Occupation exposed to road-traffic emissions and respiratory health among Congolese transit workers, particularly bus conductors, in Kinshasa: a cross-sectional study.

OBJECTIVES: Road-traffic emissions (RTE) induce adverse health effects, notably respiratory symptoms and respiratory diseases, as a result of pollutants deposited into the respiratory tract. The aim of this study was to evaluate the association between occupation groups of Congolese transit workers exposed to RTE, particularly bus conductors and respiratory health, in Kinshasa. METHODS: A cross-sectional study was conducted from 2015 April 20th to May 14th, whose participants were bus conductors (n = 110), bus drivers (n = 107), taxi-motorcyclists (n = 102) and high school teachers (control group; n = 106). Subjects had completed the American Thoracic Society respiratory symptom questionnaire. Lung function test was performed by spirometry. Air pollutants levels of PM2.5, NO2 and SO2 were measured between 7:30 and 8:30 and 16:30-17:30 using a portable gas monitor. Multivariate analysis was performed to evaluate the association between occupation exposed to RTE and impaired pulmonary function, after adjustment by plausible confounders. RESULTS: The prevalence of mixed syndrome was 21.9% for bus conductors, 10.9% for bus drivers, 15.4% for taxi-motorcyclists and 7.1% for high school teachers with (p < 0.05). The risk of developing a mixed syndrome was seven times higher among bus conductors [OR = 7.64; 95% CI: 1.83-31.67; p < 0.05] than other groups. Additionally, the prevalence of respiratory syndromes increased with the duration of exposure. CONCLUSIONS: Occupation exposed to RTE is associated with impaired pulmonary function and the prevalence of respiratory symptoms among transit workers, especially bus conductors. Furthermore, this association increases with the duration of exposure suggesting the necessity to regulate these categories of occupations and to apply preventives measures.

A cross-sectional assessment of oxidative DNA damage and muscle strength among elderly people living in the community.

OBJECTIVES: The mechanism by which muscle weakness leads to an increased risk of death remains a subject of interest. In this context, the aim of this study is to assess the relationship between urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and muscle strength, and other risk factors contributing to poor muscle strength in older persons. METHODS: This was a cross-sectional study in which a total of 86 participants, both men and women, aged 65 years or above were screened for urinary 8-OHdG, and muscle strength as measured by handgrip strength. RESULTS: Handgrip strength was lower in participants who had history of acute or chronic disease. Urinary 8-OHdG level was negatively associated with muscle strength, and the association remained after adjusting for confounding factors. CONCLUSIONS: Urinary 8-OHdG is associated with muscle strength. These findings may be clinically relevant as there is a possibility of controlling oxidative DNA damage by healthy behaviors related to lifestyle.

Health Effects of Electrolyzed Hydrogen Water for the Metabolic Syndrome and Pre-Metabolic Syndrome: A 3-Month Randomized Controlled Trial and Subsequent Analyses.

We studied the effect of three months' use of electrolyzed hydrogen water (EHW, Electrolyzed Hydrogen Water conditioner produced by Nihon Trim Co., Ltd.) on metabolic and pre-metabolic syndrome groups. This research was carried out jointly by Susaki City; Nihon Trim Co., Ltd.; and Kochi University as part of a local revitalization project with health as a keyword. A randomized, placebo-controlled, double-blind, parallel-group trial was conducted to evaluate the clinical impact of EHW on participants who suffered from metabolic syndrome or pre-metabolic syndrome. EHW was produced via electrolysis using a commercially available apparatus (Nihon Trim Co., Ltd., Osaka, Japan). During exercise, oxidative stress increases, and active oxygen species increase. In this study, we examined 181 subjects with metabolic syndrome or pre-metabolic syndrome. Among the group that drank EHW for 3 months, those who also engaged in a high level of physical activity showed a significant difference in waist circumference reduction. Although no significant difference was observed, several positive results were found in the participants who engaged in a high level of physical activity. Urinary 8-OHdG, urinary nitrotyrosine, HbA1c, and blood glucose levels increased in the filtered water (FW) group but decreased in the EHW group. High-sensitivity CRP increased less in the EHW group. 8-Isoprostane decreased more in the EHW group. In subgroup analysis, the EHW group showed a significantly greater reduction in waist circumference than the FW group only when controlled for high physical activity. Based on the result, we suggest that, among participants in the study who suffered from metabolic syndrome and pre-metabolic syndrome in which the level of active oxygen species is said to be higher than in healthy subjects, the group that consumed EHW and also engaged in a high level of physical activity experienced a suppressed or reduced increase in active oxygen species.

