Frontal, Parietal, and Temporal Brain Areas Are Differentially Activated When Disambiguating Potential Objects of Joint Attention.

Humans establish joint attention with others by following the other's gaze. Previous work has suggested that a cortical patch (gaze-following patch, GFP) close to the posterior superior temporal sulcus (pSTS) may serve as a link between the extraction of the other's gaze direction and the resulting shifts of attention, mediated by human lateral intraparietal area (hLIP). However, it is not clear how the brain copes with situations in which information on gaze direction alone is insufficient to identify the target object because more than one may lie along the gaze vector. In this fMRI study, we tested human subjects on a paradigm that allowed the identification of a target object based on the integration of the other's gaze direction and information provided by an auditory cue on the relevant object category. Whereas the GFP activity turned out to be fully determined by the use of gaze direction, activity in hLIP reflected the total information needed to pinpoint the target. Moreover, in an exploratory analysis, we found that a region in the inferior frontal junction (IFJ) was sensitive to the total information on the target. An examination of the BOLD time courses in the three identified areas suggests functionally complementary roles. Although the GFP seems to primarily process directional information stemming from the other's gaze, the IFJ may help to analyze the scene when gaze direction and auditory information are not sufficient to pinpoint the target. Finally, hLIP integrates both streams of information to shift attention to distinct spatial locations.

SkinExplorer: a new high-tech platform to interact inside the skin by immersive virtual 3D cutaneous environment.

BACKGROUND: The confocal laser scanning microscope allows performing acquisition of several histological sections with precise visual morphological landmarks and their reconstruction. A powerful and modern confocal microscope enables to quickly reconstruct virtual 3D models. OBJECTIVE: The main goal was to develop a new platform to reconstruct complex mosaic serial data, interact with it in an immersive 3D environment, and give to the observers a feeling of 'presence' inside the skin. METHOD: We have developed novel methods that transform the data into alternative representation, well-suited to explore cutaneous structures in detail and to observe fields of data from different points of view. This new way of data reconstruction in volume requires optimization of intensities, automatic matching algorithms and depth alignment. RESULTS AND CONCLUSION: The new platform - SkinExplorer evolves as a 3D exploration prototype. This technology provides an immersive virtual environment to explore cutaneous microstructures. Several serial histological sections can be matched by stacks, aligned in depth by sections and merged together to be visualized as a whole. All these time-consuming steps have been dramatically speed-up using rapid image processing. The advantages of using virtual reality technologies such as the ones used in the SkinExplorer platform are automatic matching, precise alignment, better data perception, lower memory requirement, and higher quantity of simultaneously displayed data. This platform can render volumetric data and isosurfaces, separately or both at the same time. Lighting and depth perception are enhanced using 'Sphere Mapping', 'Ambient Occlusion', and 'Halo' methods when displaying iso-surfacic volume models with high complexity depth. The assets of the platform are to interpret complex three-dimensional data, to observe and explore 3D virtual models, and to show effects of cosmetic treatments.

[Celiac disease: special features in Africa. Description of 8 cases in Djibouti (horn of Africa)]. / Maladie coeliaque: particularités africaines. A propos de 8 cas à Djibouti.

Celiac disease is poorly documented in intertropical Africa. The purpose of this retrospective report was to describe 8 cases observed at the Groupement Medico-Chirurgical of Bouffard Hospital in Djibouti (Horn of Africa) between January 2003 and January 2006. There were 5 females and 3 males ranging in age from 9 months to 17 years old (mean age: 48 months). Six patients were of Somali ethnic origin and two of Yemenite ethnic origin. Six were classified as middle class and 2 as lower class. All forms were symptomatic associating constant loss of weight with digestive manifestations (diarrhoea and vomiting). Diagnosis of celiac disease was based on the presence of anti-gliadin antibodies IgA and IgG associated with anti-endomysium or anti-transglutaminase antibodies that were measured in six and two cases respectively. Gastroduodenal endoscopy performed in three cases including two with duodenal biopsy demonstrated villous atrophy associated with gross of intra-epithelial lymphocytosis. A gluten-free diet initiated in five patients led to clinical improvement in four cases with a follow-up of 8.25 months. The findings of this study in Djibouti show that celiac disease exists in intertropical Africa. Its presentation is quite similar to elsewhere but diagnosis is more difficult due to poor knowledge about the disease and limited diagnostic facilities. Favourable response to presumptive treatment by a gluten-free diet is an alternative for diagnosis especially in Djibouti where eating habits differ from those in industrialized countries and this type of diet is easier to follow.

[Risk of nosocomial infection in Intertropical Africa. Part 4: prevention]. / Le risque nosocomial en Afrique Intertropicale. Partie 4: prévention.

