Installing biosafety level 3 containment laboratories in low- and middle-income countries: challenges and prospects from Mali's experience.

In Mali, the incidence of tuberculosis (TB) is estimated at 56 cases per 100 000 people, with a prevalence of multidrug-resistant TB in new cases of 1.7% (range, 0.3-3.1%) and in retreatment cases of 17% (range, 4.4-30%). Appropriate biosafety conditions for performing routine TB culture and antimicrobial susceptibility testing have been lacking. In 2015, a biosafety level 3 (BSL3) laboratory set up in a shipping container was donated to the Malian Ministry of Health and Public Hygiene to provide capacity for TB testing. This laboratory is now managed by Malian laboratory staff and is processing samples at the national level. We explain the necessary steps for establishing and running a BSL3 laboratory. Despite the acute need for functioning and sustainable BSL3 laboratories, low- and middle-income countries are faced with a complex process and must overcome many challenges.

[Mobile laboratories for rapid deployment and their contribution to the containment of emerging diseases in Sub-Saharan Africa, illustrated by the example of Ebola virus disease]. / Laboratoires mobiles et leur contribution dans l'endiguement de pathologies émergentes en Afrique subsaharienne illustrée par l'exemple de la maladie à virus Ebola.

The Ebola virus, which became a global health concern in 2014, is an example of an emerging pathogen. Ebola virus disease can only be diagnosed in biosafety level 3 and 4 laboratories, which provide the security required to avoid exposure of both the staff and the environment to the pathogen. These laboratories are often far from the site of outbreaks, which may occur in rural areas or border regions (when the disease is imported from a neighboring country). Rapidly deployable laboratory units can bring the diagnosis closer to the outbreak site and thus significantly shorten the time to delivery of results, thus facilitating epidemic containment. Here we report our experience from the first months of implementation in Mali of a mobile laboratory unit of the same type as the European mobile labs and we describe the workflow in the laboratory as well as the training of its Malian staff. Based on our experience and the reports of other projects, we propose a framework in which these mobile laboratory units can strengthen epidemiological surveillance and contribute to containing outbreaks of emerging diseases in sub-Saharan Africa.

Bleach treatment of sputum samples aids pulmonary tuberculosis screening among HIV-infected patients in Laos.

BACKGROUND: Laos has a high prevalence of tuberculosis (TB) and a slowly increasing prevalence of human immunodeficiency virus/acquired immunedeficiency syndrome (HIV/AIDS). Sputum smear microscopy is the only method currently available for routine screening of pulmonary TB, although it only detects one in three cases among persons living with HIV (PLWH). Bleach treatment of sputum samples (bleach method) has been shown to significantly improve the sensitivity of the test; however, its effectiveness in PLWH remains to be determined in Laos. OBJECTIVES: To determine the performance of the bleach method as a diagnostic tool for pulmonary TB in PLWH and to assess its cost-effectiveness in Laos. RESULTS: Of 174 sputum samples collected from 92 patients, 29 were culture-positive for Mycobacterium tuberculosis in 17 patients. The sensitivity of the direct method and the bleach method was respectively 59% and 93%, and specificity was 100% for both methods. The incremental cost-effectiveness ratio for screening an additional case was US$17.40. CONCLUSION: The bleach method is simple, cheap, easy to perform and cost-effective in PLWH. Its implementation in laboratories involved in routine screening of pulmonary TB among PLWH would allow practitioners to start the treatment of this life-threatening co-infection earlier.

Nonlinear wave mixing in a multilongitudinal-mode erbium-doped fiber laser.

The emission spectrum of an erbium-doped fiber ring laser is shown to result from the nonlinear wave mixing taking place between the multiple oscillating longitudinal modes. The dependence of the resultant spectral broadening upon the signal power circulating in the laser cavity is investigated both theoretically and experimentally. In the case considered here, the extent of this spectral broadening is shown to be restrained only by the spectrally discriminating element inserted in the laser cavity. Predictions of the numerical simulations for the signal buildup and propagation in the laser cavity are found to be in good agreement with the experiment.

