Aim.-The prevalence of diabetes in the French West Indies is three times higher than in mainland ... more Aim.-The prevalence of diabetes in the French West Indies is three times higher than in mainland France. We aimed to assess the associations between vitamin D deficiency, vitamin D receptor (VDR) gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes (T2D). Methods.-In this cross-sectional study of 277 patients, 25-hydroxyvitamin D was measured by radioimmunoassay. FokI, BsmI, ApaI and TaqI single nucleotide polymorphisms (SNPs) of the VDR gene were genotyped. Analysis of covariance and logistic regression were performed. Results.-The study included 76 patients of Indian descent and 201 patients of African descent. The prevalence of vitamin D deficiency (< 20 ng/mL) was 42.6%. When patients were classified into groups with (G1) and without (G2) vitamin D deficiency, there were no significant differences in age, systolic blood pressure, low-density lipoprotein cholesterol and HbA 1c , although body mass index was significantly higher in G1. Vitamin D deficiency was significantly associated with increased diastolic blood pressure and triglyceride levels, and reduced high-density lipoprotein cholesterol (P < 0.05). Prevalence of vitamin D deficiency was decreased in patients carrying the f allele of FokI (OR: 0.52; P = 0.02) and the aa genotype of ApaI (OR: 0.46; P = 0.05). BsmI and TaqI SNPs were not associated with vitamin D deficiency. Conclusion.-The rate of vitamin D deficiency was high in our T2D patients, and was associated with the VDR gene FokI and ApaI polymorphisms and cardiovascular risk profile. Measurements of vitamin D may help to detect T2D patients with cardiovascular risk, and VDR polymorphisms might explain why vitamin D deficiency is so frequently seen in some T2D patients.
Patients et méthodes : Nous rapportons le cas d'une patiente de 19 ans, diabétique de type (DT1) ... more Patients et méthodes : Nous rapportons le cas d'une patiente de 19 ans, diabétique de type (DT1) depuis l'âge de 10 ans, sous schéma basal-bolus, hospitalisée pour désorientation temporo-spatiale persistante, survenue au décours d'une hypoglycémie sévère (0,34 g/l) prolongée (malaise le matin, contrôle de la glycémie capillaire à 17 heures). Cas clinique : Examen clinique normal hormis une désorientation persistante avec amnésie antérograde. Biologie : HBA1c 7,4 %, carence martiale, hypoalbuminémie, déficit en vitamine B12 avec anticorps anti-endomysium et antitransglutaminase positifs ; hCG et sérologie VIH négatives, ponction lombaire normale (sérologies LCR syphilis et herpes négatives). Scanner cérébral non injecté, IRM cérébrale et EEG sans anomalies. Anticorps lupiques/anti-nucléaires/complément (bilan de vascularite), anticorps anti-neuronaux/LMDA (bilan d'encéphalite) négatifs. Consultation psychiatrie éliminant un trouble de la personnalité, un syndrome dépressif et une intoxication médicamenteuse volontaire. Devant la persistance de l'amnésie antérograde 8 jours après l'épisode hypoglycémique, un TEP-scan objective un hypométabolisme bilatéral des régions amygdalo-hippocampiques. La recherche systématique d'un Creutzfeldt-Jacob avant fibroscopie pour confirmation de maladie coeliaque montre la forte positivité de la protéine 14.3.3 témoignant d'une mort neuronale importante. Conclusion : Cette observation illustre la gravité potentielle des hypoglycémies chez le DT1, susceptible d'entraîner une anoxie cérébrale à l'origine d'infarcissements des régions sub-corticales et/ou corticales dont le pronostic, fonction de l'atteinte, est difficilement prédictible. Elle souligne l'intérêt du Pet-scan dans leur exploration et surtout celle du marqueur LCR de la souffrance cérébrale. Elle rappelle enfin le sur-risque d'hypoglycémies sévères chez les patients DT1 présentant une maladie coeliaque.
Bulletin de la Société de Pathologie Exotique, 1993
The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point... more The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point out a stability of new cases by year, and confirm the heterosexual transmission in this area. The sexual comportment of Martinicans seems to be different of the continental French people and different between men and women. This constation is important to know for the preventive strategy of the infection.
