AIDS--the leading cause of adult death in the West African City of Abidjan, Ivory Coast.

In 1988 to 1989, 698 adult cadavers in Abidjan's two largest morgues were studied, representing 38 to 43% of all adult deaths in the city over the study period, and 6 to 7% of annual deaths. Forty-one percent of male and 32% of female cadavers were infected with human immunodeficiency virus (HIV). Fifteen percent of adult male and 13% of adult female annual deaths are due to acquired immunodeficiency syndrome (AIDS). In Abidjan, AIDS is the leading cause of death and years of potential life lost in adult men, followed by unintentional injuries and tuberculosis. In women, AIDS is the second leading cause of death and premature mortality, after deaths related to pregnancy and abortion. AIDS-specific and AIDS-proportional mortality rates may be higher in other African cities where AIDS has been found for a longer time than in Abidjan.

The use of a compliant EHR when providing clinical pathway driven care to a subset of diabetic patients: recommendation from a Working Group.

The Belgian National Health Insurance Institute (NHII) and other Healthcare Authorities intend to improve the quality of care through promoting clinical pathway driven care and by optimising cooperation between the responsible primary care physician and the diabetologist. Patients and healthcare professionals are granted some (financial) benefits when meeting the conditions defined in a mutual agreement.This article describes the conditions and the functional requirements to be met by an EHR to enable and to maximise the benefits of a clinical pathway driven patient care to a specific group of diabetic type 2 patients, based on a mandate issued by the NHII.The generic and specific functional requirements are then translated in test criteria for certification and prioritised in an implementation plan.

3-Hydroxybenzo[a]pyrene in the urine of smokers and non-smokers.

The people studied were male volunteers without occupational and dietary exposure to PAH: 27 smokers (10 cigarettes or more) and 27 non-smokers matched for age and socio-professional category. For each person, all the 24h voided urine samples were reassembled in a single sample. 1-Hydroxypyrene (1-OHPy) and 3-hydroxybenzo[a]pyrene (3-OHBaP) were then determined by automated column-switching high-performance liquid chromatography. Urinary 1-OHPy ranged from 0.041 to 0.530 micromol/molCreatinine (arithmetic mean 0.144, median 0.115) for smokers and from 0.01 to 0.148 mmol/molCreatinine (arithmetic mean 0.044, median 0.032) for non-smokers. These values are close to those of some other studies. Urinary 3-OHBaP ranged from <0.01 to 0.084 nmol/molCreatinine (arithmetic mean 0.030, median 0.023) for smokers and from <0.01 to 0.045 nmol/molCreatinine (arithmetic mean 0.014, median 0.011) for non-smokers. Considering more particularly the urinary 3-OHBaP values, the influence of smoking could be important among workers exposed to low levels of BaP (<100 ng/m(3)) and the concentrations for smokers were equivalent to most of the preshift values of exposed workers. The dietary BaP intake was slightly lower than the BaP intake for an average smoker. From the present study, temporary basic reference levels may be proposed for urinary 3-OHBaP.

Collecting information on the quality of prescribing in primary care using semi-automatic data extraction from GPs' electronic medical records.

OBJECTIVES: To evaluate a semi-automatic data extraction from the electronic medical record (EMR) of general practitioners (GPs) through a comparison with a paper sheets data collection simultaneously used in a primary care research project on the quality of prescribing for osteoarthritis in the elderly. SUBJECTS: One hundred and fifty-two GPs using five different EMR-software systems participated with the semi-automatic data extraction from the EMR and 233 GPs collected data with paper registration sheets. METHODS: The proportion of patients with respectively a drug prescription, paracetamol, a non-steroidal anti-inflammatory drug (NSAID) and ibuprofen were compared between the semi-automatic extraction and the paper data collection and among the EMR-software systems. RESULTS: Using the semi-automatic data extraction, a significantly lower proportion of patients on drugs was obtained compared to the paper data collection (adjusted OR: 0.31; 95% CI 0.25-0.39). However, the proportion of patients on a specific type of drug was comparable. Within the results from the semi-automatic extraction, the results were heterogeneous among the different EMR-software systems. CONCLUSIONS: The semi-automatic data extraction with multiple EMR-software systems proposed in this study seems suitable for quality of prescribing assessment in primary care. However, it may be less reliable when only a single EMR-software is used.