[Frequency of G6PD deficiency in a group of preschool-aged children in a centrally located area of Cambodia]. / Déficit en G6PD, fréquence dans un groupe d'enfants d'âge préscolaire d'une région centrale du Cambodge.

The aim of this study was to determine the frequency of G6PD deficiency and assess its impact on morbidity, especially anemia, in preschool-aged children in Cambodia. A total of 151 children including 82 boys and 69 girls from the Kandal province near Phnom Penh were studied. Ages ranged from 8 to 69 months. Blood was collected in EDTA-coated tubes. Blood counts were performed with an ABX Micros 60 system and G6PD in red blood cells was measured with a Roche Cobas Mira Plus system using Gamma reagents. G6PD deficiency was found in 14 cases (13.4% of boys and 4.3% of girls). Deficiency was complete in 7.3% of children and partial in 2%. Anemia defined as hemoglobin concentration less than 110 g/l was detected in 29.1% of children. No case of anemia could be attributed to enzyme deficiency since no sign of hemolysis was observed in any of the three children presenting both conditions. Further study is needed on G6PD deficiency in Cambodia including malaria-endemic areas and on the frequency and severity of jaundice due to enzyme deficiency in newborns.

Pulse collisions in the stretched-pulse fiber laser.

We report the observation of a new regime of operation in the stretched-pulse fiber laser in which two groups of bound pulses travel in the cavity at different velocities. The pulse groups collide periodically and remain apparently unaltered after the collisions. The observed group-velocity difference is shown to exhibit a strong dependence on the time interval between the pulses in each bound state.

Hábitos alimentarios en la población urbana de Madrid. Estudio EPCUM (I): estimación de energía y macronutrientes / Nutritional behavior of Madrid urban population. EPCUM study (I): energy and macronutrients evaluation

El objetivo de este trabajo fue conocer los hábitos alimentarios de la población de Madrid como parte del Estudio de Prevalencia de Enfermedades Cardiovasculares en Madrid (EPCUM). Se estudiaron 1.373 sujetos, de ambos sexos, con edades comprendidas entre 5 y 59 años de edad, que fueron seleccionados aleatoriamente a partir del padrón municipal. La muestra se distribuyó por estratos de edad y sexo (5-12, 13-19, 20-29, 30-39, 40-49 y 50-59 años) de manera que fuera representativa de la población urbana de Madrid. Además de datos antropométricos y analíticos, se recogió información sobre hábitos alimentarios a partir de un cuestionario de frecuencias de consumo alimentario, previamente validado. Se estimó la ingestión de energía (kcal) y de los siguientes nutrientes: hidratos de carbono (CHO), proteínas (PRT), grasas totales (GRS), grasa saturada (GSAT), monoinsaturada (GMI), poliinsaturada (GPI), alcohol, expresadas en g/día y porcentaje del valor calórico total, e ingestión de colesterol (CHOL) y fibra ajustados por 1.000 kcal. El porcentaje de CHO osciló entre el 38 y el 42 por ciento de la ingestión calórica, mientras que la GRS varió entre el 38 y el 45 por ciento, según el estrato de edad y sexo evaluados. El análisis de los ácidos grasos indica que el grupo de niños (5-12 años) y adolescentes (13-19 años) consumen significativamente un mayor porcentaje de grasa saturada respecto a los adultos (el 14,5 frente al 13 por ciento; p < 0,001); sin embargo, la ingestión de colesterol (mg/1.000 kcal) es mayor entre los adultos (177 frente a 164 y 170 en niños y adolescentes, respectivamente; p < 0,01). El consumo de GMI se mantiene prácticamente igual en todos los estratos (18,5 por ciento), aunque las mujeres tienden a tener un consumo algo más elevado que los varones (18,9 frente a 18,2; p < 0,001). La ingestión de fibra es así mismo mayor en mujeres que en varones, y en adultos respecto a niños y adolescentes. Estos datos ponen de manifiesto que la población estudiada está consumiendo una alta proporción de grasa saturada y colesterol, en detrimento de una ingestión adecuada de hidratos de carbono. Aunque la elevada proporción de GMI confiere aspectos positivos a la dieta, convendría reeducar ciertos hábitos alimentarios hacia un patrón más saludable (AU)

