Hyperandrogenism and Polycystic ovary syndrome: Effects in pregnancy and offspring development.

Polycystic ovary syndrome (PCOS) is one of the major endocrine disorders affecting women of reproductive age. Its etiology remains unclear. It is suggested that environmental factors, and particularly the intrauterine environment, play key roles in PCOS development. Besides the role of androgens in PCOS pathogenesis, exposure to endocrine disruptors, as is Bisphenol A, could also contribute to its development. Although PCOS is considered one of the leading causes of ovarian infertility, many PCOS patients can get pregnant. Some of them by natural conception and others by assisted reproductive technique treatments. As hyperandrogenism (one of PCOS main features) affects ovarian and uterine functions, PCOS women, despite reaching pregnancy, could present high-risk pregnancies, including implantation failure, an increased risk of gestational diabetes, preeclampsia, and preterm birth. Moreover, hyperandrogenism may also be maintained in these women during pregnancy. Therefore, as an altered uterine milieu, including hormonal imbalance, could affect the developing organisms, monitoring these patients throughout pregnancy and their offspring development is highly relevant. The present review focuses on the impact of androgenism and PCOS on fertility issues and pregnancy-related outcomes and offspring development. The evidence suggests that the increased risk of pregnancy complications and adverse offspring outcomes of PCOS women would be due to the factors involved in the syndrome pathogenesis and the related co-morbidities. A better understanding of the involved mechanisms is still needed and could contribute to a better management of these women and their offspring. This article is categorized under: Reproductive System Diseases > Molecular and Cellular Physiology Reproductive System Diseases > Environmental Factors.

Guns, germs, and trees determine density and distribution of gorillas and chimpanzees in Western Equatorial Africa.

We present a range-wide assessment of sympatric western lowland gorillas Gorilla gorilla gorilla and central chimpanzees Pan troglodytes troglodytes using the largest survey data set ever assembled for these taxa: 59 sites in five countries surveyed between 2003 and 2013, totaling 61,000 person-days of fieldwork. We used spatial modeling to investigate major drivers of great ape distribution and population trends. We predicted density across each taxon's geographic range, allowing us to estimate overall abundance: 361,900 gorillas and 128,700 chimpanzees in Western Equatorial Africa-substantially higher than previous estimates. These two subspecies represent close to 99% of all gorillas and one-third of all chimpanzees. Annual population decline of gorillas was estimated at 2.7%, maintaining them as Critically Endangered on the International Union for Conservation of Nature and Natural Resources (IUCN) Red List. We quantified the threats to each taxon, of which the three greatest were poaching, disease, and habitat degradation. Gorillas and chimpanzees are found at higher densities where forest is intact, wildlife laws are enforced, human influence is low, and disease impacts have been low. Strategic use of the results of these analyses could conserve the majority of gorillas and chimpanzees. With around 80% of both subspecies occurring outside protected areas, their conservation requires reinforcement of anti-poaching efforts both inside and outside protected areas (particularly where habitat quality is high and human impact is low), diligent disease control measures (including training, advocacy, and research into Ebola virus disease), and the preservation of high-quality habitat through integrated land-use planning and implementation of best practices by the extractive and agricultural industries.

[Scorpion stings: a public health problem in Morelos (Mexico)]. / Les piqûres de scorpion: un problème de santé publique à Morelos (Mexique).

Scorpion stings represent a major public health problem in Mexico. Their annual incidence is estimated at 150,000 cases; 800-1,000 people die from them each year, 72.5% of whom are children younger than 5 years old. The states most affected are Aguascalientes, Colima, Durango, Guanajuato, Guerrero, Jalisco, Michoacán, Morelos, Oaxaca, Puebla, Sinaloa, and Zacatecas. Morelos is an endemic zone, and scorpion stings are relatively frequent, but the indigenous population underestimates the risks. In this locality, scorpion stings lead to high morbidity, with an average of 10,219 cases each year, and a prevalence varying from 584.86 per 100,000 inhabitants in 1994 to 2043.3 per 100,000 inhabitants in 2003. Because of this upsurge, systematic medical supervision and serum therapy are necessary if scorpion poisoning is suspected in a child. The indigenous community as well as tourists visiting Mexico must be informed about the substantial risk of scorpion poisoning.