Cross-reactivity on western blots in HIV-1 and HIV-2 infections.

To examine cross-reactivity of antibodies to heterologous antigens, on HIV-1 and HIV-2 Western blots, we tested sera from 1362 consecutive tuberculosis (TB) patients and 2127 consecutive blood donors. Specimens positive on enzyme-linked immunosorbent assay (ELISA) for HIV-1 or HIV-2 were further characterized by synthetic peptide-based tests, and tested by HIV-1- and HIV-2-specific Western blots. Dual serologic reactivity on synthetic peptide tests was proportionately more frequent in HIV-positive TB patients than in blood donors, and HIV-2 reactivity less frequent. Positive HIV-1 Western blots were seen in 73-83% of specimens specifically characterized as positive for HIV-2 on synthetic peptide tests. Cross-reactivity to HIV-2 Western blots by HIV-1-positive specimens was significantly more frequent in TB patients (35%) than in asymptomatic donors (9%; P less than 0.001). Using recently recommended criteria for HIV-2 Western blot interpretation (presence of two env bands) reduced the overall proportion of HIV-1-positive specimens having a positive HIV-2 Western blot from 27.5 to 16.4%, with [corrected] minimal effect on sensitivity in the diagnosis of HIV-2 reactivity on specimens positive on synthetic peptide tests.

HIV-1 and HIV-2 infections in men attending sexually transmitted disease clinics in Abidjan, Côte d'Ivoire.

OBJECTIVE: (1) To determine the prevalence of HIV-1 and HIV-2 infections and associated risk factors in men attending Abidjan's three sexually transmitted disease (STD) clinics; (2) to examine the use of such sites for epidemiological surveillance. DESIGN: Cross-sectional study. SETTING: Abidjan's two main STD clinics (Clinics A and T), and the University Hospital Dermatology outpatients clinic. PATIENTS: Consecutive patients with genitourinary symptoms. MAIN OUTCOME MEASURES: Prevalence of reactivity to HIV-1, HIV-2, and both viruses; descriptive characteristics of clinic attenders; clinical diagnoses of STD; risk factors associated with HIV-1 and HIV-2 positivity. RESULTS: The overall prevalence of HIV (HIV-1 and/or HIV-2) infection was 21% (250 out of 1169; 16% HIV-1, 2% HIV-2, 3% dual reactivity). Overall prevalence varied by clinic: University Hospital Dermatology outpatients clinic, 39%; Clinic T, 19%; Clinic A, 10%. Men with STD had an overall prevalence of 31% (155 out of 506), compared with 14% in men without physical signs of STD (odds ratio 2.6, 95% confidence interval 2.0-3.6). The highest prevalence, 46%, was in men with genital ulcer disease. Risk factors associated with HIV-1 as well as with HIV-2 infection after multivariate analysis were a history of sex with prostitutes, lack of circumcision, being unskilled, and a history of prior genital ulcer. Current genital ulcer, current STD and positive Treponema pallidum haemagluttination assay were associated with HIV-1 and dual reactivity. CONCLUSIONS: Risk factors for HIV-2 infection in men attending Abidjan STD clinics were broadly similar to those for HIV-1 infection. HIV-1 infection was more strongly associated with current STD. Important differences between the three clinics were observed in STD prevalence and type, and HIV seroprevalence. Such differences should be taken into account in the planning of HIV serosurveillance in STD clinics.

Mortality trends in Abidjan, Côte d'Ivoire, 1983-1988.

To assess changes in mortality in Abidjan since the development of the AIDS epidemic, we compared official city mortality statistics and hospital fatality rates in 1983, before AIDS was recognized in Abidjan, with those in 1988. Review of records in the city's major hospitals showed that fatality rates (deaths per 1000 admissions) in adult medical patients increased by 54% between 1983 and 1988, with increases of 106 and 98% in men 20-29 and 30-39 years of age, respectively, and 199 and 42% in women of the same age ranges. Mortality rates in surgical patients showed little change, while in children they declined. Over the same period, official mortality statistics for the city showed reduced mortality rates in children and women 20-29 years of age, but an increase in mortality rates of 54% in men 20 years of age and older, and of 28% in women aged 30 years and older. HIV infection may be a major cause of the increased adult mortality documented in hospital and city records, and jeopardizes improved survival from preventive measures such as maternal and child health services.