Hábitos alimentarios en la población urbana de Madrid. Estudio EPCUM (II): consumo de alimentos / Alimentary patterns of Madrid urban population. EPCUM study (II): food consumption

Antecedentes. Es importante el conocimiento de los hábitos alimentarios de la población, que contribuyen de forma determinante en su estado de salud. En las últimas décadas se ha producido en nuestro país un cambio en el patrón alimentario, alejándonos de la dieta mediterránea tradicional. Metodología. Hemos estudiado los hábitos alimentarios de una muestra representativa (n = 1.373 sujetos) del municipio de Madrid, de ambos sexos, con edades comprendidas entre 5 y 59 años. A partir de los datos obtenidos de un cuestionario de frecuencias semicuantitativo validado, se describen los consumos de los siguientes grupos de alimentos (expresados en g/per cápita/día [g/pc/d] o ajustados por 1.000 kcal/día): lácteos, hortalizas, cereales, frutas, legumbres, cárnicos, pescados, huevos, azúcar, bollería-repostería y grasas. Se realizan comparaciones con otros estudios epidemiológicos similares tanto en adultos como en niños. Resultados. Las mujeres consumen significativamente mayor cantidad de lácteos, hortalizas, frutas, carnes, pescados, bollería y grasas que los varones. La ingestión de productos de bollería en niños-adolescentes es elevado (92 g/pc/d), contribuyendo al 13 por ciento del consumo energético diario. Cuando se comparan los resultados con las recomendaciones de una alimentación saludable, se aprecia que nuestra población ingiere una alta cantidad de cárnicos (208,7 g/pc/d) y una menor proporción de cereales (249 g), legumbres (28,5 g), hortalizas (330 g), manteniéndose aceptables las cantidades de frutas, pescados, huevos y azúcares. Conclusiones. Estos datos reflejan que la población estudiada consume una alta proporción de alimentos con elevado contenido en grasa saturada y colesterol, y se aprecia una disminución de la ingestión de alimentos con predominio de hidratos de carbono. En conjunto, este patrón alimentario se distancia de las recomendaciones de una dieta saludable y puede redundar en los próximas décadas en el desarrollo de enfermedades crónicas muy prevalentes (AU)

Alpha linolenic acid in cholesterol esters: a marker of alphalinolenic acid intake in newborns.

OBJECTIVE: To evaluate alpha-linolenic acid (ALA) (18∶3 n-3) and linolenic acid (LA) (18∶2 n-6) in cholesterol esters (CE) as markers of ALA and LA dietary intakes in preterm infants. SUBJECTS: Forty-five preterm infants: two groups fed different formulas, the third fed human milk. DESIGN: ALA and LA dietary intakes were precisely recorded in each infant to accurately determine the cumulative amount of ingested ALA and LA during two intervals: (i) between the second day after the first significant formula intake (D0) and the fifteenth day (D15); and (ii) between D0 and the first day of the 37th week of post-conception age (W37). The corresponding amounts of ingested ALA and LA were related to ALA and LA levels determined by capillary column gas-liquid chromatography in plasma cholesterol esters at D15 and W37, respectively. RESULTS: ALA in CE was very significantly correlated to D0-D15 and D0-W37 ALA intakes (0.66; P=0.0001 and 0.70; P=0.0001), respectively. LA in CE was weakly correlated to D0-D15 LA intakes (0.03; P=0.01) and whatever the group (human milk or enriched formula) the correlation was lost at W37. CONCLUSION: In preterm infants, ALA in CE can be considered as representative of ALA dietary intakes, whereas LA in CE appears as a poor marker of LA intakes.

Fatty acid composition of four microsporidian species compared to that of their host fishes.