Anti-inflammatory effects of sacran, a novel polysaccharide from Aphanothece sacrum, on 2,4,6-trinitrochlorobenzene-induced allergic dermatitis in vivo.

BACKGROUND: Sacran is a newly discovered sulfated polysaccharide extracted from an algae, Aphanothece sacrum, grown in a river of the Kyushu region in Japan. OBJECTIVE: To evaluate sacran's inhibitory effect in 2,4,6-trinitrochlorobenzene (TNCB)-induced allergic dermatitis in NC/Nga mice. METHODS: Sacran was extracted by acid and alkaline treatment of A sacrum cyanobacterial biomaterials. To sensitize mice, 150 µL of 5% TNCB was applied epicutaneously on the abdomen of each mouse on day 1 and challenged with 15 µL of 1% TNCB applied on the ear skin of mice on day 8 and then every other day to induce skin lesions. Serum levels of inflammatory markers were measured and histopathologic examination of ear skin specimens performed. On the other hand, sacran's transepidermal water loss was evaluated in 11 volunteer women with dry skin. RESULTS: Epicutaneous application of sacran in mice has significantly inhibited the development of allergic dermatitis skin lesions and reduced the number of scratching behavior episodes (P < .01). In addition, sacran efficiently inhibited IgE (P < .001), tumor necrosis factor α (P = .02), interleukin 4, interleukin 5, and interferon γ (P < .01; vs buffer in the TNCB group) production and eosinophilic infiltration in the chemical allergen-exposed ear skin. In addition, sacran-treated body regions of human volunteers with dry skin significantly reduced transepidermal water loss levels compared with exogenous hyaluronic acid (P < .01), which is known to improve skin moisture and exert skin barrier repair activity. CONCLUSIONS: This study suggests that sacran exerts anti-inflammatory effects by improving skin barrier function and reducing T(H)2 cytokine production.

Limonene inhalation reduces allergic airway inflammation in Dermatophagoides farinae-treated mice.

Limonene is one of the main flavonoids which is reported to inhibit the inflammatory response by suppressing the production of reactive oxygen species. The aim of this study was to evaluate whether limonene can inhibit Dermatophagoides farinae-induced airway hyperresponsiveness (AHR), eosinophilic infiltration and other histological changes in the lung, T helper (Th) 2 cytokine production and airway remodeling in a mice model of asthma. Treatment with limonene significantly reduced the levels of IL-5, IL-13, eotaxin, MCP-1, and TGF-ß1 in bronchoalveolar lavage fluid. The goblet cell metaplasia, thickness of airway smooth muscle, and airway fibrosis were markedly decreased in limonene-treated mice. Furthermore, AHR to acetylcholine was significantly abrogated in limonene-treated mice. These results indicate that limonene has a potential to reduce airway remodeling and AHR in asthma model.

