Attempted medical management of suspected ascending colon displacement in horses.

OBJECTIVE: To determine the success of medical management of suspected displacement of the ascending (large) colon in horses. STUDY DESIGN: Retrospective case series. ANIMALS: Horses (n = 127) with suspected large colon displacement. METHODS: Medical records (January 1998-September 2008) of horses admitted for colic were reviewed. Suspected large colon displacement was diagnosed from clinical examination and in some cases, subsequent surgical examination. Medically managed horses were exercised and administered intravenous fluids and analgesia. Horses with suspected left dorsal displacement (LDD) of the large colon were also administered phenylephrine. RESULTS: Medical management had a high success rate for treatment of suspected right dorsal displacement (RDD) (64%) and LDD (76%) of the large colon; 4 horses died (1) or were euthanatized (3) and 36 horses had surgery. Of 127 horses treated medically or surgically for a colon displacement, 94% survived to hospital discharge. CONCLUSIONS: Horses with suspected RDD or LDD of the large colon may respond to medical management including exercise.

[Tobacco and marijuana use in adolescent students in Noumea]. / Tabac et cannabis chez l'adolescent scolarisé de Nouméa.

INTRODUCTION: New Caledonia is situated in the western South Pacific 20000 km from France. In this Overseas Territory (pays d'outre-mer [POM]) the prevalence of tobacco smoking is very high and estimated at 30% among men and 34% among women. Experimenting with cannabis is also very widespread. The incidence of chronic respiratory illness and lung cancer remains high in the Territory. Modern laws protecting non-smokers still do not exist. This study aims at describing the behaviour of young people from 14 to 18 years old, at school in the public sector of Noumea, with respect to tobacco and marijuana consumption. This survey examines the way this behaviour varies according to age, sex, community, place of residence and socioeconomic conditions, in order to identify the most exposed groups. Finally, we study the effect of this consumption on the respiratory health of young school people. METHODS: The enquiry was undertaken from May 4th to 15th 2009 in 16 classes drawn randomly from the colleges and secondary schools of Noumea (439 pupils). The survey consisted of an anonymous questionnaire containing 48 questions grouped into five subjects: a sociodemographic description of the subject and his/her family, the family lifestyle, tobacco consumption, marijuana consumption and a respiratory questionnaire. The completion of the questionnaires took, on average, 25 minutes and took place in class in the presence of the doctor undertaking the survey. The data were analysed with Ethnos-4 software. The analysis was made in two stages: a descriptive study after uni- and bivariate analysis and an analytical study to identify the risk factors of the addictive practices. The statistical tests used were Pearson's chi(2) test and the Hosmer-Lemeshow test for calculation of odds ratio. RESULTS: The participation rate was 95.2% (n = 415). The sample was predominantly female (56.6%) and 31% of the pupils were less than 16 years old. The number of tobacco smokers was considerable at 41.1%, 27.3% were regular daily smokers including 38.5% who smoked more than six cigarettes a day. The results were dependent on sex (female predominence) but independent of ethnic origin and socioeconomic factors. The number of cannabis smokers was 48% among whom 32% were regular consumers. The daily smokers were uniquely boys and the custom was more frequent among the Melanesian population. Only 11% of the pupils were worried about their consumption and, among them, only the regular smokers were more at risk of bronchial infection. CONCLUSIONS: In New Caledonia, tobacco consumption levels are higher than those in developed countries. We did not find a falling trend compared with previous data. The use of cannabis remains very widespread at an early age, with a male predominance for daily consumption. For both, these addictions the perception of the risk and the desire to stop are weak. The population studied is representative of teenagers in the public sector schools in Grand-Noumea but probably does not reflect the situation on the whole territory. The results obtained suggest the value of a study of the whole of New Caledonia, the eventual purpose being to guide the public health authorities towards policies that help the young people of the country.

Outbreak of leptospirosis in New Caledonia: diagnosis issues and burden of disease.