The fatty acid composition of four microsporidian species (Glugea atherinae, Spraguea lophii, Glugea americanus, and Pleistophora mirandellae) and their host fishes has been determined using gas chromatography. Twenty-four fatty acids were identified with differences in relative abundance of fatty acids among the four parasites. Certain even-saturated fatty acids were found in a very high proportion: palmitic acid (16:0) represented one-third of total fatty acids in Pleistophora mirandellae. The level of docosahexaenoic acid (22:6omega3) attained 26-28% in Glugea atherinae, Spraguea lophii, and Glugea americanus, but only 8-9% in P. mirandellae. With respect to fatty acid compositions of host organs, some significant differences were evident between marine and freshwater fishes. Palmitic acid was prevalent in the marine fishes, Atherinae boyeri and Lophius piscatorius, and oleic acid (18:1omega9) in the freshwater fish Leuciscus cephalus. The proportion of docosahexaenoic acid in marine fishes was two or three times as great as in freshwater fish Leuciscus. The high polyunsaturated fatty acid content in both parasites and host fishes may be related to the scavenging of these fatty acids by the parasites rather than a microsporidia-specific fatty acid biosynthesis pathway.

Differences between polyunsaturated fatty acid status of non-institutionalised elderly women and younger controls: a bioconversion defect can be suspected.

OBJECTIVE: To evaluate the polyunsaturated fatty acid (PUFA) status in non-institutionalised elderly women and to detect a possible essential fatty acid bioconversion defect. DESIGN AND SUBJECTS: The fatty acid composition of total plasma lipids, plasma triglycerides (TG), cholesterol esters (CE), phospholipids (PL), and erythrocytes was determined by capillary column gas-liquid chromatography in a sample of 200 non-institutionalised healthy elderly women over 75 years of age. The data were compared with those of a control group of 50 young female volunteers aged 20-48 y. RESULTS: In elderly women, the n-6 series precursor, linoleic acid (18:2 n-6), was lower in TG and CE (P = 0.029 and 0.014, respectively). In CE, this fatty acid was highly correlated with vegetable and vegetal fat intakes (P < 0.0001), suggesting a lower dietary supply than in controls. Higher percentages of 16:1 n-7 were found in all the plasma lipid fractions in elderly women, especially in CE (P < 0.0001). The ratios 20:4 n-6/20:3 n-6 and 22:6 n-3/20:5 n-3 were significantly lower in PL from elderly women (P < 0.005 and P < 0.002, respectively), raising the question of the efficiency of the terminal steps of 20:4 n-6 and 22:6 n-3 biosynthesis. Dietary investigations in elderly women indicated that a high dietary protein intake via meat probably contributed to the supply of 20:4 n-6 and thus maintained the status of this fatty acid, despite the suspected altered biosynthesis. CONCLUSION: The PUFA status in the elderly women group could be more fragile and dependent on exogenous supply of long-chain PUFAs than previously suspected.

Longitudinal multicentric study of plasma and red blood cell fatty acids and lipids in preterm newborns fed human milk.

The present multicentric study (three centers) deals with the values of plasma and red blood cell fatty acids obtained in a group of 18 preterm newborns after 2 days (D2), 15 days (D15) and 5 weeks (37th week postconception: 37th wk) of human milk feeding. Analytical methods were randomized between the three centers and quality control was evaluated by repeated analysis of reference samples. 20:4 n-6 varied from 10.71 +/- 1.58% to 9.51 +/- 1.65 and 10.10 +/- 1.42% in plasma phospholipids and from 16.59 +/- 3.30% to 14.68 +/- 3.14 and 18.24 +/- 4.09% in red blood cell phosphatidylethanolamine (RBC-PE) at D2, D15 and 37th wk, respectively, contrasting with the important rise of the precursor (18:2 n-6) in all the fractions studied. In RBC-PE, 22:6 n-3 significantly declined from 3.52 +/- 1. 03% at D2 to 2.56 +/- 0.83% at D15 (p < 0.02) and recovered its initial level at 37th wk (4.08 +/- 1.94%). The recovery of long chain polyunsaturated fatty acid homeostasis at that time was also confirmed by the decline of 16:1 n-7 in cholesterol esters (10.69 +/- 3.92 to 4.32 +/- 2.38%).

Effects of preterm infant formula supplementation with alpha-linolenic acid with a linoleate/alpha-linolenate ratio of 6: a multicentric study.