Anti-allergic effects of Vernonia amygdalina leaf extracts in hapten-induced atopic dermatitis-like disease in mice.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritic and eczematous skin lesions. In this study, AD-like disease was induced in NC/Nga mice so as to evaluate the anti-allergic effects of Vernonia amygdalina leaf extracts (VAM). METHODS: Forty NC/Nga mice were purchased for each of the two protocols (prophylactic and curative) of the study. Mice were randomly divided in groups of five or six after sensitization with 5% trinitrochlorobenzene (TNCB): aqueous extracts (VAM1), methanolic extracts (VAM2), hydrocortisone (HCT), buffer for the control (TNCB) and the normal mice (NORM) groups. RESULTS: As for HCT, VAM1 and VAM2-pretreated mice showed significantly lower number of scratching behavior episodes (p < 0.01; vs. TNCB) following TNCB challenge. In addition, VAM1, VAM2 exerted a significant inhibitory effect on the development of AD skin symptoms (vs. TNCB group; p < 0.001), the production of IgE, TNF-alpha (p < 0.05), IL-5 and IFN-gamma (p < 0.01) (vs. TNCB group) and on the increase in ear thickness (p < 0.05) in prophylactic protocol. In the AD curative protocol, topical VAM1, VAM2 markedly improved skin lesions such as erythema/hemorrhage (p < 0.05), scaling/dryness, erosion/excoriation (p < 0.01) (vs. TNCB mice). Furthermore, a significant decrease in ear thickness was noted in VAM1, VAM2, HCT groups (vs. TNCB group; p < 0.05) as well as the serum total IgE, MCP-1 (p < 0.01) and eotaxin (p < 0.05). VAM2 also improved chronic eczema dermatitis skin symptoms in a patient. CONCLUSIONS: Results from this report suggest that VAM extracts, known as ERK pathway inhibitor, prevent and improve atopic/eczema dermatitis syndrome.

Perception of the risk of sexual transmission of HIV among Congolese and Japanese university students.

OBJECTIVE: Sub-Saharan Africa remains the region most heavily affected by HIV infection. This study aimed to evaluate the knowledge, attitudes, and practices of Congolese students of risk behaviors for sexual transmission of HIV in comparison with their Japanese counterparts. METHODS: Of the 1,747 undergraduate students who participated in the survey, there were 1,326 respondents (752 Japanese, 574 Congolese) who voluntarily and fully filled out the auto-administered questionnaire. RESULTS: The proportion of Congolese respondents who do not always use condoms with an occasional sex partner was significantly higher, 57%, as compared with their Japanese counterparts (15%; p < 0.001). Fewer than 40% (9.9-39.7%) of Congolese respondents had accurate knowledge about multiple sex partnership (MSP), men sex with men (MSM), precocious sex, and commercial sex work (CSW) being high-risk behaviors (p < 0.001) for the sexual transmission of HIV infection. However, the proportion of Congolese tested or willing to get tested for HIV was significantly higher (97.2%) than that in the Japanese group (72.4%, p < 0.001). In Congolese students, we observed an absence of adherence to preventive measures such as condom use with an occasional sex partner, and a greater proportion of students having inaccurate knowledge of major risk behaviors such as MSM, precocious sex, and MSP, compared with their Japanese counterparts. CONCLUSIONS: This study showed that, though sexual contact remains the main mode of HIV transmission in the region, Congolese students tend to have inaccurate knowledge of risk behaviors that expose people to the sexual transmission of HIV. This suggests that continuous education targeting those risk behaviors is of great importance to reduce the spread of the HIV epidemic.

Goishi tea consumption inhibits airway hyperresponsiveness in BALB/c mice.

