High lead level in the Alps in XIXth century, learning from the analysis of 138 historical hair stands.

Analysis of hair is known to provide useful information about environmental and toxic exposures. Very little historical use has been made of this type of investigation. Here we study 138 human hair samples from 19th century in France. In order to examine the potential association between contamination and historical health impacts, we characterized contamination by 33 elements in a set of hair strands sampled during the last quarter of the 19th century in the Savoy region of France. After a selected washing step on 138 hair strands conserved at the Museum National d'Histoire Naturelle in Paris (France), we assessed the presence of inorganics by ICP/MS, and lead level was higher than values reported in literature. We then compared concentrations and distributions between women and men, sampling locations and crossing gender and geographical origin. Hair lead level was high throughout Savoy at the end of the 19th century: significantly higher for people living in towns or industrial valleys, and lower for those of countryside and mountains areas. Environmental and economic changes (industrialization and urbanization with water adduction and leaded paints), living habits (kitchenware, cosmetics, wine, and tobacco), and local features (mines exploitation, railroad development, and industrialized narrow valleys) could be envisaged for explaining the level of lead contamination. In the same period, the two main industrial valleys of Savoy (Maurienne and Tarentaise) had high rates of endemic goiter and cretinism and among the highest hair lead levels. Other lines of evidence will need to be explore to investigate a possible link between historical Pb exposure and goiter in the study area.

The mandible of Saint-Louis (1270 AD): Retrospective diagnosis and circumstances of death.

INTRODUCTION: Recent paleopathological cases have shown the usefulness of interdisciplinary odontological studies in the investigation of historical figures. OBSERVATION: A macroscopic examination of the mandible of Saint-Louis (13th c. AD), conserved in the cathedral of Notre-Dame (Paris, France) was carried out, and compared with biographical data about the life and death of the King, and contemporaneous cases of infectious/inflammatory diseases. We found post-mortem tooth loss associated with moderate signs of infectious and inflammatory diseases, which precise diagnoses are discussed facing historical chronicles and sources: main diagnosis is scurvy, potentially associated with bacterial infection. DISCUSSION: Our results support the identification of the relics, and improve the knowledge about the saint's circumstances of death related to metabolic deficiencies and infections.

Higher frequency of genetic variants conferring increased risk for ADRs for commonly used drugs treating cancer, AIDS and tuberculosis in persons of African descent.

There is established clinical evidence for differences in drug response, cure rates and survival outcomes between different ethnic populations, but the causes are poorly understood. Differences in frequencies of functional genetic variants in key drug response and metabolism genes may significantly influence drug response differences in different populations. To assess this, we genotyped 1330 individuals of African (n=372) and European (n=958) descent for 4535 single-nucleotide polymorphisms in 350 key drug absorption, distribution, metabolism, elimination and toxicity genes. Important and remarkable differences in the distribution of genetic variants were observed between Africans and Europeans and among the African populations. These could translate into significant differences in drug efficacy and safety profiles, and also in the required dose to achieve the desired therapeutic effect in different populations. Our data points to the need for population-specific genetic variation in personalizing medicine and care.

Comparison of various microalgae liquid biofuel production pathways based on energetic, economic and environmental criteria.

In view of the increasing demand for bioenergy, in this study, the techno-economic viabilities for three emerging pathways to microalgal biofuel production have been evaluated. The three processes evaluated are the hydrothermal liquefaction (HTL), oil secretion and alkane secretion. These three routes differ in their lipid extraction procedure and the end-products produced. This analysis showed that these three processes showed various advantages: possibility to convert the defatted microalgae into bio-crude via HTL thus increasing the total biodiesel yield; better energetic and environmental performance for oil secretion and an even increased net energy ratio (NER) for alkane secretion. However, great technological breakthroughs are needed before planning any scale-up strategy such as continuous wet biomass processing and heat exchange optimization for the HTL pathway and effective and sustainable excretion for both secretion pathways.

An economic, sustainability, and energetic model of biodiesel production from microalgae.