In order to assess prevalences, characteristics and risk factors of malnutrition and anemia, a cl... more In order to assess prevalences, characteristics and risk factors of malnutrition and anemia, a clinical and biological study was undertaken at Lamentin hospital in 100 hospitalized children aged 6 months to 6 years. Forty seven p. cent of children were underweight and 38 p. cent were anemic. Anemia and iron deficiency predominated in the under-24-month age group, whereas wasting was the dominate finding in older children. Under 2 years of age, risk factors for wasting and anemia were associated with method of breastfeeding. Over 2 years of age, low birthweight was the only risk factor of wasting identified. In Martinique, nutritional deficiency is common in children admitted to hospital and a high index of suspicion is indicated in the hospitalized population. Following the resolution of infections, supplemental iron therapy must be considered for a great number of children under 2 years of age.
Bulletin de la Societe de pathologie exotique, 1993
The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point... more The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point out a stability of new cases by year, and confirm the heterosexual transmission in this area. The sexual comportment of Martinicans seems to be different of the continental French people and different between men and women. This constation is important to know for the preventive strategy of the infection.
In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Tre... more In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19% of the women had at least one pathogen: C. trachomatis was found in 16%, HTLV-1 in 2%, HIV-1, HBV and N. gonorrhoeae each in 0.5% C. trachomatis infection was more prevalent in women less than 20 years of age (31%) than in those 20 years and older (16%; OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica.
The progression of the HIV virus has overshadowed attention to the HTLV-1 virus which is transmit... more The progression of the HIV virus has overshadowed attention to the HTLV-1 virus which is transmitted almost exactly like the HIV. HTLV-1 is not screened in blood supplies or in high-risk populations but it is not benign. It is implicated in acute T-cell leukemia and in chronic neuromyelopathies. Blood samples of pregnant women in Africa and Martinique and of women of foreign origin living in France were screened for HTLV-1. 814 samples were from rural and urban Ivory Coast and 565 were from urban Togo. 63 samples from Mali 61 from Niger and 281 from Senegal were taken in rural areas. 716 samples were obtained in rural Martinique mainly in maternal-child health centers. The French samples were from 840 women seen in a hospital center in Limoges between 1984-87. The samples were screened by an indirect immunofluorescence technique and positive or doubtful cases were confirmed by Western blot. 2.37% of the samples from Martinique and 1.34% from the African countries were positive. The ...
This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-... more This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-1995. 13,978 stool specimens collected in 1994-1995 were tested by parasitologic examination. Stool specimens were from patients hospitalised in the 3 principal hospitals of Martinique or coming to the Laboratoire départemental d'hygiène. The parasitism rate was 8.73%. This study showed a significant reduction of intestinal parasitism between results of 1988 and results of 1994-1995. The oro-faecal parasitism was not very important that reflected the good economic and sanitation level of Martinique. On the other hand, regarding the important prevalence of parasitism with Strongyloïdes stercoralis and hookworm, it would be good to improve detection, sanitary education and know better local contamination factors to decrease the prevalence of this parasitism.
ABSTRACT We studied the sensitivity of 4,511 Enterobacteriaceae strains to six betalactam agents:... more ABSTRACT We studied the sensitivity of 4,511 Enterobacteriaceae strains to six betalactam agents: amoxicillin, amoxicillin + clavulanate, ticarcillin, cefazolin, cefotaxime, ceftazidime, imipenem. These test strains were isolated from urinary and non urinary specimen in patients hospitalized during the year 1995, in the 3 main hospitals of Martinique. They were then sorted in 3 phenotypic groups: group 1 (sensible phenotype), group 2 (low level penicillinase phenotype), and group 3 (low level cephalosporinase phenotype). Group 1 Enterobacteriaceae represented 45.6 % of strains, group 2 Enterobacteriaceae represented 28.4 %, and group 3 Enterobacteriaceae represented 26 %. The distribution of resistance phenotypes to betalactam agents for group 1 and 2 was not very different from that of continental France. On the other hand, for group 3, the frequency of wild types was more important in Martinique. Moreover, in group 2 and 3, we noticed that non urinary strains presented a larger sensitivity to betalactam agents than urinary strains; there was also a more frequent secretion of penicillinase in urinary strains.