Relation between coffee drinking and blood pressure: analysis of 6,321 subjects in the Paris region.

The possible link between coffee drinking and blood pressure (BP) was studied in a cross-sectional epidemiologic survey of 6,321 adults in the Paris region. Systolic and diastolic BP levels were higher among the 5,430 coffee drinkers than among the 891 nondrinkers (p less than 0.001 and p less than 0.01). BP levels adjusted for age by covariance analysis increased gradually from the non-coffee consumption category (125.6/79.8 +/- 15.0/10.5 mm Hg [mean +/- standard deviation]) to the highest consumption category (greater than or equal to 5 cups/day) (128.1/80.6 +/- 15.6/10.2 mm Hg) (p less than 0.001 for systolic BP and p less than 0.002 for diastolic BP). The positive association between coffee consumption and systolic, but not diastolic, BP remained significant in a multivariate analysis after controlling for age, sex, body mass index, alcohol consumption, tobacco consumption and socioeconomic category (p less than 0.02 for systolic BP and p = 0.16 for diastolic BP). It is concluded that coffee consumption is a significant but not strong contributor to the variation in BP levels.

Mitral valve repair: results and the decision-making process in reconstruction. Report of 275 cases.

From January 1975 to June 1988, 275 patients underwent mitral valve repair for mitral regurgitation, pure (148 patients) or associated with mitral stenosis (127 patients). Patients with pure mitral stenosis were excluded from this study. The cause of mitral regurgitation was rheumatic in 180 patients (aged 28.6 +/- 1.2 years, mean +/- standard error of the mean) and degenerative in 84 patients (aged 54.7 +/- 1.5 years). Fifty-nine percent of the patients were in New York Heart Association classes III and IV before the operation. Intraoperative assessment of the mitral valve led us to identify four major mechanisms of mitral regurgitation: (1) restriction of leaflet motion by fibrosis (group I, 63 patients); (2) enhancement of leaflet motion by leaflet and chordal extension and prolapse (group II, 139 patients), (3) combination of both (group III, 64 patients); and (4) isolated dilatation of the anulus (group IV, 10 patients). One hundred sixty-one patients had isolated mitral disease and 114 had associated aortic or tricuspid valve disease, or both. The hospital mortality rate was 4.0%. Follow-up was 96% complete and totaled 1247.47 patient-years. At 13 years' follow-up, the survival rate was 93.0% +/- 6.8% in group I, 90.0% +/- 6.0% in group II, and 96.6% +/- 4.6% in group III. Freedom from reoperation was 78.1% +/- 21.0%, 83.2% +/- 18.9%, and 79.6% +/- 16.2%, respectively. Freedom from embolism was 94.7% for the whole series. In patients with isolated mitral valve repair, the cumulative morbidity was significantly higher in groups I (6.3 +/- 2.0%/pt-yr) and III 6.3% +/- 1.7%/pt-yr) than in group II (2.5% +/- 0.9%/pt-yr, p less than 0.05). Multivariate analysis identified age and associated tricuspid valve disease as significant predictors of reoperation (p less than 0.01 for both factors). These results suggest that conservative surgery should be used with caution in group I and III patients. In contrast, indications for mitral valve repair should be extended in group II patients. This observation has important clinical implications since, in Western countries, valve prolapse tends to be a major cause of mitral regurgitation.

Computerized patient management in a nephrology department.

