Screening athletes for cardiovascular disease in Africa: a challenging experience.

AIMS: Preparticipation cardiovascular (CV) screening has been advocated as an efficient strategy to reduce sudden cardiac death in Caucasian athletes. At present, uncertainty remains if such strategy is feasible and efficient in native African athletes. To this scope, we performed a CV screening in an African setting. METHODS: 210 male Gabonian football players were examined with history, physical examination, ECG and echocardiography. RESULTS: On history, 19 players (9%) referred atypical chest discomfort/oppression. Familial sudden death was referred by 36 (17%). No anomalies were detected at physical examination. ECG showed large proportions of 'training-related' abnormalities, that is, ST-segment elevation in precordial leads in 150 (71.4%), and isolated increase in R/S-wave voltage in 116 (55.2%). A substantial subset (12.4%) showed 'training-unrelated' abnormalities, that is, inverted T-waves in 10 (4.8%), left atrial enlargement in 8 (4%), deep Q-waves in 3 (1.4%). On echocardiography, one athlete meet criteria for hypertrophic cardiomyopathy (HCM); none showed evidence for arrhythmogenic right ventricular cardiomyopathy (ARVC) or dilated cardiomyopathy (DCM). Other abnormalities included mitral valve prolapse in three, atrial septal defect in two and pulmonary hypertension in one. CONCLUSIONS: About 12% of native African athletes showed ECG abnormalities unrelated to training and requiring additional testing and periodical follow-up. Structural abnormalities were found, however, in a minority (5%), including HCM in one, but no ARVC or DCM. In conclusion, this study demonstrates that preparticipation CV screening is efficient to identify (or raise suspicion) for CV abnormalities in native African athletes, but challenging for conclusive identification of cardiac diseases in the difficult scenario of a developing African country.

Searching for success: boys, family aspirations, and opportunities in Gabon, ca. 1900-1940.

Boys growing up in rural Gabon between 1900 and 1940 negotiated with many challenges: the rise of migrant labor, famines and hardships brought on by World War I, the growth of Christianity and African-based spiritual traditions, and the undermining of clans, which had been the main form of social and political organization in the nineteenth century. Parents, extended family members, missionaries, and European businesses recruited boys to serve their varied interests. Boys in turn developed new self-understandings by leaving their homes as students, workers, and clients of older men. This article examines the life histories of four boys to trace the successes and challenges that individual boys encountered in this turbulent era. Interestingly, older biological relatives of boys generally succeeded in maintaining their authority over children living far from home, although the education and wages that boys received forced older men to offer boys more benefits.

Impact of knowledge, attitudes, and sociocultural factors on school enrollment of children with epilepsy in Gabon.

PURPOSE: Perceptions, beliefs and culture influence attitude towards epilepsy in sub-Saharan Africa. Misconceptions on epilepsy contribute to the persistence of negative attitudes in children with epilepsy particularly on their school enrollment. The aim of the study was to assess knowledge, attitudes, and sociocultural factors affecting schooling of children with epilepsy in Gabon. METHODS: Teachers and health workers from two urban and four rural localities of Gabon were assessed using a self-administered questionnaire. RESULTS: Overall 1310 subjects filled the survey questionnaire, including 813 teachers and 497 health workers. Knowledge on risk factors and suggestive signs of childhood epilepsy were globally poor. Misconceptions on etiology of epilepsy were significant with contagiousness (27.5%) and demonic possession (16.0%) representing the major prevalent idea about the origin of epilepsy in children. Attitudes of teachers and health workers towards schooling of children with epilepsy were positive (85.0%). However, more than half recommended enrollment of these children in specialized school programs. In multivariate analysis, education level (OR = 1.40; 95% confidence interval 1.01-1.81) and marital status (OR = 1.62; 95% confidence interval 1.18-2.22) were sociocultural factors likely to affect chances of school enrollment of children with epilepsy. CONCLUSION: Understanding the influence of socio-cultural factors surrounding school enrollment of children with epilepsy could enhance public awareness campaigns about epilepsy and to improve school integration of these children.

The Evolution of Musical Diversity: The Key Role of Vertical Transmission.