A leptospirosis epidemic affected New Caledonia during the first semester of 2008. A total of 135 cases were diagnosed with a relatively low fatality rate of 3.7%. Heavy rainfalls, related to La Niña, favoured this epidemic. The PCR, routinely used, confirmed 54% of the cases, and the microagglutination test 56%. Epidemiological and economical data on this epidemic are presented and discussed.

[Laboratory based hepatitis A surveillance in New Caledonia: from an endemic to an epidemic pattern (1986-2007)]. / Surveillance biologique de l'hépatite A en Nouvelle-Calédonie: de l'endémie à l'épidémie (1986-2007).

UNLABELLED: This study aimed at describing the evolution of the epidemiological pattern of hepatitis A in New Caledonia since 1986 and the recent epidemic which occurred in 2005-2006, regarding particularly its demographic and virological aspects and the public health response implemented. The annual or monthly activity records for Hepatitis A sero-diagnostic performed at the Pasteur Institute of New Caledonia were processed in a retrospective analysis (9723 samples tested for the detection of IgM to hepatitis A). Over the 2004-2006 period, a phylogenetic study of representative strains from New Caledonia and other Pacific islands was carried out by the French National Reference Laboratory for hepatitis A (Paul-Brousse hospital, Villejuif, France). RESULTS: The continuous improvement of hygiene that occurred in New Caledonia during the last two decades led to a dramatic drop in the frequency of hepatitis A among patients tested, ranging from an average value of 79 cases (14%) for the 1986-1999 period to 0 case from 2002. However, in 2005, a strong increasing number of confirmed cases was notified, mainly among young people (78% were under the age of 20). In 2006, this epidemic reached the island of Futuna where it involved more than 1% of the total population (56 cases). The phylogenetic study has confirmed the clonality of the virus circulating during this epidemic, not related to other regional strains (Fiji, Vanuatu, New Zealand) nor with a New Caledonian strain from the previous endemic period. This transition situation, with persistence of a high epidemic risk, should encourage the health authorities to implement adapted response strategies, based in particular on systematic case declaration and targeted immunisation programmes.

Genetic markers of immunoglobulins and diabetes mellitus in the multiracial population of New Caledonia. The CALDIA Study Group.

GM and KM immunoglobulin allotypes, which are the markers, respectively, of the constant parts of the heavy and the light chains of the IgG1, IgG2 and IgG3 subclasses, have been analysed in diabetic mellitus patients and controls living in New Caledonia. We tested 40 Europeans, 256 Melanesians and 44 Polynesians, as well as their 340 matched controls, in order to search for a genetic susceptibility at those polymorphic loci. All the subjects were tested for G1M (1, 2, 3, 17), G2M (23), G3M (5, 6, 10, 11, 13, 14, 15, 16, 21, 24, 28) and KM (1) by the classical hemagglutination method. The frequencies of GM haplotypes and KM alleles have been estimated by a maximum likelihood method. The results are in favour of no influence of the GM and KM loci. The prevalence of diabetes mellitus varies in the populations of New Caledonia: Polynesians are at much higher risk than Melanesians or Europeans. The GM haplotype distribution differs among ethnic groups; so they provide a useful marker to measure genetic admixture. The higher prevalence of diabetes observed among New Caledonians of European origin compared to the prevalence in Europe may be explained by genetic admixture with neighbouring Pacific populations, notably Polynesians (Asian haplotypes are present at a frequency of 9.4%). So, the genetic admixture should be measured in any genetic epidemiological study.

[Survey of lymphatic filariasis on Ouvea Island in New Caledonia]. / Enquete sur la filariose lymphatique dans l'île d'Ouvéa en Nouvelle-Calédonie.