An integrated approach is described for the computerized management of a nephrology department. On a medical point of view, the system comprises a minimum medical record for every patient, different specialized records and knowledge bases presently covering hypertension, diabetes and chronic renal failure. From a technical point of view, the methodology used integrates data and knowledge management techniques. Various individual reports facilitate patient management. For hypertensive patients, an expert system is combined with the record system. The results of a preliminary evaluation are reported and future developments considered.

[Alcohol consumption and treatment of hypertension. Results of an occupational medicine survey]. / Consommation d'alcool et traitement de l'hypertension artérielle. Résultats d'une enquête en médecine du travail.

The results of a cross-sectional study were analysed in order to assess the therapeutic control of hypertension in relation to alcohol consumption. 6,665 subjects, employed in small and medium-sized companies of the Paris region were examined in a cross sectionnal study. Among the 1,008 hypertensive subjects, awareness of hypertension decreased with increasing alcohol consumption, from 72% among the 304 non-drinkers to 59% among the 201 heavy drinkers (six glasses/day and more) (p less than 0.05). Similarly, the percentage of subjects under current antihypertensive medication on the day of examination was lower in heavy drinkers, 19%, than among tetotalers, 42% (p less than 0.001). An antihypertensive treatment had been prescribed to 510 subjects. Among them, compliance, as stated by the interview, decreased with increasing alcohol consumption, from 70% to 34% (p less than 0.001). Using a logistic regression, the adjusted relative risk of non-compliance among heavy drinkers (6 glasses/day or more) was found to be 1.9. Among the 344 subjects under antihypertensive treatment on the day of examination, systolic and diastolic blood pressure were higher among heavy drinkers, 167/102 mmHg, than among teetotallers, 154/95 mmHg (p less than 0.01 both). The relative hypertension awareness, treatment and control status was thus poorer among, moderate and heavy drinkers than among the light and non-drinkers (table I). (Table: see text). The importance of the problem of alcoholism is thus emphasized, in both the fields of hypertension prevalence and control.

[Methods and results of arterial hypertension control in a working population]. / Modalités et résultats de la prise en charge de l'hypertension artérielle dans une population de salariés.

The health benefits of hypertension treatment at the community level depend both of the quality of the blood pressure control obtained for each patient treated individually and of the percentage of the hypertensive patients actually aware, treated and controlled for hypertension in the entire population. The data collected in 1987 in a group of 7,901 subjects working in medium-sized companies of the Paris region were analysed, and compared with those obtained in a very comparable population in 1979-80. Among patients aware of their disease, the percentage of treated patients was higher in 1987 than in 1979, 55 p. 100 and 46 p. 100 respectively in men (p less than 0.001); 70 p. 100 in 87, 59 p. 100 in 79 for women (p less than 0.01). Hypertension was treated and controlled in 27 p. 100 of the men (16 p. 100 in 1979), and 42 p. 100 of women (27 p. 100 in 1979). Awareness was significantly lower among migrant workers than among european personnel (p less than 0.001). The lower the educational level, the lower the compliance with antihypertensive treatment, ranging from 99 p. 100 for the highest educational level, to 82 p. 100 among low educated subjects (p less than 0.001). The hospitalization rate did not differ according to sociocultural factors. Hypertension was detected by the worksite physician in 51 p. 100 of the male hypertensive patients. He was the sole physician who examined 17 p. 100 of the patients in the previous year. These results suggest a moderate improvement in hypertension detection and control. However, development of intervention strategies and their evaluation are clearly needed.

[Sleep and hypertension. An epidemiologic study in 7,901 workers]. / Sommeil et hypertension artérielle. Une étude épidémiologique chez 7,901 salariés.

