Prevalence and factors associated to gestational diabetes mellitus among pregnant women in Libreville: a cross-sectional study.

Introduction: mainly occurring in low and middle income countries, gestational diabetes mellitus (GDM) represents 84% of hyperglycemia during pregnancy throughout the world. Moreover, being black is a risk factor to develop the disease. Our objective was to determine the prevalence and the associated factors of GDM in Libreville (Gabon). Methods: a cross-sectional study was carried out. Known diabetic women were excluded from the study and we had submitted asymptomatic pregnant women to a 2 steps 75g oral glucose tolerance test (T0-T2H), regardless of the stage of pregnancy at the moment of recruitment. The threshold for positivity was set at blood glucose level ≥ 8.5mmol/L World Health Organization (WHO 2013 threshold) and ≥ 7.8mmol/L (WHO 1999 threshold). Data were analyzed using Statview® for descriptive statistics, for both bivariate and multivariate analysis. Results: among 245 participants, we have found a GDM prevalence of 10.2% according to WHO 1999 threshold and 4.5% according to WHO 2013 threshold. Applying the WHO 1999 threshold, the associated factors were high maternal weight (p= 0.0498), overweight at recruitment (p=0.0246), personal history of GDM (p< 0.0001), age becomes an associated factor only if it is combined with high parity (p=0.0061). ceaserian-section and macrosomia were the two outcomes of GDM. Conclusion: Libreville has a high prevalence of GDM when the WHO 1999 criteria is compared to the WHO 2013 criteria. Discordance is also found with the identified associated factors. Further studies are needed to better appreciate gestational diabetes in Gabon.

Plasmatic neuroglobin during the primitive open-angle glaucoma.

OBJECTIVE: Elucidate the relation between neuroglobin and the primitive open-angle glaucoma. PATIENTS AND METHODS: This cross-sectional case-control study involved 64 patients with primitive open-angle glaucoma on 2 eyes and 64 control subjects. Glaucoma was classified as early, moderate or severe according to ophthalmological examination. Then we determined neuroglobin concentration and compared his ROC curve with characteristics of glaucoma. Chi-square test was used to compare proportions and spearman test for correlations between quantitative variables. RESULTS: Neuroglobin concentrations were higher among patients with glaucoma compared to control's (4.7±4.6 ng/mL versus 0.9±1.1 ng/mL, p=0.0000). Neuroglobin concentration was related to visual acuity, to the cup/disc ratio (eye right: r=0.340, p=0.006 and left eye: r=0.413, p=0.001). In addition, neuroglobin concentration was correlated with duration (r=0.565; p=0.000) and glaucoma severity (r=0.506, p=0.000). The area under the curve of neuroglobin concentration was 0.82 compared to that of intra ocular pressure (0.70). CONCLUSION: This study suggests that neuroglobin could be used as biomarker for glaucoma diagnosis.

[Lipid, lipoproteins and atherogenesis profiles in sickle cell disease among Central African patients]. / Évaluation du profil lipoprotéique et du risque athérogène chez les drépanocytaires homozygotes et hétérozygotes de Brazzaville.

Lipid and lipopproteins disorders are well established in sera from sickle cell disease (SCD) patients out of Central Africa. The present case-control study was conducted to compare serum levels of total cholesterol (TC), HDL-C, triglycerides (TG), LDL-C and TC/HDL-C ratio (atherogenic index) from SCD homozygotes (SS) in steady state, SCD heterozygotes (AS) and controls (AA) in Brazzaville, Congo. Significant reductions of TC and LDL-C vs. increase in TG were reported in SS. However, significant decrease in HDL-C and increase in atherogenic index were observed in AS. We recommend prevention of oxidative stress, dyslipidemia and atherosclerosis in SCD using hygiene-diet measures. Only longitudinal studies in large populations will provide pathophysiological basis of lipid and lipoproteins disorders in SCD.

[Profile of immunoglobulins A, G, and M during breast milk maturation in a tropical area (Gabon)]. / Profil des immunoglobulines A, G et M au cours de la maturation du lait maternel en milieu tropical (Gabon).