Nosocomial infections have long been neglected in Sub-Saharan Africa, even though their prevalence is higher than in developed countries. Recently, however, this major public health problem has been the focus of a growing number of recommendations not only from the World Health Organization but also from some national health ministries. Because of the numerous limitations especially in financial resources in these regions, priority must be given to the implementation of simple and cost-effective measures. Accordingly the greatest efforts must be devoted to educating healthcare workers and patients about the importance of handwashing, eliminating unnecessary injections and transfusions, performing the latter acts in aseptic conditions, isolating patients with communicable diseases, handling waste products safely, and using antimicrobials properly. Amid the daunting health issues facing Sub-Saharan Africa, implementing these inexpensive measures that could save the lives of thousands of patients and healthcare workers appears easy. However it will require a cultural revolution. The keys to success will be changing the organizational culture, developing a commitment to prevention and evaluating performance regularly.

Le risque nosocomial en Afrique intertropicale - Partie 4 : prevention

Alors que les infections nosocomiales representent en Afrique Intertropicale un probleme de sante publique encore plus preoccupant que dans les regions developpees du globe; leur prevention est longtemps restee negligee. Depuis quelques annees neanmoins elle fait l'objet d'un nombre croissant de recommandations emanant d'instances internationales comme l'Organisation Mondiale de la Sante ou d'un certain nombre de ministeres concernes. Les multiples contraintes du sous-continent; notamment economiques; imposent la mise en place prioritaire de mesures simples et adaptees. Les efforts doivent ainsi porter sur l'education des personnels de sante mais aussi des patients; le lavage des mains; la limitation des injections et des transfusions et leur realisation dans des conditions securisees; les mesures d'isolement; la gestion des dechets ou encore les bonnes pratiques d'antibiotherapie. Cette revolution culturelle; semblant decalee face aux grandes urgences africaines; pourrait neanmoins epargner a peu de frais la vie demilliers de patients et soignants. La culture d'etablissement; la priorisation et l'evaluation reguliere des mesures sont des points-cles du succes

Maladie coeliaque : particularites africaines. A propos de 8 cas a Djibouti

La maladie coeliaque est meconnue en Afrique intertropicale. Nous en rapportons 8 observations colligees de facon retrospective entre janvier 2003 et janvier 2006; au Groupement Medico-Chirurgical Bouffard a Djibouti. Elles ont concerne 5 filles et 3 garcons dont l'age varie de 9 mois a 17 ans (age moyen : 48 mois); d'ethnie Somali 6 fois et Yemenite 2 fois; issus des classes moyennes de la population 6 fois et des classes les plus defavorisees 2 fois. Il s'agissait toujours de formes symptomatiques : alteration de l'etat general constante associee a des troubles digestifs (diarrhee ou vomissements). Le diagnostic a ete retenu dans ce contexte sur la presence d'anticorps anti-gliadine de type IgA et IgG; associes a des anticorps anti-endomysium ou anti-transglutaminase respectivement realises dans 75et 25des cas. Une endoscopie gastroduodenale realisee 3 fois avec biopsies duodenales a montre deux fois une atrophie villositaire totale associee a une augmentation de la lymphocytose intra epitheliale. Un regime sans gluten; instaure chez 5 malades; a entraine une reponse clinique favorable dans 4 cas avec un recul de 8;25 mois. La maladie coeliaque existe en Afrique intertropicale dans la region de la Corne de l'Afrique ou elle ne presente pas de particularite; en dehors de difficultes diagnostiques liees a une meconnaissance de l'affection et des moyens diagnostiques souvent insuffisants. La reponse favorable au regime sans gluten d'epreuve peut constituer une alternative diagnostique d'autant que ce regime parait moins astreignant a suivre a Djibouti qu'en occident en raison d'habitudes alimentaires differentes

[Risk of nosocomial infection in intertropical Africa--part 3: health care workers]. / Le risque nosocomial en Afrique intertropicale. Partie 3: les infections des soignants.

Parts of the nosocomial infections issue are the professionally-acquired infections of health care workers. This problem is widely neglected in sub-Saharan Africa, and little is known on the subject, in spite of the high prevalence of blood-borne infections such as HIV or hepatitis B and C, and air-borne diseases like tuberculosis. Besides, unsafe practices and accidents like blood exposures are more frequent than in western countries. This is due to the lack of political concern, of safer equipment and of specific teachings. Most of this severe infections' treatments are long, difficult or unavailable in Subsaharan Africa. The loss of contaminated health care workers can then become devastating for their family and the fragile health care structures of those developing countries. Finally, one should not underestimate the risk of infection transmission from health care provider to patient, like in several past outbreaks of Ebola hemorrhagic fever.

[Risk of nosocomial infection in intertropical Africa--part 2: patient infection]. / Le risque nosocomial en Afrique intertropicale partie 2: les infections des patients.

