12-18 months, n=21); group C (>18 months, n=13). Metabolic parameters associated with the percentage of excess weight lost (EWL) 1 year after surgery were analyzed in univariate and multivariate regressions. RESULTS: Mean weight loss was 26.2+/-11.4 kg. Mean fat mass loss was 17.3+/-8.1 kg. All biological parameters associated with excess weight improved after surgery. Excess weight lost at 1 year was 45.9+/-17.1% in group A, 47.4+/-17.1% in group B and 51.4+/-18.5% in group C (P=NS). Resting metabolic rate/fat-free mass (FFM) slightly decreased (28.9+/-3.26 vs 30.3+/-2.8, P<0.00001) and RMR/body weight slightly increased (18.5+/-2.8 vs 17.3+/-1.9, P<0.00001) after surgery. Respiratory quotient (0.81+/-0.06 vs 0.82+/-0.05) and FFM-adjusted lipid oxidation (1.10+/-0.41 vs 1.05+/-0.33 mg/min/kg FFM) were not significantly modified after surgery. In multiple linear regression analysis, difference in RMR/body weight, difference in energy sparing, baseline BMI and postsurgery time, were significantly and independently correlated with EWL (total R2=72.5%). CONCLUSIONS: Adjustable gastric banding promotes gradual but sustained weight loss and is associated with long-term conservation of lipid oxidation and energy expenditure. The individual variability in energy sparing mechanisms predicts weight loss during the first year after surgery.

System size and centrality dependence of charged hadron transverse momentum spectra in Au + Au and Cu + Cu collisions at square root of SNN = 62.4 and 200 GeV.

We present transverse momentum distributions of charged hadrons produced in Cu + Cu collisions at square root of SNN = 62.4 and 200 GeV. The spectra are measured for transverse momenta of 0.25 < pT < 5.0 GeV/c at square root of SNN = 62.4 GeV and 0.25 < pT < 7.0 GeV/c at square root of SNN = 200 GeV, in a pseudorapidity range of 0.2 < eta < 1.4. The nuclear modification factor R(AA) is calculated relative to p + p data at both collision energies as a function of collision centrality. At a given collision energy and fractional cross section, R(AA) is observed to be systematically larger in Cu + Cu collisions compared to Au + Au. However, for the same number of participating nucleons, R(AA) is essentially the same in both systems over the measured range of pT, in spite of the significantly different geometries of the Cu + Cu and Au + Au systems.

Treatment and prophylaxis of Isospora belli infection in patients with the acquired immunodeficiency syndrome.

Enteric infection with the protozoan Isospora belli is common in patients with the acquired immunodeficiency syndrome (AIDS) and causes severe diarrhea. I. belli responds well to treatment with trimethoprim-sulfamethoxazole, but there is a high rate of recurrence. To investigate the effect of long-term prophylaxis, we studied 32 Haitian patients with AIDS complicated by I. belli infection and chronic diarrhea. All were treated with trimethoprim (160 mg) and sulfamethoxazole (800 mg), given orally four times a day for 10 days; the patients were then randomly assigned to receive 500 mg of sulfadoxine and 25 mg of pyrimethamine weekly, 160 mg of trimethoprim and 800 mg of sulfamethoxazole three times a week, or placebo. Half of the patients (5 of 10) who received placebo had recurrent, symptomatic isosporiasis a mean of 1.6 months after the initial treatment. All 22 patients who received either trimethoprim-sulfamethoxazole or sulfadoxine-pyrimethamine remained asymptomatic. I. belli was identified in the stools of only one of these patients, who was receiving trimethoprim-sulfamethoxazole. The study medications were generally well tolerated but had to be discontinued in the cases of two patients because of severe pruritus. In 10 patients, the prophylactic regimen has been continued for a mean of 16 months without recurrent isosporiasis. We conclude that isosporiasis in patients with AIDS can be treated effectively with a 10-day course of trimethoprim-sulfamethoxazole and that recurrent disease can subsequently be prevented by ongoing prophylaxis with either trimethoprim-sulfamethoxazole or sulfadoxine-pyrimethamine.