A new process evaluation methodology of microalgae biodiesel has been developed. Based on four evaluation criteria, i.e. the net energy ratio (NER), biodiesel production costs, greenhouse gases (GHG) emission rate and water footprint, the model compares various technologies for each step of the process, from cultivation to oil upgrading. An innovative pathway (hybrid raceway/PBR cultivation system, belt filter press for dewatering, wet lipid extraction, oil hydrotreating and anaerobic digestion of residues) shows good results in comparison to a reference pathway (doubled NER, lower GHG emission rate and water footprint). The production costs are still unfavourable (between 1.94 and 3.35 €/L of biodiesel). The most influential parameters have been targeted through a global sensitivity analysis and classified: (i) lipid productivity, (ii) the cultivation step, and (iii) the downstream processes. The use of low-carbon energy sources is required to achieve significant reductions of the biodiesel GHG emission rate compared to petroleum diesel.

Prevalence of overweight and obesity for urban adults in Cameroon.

BACKGROUND: The emergence of a nutrition transition in developing countries might lead to higher prevalence of obesity and related adverse health effects. In Cameroon,urbanization growth rate is one of the highest in sub-Saharan Africa. Such dramatic demographic change favours important modifications, notably in nutritional patterns. AIM: In this paper we examine the current prevalence of overweight and obesity in Yaounde,the capital city of Cameroon and search for possible causal factors. Detrimental consequences of overweight are also discussed. MATERIAL AND METHODS: Samples of adults (519 women, 252 men) of all ages in all districts of Yaounde were subjected to anthropometric and body composition measurements, blood pressure and resting heart rate determination, and interviewer-administered questionnaires on socio-demography, smoking habits, physical activity, self-perception of body weight and health status. RESULTS: In both sexes body mass index (BMI) increases with age and peaks in the years of maturity. These changes are related to changes in adiposity. Prevalence rates of overweight(BMI >or= 25) and obesity (BMI > or = 30) increase from 20 to 29 years and peak at 40-49 years in men and at 50-59 years in women before starting to decline. One woman in two is overweight and one woman in five is obese, whereas one-third of men are overweight and only 5% are obese. Obese subjects have a larger age-adjusted waist to hip ratio(WHR) than their non-overweight counterparts, attesting that fat gain is oriented towards a more abdominal fat mass distribution. The length of residence in Yaounde, increasing education level, occupation, ethnicity, physical inactivity and smoking practices appear to influence early overweight and/or obesity. No parity effect is observed in women. From the present study, it appears that obesity, and especially obesity in women, could be less benign than that described in other studies in Africa. CONCLUSION: Research is needed in Cameroon, including aetiological and cohort studies aimed at the quantification of morbidity and mortality risks associated with overweight and obesity.

[Adrenal vein catheterization in primary hyperaldosteronism: aid in surgical decision making?]. / Cathétérisme des veines surrénales dans l'hyperaldostéronisme primaire: aide à la décision chirurgicale?

UNLABELLED: The localisation of aldosterone-producing adenomas (APA's) remains difficult. Indeed, CT scan may not detect small APA's while CT detected tumours do not necessarily produce aldosterone. OBJECTIVE: To evaluate the value of adrenal vein catheterization (AVC) for the diagnosis of APA's and also the rates of unsuccessful procedures and complications. PATIENTS: One-hundred-and-nine hypertensives with biological features of primary hyperaldosteronism were included. Plasma sodium, potassium, aldosterone and renin levels were obtained after one night in lying position. Aldosterone and renin levels were also measured after a one-hour walking period and after a sodium expansion with saline. All patients underwent a CT scan and AVC. For adrenal samples, the ratio of aldosterone to cortisol concentrations was calculated for both sides. Both ratios were divided by the opposite one and the higher was retained as an index of laterization (IL). For lack of a golden standard variable, we have taken as a working hypothesis that operated patients had an APA (n = 38) and the non operated ones bilateral hypereplasia (n = 71). RESULTS: Operated patients had a shorter history of hypertension, more frequently a left ventricular hypertrophy on ECG, and lower serum creatinine and potassium levels, along with a higher sodium level. None of these features appeared discriminant, however. Presence of a 10-mm tumour on CT scan was not significantly different between the 2 groups. Operated patients had more than a five-fold higher IL compared with that of non-operated patients. Analysis using a ROC curve showed that the value of 12 for "IL" was an acceptable operational criterium of lateralization, producing a specificity of 90%, while maintaining a sensitivity of 62%. AVC appeared most useful in case of middle-range pre-test probability of an APA being present, that is when when clinical, biological, or radiological features are not fully concordant. The rate of unsuccessful procedure and the rate of complications were low (1.8% and 3.6%, respectively). CONCLUSION: With a low iatrogenicity, AVC appears helpful in indicating surgery mostly when clinical, biological, and CT scan features are not fully concordant. A value of 12 for IL appears to allow a high specificity while retaining an acceptable sensitivity.