In order to evaluate possible correlations between blood pressure levels and sleep quality, 7,901 workers of both sexes living in Paris area have been the subject of a survey during their annual examination performed by workside physicians. The enquiry included questions related to sleep quantity and quality, sleeping pills consumption, awakenings, nightmares, snoring, way of life and working conditions. The information concerning these parameters was available for 7,542 people. Among them, 6,551 (86.9%) did not suffer from high blood pressure (HBP) (blood pressure less than 160/95 mmHg), 618 (8.2%) presented a high blood pressure but were not treated, 371 (4.9%) received a treatment against HBP. The average sleep duration is about 7.4 h (S.D. = 1.0) for men and about 7.6 h (S.D. = 1.0) for women (less than 0.001). It is significatively and negatively correlated with the systolic blood pressure level (SBP) (less than 0.001) and the diastolic blood pressure level (DBP) (less than 0.001). The frequency of patients complaining of nightly awakening and of snoring significatively increase with SBP (p less than 0.05) and DBP (p less than 0.001). The observed association between DBP (but not SBP) and sleep duration and nightly awakening remains significant in multivariate analysis including age, sex, tobacco smoking, alcohol and coffee consumption, use of sleeping pills and hypotensive treatment, as well as the negative correlation between SBP and nightmare frequency. The correlation between SBP or SBP and snoring was no more significant. In conclusion, a significant correlation has been found between the blood pressure levels and the sleep quality whose clinical consequences remain to be explored.(ABSTRACT TRUNCATED AT 250 WORDS)

[Heart surgery in normothermia and aerobiosis: apropos of 530 patients]. / Chirurgie cardiaque en normothermie et aéorobiose: à propos de 530 patients.

Between February and October 1991, 530 consecutive patients underwent myocardial revascularization or valvular surgery with warm continuous antegrade and retrograde cardioplegia (37 degrees C). Three hundred and thirty three patients had isolated myocardial revascularization, 159 valvular surgery alone and 25 had combined valvular and coronary bypass. The global mortality was 5.1%, 3.7% for coronary bypass, 7.5% for valvular surgery and 8% for combined valvular and coronary surgery. A multivariate analysis identified the "reperfusion time" as the only predictive factor of hospital mortality (p < 0.001). Intraortic balloon counterpulsation was required postoperatively in 3.2% of cases, 5.2% of coronary bypass and 0.8% of the valvular patients. Inotropic drugs were used to come off cardiopulmonary bypass in 16.5% of coronary and 37.5% of valvular patients. There were 0.9% perioperative infarctions: 1.2% in the coronary bypass cases and 0.6% in the valvular cases. Spontaneous return to sinus rythm was observed in 87.9% of cases. The average "reperfusion time" was 20.48 +/- 0.7 mn. Analysis of the influence of aortic cross clamp time on cardiac morbidity in two groups of coronary patients (Group I: short cross clamp time less than 60 mn; Group II: long cross clamp time, 60 to 33 mn) showed that the hospital mortality, the prevalence of the use of inotropic drugs and balloon counterpulsation the postoperative cardiac index, the rate of spontaneous de fibrillation and the reperfusion time did not depend on the aortic cross clamp time. Cardiac morbidity.

[Decentralization of the ARTEMIS system in a nephrology service in a general hospital]. / Expérience de dècentralisation du système "ARTEMIS" dans un service de néphrologie en hôpital général.

"ARTEMIS" is a standardized and computerized medical file which is intended for improving the follow-up of hypertensive patients, the efficacy of treatment and for realising national-wide surveys. The software "LIED" of data base for "ARTEMIS" is nowadays transposable on mini-computer. In Nephrology Unit of General Hospital from Colmar, the system has been working since September 1985 with MICRO-MEGA E 32 (Thomson). The administrative and medical data are directly acquired by the doctors and secretaries of the Unit on a conversational mode from six terminals. There is no writing collecting of data. An evaluation of the system was realized with the 113 first hypertensive patients. The results were compared to those obtained from patients of Paris area.

[Psychosocial consequences of HIV infection]. / Les conséquences psychosociales de l'infection VIH.