A comparison of HIV-1 and HIV-2 infections in hospitalized patients in Abidjan, Côte d'Ivoire.

In late 1988, a cross-sectional study of 1715 adult medical patients hospitalized in Abidjan, Côte d'Ivoire, west Africa, showed an overall prevalence of HIV infection of 46% in men and 28% in women. On the basis of specific testing by whole virus enzyme-linked immunosorbent assay (ELISA), Western blot and synthetic peptide ELISA, HIV-1 infection was found in 25%, HIV-2 infection in 4%, and reactivity to both viruses in 11% of male and female patients combined. People infected with HIV-2, as well as those who were reactive to both HIV-1 and HIV-2, had a frequency of AIDS-associated symptoms and signs similar to that in HIV-1-infected patients, and significantly greater than that in seronegative patients. The significance of dual reactivity, and the natural history and disease spectrum of HIV-2 infection, require further study. Synthetic peptide ELISA is valuable for specific serodiagnosis of HIV-1 and HIV-2 infections. Advanced HIV-2 infection in hospitalized patients in Abidjan is associated with the same symptoms and signs as HIV-1 infection.

Rapid and specific diagnosis of HIV-1 and HIV-2 infections: an evaluation of testing strategies.

To identify cost-effective testing strategies for HIV-1 and HIV-2 infections, we evaluated different combinations of tests on serum specimens from 1134 consecutive patients attending tuberculosis treatment centers in Abidjan, Côte d'lvoire. Virus-specific whole-virus enzyme-linked immunosorbent assay (WVE), Western blot (WB) and synthetic peptide enzyme-linked immunosorbent assay (SPE) were used in sequential fashion to determine the true prevalence of infection; 27% were reactive to HIV-1, 5% to HIV-2, and 10% to both viruses. Of 239 specimens positive on WB for both HIV-1 and HIV-2, SPE diagnosed 38% as HIV-1-reactive and 16% as HIV-2-reactive, while 46% remained reactive to both viruses. Using WVE or one of two rapid (5-10 min) mixed (HIV-1 and HIV-2) antigen tests (RMATs) as a screening test, followed by SPE as a supplemental test, gave results with sensitivity of 97.3-99.2%, specificity of 99.5-99.7%, and positive predictive value for diagnosing HIV infection of 99.4-99.6%, with important savings in time and reagent costs. SPE allows more specific distinction between HIV-1 and HIV-2 infections than WB, and could replace it as a supplemental test in many settings. WB may be required for specimens reactive on screening tests but negative on SPE, until sensitivity of the SPE is further evaluated. A mixed antigen screening test followed by SPE seems to be an efficient testing strategy for diagnosing HIV-1 and HIV-2 infections.

Brain oxidative stress in animal models of accelerated aging and the age-related neurodegenerative disorders, Alzheimer's disease and Huntington's disease.

Oxidative stress in brain is emerging as a potential causal factor in aging and age-related neurodegenerative disorders. Brain tissue from living patients is difficult to acquire; hence, animal models of aging and age-related neurodegenerative disorders, though not perfect models, have provided tissue to study the role of oxidative stress in these disorders. In this review, the central role of oxidative damage in brain in models of accelerated aging (progeria and Werner's syndrome) and the age-related neurodegenerative disorders, Alzheimer's disease and Huntington's disease, will be presented and evaluated. To the extent that the animal models faithfully mirror their respective disorders, and based on the totality of the studies, it is apparent that oxidative stress, the excess of free radicals over the means of scavenging these harmful agents, may play critical roles in the molecular basis of accelerated aging, Alzheimer's disease, and Huntington's disease.

Human thymic dendritic cells.