Age at menarche and urbanization in Cameroon: current status and secular trends.

Status quo data on the age at menarche were obtained on samples of Cameroonian girls living in urban (Yaoundé) (n = 205), suburban (n = 505) and rural areas (n = 201). Mean ages at menarche, estimated by probit analysis, are 13.18 years (SD 1.08) in Yaoundé, 13.98 years (SD 1.55) in the suburban area, and 14.27 years (SD 1.65) in the rural area. The early menarcheal age observed in Yaoundé girls attending 'privileged schools' (12.72 years, SD 1.18) substantiates the hypothesis that in good environmental conditions Africans are as early-maturing as Asiatic or Mediterranean populations. Comparison with retrospective data on age at menarche during previous decades reveals the presence of a clear secular trend towards earlier maturation, at a rate of 2.5-3.2 months per decade, only in the main cities of the country (Yaoundé/Douala) and a lack of temporal variation in rural areas. The degree of urbanization influences maturational age and its evolution, probably through improvements in the nutritional standards.

PIP: "Status quo data on the age at menarche were obtained on samples of Cameroonian girls living in urban (Yaounde) (n=205), suburban (n=505) and rural areas (n=201).... Comparison with retrospective data on age at menarche during previous decades reveals the presence of a clear secular trend towards earlier maturation, at a rate of 2.5-3.2 months per decade, only in the main cities of the country (Yaounde/Douala) and a lack of temporal variation in rural areas. The degree of urbanization influences maturational age and its evolution, probably through improvements in the nutritional standards." (EXCERPT)

[Anopheles species and the transmission of malaria in the forest/savannah transition zone in central Cameroon]. / La faune anophélienne et la transmission du paludisme dans une zone de transition forêt/savane au centre du Cameroun.

A longitudinal study on malaria vectors and transmission was carried out in a forest-savannah transitional area in Cameroon. Indoor all night mosquito collections on human bait were performed during one year in two villages: Nditam and Ngoume. Nditam was located in a secondary forest block surrounded by savannah, while Ngoume was situated in an ancient forest block. The results showed that at Nditam, only one anopheline species was collected, that was Anopheles gambiae s.l.. The average daily biting rate was 2.4 bites per man per night. The sporozoitic index of An. gambiae was 9.4%. The entomological inoculation rate was therefore estimated at 0.225 infective bite per man per night that is to say 82 infective bites per man per year. Malaria transmission was low during the year, but an important increase was observed in September, when the rainfall was at its peak. At Ngoume, no Anopheles mosquito was collected. Therefore, malaria transmission was not observed in that village.

[Human ecology and tropical medicine]. / Ecologie humaine et médecine tropicale.

Tropical medicine's growing interest in social sciences has not remedied the neglect of some biological aspects related to human species polymorphism. These are adaptability to the environment and variability in time and space. Physical anthropology, when it is enlarged to include population genetics and the influence of the non-linear mode of thinking used in ecological sciences, may provide a good approach for solving problems related to development. Adaptability to a changing environment is partly cultural and partly biological. Medical standards used in developed countries may not be adequate in tropical regions. This paper reviews different areas in which human ecology can be useful to physicians, especially the study of the interactions between pathogens, human hosts, culture, and the physical environment.

New meta-analysis of treatment trials of hypertension: improving the estimate of therapeutic benefit.

The objectives of this sub group meta-analysis on the treatment of hypertension was to: (1) high-light specific results of well-designed trials; (2) group trials according to their specific clinical context; (3) express results of the meta-analysis in absolute reduction terms; and (4) estimate the bias of withdrawal because of blood pressure increase. This meta-analysis is based on summarised published results from randomised controlled trials, comparing a drug treatment versus placebo or no treatment, with morbi-mortality as the principle outcome. The following data were analysed: (1) total mortality; (2) cardiovascular mortality; (3) stroke; (4) major coronary events; and (5) congestive heart failure. The treatment significantly reduced the incidence of all outcomes in trials involving older patients, avoiding up to nine strokes (OR = 0.66, 95% Cl: 0.56-0.77) and four major coronary events (OR = 0.79, 95% Cl: 0.68-0.92) every 1000 patient-years when the bias of withdrawal was taken into account. The only outcome significantly influenced by treatment in younger patients with mild-to-moderate hypertension was stroke, with one stroke avoided every 1000 patient-years (OR = 0.51, 95% Cl: 0.39-0.66). There was insufficient statistical power in the trials which enrolled patients with non-moderate hypertension to reach clinical significance, except for the reduction in the incidence of congestive heart failure. However, the results indicated a trend towards greater absolute benefit under treatment. Trials enrolling patients with post-stroke hypertension also had insufficient power, but suggested benefit by the reduction of the incidence of stroke recurrence and congestive heart failure under treatment. In conclusion, the most constant treatment benefit concerned stroke, although the absolute reduction was very modest in younger patients with mild-to-moderate hypertension. Only the results from trials in older patients showed a significant reduction of major coronary events. Such results need further analyses, ideally based on individual patient data.