Music, like languages, is one of the key components of our culture, yet musical evolution is still poorly known. Numerous studies using computational methods derived from evolutionary biology have been successfully applied to varied subset of linguistic data. One of the major drawback regarding musical studies is the lack of suitable coded musical data that can be analysed using such evolutionary tools. Here we present for the first time an original set of musical data coded in a way that enables construction of trees classically used in evolutionary approaches. Using phylogenetic methods, we test two competing theories on musical evolution: vertical versus horizontal transmission. We show that, contrary to what is currently believed, vertical transmission plays a key role in shaping musical diversity. The signal of vertical transmission is particularly strong for intrinsic musical characters such as metrics, rhythm, and melody. Our findings reveal some of the evolutionary mechanisms at play for explaining musical diversity and open a new field of investigation in musical evolution.

[A case of loiasis].

Loiasis is quite common in the endemic regions of Central and West Africa. But only three cases were reported in Japan. This is a report of a 28 year old male from Gabon infected with Loa loa with eye symptoms as the chief complaint. For the first time in Japan he was treated with Ivermectin (IVM) which is recently attracting attention as the drug for filariasis world wide. IVM therapy was effective, and decreased the counts of microfilarias in the patient's blood. No adverse effect was seen in this patient. This case suggested that IVM is an useful drug for loiasis, and further study is warranted.

[Radiologic diagnosis for a Gabonese case]. / Un diagnostic radiologique pour une histoire gabonaise.

We describe a case of porocephalosis diagnosed in a 50 year old Gabonese male hospitalized in France for a HIV-related renal insufficiency. A standard abdominal radiography showed numerous ring-shaped calcifications, predominantly in the hepatic area. This aspect was very suggestive of the diagnosis in a patient living in Central Africa and eating occasionally meat of snake. The parasites live normally in the lungs of snakes (python, Bitis sp.). People become infected in eating undercooked snake or in handling snakes. In the majority of cases, the disease is asymptomatic and diagnosis made accidentally as in the case of our patient.

[Malaria, pregnancy and prophylaxis]. / Paludisme, grossesse et prophylaxie.

We present two case histories. The first is a case of congenital malaria in a newborn whose Laotian mother immigrated into France 2 years ago. The other is a case of very severe malaria with fetal death in a 28 year old woman who was 8 months pregnant and who had come back to France from Gabon where she had lived for 2 years. The authors wish to draw attention to malaria brought into the country and how serious it can be, and suggest prophylactic measures to be applied for pregnant women and their newborn babies.

Prevalence of the sickle cell trait in Gabon: a nationwide study.

Sickle Cell Disease (SCD) is an important cause of death in young children in Africa, which the World Health Organization has declared a public health priority. Although SCD has been studied at the continental scale and at the local scale, a picture of its distribution at the scale of an African country has never been given. The aim of this study is to provide such a picture for the Republic of Gabon, a country where precisely the epidemiology of SCD has been poorly investigated. To this effect, 4250 blood samples from persons older than 15 were collected between June 2005 and September 2008 in 210 randomly selected villages from the nine administrative provinces of Gabon. Two methods were used to screen Sickle Cell Trait (SCT) carriers: isoelectric focusing (IEF) and high-performance liquid chromatography (HPLC). SCT prevalence in Gabon was 21.1% (895/4249). SCT prevalence was significantly larger for the Bantu population (21.7%, n=860/3959) than for the Pygmy population (12.1%, n=35/290), (p=0.00013). In addition, the presence of Plasmodium sp. was assessed via thick blood examination. Age was positively associated with SCT prevalence (odds-ratio for an increase of 10 years in age=1.063, p=0.020). Sex was not associated with SCT prevalence. The study reveals the absence of homozygous sickle-cell patients, and marked differences in SCT prevalence between the Gabonese provinces, and also between population groups (Bantu vs Pygmy). These findings could be used by the public health authorities to allocate medical resources and target prevention campaigns.

[Transplacental passage of toxoplasma antibodies. The difference between African and European mothers]. / Passage transplacentaire des anticorps toxoplasmiques. Différence entre la mère africaine et européenne.

The transplacental transfer of toxoplasmosis antibodies has been compared between european and african cord/mother ratios. A lack of transfer is statistically noticed among african cord-mother pairs. This transfer deficiency is highly significantly negative correlated with mother total IgG level.