Patients admitted to hospitals in tropical Africa are at increased risk for nosocomial infection. However accurate description of this risk is difficult due to a lack of published data in the literature. The main promoting factors are poor health care facilities, high microbial levels in the hospital and community environment and generally uncertain health status. Most available information is about neonatal infection. The increasing number of reports involving multiresistant bacteria is evidence of poor hospital sanitation. Infections involving operative incision sites, tuberculosis and respiratory virus transmission are grossly underestimated. Infections transmitted by the parenteral route are probably decreasing due to more widespread use of disposal equipment and adequate transfusion safety measures. Epidemics involving viral hemorrhagic fever are rare but highly publicized events that attest to daily neglect of nosocomial risk factors in some health care facilities

Le risque nosocomial en Afrique intertropicale. Partie 3 : les infections des soignants

La grippe est une maladie virale saisonniere qui peut etre benigne ou redoutable du fait du taux de morbidite et de mortalite occasionne lors des epidemies. En absence de donnees epidemiologiques et virologiques en Cote d'Ivoire; un reseau de surveillance de la grippe a ete mis en place a Abidjan pour determiner le niveau de circulation de virus grippaux et caracteriser les virus isoles. De janvier 2003 a decembre 2004; soit pendant 24 mois; des secretions nasales ont ete collectees dans les formations sanitaires de la ville d'Abidjan. L'identification des virus grippaux au laboratoire a ete realisee par technique ELISA utilisant des anticorpsmonoclonaux anti-A et anti-B (immunocapture) et par isolement sur cellules MDCK. Une partie des echantillons d'origine et les isolats ont ete envoyes pour confirmation a l'Institut Pasteur de Paris (2003) et au National Institute for Communicable Diseases (NICD) a Johannesburg. Parmi les 211 echantillons analyses; 30 (12;8) se sont reveles positifs : 22 isolats de virus InfluenzaA dont 21 de typeA(H3N2) et une souche de typeA(H1N1); et 8 isolats de virus Influenza B. Ces souches ont ete isolees majoritairement chez des patients de 0-5 ans (34) et 15-59 ans (47). Bien que plus de 60des souches aient ete isolees en juin et en octobre; il est difficile de definir une saisonnalite du fait de la courte duree de l'etude. La poursuite de cette etude permettra une meilleure appreciation de la saisonnalite; des caracteristiques virologiques et cliniques pour envisager une prevention par la vaccination

[Risk of noscomial infection in intertropical Africa--part 1: background]. / Le risque nosocomial en Afrique intertropicale--partie 1: le contexte.

Nosocomial infection is a risk in any health care setting. A review of recent medical literature shows that there is a paucity of information on nosocomial infection in intertropical Africa. Often misunderstood or denied, nosocomial infection is in reality an underestimated public health problem at most medical facilities even university hospital centers. However most hospitals are confronted with the same financial, structural and logistics difficulties, with limited training and awareness about hospital hygiene among caregivers, and with situations bringing together contagious infections with susceptible subjects. Assessment of the risks for patients and caregivers is a necessary prerequisite for implementing measures to control nosocomial infections in intertropical Africa.

[Extensive bone marrow necrosis as presenting manifestation of sickle cell disease in Africa]. / Necrose médullaire etendue en Afrique révélant une drépanocytose homozygote.

Extensive bone marrow necrosis is a rare but severe complication of sickle cell disease. A formerly healthy man was admitted for bone pain, fever, and jaundice with severe aregenerative anemia. Bone marrow aspiration and biopsy showed extensive bone marrow necrosis while hemoglobin electrophoresis demonstrated homozygotic sickle cell disease. Despite early onset of septic arthritis of the right shoulder, outcome after blood transfusion and nonspecific treatment was favorable. Six months later, hemoglobin level remained stable up to 97 g/L. This first African case report illustrates typical features and good prognosis of extensive bone marrow necrosis in sickle cell disease. Extensive bone marrow necrosis is a highly unusual presenting manifestation of sickle cell in an adult.

[Management of Grave's disease in the tropics (experience at Bouffard Army Hospital Center in Djibouti]. / Prise en charge de la maladie de Basedow en milieu tropical (expérience du cha Bouffard de Djibouti).

Based on their experience in managing Grave's disease at the Bouffard Army Hospital Center within the local health care context in Djibouti, the authors advocate surgery as the first line treatment. Medical and economical factors supporting this preference are discussed so that readers can adapt them to his own local context.

[Management of American cutaneous leishmaniasis. Outcome apropos of 326 cases treated with high-dose pentamidine isethionate]. / Thérapeutique des leishmanioses tégumentaires du Nouveau Monde. Expérience à propos de 326 cas traités par iséthionate de pentamidine à fortes doses.