[Health indicators of a population in an agro-industrial complex of southern Cameroon]. / Indicateurs de santé dans la population d'un complexe agro-industriel du Sud Cameroun.

An agro-industrial program involving sugar cane farming was established in Mbandjock (Cameroon) in the 1960's. We studied the impact of this development project on the health of the population by determining the prevalence and distributions of the major parasitic diseases according to district, ethnic origin, age and sex. Three main conclusions can be drawn. First, in the study area, economic development was not associated with deteriorating health conditions. Indeed, the incidence of parasitic disease was lower in Mbandjock than in surrounding areas. Second, imported diseases (loaiasis and schistosomiasis for example) did not develop locally despite the large population concentrations created by the implantation of the agro-industrial complex. Third, endemic parasitic diseases (malaria, onchocerciasis and intestinal infection by helminths or protozoan) were found only in a few districts. Thus, integrated control measures should be taken in these areas as a priority.

Isolation and molecular characterization of a human T-cell lymphotropic virus type II (HTLV-II), subtype B, from a healthy Pygmy living in a remote area of Cameroon: an ancient origin for HTLV-II in Africa.

We report characterization of a human T-cell lymphotropic virus type II (HTLV-II) isolated from an interleukin 2-dependent CD8 T-cell line derived from peripheral blood mononuclear cells of a healthy, HTLV-II-seropositive female Bakola Pygmy, aged 59, living in a remote equatorial forest area in south Cameroon. This HTLLV-II isolate, designated PYGCAM-1, reacted in an indirect immunofluorescence assay with HTLV-II and HTLV-I polyclonal antibodies and with an HTLV-I/II gp46 monoclonal antibody but not with HTLV-I gag p19 or p24 monoclonal antibodies. The cell line produced HTLV-I/II p24 core antigen and retroviral particles. The entire env gene (1462 bp) and most of the long terminal repeat (715 bp) of the PYGCAM-1 provirus were amplified by the polymerase chain reaction using HTLV-II-specific primers. Comparison with the long terminal repeat and envelope sequences of prototype HTLV-II strains indicated that PYGCAM-1 belongs to the subtype B group, as it has only 0.5-2% nucleotide divergence from HTLV-II B strains. The finding of antibodies to HTLV-II in sera taken from the father of the woman in 1984 and from three unrelated members of the same population strongly suggests that PYGCAM-1 is a genuine HTLV-II that has been present in this isolated population for a long time. The low genetic divergence of this African isolate from American isolates raises questions about the genetic variability over time and the origin and dissemination of HTLV-II, hitherto considered to be predominantly a New World virus.

[Infectious endocarditis induced by Actinobacillus actinomycetemcomitans. 8 new cases]. / Endocardite infectieuse à Actinobacillus actinomycetemcomitans. Huit nouvelles observations.

A commensal organism of the buccal cavity, Actinobacillus actinomycetemcomitans (AAC) has been responsible for at least four new cases of infectious endocarditis by year in France. This retrospective study was based on 90 new cases of infectious endocarditis by AAC, including 8 personal observations. One third of patients had no known cardiac disease before their infectious endocarditis, the portal of entry of which was usually dental. In cases of suspected infectious endocarditis, rapid and severe weight loss (43% of cases) and, less commonly, anicteric cholestasis (8%) should alert the physician for the possible pathological role of AAC. The echocardiographic appearances are non-specific. The diagnosis is confirmed on blood cultures but the organism grows slowly in CO2 enriched atmosphere. Initially, the course of the disease was favourable in one third of patients but, in two thirds of cases, complications were observed almost renal (26%), cardiac (24%) and neurological (18%). Two thirds of patients were cured by the time they were discharged whereas the remainder had sequellae, mainly valvular and neurological. The hospital mortality was 9%; late mortality was 6%. Therefore, the prognosis of AAC endocarditis, seems to be better than that of other bacteriological forms. A combination of cephalosporin and aminoside, or even a simple third generation cephalosporin antibiotic therapy for at least 4 weeks are usually effective. The complementary surgical indications are the same as for other forms of infectious endocarditis. Prophylaxis depends on strict prophylactic amoxicillin therapy for all cardiac patients at risk of infectious endocarditis before dental treatment and on good bucco-dental hygiene.