Several cases of Bancroftian filariasis were recently reported on Ouvea Island which is part of the archipelago of New Caledonia located in the south Pacific Ocean. Following these reports systematic screening was carried out in a group of 382 adult consultees at two medical dispensaries. Tests to detect microfilariae in the blood and antibodies in serum were performed at the Pasteur Institute in New Caledonia and the Malarde Institute in Papeete, French Polynesia, respectively. Of the two subjects with manifestations consistent with filariasis, one was seropositive but neither presented microfilariae. Overall 14 subjects (3.7 p. 100) presented microfilariae and 124 were seropositive (33.5 p. 100). The serologic index was significantly higher in men than in women (6.1 p. 100 vs 2.1 p. 100). Parasitic and serologic indexes were significantly higher (p < 0.001) in subjects living in the northern than southern part of the island. As in previous studies in New Caledonia, present data showed that Bancrofitian filariasis is asymptomatic on Ouvea Island. This finding contrasts with the symptomatic forms described on other islands in the south Pacific.

Hormonal status and NIDDM in the European and Melanesian populations of New Caledonia: a case-control study. The CALedonia DIAbetes Mellitus (CALDIA) Study Group.

OBJECTIVE: To assess ethnic differences in androgenic status related to non insulin-dependent diabetes mellitus (NIDDM) in male and female Melanesians and Europeans of New Caledonia. DESIGN: This is a case-control study nested in a prevalence study for diabetes mellitus in the multiracial population of New Caledonia. SUBJECTS: 186 male subjects were included in the survey (77 Melanesians and 16 Europeans in each case and control group). Each case and control group included 104 female Melanesian subjects (69 premenopausal and 35 postmenopausal). METHODS: Diabetic subjects were matched for age, gender, ethnic group and location, with healthy normoglycaemic subjects. Testosterone levels in men and sex hormone-binding globulin (SHBG) levels in women (measured by radioimmunoassay, RIA) were compared between NIDDM and control subjects in relation to obesity, central adiposity and insulin levels. RESULTS: In both ethnic groups, NIDDM was associated with lower testosterone levels but there was a marked difference among Europeans. Testosterone was negatively associated with the body mass index (BMI) (r= -0.35, P <0.01) and fasting insulin (r= -0.37, P <0.001) in control Melanesians only. In Melanesian women, NIDDM was associated with lower SHBG levels in pre- and postmenopausal women (P <0.001). SHBG mean level was not associated with menopausal status. CONCLUSION: Our results confirm in a Pacific population that NIDDM is associated with low levels of testosterone in men and low levels in SHBG in women. In contrast to white populations, Melanesian women have a more androgenic profile, whatever their menopausal status.

Nutritional status in adults in the pluri-ethnic population of New Caledonia. The CALDIA Study Group.

OBJECTIVE: To describe the nutritional status (body mass index (BMI) and waist-hip ratio (WHR)) of the population of New Caledonia in relation to ethnicity and urban-rural environment. DESIGN: Diabetes screening survey in two rural provinces of New Caledonia and in the suburbs of Noumea. SUBJECTS: 8875 subjects aged 30-59 y, Europeans, Melanesians and Polynesians. MEASUREMENTS: BMI, WHR. RESULTS: Obesity (BMI > or = 27 kg/m2 in men, 25 kg/m2 in women) was highly prevalent in all groups, but varied according to ethnicity: respectively, 43% and 52% in Europeans, 46% and 72% in Melanesians, 72% and 83% in Polynesians. In the urban area, mean WHR values, adjusted for age and BMI, were significantly higher than in rural areas, especially in Melanesians. CONCLUSION: Both ethnicity and urban-rural environment are linked to the amount and distribution of adiposity, which appeared worsened in the urban area in Europeans, and even more in Melanesians.

Prevalence of diabetes mellitus in New Caledonia: ethnic and urban-rural differences. CALDIA Study Group. CALedonia DIAbetes Mellitus Study.