OBJECTIVE: To investigate the effects of a milk formula supplemented with a alpha-linolenic acid (ALA) (18:2 n-6/18:3 n-3 ratio near 6/1) on plasma and red blood cell (RBC) fatty acids (FAs) in premature infants and compare with a non supplemented formula (18:2 n-6/18:3 n-3 = 22/1). DESIGN AND SUBJECTS: Infants of mothers who elected not to breast-feed were randomly assigned to either a high alpha linolenic formula (HLF: n = 31) group or a low alpha-linolenic formula (LLF: n = 32) control group. Infants fed human milk (HM: n = 25) were enrolled concurrently as a reference group. Anthropometric and biological measurements were made after two days (D2) and 15 d (D15) of enteral feeding and at the 37th week (W37) of postconceptual age. In HLF, the 18:3 n-3 content was 1.95% of total FAs (0.77% of total energy) and the 18:2 n-6/18:3 n-3 ratio was near 6/1. In LLF, the 18:3 n-3 content was 0.55% of total FAs (0.22% of total energy) and the 18:2 n-6/18:3 n-3 ratio was 22/1. RESULTS: ALA supplementation had minimal effect on the n-6 series, did not alter the anthropometric data and confirmed the conversion of ALA into docosahexaenoic acid (DHA). Throughout the study, it maintained, the RBC membrane DHA values within the confidence interval of those obtained in the HM group. Such was not the case with LLF CONCLUSION: alpha-linolenic acid supplementation (from Rapeseed oil and in a 18:2 n-6/18:3 n-3 ratio = 6) in premature infant formula can contribute efficiently to the maintenance of the n-3 status in the premature newborns.

[Biological effects on premature neonates of a milk formula enriched with alpha-linolenic acid: a multicenter study]. / Effets biologiques, chez le prématuré, d'une supplémentation des formules lactées en acide alpha-linolénique: une étude multicentrique.

Nervous tissues and the retina are rich in docosahexaenoic acid [DHA, C22: 6(n-3)], an essential fatty acid which is the product of the elongation and desaturation of alpha-linolenic acid [alpha-LnA, C18:3(n-3)]. Lower plasma and membrane DHA levels as well as impaired nervous function (psychomotor development, visual disturbances) have been observed in premature babies receiving standard milk products compared to breast-fed babies and have been related to the lack of long-chain (> C20) fatty acids in these products. In the present study, we have investigated whether it is possible to increase the plasma and erythrocyte DHA level in premature infants by giving them a milk formula enriched in alpha-LnA (1.95% vs 0.55%). Results showed that, after 15 days of feeding, alpha-LnA supplementation significantly increased plasma DHA availability [2.20 vs 1.54% (p < 0.0001) in the plasma phospholipids] and increased DHA level in erythrocyte membranes [3.02 vs 2.54% (n.s.) in the red blood cell phosphatidylethanolamines]. At the LA/alpha-LnA ratio used (6/1), there was only a limited impact on the n-6 pathway which was reflected in a slight decrease in the arachidonic acid (AA) of the plasma phospholipids [6.88 vs 7.53% (p < 0.05) after 15 days]. Furthermore, the AA content of the red blood cell phosphatidylethanolamines was perfectly preserved even after a mean period of 4-5 weeks of feeding [(15.70 vs 14.86% (n.s)]. The observed enhancement in fatty acids of the n-3 series calls for a prospective study investigating whether these improvements are associated with changes in the kinetics of psychomotor development and in the visual function of enriched-formula-fed versus breast-fed babies.

Nervonic acid in red blood cell sphingomyelin in premature infants: an index of myelin maturation?