OBJECTIVES: To study the maturation of breast milk by the course of immunoglobulins A, G and M during the first three weeks of breast feeding. MATERIAL AND METHODS: This longitudinal and prospective survey took place from August to October, 2007, in Libreville, the capital of Gabon. The population comprised women with no significant medical history who had given birth in the obstetrics department of Center Hospital of Libreville. Women who delivered at home, had stillbirths, or infants positive for HIV hepatitis B virus were excluded. Three samples were taken, on D1 for colostrum, D7 for the transitional milk and D21 for mature milk. Immunoglobulins were determined by nephelometry, with the Turbox Plus(®) system from Diagnostica Orion. Variables were compared with Spearman's non-parametric test. The survey of the kinetic has been made from the test of Friedman's test was used to assess the kinetics. Significance was set at p<0.05. RESULTS: This survey included 60 mother-child pairs. The mean IgA concentration on D1 was 13.4 ± 5.9 g/L. This concentration fell very quickly by the end of the first week, to 2.3 ±â€Š2.0 g/L on D8, and then stabilized through D21. This rapid drop explains the need for early breast feeding after birth. On the other hand, IgG and IgM concentrations varied less and about one-sixth as high as the IgA. This finding confirms that they were minor components of breast milk. CONCLUSION: This work shows the importance of the early immune protection provided by the mother to her child during the first week of life.

[Plasma and erythrocyte membrane phospholipids in children with Plasmodium falciparum malaria: relation to blood parasite counts and lactate levels]. / Phospholipides plasmatiques et de la membrane érythrocytaire chez les enfants atteints de paludisme à Plasmodium falciparum.

BACKGROUND: Plasmodium falciparum infection modifies the distribution of phospholipids on both sides of the erythrocyte-plasma membrane. We sought to understand the action of the parasite on both plasma and membrane phospholipids and their relation to parasite counts in the blood. PATIENTS AND METHODS: We conducted this study from 1 February through 30 June 2007 in the Malaria Clinical Research Unit of the Libreville General Hospital Centre, measuring phospholipids in plasma and erythrocyte membranes of children affected by P. falciparum malaria and assessing their relation to blood parasites, lactates and hemoglobin. RESULTS: The study included 60 children. The mean blood parasite count was 1.07 x 105 per ml. Mean plasma phospholipids were 2.6+/-0.9 mmol/l and lactates 4.7+/-3.7 mmol/l. At the membrane level, we found 2.8+/-1.2 mmol/l of phospholipids per 106 red blood cells. Phospholipids in these two compartments were positively correlated with one another (r=0.392; p=0.023). Plasma phospholipids were also correlated positively with hemoglobin (r=0.36; p=0.032) and negatively with the number of parasites (r=0.442; p=0.002). The latter, in turn, was positively correlated with lactates (r=0.527; p=0.022) and negatively with membrane phospholipids (r=0.542; p=0.006). The mean hemoglobin level (8.9 g/dl) suggests permanent blood loss in these children, although they may be considered new malaria patients. The relations revealed here between membrane phospholipids, blood parasite counts, and lactate levels are due to the increased energy needs of erythrocytes, but also to the need to synthesize substances intended for cellular defense. P. falciparum thus leads to a decrease in plasma phospholipids, which could be estimated and correlated with blood parasites in a study with a wider range of parasite counts.

[Vitamin A in Gabonese children not receiving supplements: relation to ocular and nutritional diseases]. / Vitamine A chez les enfants gabonais non supplémentés : relation avec les pathologies oculaires et nutritionnelles.

To define vitamin A status in Gabonese children before the supplementation campaigns by UNICEF and the Gabonese Ministry of Health. We conducted an epidemiological, clinical and laboratory study at two of the main child health centers of Libreville and included 150 children aged from 0 to 156 months. We assessed their nutritional and ophthalmological status, their consumption of food rich in vitamin A and their blood levels of vitamin A (retinol). The latter was below the normal level (0.76 mmol/l) for 70% of the children. We observed the following eye diseases correlated with retinol levels: nyctalopia (16%), conjunctiva xerosis (6.7%), Bitot's spots (1.3%), corneal xerosis (3.3%), leukoma (0.7%) and blindness (1.3%). Moreover, 48.7% of the children had delayed growth, positively correlated with low retinol concentrations (0.643 mmol/l), 10% kwashiorkor and 19.9% marasmus. Among the mothers interviewed, 56% were unemployed and 69.3% knew little about vitamin A-rich food, which indeed is a rare part of the population's diet. This prospective study showed that the vitamin A deficiency is a major public health problem in Libreville. Supplementation campaigns are certainly necessary to fight it, but also and especially improved nutrition, including regular consumption of the vitamin A-rich food available in Gabonese market places.

Cortisol and susceptibility to malaria during pregnancy.

We measured cortisol and prolactin concentrations in the peripheral venous blood of 23 non-pregnant and 59 pregnant Gabonese women from the second trimester of pregnancy until delivery. Cortisol concentrations were significantly higher in primigravidae women than in multigravidae women between 20 and 25 weeks' gestational age (166 vs. 132 ng/ml, respectively), between 28 and 37 weeks (226 vs. 161 ng/ml) and at delivery (287 vs. 188 ng/ml). Conversely, plasma prolactin levels were highest in multigravidae women. Cortisol and prolactin concentrations both increased with the period of pregnancy (P = 0.01 and P < 0.01, respectively), suggesting that a sustained increase in cortisol level underlies the increased susceptibility of pregnant women, particularly primigravidae women, to malaria. In support of this hypothesis, we found a significant association between cortisol concentration and Plasmodium falciparum infection, on the one hand, and strong correlations with parasite load in P. falciparum-infected primigravidae women, on the other hand (rho between 0.35 and 0.45 with P < 0.01).