ABSTRACT Human thymic dendritic cells (DC) represent a member of the bone marrow-derived dendritic cell family. They have a dendritic shape and are found in small numbers mainly at the corticomedullary border and in medullary regions of the thymus. Human thymic DC were isolated by density gradient separation, followed by treatment with CD2, CD7, CD1, and CD11b mAb and immunobeads magnetic separation. The resulting population contains 60-75% brightly HLA-DR+ cells which present the morphological characteristics of DC observed in situ. Extensive phenotypic analysis confirmed that they are of mesenchymal origin and that some express CD11a and CD54 molecules. Freshly isolated DC do not stain with a wide variety of anti-T-B and -monocyte or -macrophage mAb. However, they acquire the CD1 molecule after a few days in culture. By using a cell sorter we obtained 90-95% of purified human thymic DC. Functional studies have shown that human thymic DC are potent activators in mixed lymphocyte reactions, act as accessory cells in mitogenic thymocyte proliferation, increase the thymocyte proliferative response to a toxin signal, and produce IL-1. They also formed spontaneous physical associations with thymocytes, which raises questions about the implication of DC in differentiation and/or maturation processes of thymocytes.

Neuroanatomical correlates of selective downgaze paralysis.

A 56-year-old woman had the sudden onset of a selective paralysis of downgaze associated with a partial third nerve paralysis on the right. On numerous examinations over the ensuing 3 and 3/4 years, these deficits were observed to persist. At autopsy, bilateral somewhat asymmetrical cavitated lesions were seen in the region of the thalamo-mesencephalic junction. Because this patient's selective downgaze paralysis was permanent, it is concluded that the supranuclear neural elements mediating downgaze are situated within the confines of these lesions. A consideration of the present case together with previous reports of selective vertical gaze paralysis permits the relevant region to be further localized to an area extending from the oculomotor nucleus to the rostral pole of the red nucleus and immediately dorsomedial to the latter. This is likely to be the location of the human analogue of the monkey "nucleus of the prerubral fields", a supranuclear structure which is thought to mediate vertical gaze and especially downgaze.

Evaluation of current techniques of corneal epithelial removal in hyperopic photorefractive keratectomy.

PURPOSE: To determine the efficacy of 3 current methods used to remove corneal epithelium prior to photorefractive correction of hyperopia and to compare clinical data in patients who had rotary brush or blunt scrape epithelial removal in the treatment of hyperopic photorefractive keratectomy (PRK). SETTING: University of Ottawa Eye Institute, Ottawa General Hospital, Ottawa, Ontario, Canada. METHODS: The epithelium from human eye-bank eyes was removed using a Paton spatula, 15% alcohol, and the Amoils rotating plastic brush. The effects were examined by scanning and transmission electron microscopy. Twelve month postoperative data were obtained on 25 eyes with refractions of +1.00 to +4.00 diopters (D) that had been treated for hyperopia with the VISX Star excimer laser, using blunt scrape or the rotary brush to remove the corneal epithelium. RESULTS: All 3 methods effectively removed corneal epithelium. The Paton spatula, however, left small nicks in Bowman's layer. Both the rotating brush and alcohol debridement left Bowman's layer intact. Alcohol treatment required follow-up epithelial debris removal, while brushing left minimal amounts of debris. There was a strong trend toward rapid epithelial healing in the brushed corneas compared with the scraped ones, but this was not statistically significant. Clinically, at 12 months postoperatively, brushed corneas showed a trend toward more superior outcomes than scraped corneas in actual refractive outcome, uncorrected visual acuity (UCVA), lines of UCVA gained, and predictability of the desired outcomes. However, only the outcome in UCVA of 20/40 or better and the decreased incidence of haze in the brushed corneas over scraped ones were statistically significant. CONCLUSIONS: Both alcohol and the rotating brush provide a quick, effective means of removing the corneal epithelium with minimal risk of damage to Bowman's layer. In our experience, the brush technique was as effective as and possibly superior to the blunt scrape for epithelial removal in hyperopic PRK.

Risk of lung, larynx, pharynx and buccal cavity cancers among carbon electrode manufacturing workers.

Among workers employed in factories producing carbon graphite products the risk of cancer due to exposure to polycyclic aromatic hydrocarbons was estimated. In one cohort (plant A), a cancer incidence study was carried out; the number of cases were not significantly increased for lung cancers [7 cases, standardized incidence ratio (SIR) 79] or for cancers of the upper respiratory and alimentary tract (10 cases, SIR 103). In another cohort (plant B), a mortality study was carried out; neither the mortality from lung cancer [13 deaths, standardized mortality ratio (SMR) 118] nor that from upper respiratory and alimentary tract cancers (10 deaths, SMR 125) was significantly higher than expected. Within each cohort, a case-referent study was carried out. In plant A the odds ratios were high but nonsignificant for lung cancers (odds ratio 3.42) and upper respiratory and alimentary tract cancers (odds ratio 2.19) and they showed a nonsignificant relationship with duration of exposure. In plant B, the odds ratios were low for every cancer site.