[Value and role of echo-Doppler in the screening of renovascular hypertension. A prospective study of 144 arteries with reference to angiography]. / Intérêt et place de l'écho-Doppler dans le dépistage des hypertensions réno-vasculaires. Une étude prospective portant sur 144 artères, en référence à l'angiographie.

The purpose of the study is a rigorous validation of different ultrasonic criteria of renal artery stenosis, and the presentation of the performances of duplex sonography in renal artery stenosis screening. Sixty seven patients have been investigated by ultrasonic techniques, and the results of duplex compared with intraarterial or intravenous digital subtraction angiography. Two kinds of ultrasonic investigations have been defined: complete explorations when the renal artery ostium is accessible, incomplete explorations in other cases. The main difficulty preventing the exploration from being complete is obesity: all patient with an overweight of more than 20% of their theoretical weight have an incomplete exploration of at least one of their renal arteries. Furthermore, duplex sonography was not able to demonstrate polar artery in any case. When the exploration is complete, maximum systolic frequency (F max) recorded on the renal artery course, and the systolic frequency ratio of renal and aortic recordings (RAR) are two valuable criteria of significant stenosis (> 50%): mean difference between normal and stenosed arteries for these two variables is statistically significant (p < 0.01). To obtain a good specificity, pathological threshold have been fixed at F max > 3,500 Hz and RRA > 2.5. When the exploration in incomplete, ascending time (asc. T) and resistance index (RI) of doppler recording obtained in the renal hilum are two valuable criteria for severe stenosis (> 80%), or occlusion: the mean between stenosed and non stenosed arteries is statistically different (p < 0.001 and p < 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

[Nutrition and anthropobiology]. / Nutrition et anthropobiologie.

PIP: In analyzing the connections between nutrition and anthropology, it should be noted that the state of knowledge and available techniques are not yet sufficiently developed to support conclusions about such questions as the universality of dietary norms. Food choices are above all cultural, although they are limited by the physical environment and technological capacities. Human beings have some dietary constraints imposed by metabolic needs, but they manifest great ability to adapt to different dietary regimes, from the exclusive vegetarianism of Hindus to the almost exclusively animal-based diet of the Eskimos. In most parts of the world, the contribution of proteins is remarkably stable at about 12% of total caloric intake. Numerous examples of genetic adaptation illustrate the flexibility of humans. Many African populations, for example, have deficits of intestinal lactase, but herding groups do not. the diet of parts of the New Guinea highlands is almost completely lacking in proteins, but body growth is not inhibited. Such examples raise questions about the applicability of Recommended Dietary Allowances and evaluation of nutritional risks. Daily protein intake ranging from .2 to 5 gm/kg of body weight has been measured in different societies. WHO recommended 1.3 gm, but this norm has changed through time, and it is currently believed that total caloric intake is more important in insuring adequate growth. Food supplementation programs based on protein have generally failed. For most societies, the diet is varied enough to contain a sufficient portion of essential nutrients. Specific lacks have often been noted under very artificial conditions such as on ships at sea or in prisons. A reduction of body format may be biologically fixed quantity of food. The population of Mexico represents 24% of that of the US in individuals but only 17% in body mass. Clinical methods allow signs of deficiency at an earlier phase of development has been costly and disappointing. Anthropometry, which is sensitive, easy, and inexpensive, has been found to be the most appropriate method for nutritional screening in public health. The 4 essential measurements proposed by the WHO to assess nutritional status are weight, height, arm circumference, and tricepital as well as for excess feeding and obesity are all based on anthropometry. Nutritional risks appear especially heightened when traditional ways of life are modified by social forces as in urbanization or by introduction of a new food, as with potatoes in Ireland.^ieng