Evaluation des procddures d'hygidne des spdculums auriculaires (SA). Enquate microbiologique et 6... more Evaluation des procddures d'hygidne des spdculums auriculaires (SA). Enquate microbiologique et 6tude de comportement*
Afin d'établir les prévalences, la nature et les facteurs de risque des malnutritions et des aném... more Afin d'établir les prévalences, la nature et les facteurs de risque des malnutritions et des anémies chez les enfants hospitalisés, un bilan clinique et biologique a été réalisé chez 100 enfants âgés de 6 mois à 6 ans. La prévalence des déficits du poids en fonction de la taille atteint 47 % et celle de l'anémie 38 %. Deux groupes d'âge se distinguent nettement : les moins de 24 mois oÙ prédominent les anémies et la carence en fer; les plus de 24 mois oll prédominent les déficits pandéraux, Avant deux ans les facteurs de risque d'anémie et de déficit pondéral sont liés aux modalités de l'allaitement maternel; après deux ans le seul facteur de risque de déficit pondéral identifié est un faible poids de naissance. L 'étude montre que le pédiatre hospitalier doit rester vbilant vis-à-vis des problèmes nutritionnels. Une supplémentation en fer, après résolution des infections, paraît souvent justifiée. Malnutrition and anemia in children hospitalized in Martinique. Summary. In order to assess prevalences, characteristics and risk factors of malnutrition and anemia, a clinical and biological study was undertaken at Lamentin hospital in 100 hospitalized children aged 6 months to 6 years. Forty seven p. cent of children were underweight and 38p. cent were anemic. Anemia and iron deficiency predominated in the under-24-month age group, whereas wasting. was the dominate finding in older children. Under 2 years of age, risk factors for wasting and anemia were associated with method of breastfeeding. Over 2 years of age, low birthweight was the only risk factor of wasting identified. In Martinique, nutritional deficiency is common in children admitted to hospital and a high index of suspicion is indicated in the hospitalized population. Following the resolution of infections, supplemental iron therapy must be considered for a great number of children under 2years of age.
Aim.-The prevalence of diabetes in the French West Indies is three times higher than in mainland ... more Aim.-The prevalence of diabetes in the French West Indies is three times higher than in mainland France. We aimed to assess the associations between vitamin D deficiency, vitamin D receptor (VDR) gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes (T2D). Methods.-In this cross-sectional study of 277 patients, 25-hydroxyvitamin D was measured by radioimmunoassay. FokI, BsmI, ApaI and TaqI single nucleotide polymorphisms (SNPs) of the VDR gene were genotyped. Analysis of covariance and logistic regression were performed. Results.-The study included 76 patients of Indian descent and 201 patients of African descent. The prevalence of vitamin D deficiency (< 20 ng/mL) was 42.6%. When patients were classified into groups with (G1) and without (G2) vitamin D deficiency, there were no significant differences in age, systolic blood pressure, low-density lipoprotein cholesterol and HbA 1c , although body mass index was significantly higher in G1. Vitamin D deficiency was significantly associated with increased diastolic blood pressure and triglyceride levels, and reduced high-density lipoprotein cholesterol (P < 0.05). Prevalence of vitamin D deficiency was decreased in patients carrying the f allele of FokI (OR: 0.52; P = 0.02) and the aa genotype of ApaI (OR: 0.46; P = 0.05). BsmI and TaqI SNPs were not associated with vitamin D deficiency. Conclusion.-The rate of vitamin D deficiency was high in our T2D patients, and was associated with the VDR gene FokI and ApaI polymorphisms and cardiovascular risk profile. Measurements of vitamin D may help to detect T2D patients with cardiovascular risk, and VDR polymorphisms might explain why vitamin D deficiency is so frequently seen in some T2D patients.