Bonding of hydroxyapatite-coated femoral prostheses. Histopathology of specimens from four cases.

We examined specimens of hydroxyapatite-coated femoral prostheses from four patients who had died within nine months of implantation for fractured neck of femur. Histology showed newly formed immature bone overlying the hydroxyapatite coating with new trabeculae bridging to the endosteal bone layer. In the diaphysis, where there had been contact between the hydroxyapatite and the cortex, there was dense, firmly anchored bone with an haversian architecture. In other places the newly formed bone had a trabecular structure, containing bone marrow tissue with normal cellularity. It appeared that biological osseointegration had taken place.

Pigmented villonodular synovitis of the hip. A case report and review of the literature.

A 73-year-old patient, whose hip was completely destroyed by pigmented villonodular synovitis, was successfully treated by a total prosthetic replacement of this articulation. The etiopathogenesis of the illness is uncertain. Its' localization in the hip is, fortunately, a rare occurrence. It can be responsible for frequently extensive articular destruction which is even more dramatic when it affects young patients, whose average age is 35. Only early diagnosis permits conservative surgical treatment: total synovectomy associated with curettage of the foyers of osteolysis and their filling with bone grafts. If the destructive lesions are too extensive, an arthrodesis or replacement arthroplasty are proposed.

Bitumen fumes: review of work on the potential risk to workers and the present knowledge on its origin.

Bitumens fumes contain polycyclic aromatic compounds (PAC). There is a possibility of long-term health effects following chronic exposure by inhalation or skin contamination in asphalt road pavers and highway maintenance workers. Epidemiological and experimental studies on this topic are reviewed and the possible causes of cancer discussed with a primary focus on heterocyclic polyaromatic compounds. In 2001, the results of the IARC epidemiological study confirmed an excess of lung cancer despite a lower cancer mortality. In vitro genotoxicity and mechanistic studies demonstrated a mutagenic effect of bitumen fume condensates (BFC) and some data suggested that the polycyclic aromatic hydrocarbons (PAH) analysed were not the major genotoxic compounds in bitumen fume condensates. Other compounds such as nitrogen-, sulfur- and/or oxygen-containing PAH or their alkyl substituted analogues, mutagenic in the Ames mutation assay, may be involved in the genotoxic effect of BFC. After skin painting with BFC, DNA adducts were found in skin, lung and lymphocytes of all the treated animals. Differences in the adduct patterns were also observed, but a more polar adduct was common to the three tissues and not observed in those from rats treated with coal-tar fume condensates (CTFC). Rat inhalation experiments with bitumen fumes confirmed the presence of a DNA-adduct in the lungs with the same Rf as the previous polar adduct. This adduct therefore merits further investigation as a potential biomarker in lymphocyte DNA to follow exposed workers. All the analytical data and the mechanistic data are complementary and suggest the potential role of thiophenes in the genotoxicity of bitumen fumes. Some thiophenes have lower mutagenic activity than their isosteric PAH, whereas others are very potent carcinogens. Generally, the sulfur analogues of PAH (SPAH) in bitumen fumes have a higher concentration than the PAH of similar molecular weight, whereas the SPAH in coal-tar fumes have a much lower concentration than the corresponding PAH. This may explain why the more polar adducts have been detected only in animals exposed to bitumen fume. In a skin carcinogenicity study of condensed asphalt roofing fumes, it has been demonstrated that the most active fractions were those containing a variety of aromatic SPAH. In conclusion to this review, there is an interest in determining the chemical identity of the major DNA adducts induced by BFC. This would allow experimental studies on the carcinogenic potency of these compounds and their validation as potential biomarkers. These compounds could thus merit further analytical investigation in preference to the PAH included in the list of the US Environmental Protection Agency that are currently being analysed by the industry in field studies.