A questionnaire survey of 103 patients of the Paris Pitié-Salpêtrière Hospital measures the changes in family life, work relations and in sexual behaviour occurring after an HIV infection diagnosis. Most patients choose to keep their diagnosis secret, an attitude that places them into a double bind situation. This silence, chosen as a mean of self-protection, prevents patients from making themselves understood and from mobilising the material and psychological help they need.

[Effect of socio-occupational category on iterative hemodialysis treatment of advanced chronic renal insufficiency. Results of the DIAPHANE computerized Dialysis Registry cooperative program]. / Influence de la catégorie socio-professionnelle sur le traitement par hémodialyse itérative de l'insuffisance rénale chronique avancée. Résultats du programme coopératif DIAPHANE Dialyse Informatique.

The hypothesis that inequalities may be observed between patients of different socio-professional categories (S.P.C.) was assessed in a group of 1267 men treated by chronic haemodialysis (C.H.) in 34 dialysis centers throughout France and followed up in the computerized DIAPHANE Dialysis Registry. The percentages of manual workers and farmers were found lower than those calculated on the whole active french population. In contrast, the percentages of senior executives and patient with liberal professions were higher. Primary renal disease was detected sooner in patient of the higher S.P.C. than in other groups. Patients of the higher S.P.C. were more frequently treated in university or in private hospitals than in general hospitals. They were more likely on evening or night dialysis schedules than on daylight schedules; they more frequently received hypotensive drugs, vitamin D, calcium, iron, prescriptions of blood transfusions than patients of the lower categories. Survival rates were not correlated with the S.P.C., but the rehabilitation rate, expressed as the percentage of part or full time employments, was greater in patients of the higher S.P.C. Results indicate that, in patients treated by chronic haemodialysis, inequalities in favor of the patients of the higher socio-economic categories are observed and that these inequalities concern both the access and the delivery of care.

[Colorectal villous tumors. Treatment by electro-resection and laser photocoagulation. 134 cases]. / Tumeurs villeuses colo-rectales. Traitement par électro-résection et photocoagulation au laser. 134 observations.

Endoscopic snare resection prior to Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenoma. One hundred and thirty four patients were included in the study: 72 with surgical contraindications, 61 for whom surgical resection appeared to be too drastic and 1 who refused surgery. Treatment sessions were repeated every fifteen days until total tumour destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of seven patients. Eight patients were lost to follow up. Treatment results could be analysed in 119 patients. A successful treatment was achieved in 108 patients. Tumour destruction was complete in 85.4 percent of the cases with lesions of at least 4 cm in diameter and in 94.3 percent of the cases with smaller lesions. During the average 101 weeks follow up period, 15.7 percent of the patients with total tumour destruction had recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgical treatment. It would appear that endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method for the destruction of colorectal villous adenomas.

[Cardio-respiratory complications of sleep apnea in obese patients]. / Les complications cardio-respiratoires des apnées du sommeil chez l'obèse.

The cardio-respiratory complications of sleep apnea syndrome have been prospectively assessed in 60 patients with massive obesity and free of chronic obstructive lung disease while the associated cardiovascular diseases and the alterations of pulmonary function were taken into account. These cardio-respiratory complications were observed only in patients with a number of apneas per hour of sleep greater than 20. The sleep apneas induced nocturnal hypoxemia that is frequently severe and independently correlated to the apnea index, diurnal hypoxemia and hypercapnia that are usually moderate, and presumably left ventricular hypertrophy that is not related to the development of daytime hypertension. However the nocturnal apneas were not associated with the development of an impairment of right or left ventricular function, or with the occurrence of cardiac arrhythmias or conduction disturbances. The absence of severe cardiac complications in this study may be related to the fact that the patients were relatively young and that the sleep apnea syndrome was diagnosed at an early stage of evolution. The findings of this study could help to define a more rationale approach in several therapeutic indications of sleep apnea syndrome.

[The multimedia workstation, electronic assistant to the health care professional]. / Le poste de travail multimédia, assistant électronique du professionnel de santé.