Severe falciparum malaria in Gabonese children: clinical and laboratory features.

BACKGROUND: Malaria continues to claim one to two million lives a year, mainly those of children in sub-Saharan Africa. Reduction in mortality depends, in part, on improving the quality of hospital care, the training of healthcare workers and improvements in public health. This study examined the prognostic indicators of severe falciparum malaria in Gabonese children. METHODS: An observational study examining the clinical presentations and laboratory features of severe malaria was conducted at the Centre Hospitalier de Libreville, Gabon over two years. Febrile children aged from 0 to 10 years with Plasmodium falciparum infection and one or more features of severe malaria were enrolled. RESULTS: Most children presenting with severe falciparum malaria were less than 5 years (92.3% of 583 cases). Anaemia was the most frequent feature of severe malaria (67.8% of cases), followed by respiratory distress (31%), cerebral malaria (24%) hyperlactataemia (16%) and then hypoglycaemia (10%). Anaemia was more common in children under 18 months old, while cerebral malaria usually occurred in those over 18 months. The overall case fatality rate was 9%. The prognostic indicators with the highest case fatality rates were coma/seizures, hyperlactataemia and hypoglycaemia, and the highest case fatality rate was in children with all three of these features. CONCLUSIONS: Prompt and appropriate, classification and treatment of malaria helps identify the most severely ill children and aids early and appropriate management of the severely ill child.

Depressed natural killer cell cytotoxicity against Plasmodium falciparum-infected erythrocytes during first pregnancies.

We measured natural killer (NK) cell cytotoxicity and cortisol and prolactin concentrations in peripheral venous blood samples obtained from pregnant Gabonese women at the time of delivery. The NK cell-mediated cytotoxicity against Plasmodium falciparum-infected erythrocytes in vitro was lower in samples obtained from primiparous women than in samples obtained from multiparous women; cortisol concentrations were significantly higher in primiparous women than in multiparous women, and prolactin concentrations were significantly lower. The highest cortisol concentrations were found in the plasma of P. falciparum-infected primiparous women. A positive correlation was found between cortisol concentration and parasite load; an inverse correlation was found between the magnitude of the NK cell cytolytic effect and cortisol production. A positive correlation was found between this effect and prolactin production. Thus, depressed NK cell cytotoxicity against P. falciparum-infected erythrocytes is correlated with high cortisol concentrations and may contribute to increased susceptibility to malaria during pregnancy.

The impact of malaria on common lipid parameters.

No data are available in the literature to indicate whether low-level Plasmodium falciparum infections induce lipid parameter changes. We hypothesized that low-level P. falciparum infections induce significant changes in common lipid parameters. We retrospectively selected samples from a malaria prophylaxis study to measure the impact of sustained parasite clearance on common lipid parameters [total cholesterol (TChol), high-density lipoprotein (HDL)-cholesterol (HDL-c), low-density lipoprotein (LDL)-cholesterol (LDL-c) and triglycerides (TG)] in 47 apparently healthy schoolchildren whose P. falciparum parasitemia was initially below 1000/ microl. After parasite clearance, mean values were significantly increased for Tchol ( P<0.001) and HDL-c ( P<0.001), unlike LDL-c ( P=0.93); and TG were significantly decreased from the baseline ( P=0.004). No significant change was found in a control group. This is the first study showing significant lipid changes related to low-level P. falciparum infections. Further studies are needed to explore the relevance of this finding at the population level in hyperendemic malaria areas.

Klaivanolide, an antiprotozoal lactone from Uvaria klaineana.

Bioguided-fractionation of a CH(2)Cl(2) extract of the stems of Uvaria klaineana (Annonaceae) led to isolation of klaivanolide, a novel bisunsaturated 7-membered lactone (5-acetoxy-7-benzoyloxymethyl-7H-oxepin-2-one), together with benzyl benzoate. Klaivanolide showed potent in vitro antileishmanial activity against both sensitive and amphotericin B-resistant promastigote forms of Leishmania donovani with IC(50) values of 1.75 and 3.12 microM, respectively. The compound also showed in vitro trypanocidal activity against trypomastigote forms of Trypanosoma brucei brucei GVR 35. Its structure was established by 1D and 2D NMR and other spectroscopic techniques.