BACKGROUND: Airway hyperresponsiveness (AHR) is one of the important traits that characterize bronchial asthma. Goishi tea is a post-heating fermented tea that has been reported to have higher free radical scavenging activity. In this study, we evaluated the prophylactic effects of Goishi tea on AHR in BALB/c mice. RESULTS: The number of inflammatory cells in BAL fluid was considerably reduced in Goishi tea/Der f and Gallic acid/Der f groups as compared with Tap water/Der f group. Regarding inflammatory cells in BAL, a significant reduction of eosinophils and neutrophils was observed in Goishi tea-treated mice (p < 0.01), as well as in the Gallic acid/Der f group (p < 0.05), as compared with Tap water/Der f group. In asthmatic mice (Tap water/Der f group), the intensity of airway resistance increased simultaneously with the increase in acetylcholine concentration in a dose-dependant way. AHR was significantly inhibited in Goishi tea/Der f and Gallic acid/Der f (p < 0.01) groups as compared with the Tap water/Der f group. Regarding serum specific-IgG1, significantly lower levels of this antibody were observed in Goishi tea/Der f and Gallic acid/Der f groups as compared with the Tap water/Der f group (p < 0.05). In addition, adiponectin level was significantly higher in the Goishi tea group as compared with the Tap water treated mice (p < 0.01). CONCLUSIONS: The results suggest that Goishi tea consumption exerted an inhibitory effect on eosinophilic and neutrophilic infiltration in the lung, attenuated the increase in airway resistance and increased the production of adiponectin; thus reducing Der f induced allergic inflammatory process in mice.

Erratum: Correction of the received and accepted dates: Exposure to paraben and triclosan and allergic diseases in Tokyo: A pilot cross-sectional study.

[This corrects the article e5 in vol. 9, PMID: 30740353.].

Increased Prevalence of Atopic Dermatitis in Children Aged 0-3 Years Highly Exposed to Parabens.

The prevalence of allergic diseases, such as bronchial asthma, atopic dermatitis, nasal allergies (pollinosis), and food allergies, has been increasing in many countries. The hygiene hypothesis was recently considered from the perspective of exposure to antimicrobial agents and preservatives, such as parabens (CAS number, 94-13-3). It currently remains unclear whether parabens, which are included in many daily consumer products such as cosmetics, shampoos, and personal care products as preservative antimicrobial agents, induce or aggravate allergies. Therefore, the aim of the present study was to examine the relationship between exposure to parabens and the prevalence of allergic diseases in Japanese children. The cross-sectional epidemiology of 236 children aged 0-3 years who underwent health examinations in Shika town in Japan assessed individual exposure to parabens using urinary concentrations of parabens. The results obtained showed that the prevalence of atopic dermatitis was significantly higher in children with high urinary concentrations of parabens than in those with low concentrations (p < 0.001). This relationship remained significant after adjustments for confounding factors, such as age, sex, Kaup's index, and passive smoking (p < 0.001). In conclusion, the present results from a population study suggested a relationship between atopic dermatitis and exposure to parabens. A longitudinal study using a larger sample number and a detailed examination of atopic dermatitis, including EASI scores and exposure to parabens, will be necessary.

Nationwide cross-sectional population-based study on the prevalences of asthma and asthma symptoms among Japanese adults.

BACKGROUND: Asthma is a common respiratory disease worldwide. However, few reports are available on the prevalences of asthma and asthma symptoms among Asian subjects. METHODS: To determine the prevalences of asthma and asthma symptoms among Japanese subjects, we performed a nationwide cross-sectional, population-based study on Japanese adults aged 20-79 years. Ten areas spread throughout the country were randomly selected. Door-to-door or postal surveys were performed using a translated version of the European Community Respiratory Health Survey questionnaire. RESULTS: The survey was completed by 23,483 participants. The overall response rate was 70.6%. The prevalences of wheeze and current asthma among all participants aged 20-79 years were 10.1% (95% CI: 9.7-10.5%) and 4.2% (95% CI: 4.0-4.5%), respectively. The prevalences among young adults aged 20-44 years were 9.3% (95% CI: 8.7-9.9%) and 5.3% (95% CI: 4.8-5.8%), respectively. The prevalence of current asthma was highest in females aged 30-39 years in comparison with the other gender and age groups. CONCLUSIONS: This nationwide study determined the prevalences of asthma and asthma symptoms among Japanese adults. The results provide fundamental information on the respiratory health of Japanese adults.