The present study addresses the question whether nervonic acid (24:1n-9) accumulation in sphingomyelin (SM) of red blood cells (RBC) could yield information on cerebrum maturation in premature infants. The study included 28 premature eutrophic infants of 31.5 wk gestational age. Eleven were fed with human milk, nine with a regular formula and eight with an alpha-linolenate-enriched formula. The fatty acid composition of the SM fraction was determined by gas-liquid chromatography on a 50-m fused silica capillary column. At 32 wk gestational age, the main fatty acids in SM were 16:0, 18:0, 20:0, 22:0, 24:0 and 24:1n-9. After five weeks of feeding, at week 37 of postconceptional age, the most striking variation was a rise in 24:1n-9, from 9.9 +/- 0.7 to 12.8 +/- 0.9 (P < 0.02), regardless of regimen in all three feeding groups. The rise in 24:1n-9 after birth in premature eutrophic infants is the beginning of a trend toward the higher levels in 24:1n-9 observed in mature newborns and older infants. The 24:1n-9 level in SM of RBC from premature infants may reflect 24:1n-9 levels in SM of brain and could thus reflect brain maturity.

[Jails and AIDS. Risk factors for HIV infection in the prisons of Madrid]. / Cárceles y SIDA. Factores de riesgo de infección por el VIH en las cárceles de Madrid.

The spread and risk factors for HIV infection were studied in 288 men and 95 women at the prisons of Carabanchel and Yeserias, Madrid. These men and women requested care at the AIDS prevention program in the jails of Madrid, from April to December 1987. Among the men studied at Carabanchel, 55% were positive to HIV (77% seropositivity among intravenous drug users, IVDU). Tattooing (OR = 2.8), and number of times in prison (OR = 4.5 comparing those who had been 8 or more times in prison with those who had been in prison only once) were independent risk factors for infection, after controlling for IVDU. No association was found between seropositive status to HIV and reported anal intercourse. Among the women studied at Yeserias, the proportion of HIV seropositive women was 26% (70% of the IVDUs were seropositive). Tattooing, number of times in prison, history of prostitution and history of syphilis were associated with HIV infection. When controlling for IVDU, number of times in prison and history of prostitution were not independent risk factors for infection. These data indicate that there is a need for control measures to avoid further spread of the HIV infection among the inmate population, in particular through the use of contaminated needles while in prison.

Proton and phosphorus NMR study of RNA self-complementary hexamers: influence of the 5-methylcytidine on the conformational transitions and the molecular motions.

We present proton and phosphorus NMR data, which contribute to explain why the 5-methylcytidine (m5C) differently affects the conformational transitions of CGUAm5CG (Bloch et al., FEBS Letters 219, 464 (1987)) and CGm5CGCG (Ceolin et al., J. Am. Chem. Soc. 109, 2539 (1987)). The atypical intermediate form observed in the random coil to A-like duplex transition of CGm5CGCG is determined: this original duplex structure exhibits a frame-shift pairing of the two strands, with a partial conservation of the A-type structure. In the case of CGUAm5CG such a pairing process would lead to a complete mismatch pairing. This feature probably explains that the NMR data of CGUACG and CGUAm5CG are similar and consistent with a random coil to A-type helix transition. Nevertheless a significant difference between the correlation times observed for the molecular motions of the two duplexes is detected. Another example of unusual conformational transition of methylated RNA oligomers is given by CAm5CGUG.

Plasma fatty acid composition and lipid peroxide levels in children with paucity of interlobular bile ducts.

The total and free fatty acid composition of plasma and lipid peroxide concentrations was studied in 32 cholestatic children with syndromatic paucity of interlobular bile ducts (Alagille's syndrome). The mean lipid peroxide value in these patients was 8.80 +/- 3.70 nmol/ml, nearly 4 times higher than the mean control value. Compared to the control group, the patients exhibited significant variations in total fatty acids, and in particular a relative decrease in linoleic acid (from 29.5 +/- 6.1% in the controls to 19.1 +/- 8.03% in the patients) compensated by an increase in saturated and monounsaturated fatty acids. The plasma lipid peroxide levels were inversely correlated with the unsaturated/saturated fatty acids ratio in total fatty acids, and with the vitamin E status (vitamin E/total lipids). Most of the total and free fatty acid variations observed were largest in patients with severe jaundice. Dietary fat malabsorption and the increase in lipid peroxidation partly explain these results. Furthermore, in free fatty acids, we observed a marked increase in arachidonic acid (from 1.43 +/- 0.85% in the controls to 4.27 +/- 2.24% in the patients), suggesting abnormal eicosanoid synthesis.