Patients et méthodes : Nous rapportons le cas d'une patiente de 19 ans, diabétique de type (DT1) ... more Patients et méthodes : Nous rapportons le cas d'une patiente de 19 ans, diabétique de type (DT1) depuis l'âge de 10 ans, sous schéma basal-bolus, hospitalisée pour désorientation temporo-spatiale persistante, survenue au décours d'une hypoglycémie sévère (0,34 g/l) prolongée (malaise le matin, contrôle de la glycémie capillaire à 17 heures). Cas clinique : Examen clinique normal hormis une désorientation persistante avec amnésie antérograde. Biologie : HBA1c 7,4 %, carence martiale, hypoalbuminémie, déficit en vitamine B12 avec anticorps anti-endomysium et antitransglutaminase positifs ; hCG et sérologie VIH négatives, ponction lombaire normale (sérologies LCR syphilis et herpes négatives). Scanner cérébral non injecté, IRM cérébrale et EEG sans anomalies. Anticorps lupiques/anti-nucléaires/complément (bilan de vascularite), anticorps anti-neuronaux/LMDA (bilan d'encéphalite) négatifs. Consultation psychiatrie éliminant un trouble de la personnalité, un syndrome dépressif et une intoxication médicamenteuse volontaire. Devant la persistance de l'amnésie antérograde 8 jours après l'épisode hypoglycémique, un TEP-scan objective un hypométabolisme bilatéral des régions amygdalo-hippocampiques. La recherche systématique d'un Creutzfeldt-Jacob avant fibroscopie pour confirmation de maladie coeliaque montre la forte positivité de la protéine 14.3.3 témoignant d'une mort neuronale importante. Conclusion : Cette observation illustre la gravité potentielle des hypoglycémies chez le DT1, susceptible d'entraîner une anoxie cérébrale à l'origine d'infarcissements des régions sub-corticales et/ou corticales dont le pronostic, fonction de l'atteinte, est difficilement prédictible. Elle souligne l'intérêt du Pet-scan dans leur exploration et surtout celle du marqueur LCR de la souffrance cérébrale. Elle rappelle enfin le sur-risque d'hypoglycémies sévères chez les patients DT1 présentant une maladie coeliaque.
Bulletin de la Société de Pathologie Exotique, 1993
The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point... more The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point out a stability of new cases by year, and confirm the heterosexual transmission in this area. The sexual comportment of Martinicans seems to be different of the continental French people and different between men and women. This constation is important to know for the preventive strategy of the infection.
In order to assess prevalences, characteristics and risk factors of malnutrition and anemia, a cl... more In order to assess prevalences, characteristics and risk factors of malnutrition and anemia, a clinical and biological study was undertaken at Lamentin hospital in 100 hospitalized children aged 6 months to 6 years. Forty seven p. cent of children were underweight and 38 p. cent were anemic. Anemia and iron deficiency predominated in the under-24-month age group, whereas wasting was the dominate finding in older children. Under 2 years of age, risk factors for wasting and anemia were associated with method of breastfeeding. Over 2 years of age, low birthweight was the only risk factor of wasting identified. In Martinique, nutritional deficiency is common in children admitted to hospital and a high index of suspicion is indicated in the hospitalized population. Following the resolution of infections, supplemental iron therapy must be considered for a great number of children under 2 years of age.
Bulletin de la Societe de pathologie exotique, 1993
The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point... more The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point out a stability of new cases by year, and confirm the heterosexual transmission in this area. The sexual comportment of Martinicans seems to be different of the continental French people and different between men and women. This constation is important to know for the preventive strategy of the infection.
In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Tre... more In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19% of the women had at least one pathogen: C. trachomatis was found in 16%, HTLV-1 in 2%, HIV-1, HBV and N. gonorrhoeae each in 0.5% C. trachomatis infection was more prevalent in women less than 20 years of age (31%) than in those 20 years and older (16%; OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica.
The progression of the HIV virus has overshadowed attention to the HTLV-1 virus which is transmit... more The progression of the HIV virus has overshadowed attention to the HTLV-1 virus which is transmitted almost exactly like the HIV. HTLV-1 is not screened in blood supplies or in high-risk populations but it is not benign. It is implicated in acute T-cell leukemia and in chronic neuromyelopathies. Blood samples of pregnant women in Africa and Martinique and of women of foreign origin living in France were screened for HTLV-1. 814 samples were from rural and urban Ivory Coast and 565 were from urban Togo. 63 samples from Mali 61 from Niger and 281 from Senegal were taken in rural areas. 716 samples were obtained in rural Martinique mainly in maternal-child health centers. The French samples were from 840 women seen in a hospital center in Limoges between 1984-87. The samples were screened by an indirect immunofluorescence technique and positive or doubtful cases were confirmed by Western blot. 2.37% of the samples from Martinique and 1.34% from the African countries were positive. The ...