Biomass energy, particulate matter (PM2.5), and the prevalence of chronic obstructive pulmonary disease (COPD) among Congolese women living near of a cement plant, in Kongo Central Province.

This study investigated whether the individual and combined effects of using biomass energy and living in the neighborhood of a cement plant were associated with the risk of COPD and respiratory symptoms among Congolese women. A total of 235 women from two neighborhood communities of a cement plant participated in this cross-sectional study. Participants were classified into the more exposed group (MEG = 137) and a less exposed group (LEG = 98), as well as into biomass users (wood = 85, charcoal = 49) or electricity users (101 participants). Participants completed a questionnaire including respiratory symptoms, sociodemographic factors, medical history, lifestyle, and household characteristics. In addition to spirometry performance, outdoor PM2.5 (µg/m3) was measured. Afternoon outdoor PM2.5 concentration was significantly higher in MEG than LEG (48.8 (2.5) µg/m3 vs 42.5 (1.5) µg/m3). Compared to electricity users, wood users (aOR: 2.6, 95%CI 1.7; 5.9) and charcoal users (aOR: 2.9, 95%CI 1.4; 10.7) were at risk of developing airflow obstruction. Combined effects of biomass use and living in the neighborhood of a cement plant increased the risk of COPD in both wood users (aOR: 4, 95%CI 1.3; 12.2) and charcoal users (aOR: 3.1, 95%CI 1.7; 11.4). Exposure to biomass energy is associated with an increased risk of COPD. In addition, combined exposure to biomass and living near a cement plant had additive effects on COPD.

Exposure to paraben and triclosan and allergic diseases in Tokyo: A pilot cross-sectional study.

BACKGROUND: Previous studies have reported that exposure to paraben (Pb) and triclosan (TCS) is associated with allergies. However, Pb and TCS exposure in the Japanese population is not fully understood. OBJECTIVES: The present study was aimed to examine such exposure among Japanese individuals with allergic diseases. METHODS: This cross-sectional study included the International Study of Asthma and Allergies in Childhood questionnaire survey to evaluate allergic outcomes and the collection of urine samples to examine Pb and TCS exposure. RESULTS: Pb containing daily commodities was used in 84.8% children. Pb use was positively associated with current atopic dermatitis (adjusted odds ratio, 4.61; 95% confidence interval, 1.23-17.3). Urinary Pb concentrations were increased significantly in those with current atopic dermatitis (AD) (median, 4.58 vs. 0; p < 0.0001), and showed an increased tendency in those with current wheeze (median, 3.45 vs. 1.81; p = 0.0535) in participants ≤15 years old. Urinary TCS concentration was under the limit of detection in all children. CONCLUSION: Urinary levels of Pb were associated with current AD in children. We should pay more attention about Pb and TCS.

In vitro toxicity evaluation of diesel exhaust particles on human eosinophilic cell.

Diesel exhaust particles (DEPs), comprised mainly of particles less than 2.5 microm (PM 2.5) in aerodynamic diameter, have been assumed to enhance the response of asthma to allergen inhalation. Although eosinophilic infiltration is remarkable in the event of bronchial asthma induced by DEPs, the precise mechanisms leading to eosinophilia are unknown. To examine the effect of DEPs on eosinophils, we measured the cytokine products and activity of nuclear factor-kappa B (NF-kappa B) after addition of the proteasomal inhibitor MG132 in HL-60 clone 15 cells differentiated into eosinophils. We measured eotaxin-induced chemotaxis of cells and their activity of p38 mitogen-activated protein (MAP) kinase was analysed. Interleukin (IL)-8 and monocyte chemoattractant protein-1 (MCP-1) were increased markedly in DEPs-treated cells. The active form of NF-kappaB in cells treated with DEPs was increased, and this effect was significantly decreased by the administration of MG132. Cell migration in the presence of DEPs was significantly greater, and inhibited by adding N-acetyl l-cysteine. P38 MAP kinase activity was highly influenced by DEPs-treatment. DEPs induce MCP-1 and IL-8 production by up-regulating NF-kappa B activity, which is inhibited in the presence of an inhibitor of proteasomal degradation. DEP also promotes eotaxin-induced chemotaxis in a p38-dependent manner.