The prevalence of diabetes mellitus was assessed in the multiracial population of New Caledonia in the South Pacific with the use of a two-step procedure. The first step included 9,390 subjects aged 30-59 years who were visited at home for screening with glucose strips. All subjects who had a fasting capillary blood glucose value > or = 110 mg/dl were invited to come to the health center for a more detailed examination. In non-fasting subjects, a capillary blood glucose value of 140 mg/dl was chosen as the cut-off point for further examination. A 2-hour glucose tolerance test was performed according to World Health Organization (WHO) recommendations on 424 positive screenees as well as in a sample of 517 negative screenees. In all, 219 previously known diabetic subjects were found; among subjects classified as positive at the first step, 277 were detected as new cases or diabetes. After correction to take into account false negative subjects, the age-adjusted prevalence rate of diabetes was estimated to be 8.9% overall; Polynesians (15.3%) were found to be more at risk than Melanesians or Europeans (8.4% in two other groups). A higher prevalence of diabetes was found in Melanesians who lived in the urban area compared with Melanesians who lived in villages. This finding confirms the deleterious effect of western life in this population subject to rapid modernization.

[Prevalence and risk factors of hepatitis C virus infection in a hospitalized population in a gastroenterology unit. Role of endoscopic biopsies]. / Prévalence et facteurs de risque de l'infection par le virus de l'hépatite C dans une population hospitalisée en Gastroentérologie. Rôle des biopsies per-endoscopiques.

OBJECTIVES AND METHODS: In order to study the prevalence and risk factors of HCV infection in a population hospitalized in a Gastroenterology Unit, 3,767 patients were tested for serum anti-HCV, and 2,607 filled out a questionnaire about risk factors. RESULTS: With the RIBA 2 test, the overall prevalence was 5.9%. Because of the age distribution, two populations were studied. In patients younger than 45, intravenous drug use was the only independent risk factor linked to serum anti-HCV positivity (Odds ratio: 151, CI 95%: 66.9-340). In patients older than 45, the independent risk factors were chronic liver disease (Odds ratio: 8.5, CI 95%: 4.4-16.8), per-endoscopic biopsies (Odds ratio: 2.7, CI 95%: 1.4-5.4), and blood transfusions (Odds ratio: 1.8, CI 95%: 0.9-3.5). Two variables were dominant for the entire population: IV drug use and chronic liver disease. In patients without these factors, only one risk factor was linked to serum anti-HCV positivity: perendoscopic biopsies (Odds ratio: 5.2, CI 95%: 1.6-16.5). CONCLUSION: These results suggest that HCV may be transmitted by perendoscopic biopsies.

Predictive value of uterine artery velocity waveforms in pregnancies complicated by systemic lupus erythematosus and the antiphospholipid syndrome.

The objective of this study was to see if determination of uterine artery velocity waveforms between 20 and 30 weeks in lupus pregnancy and the antiphospholipid syndrome (APS) have a good predictive value for later fetal distress before labor, intrauterine growth retardation, and preeclampsia. Uterine and umbilical artery blood flow velocity waveforms were determined in 21 pregnancies complicated by systemic lupus erythematosus (SLE): 12 with antiphospholipid antibodies (aPL), 9 without aPL. We also studied 7 pregnancies with APS. This retrospective study was running from January 1st 1986 to July 31st 1991, at the Port-Royal Maternity, Paris, France. Abnormal uterine artery blood flow velocity waveforms were found in 10 out of 28 pregnancies at the first examination performed between 20 and 30 weeks gestational age. All the later adverse fetal and neonatal events were predicted by an abnormal uterine artery blood flow velocity waveform. From the 7 cases of fetal distress diagnosed during pregnancy, 6 were predicted by abnormal uterine waveforms and all of these pregnancies resulted in induced delivery before 32 weeks of gestational age. Twelve pregnancies with aPL and normal uterine artery waveforms were uncomplicated. Only 1 out of 7 pregnancies with abnormal uterine artery waveform and aPL ended without complication. Determination of uterine artery flow velocity waveform is a good adjunct to the management of pregnancies complicated by SLE or aPL. This determination has a better predictive value than the presence of aPL.