[Interactions between secretin and somatostatin on acid secretion and gastric emptying in dogs]. / Interactions entre la sécrétine et la somatostatine sur la sécrétion acide et la vidange gastrique chez le chien.

Secretin and somatostatin are two peptides released by H+ ions. The fact that blood levels of these peptides increase during the postprandial period makes them the most probable candidates for gastric acid secretion retrocontrol . The aim of our study was to determine whether a potentiation of inhibitory effects exists when the two peptides are administered simultaneously. Seven dogs were provided with a gastric fistula. Gastric acid secretion was stimulated by intragastric infusion of a bactopeptone solution or by pentagastrin (1 microgram X kg-1 X h-1). Acid outputs and gastric emptying rates were measured at regular intervals. The tests were repeated during intravenous infusion of secretin (0.125 micrograms X kg-1 X h-1), somatostatin (0.2 micrograms X kg-1 X h-1) or both peptides together at the same doses. Both secretin and somatostatin inhibited acid secretion and gastric emptying. The inhibition was not greater when both peptides were administered together. Under the conditions used, no potentiation or additive effects between the two peptides were observed on gastric acid secretion or gastric emptying.

[Mortality due to bronchopulmonary cancers in workers of 2 foundries]. / La mortalité par cancers broncho-pulmonaires parmi les salariés de deux usines sidérurgiques.

A mortality study was carried out in two factories producing stainless steel in order to assess lung cancer risk among workers employed in coke oven, blast and open hearth furnaces, foundry, electric furnace, hot and cold rolling mills and pickling areas. Occupational exposures of interest were chromium compounds, nickel compounds, polycyclic aromatic hydrocarbons (PAH), silica and asbestos. All male workers having at least one year of employment between 01.01.1960 and 31.12.1990 were followed up for mortality. The vital status was assessed from birth place registries. Complete job histories since date of first employment were abstracted from the company files. The smoking habits of 50% of the cohort members were known from medical records. The observed number of deaths (obs) were compared with the expected ones based on regional rates with adjustment for age, sex and calendar time (Standardized Mortality Ratio, SMR). The cohorts included 6324 (factory 1) and 5270 (factory 2) workers. The overall mortality did not differ markedly from that expected in both factories: SMR = 0.95 (obs = 1540, p = 0.05) in factory 1 and SMR = 1.06 (obs = 916, non-significant) in factory 2. SMRs for lung cancer did not differ from unity, respectively 0.99 (obs = 105) and 1.00 (obs = 54), in whole cohorts. Non-significant lung cancer excesses were observed among workers of some workshops where exposures of interest might have occurred: coke oven (SMR = 2.04), blast furnace (SMR = 1.36), open hearth furnace (SMR = 1.75), hot rolling mills (SMR = 1.29). These processes, however, are no longer involved in the study factories. Furthermore, no lung cancer excess was observed among workers employed in current workshops: electric furnaces and cold rolling mills.

Risk of tuberculosis in patients with HIV-I and HIV-II infections in Abidjan, Ivory Coast.

OBJECTIVE: To examine the association between HIV-II infection and tuberculosis. DESIGN: Cross sectional study comparing the prevalence of HIV-I and HIV-II infections in patients with tuberculosis and in blood donors. SETTING: Abidjan, Ivory Coast, west Africa. PATIENTS: 2043 consecutive ambulant patients with tuberculosis (confirmed pulmonary, presumed pulmonary, or extrapulmonary) and 2127 volunteer blood donors. MAIN OUTCOME MEASURE: Prevalence of HIV-I and HIV-II infections as assessed by presence of serum antibodies. RESULTS: Overall rates of HIV infection were 40.2% in patients with tuberculosis (26.4% positive for HIV-I, 4.7% for HIV-II, and 9.0% for both); and 10.4% in blood donors (7.2% positive for HIV-I, 1.9% for HIV-II, and 1.3% for both). HIV-II infection was significantly more common in patients with all types of tuberculosis than in blood donors (97/2043, 4.7% v 40/2127, 1.9%; odds ratio 3.8%, 95% confidence interval 2.6 to 5.6). CONCLUSION: Both HIV-I and HIV-II infections are associated with tuberculosis in Abidjan. 35% of adult tuberculosis in Abidjan is attributable to HIV infection and 4% specifically to HIV-II.