Prevalence of chronic obstructive pulmonary disease (COPD) among Congolese cement workers exposed to cement dust, in Kongo Central Province.

Chronic exposure to cement dust may induce adverse health effects, including a significant decrease in lung function. The study investigated whether the prevalence of COPD and respiratory symptoms was associated with working at different tasks exposed to varying levels of cement dust. The cross-sectional study was carried out among 223 exposed and 156 less exposed workers from two cement factories from November 20 to December 15, 2016 in DRC. Workers completed a questionnaire and spirometry was performed. Multivariate analysis was performed to evaluate the association between occupation exposed to cement dust, COPD, and respiratory symptoms, after adjustment for confounders. Morning cough and cough on most days for as much as 3 months each year were significantly higher in the exposed group (p < 0.05) (p = 0.001) than in the less exposed group. As compared to the less exposed group, the prevalence of COPD was higher among the exposed group, 28.2 and 9.6% respectively (p < 0.001). A significant association with COPD, aOR 14.49 (5.33; 39.40), aOR 3.37 (1.44; 7.89), and aOR 3.09 (1.58; 6.05) was found among cleaning, transportation, and production workers, respectively. Working at certain tasks exposed to cement dust is associated with the higher prevalence of COPD and respiratory symptoms. A greater risk is being among cleaning, transportation, and production workers. This suggests the necessity to prioritize the quality of preventive measures in each work area.

Anti-allergic and Profilaggrin (ProFLG)-mRNA expression modulatory effects of sacran.

Atopic dermatitis (AD) is a skin disorder characterized by filaggrin (FLG) defect. We evaluated sacran's effects on dust-mite extracts (DME)-induced AD-like disease and also its effect on profilaggrin (proFLG) in a murine model of 2,4-dinitroflurobenze (DNFB)-induced contact hypersensitivity. In the murine AD-like disease model, allergic NC/Nga mice (N=60) were randomly divided into five treatment groups of 12 animals each: 0.2% and 1%sacran; 0.1% Tacrolimus; Vaseline and buffer-treated controls. Blood samples were drawn and serum levels of representative Th-1, Th-2 and also Th-17 (IL-17A) cytokines were assayed by Cytometric Bead Array (CBA). In the contact hypersensitivity model, diseased NC/Nga mice (N=20) were divided into four groups of five mice each [0.05%sacran, 0.05% chondroitin sulfate (CS), 0.5% prednisolone (PD), non-treated control group] and were treated for 14days. Skin biopsies were performed for the measurement of proFLG-mRNA by real-time PCR. Sacran solutions and 0.1%Tacrolimus reduced disease severity, suppressed histological changes and decreased the serum Th-1 (IFN-γ, TNF-α, IL-2) and Th-2 (IL-4, IL-6, IL-10) cytokines in allergic mice (vs. controls). Additionally, a marked increase of proFLG-mRNA expression was observed in 0.05%sacran group (vs. control 0.05% CS and 0.5% PD groups). Thus, Sacran might be useful as a natural skin barrier enhancer and anti-allergic agent.

Selenium and exposure to fibrogenic mineral dust: a mini-review.