The health professional multimedia workstation is the natural entry point to health and knowledge networks. It should allow an easy and transparent management of all the data necessary for patient management. Multimedia nature of processed information reflects evolution of medical techniques that involve more and more complex objects such as video sequences or digitized signals. Workstations can be considered from 3 points of view: the professional end-users, the developers and the decision makers. The long term goal for the end-user is to establish an easy access in a working environment, that gives him/her the feeling of a single comprehensive application running on a single computer when the information system relies on a set of heterogeneous and geographically distributed components. Development of a workstation requires the integration into the same environment of tools to localize, access, manipulate and communicate the required information within a health information network. Analysis of the 445 Medline-indexed publications for the January 1991 to December 1994 period, that included the word workstation either in their title or in their abstract, helps in refining objectives and challenges both for the health professionals and the decision makers.

Monitoring great ape and elephant abundance at large spatial scales: measuring effectiveness of a conservation landscape.

Protected areas are fundamental to biodiversity conservation, but there is growing recognition of the need to extend beyond protected areas to meet the ecological requirements of species at larger scales. Landscape-scale conservation requires an evaluation of management impact on biodiversity under different land-use strategies; this is challenging and there exist few empirical studies. In a conservation landscape in northern Republic of Congo we demonstrate the application of a large-scale monitoring program designed to evaluate the impact of conservation interventions on three globally threatened species: western gorillas, chimpanzees and forest elephants, under three land-use types: integral protection, commercial logging, and community-based natural resource management. We applied distance-sampling methods to examine species abundance across different land-use types under varying degrees of management and human disturbance. We found no clear trends in abundance between land-use types. However, units with interventions designed to reduce poaching and protect habitats--irrespective of land-use type--harboured all three species at consistently higher abundance than a neighbouring logging concession undergoing no wildlife management. We applied Generalized-Additive Models to evaluate a priori predictions of species response to different landscape processes. Our results indicate that, given adequate protection from poaching, elephants and gorillas can profit from herbaceous vegetation in recently logged forests and maintain access to ecologically important resources located outside of protected areas. However, proximity to the single integrally protected area in the landscape maintained an overriding positive influence on elephant abundance, and logging roads--even subject to anti-poaching controls--were exploited by elephant poachers and had a major negative influence on elephant distribution. Chimpanzees show a clear preference for unlogged or more mature forests and human disturbance had a negative influence on chimpanzee abundance, in spite of anti-poaching interventions. We caution against the pitfalls of missing and confounded co-variables in model-based estimation approaches and highlight the importance of spatial scale in the response of different species to landscape processes. We stress the importance of a stratified design-based approach to monitoring species status in response to conservation interventions and advocate a holistic framework for landscape-scale monitoring that includes smaller-scale targeted research and punctual assessment of threats.

Endoscopic treatment by snare electrocoagulation prior to Nd:YAG laser photocoagulation in 85 voluminous colorectal villous adenomas.

The association of endoscopic resection with Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenomas. Eight-five patients were included: 49 with surgical contraindications, 35 for whom surgical resection appeared to be too hazardous, and 1 who refused surgery. Forty-five tumors had an axial extension between 1 and 3 cm, and 40 tumors had an axial extension of at least 4 cm. Diathermic snare resection was performed to remove large tumoral fragments prior to laser photocoagulation of the residual flat lesions. Treatments were repeated every 15 days until total tumor destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of five patients. Two patients were lost to follow-up. Treatment results could be analyzed in 78 patients. Successful treatment was achieved in 67 patients. Tumor destruction was complete in 77 percent of patients who had lesions of at least 4 cm diameter and in 93 percent of patients with smaller lesions. The axial extension of the tumor was the main factor affecting the results of treatment. No major complications occurred. During the average 103-week follow-up period, 21 percent of the patients with total tumor destruction had a recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgery treatment. It would appear that the treatment with endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method in the destruction of colorectal villous adenomas.