This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-... more This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-1995. 13,978 stool specimens collected in 1994-1995 were tested by parasitologic examination. Stool specimens were from patients hospitalised in the 3 principal hospitals of Martinique or coming to the Laboratoire départemental d'hygiène. The parasitism rate was 8.73%. This study showed a significant reduction of intestinal parasitism between results of 1988 and results of 1994-1995. The oro-faecal parasitism was not very important that reflected the good economic and sanitation level of Martinique. On the other hand, regarding the important prevalence of parasitism with Strongyloïdes stercoralis and hookworm, it would be good to improve detection, sanitary education and know better local contamination factors to decrease the prevalence of this parasitism.
ABSTRACT We studied the sensitivity of 4,511 Enterobacteriaceae strains to six betalactam agents:... more ABSTRACT We studied the sensitivity of 4,511 Enterobacteriaceae strains to six betalactam agents: amoxicillin, amoxicillin + clavulanate, ticarcillin, cefazolin, cefotaxime, ceftazidime, imipenem. These test strains were isolated from urinary and non urinary specimen in patients hospitalized during the year 1995, in the 3 main hospitals of Martinique. They were then sorted in 3 phenotypic groups: group 1 (sensible phenotype), group 2 (low level penicillinase phenotype), and group 3 (low level cephalosporinase phenotype). Group 1 Enterobacteriaceae represented 45.6 % of strains, group 2 Enterobacteriaceae represented 28.4 %, and group 3 Enterobacteriaceae represented 26 %. The distribution of resistance phenotypes to betalactam agents for group 1 and 2 was not very different from that of continental France. On the other hand, for group 3, the frequency of wild types was more important in Martinique. Moreover, in group 2 and 3, we noticed that non urinary strains presented a larger sensitivity to betalactam agents than urinary strains; there was also a more frequent secretion of penicillinase in urinary strains.
Evaluation des procddures d'hygidne des spdculums auriculaires (SA). Enquate microbiologique et 6... more Evaluation des procddures d'hygidne des spdculums auriculaires (SA). Enquate microbiologique et 6tude de comportement*
Afin d'établir les prévalences, la nature et les facteurs de risque des malnutritions et des aném... more Afin d'établir les prévalences, la nature et les facteurs de risque des malnutritions et des anémies chez les enfants hospitalisés, un bilan clinique et biologique a été réalisé chez 100 enfants âgés de 6 mois à 6 ans. La prévalence des déficits du poids en fonction de la taille atteint 47 % et celle de l'anémie 38 %. Deux groupes d'âge se distinguent nettement : les moins de 24 mois oÙ prédominent les anémies et la carence en fer; les plus de 24 mois oll prédominent les déficits pandéraux, Avant deux ans les facteurs de risque d'anémie et de déficit pondéral sont liés aux modalités de l'allaitement maternel; après deux ans le seul facteur de risque de déficit pondéral identifié est un faible poids de naissance. L 'étude montre que le pédiatre hospitalier doit rester vbilant vis-à-vis des problèmes nutritionnels. Une supplémentation en fer, après résolution des infections, paraît souvent justifiée. Malnutrition and anemia in children hospitalized in Martinique. Summary. In order to assess prevalences, characteristics and risk factors of malnutrition and anemia, a clinical and biological study was undertaken at Lamentin hospital in 100 hospitalized children aged 6 months to 6 years. Forty seven p. cent of children were underweight and 38p. cent were anemic. Anemia and iron deficiency predominated in the under-24-month age group, whereas wasting. was the dominate finding in older children. Under 2 years of age, risk factors for wasting and anemia were associated with method of breastfeeding. Over 2 years of age, low birthweight was the only risk factor of wasting identified. In Martinique, nutritional deficiency is common in children admitted to hospital and a high index of suspicion is indicated in the hospitalized population. Following the resolution of infections, supplemental iron therapy must be considered for a great number of children under 2years of age.
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