Individuals exposed to fibrogenic mineral dust may exhibit an impaired antioxidant system and produce high levels of reactive oxygen and nitrogen species through immune cells, contributing to the perturbation of immune cell function, inflammation, fibrosis and lung cancer. The lung diseases which are caused by inhalation of fibrogenic mineral dust, known as pneumoconioses, develop progressively and irreversibly over decades. At the moment there is no known cure. The trace element selenium has potent antioxidant and anti-inflammatory properties mediated mainly through selenoproteins. Research has demonstrated that selenium has the ability to protect against cardiovascular diseases; to kill cancer cells in vitro and reduce cancer incidence; and to immunomodulate various cellular signaling pathways. For these reasons, selenium has been proposed as a promising therapeutic agent in oxidative stress associated pathology that in theory would be beneficial for the prevention or treatment of pneumoconioses such as silicosis, asbestosis, and coal worker's pneumoconiosis. However, studies regarding selenium and occupational lung diseases are rare. The purpose of this study is to conduct a mini-review regarding the relationship between selenium and exposure to fibrogenic mineral dust with emphasis on epidemiological studies. We carried out a systematic literature search of English published studies on selenium and exposure to fibrogenic mineral dust. We found four epidemiological studies. Reviewed studies show that selenium is lower in individuals exposed to fibrogenic mineral dust. However, three out of the four reviewed studies could not confirm cause-and-effect relationships between low selenium status and exposure to fibrogenic mineral dust. This mini-review underscores the need for large follow-up and mechanistic studies for selenium to further elucidate its therapeutic effects.

Workplace violence towards Congolese health care workers: a survey of 436 healthcare facilities in Katanga province, Democratic Republic of Congo.

OBJECTIVES: The aim of this study was to investigate workplace violence by patients or their relatives towards health-care workers in Congolese hospitals. METHODS: Through the autumn of 2012, a cross-sectional survey on workplace violence was conducted in a sample of 2,210 registered health-care workers (989 males and 1,221 females, aged 33 ± 8 years) from 436 hospitals located in the province of Katanga, Democratic Republic of the Congo. Verbal aggression, harassment and physical violence perpetrated by patients or their relatives within the previous year along with factors contributing to violence, were recorded, and the response rate was 99%. RESULTS: About 80.1% of the health-care workers had experienced one or more types of workplace violence. Overall, the severity of workplace violence varied from verbal aggression (57.4%) and harassment (15.2%) to physical violence (7.5%). Patients were the major perpetrators of verbal aggression and harassment, whereas patients' relatives were mainly involved in physical violence. The frequency of workplace violence was similar across hospitals. Male health-care workers were more likely to be victims of physical violence, whereas female health-care workers were the prime target for harassment. Only 34.3% of the violent episodes were reported to a supervisor. Furthermore, disrespect for medical deontology was the main cause of workplace violence perceived by 68.8% of the health-care workers. CONCLUSIONS: Although it has not been officially recognized, there has been workplace violence towards health-care workers perpetrated by patients or their relatives despite the fact that health-care workers have traditionally been highly respected in Congolese society. Further studies on this issue may suggest opportunities for combating violence in Congolese hospitals.

Japanese familial hypercholesterolaemia with a 327insC mutation in the LDL receptor gene.

Mutations in the LDL receptor (LDLR) cause familial hypercholesterolaemia (FH) in an autosomal dominant manner. The condition frequently progresses to coronary atherosclerosis. We describe a patient with FH, but without ischaemic heart disease, who had a novel frameshift mutation (327insC) in exon 4 of the LDLR gene. This mutation introduced a premature termination codon (TGA, codon 158). The patient was a 59-year-old man who had presented with hypercholesterolaemia and a plasma total cholesterol (TC) concentration of 12.2 mmol/L at age 44 years. The mutation 327insC in this patient was heterozygous and hypercholesterolaemia was common within his family. Despite taking lipid-lowering medications (probucol and pravastatin) for more than 20 years, his TC concentration hardly fell below 7.8 mmol/L. However, neither the patient nor anyone else in his family developed characteristic symptoms of ischaemic heart disease or xanthoma. This patient was discovered by an intensive mutation survey among 22 unrelated Japanese with FH mainly in the Kanto area of Japan, suggesting a low incidence of the mutation in the area.