The purpose of this retrospective analysis was to evaluate the outcome of pentamidine isethionate treatment (4 mg/kg of Pentamidine by the intramuscular route on Days 1 and 3) of cutaneous leishmaniasis in 326 cases that occurred during an outbreak among French military personnel in French Guyana from 1998 to 1999. A great difference was found between the 205 patients treated in French Guyana (series G) and 32 patients treated at the Laveran Military Hospital in Marseille, France (series L). Failure rate, i.e. 25% in series L versus 5% in series G, was significantly correlated with the delay to treatment which was much longer in series L. Extensive rhabdomyolysis was observed in all cases tested: this side-effect has not been reported. Based on these findings and a review of the literature on pentamidine isethionate, the authors recommend prompt treatment using lower doses. Other treatment alternatives for American cutaneous leishmaniasis are also presented including two of the latest developments in the field, i.e., oral treatment using miltefosine and topical treatment using agents such as paromomycine.

[Does emergency tropical medicine exist? The physician's point of view]. / Existe t-il des urgences médicales tropicales? Le point de vue du medecin.

The existence of tropical medical emergencies is a recurrent issue that joins the debate over the definition of tropical medicine. Is it medicine practiced in warmer climates, medicine practiced with poor diagnostic and therapeutic facilities or medicine involving only tropical diseases? Presentation of a few case reports provides a better response to this question than a long speech. The first case involves a 57-year-old man presenting a complicated attack of Plasmodium falciparum malaria and severe respiratory distress. The second case involves a pregnant AIDS patient presenting multifocal miliary tuberculosis associated with renal abscess and bacteremia. The third case involves a 34-year-old soldier hospitalized for right hilar pneumonia in whom work-up demonstrated co-infection by HIV 1 and 2, thick drop tests revealed uncomplicated Plasmodium falciparum malaria, and cytobacterial examination of sputum samples identified Salmonella enteritidis and acid-alcohol resistant germs. The fourth case involves a 60-year man hospitalized for febrile collapse in whom work-up revealed amebic pericarditis. These four case reports illustrate the main features of tropical medical emergencies: adult patients (frequently young), associated deficiencies or immunocompromise (HIV infection/AIDS), severe or complicated tropical disease, severe advanced stage disease because of inability to pay for care, multiple pathology, poor diagnostic/therapeutic facilities, and high mortality.

[Epidemiologic surveillance of cutaneous leishmaniasis in Guiana. Summary of military data collected over 10 years]. / Surveillance épidémiologique des leishmanioses tégumentaires en Guyane. Synthése de données militaires sur 10 ans.

This report describes the results of epidemiological surveillance of cutaneous leishmaniasis in French military personnel in French Guiana. Data was collected regarding microscopic diagnosis, clinical manifestations, and lesion location as well as compliance with vector control measures. Year-to-year variations in the incidence in the general population have been attributed to changes in climatic conditions. Monitoring incidence and density curves, correlation of findings with local epidemiological data, and analysis of the most recent epidemic in 1998/99 (326 cases, attack rate 3.2% men years) highlight the importance of behavioral factors. The proportion of total cases involving military personnel varied widely from 20 to 85%. Investigation consistently showed that failure to apply elementary protective measures against sandfly bites was the most determinant factor in this proportion. Strict compliance with these measures appears to reduce the risk of infection considerably.

[Clinical overview of New World tegumentary leishmaniasis]. / Panorama clinique des leishmanioses tégumentaires du Nouveau Monde.

This richly illustrated article (80 color photographs) based on the authors' experience in French Guyana documents the clinical diversity of American tegumentary leishmaniasis. Main highlights include the often outstanding aspect of lesions, the high frequency of forms not associated with ulceration or scab formation that must be recognized to achieve diagnosis in travellers returning from endemic zones, and the special prognosis of clinical forms associated with intradermic, lymphatic or hematogenous spread. The article also reviews an original diagnostic method based on culture of cutaneous biopsy specimens on specific nutrient mediums that provides isolates in a high percentage of cases (80%) and thus allows identification of offending parasite.

Effects of binge ethanol administration on the behavioral outcome of rats after lateral fluid percussion brain injury.

This study examined the effects of 4 weeks of binge ethanol administration (BEAn) on the behavioral outcome in rats after lateral fluid percussion (FP) brain injury. Rats were intragastrically given 7.5 mL/kg of either 40% ethanol in 5% glucose solution (3 g ethanol/kg; binge ethanol group), or 5% glucose solution (vehicle group), twice on Thursday and Friday of 3 consecutive weeks. Then rats from both groups were subjected to either lateral FP brain injury of moderate severity (1.8 atm) or to sham operation. Postinjury behavioral measurements revealed that brain injury caused significant spatial learning disability in both groups. There were no significant differences in mean search latencies in the sham animals between the vehicle and binge ethanol groups. On the other hand, the mean search latency of the binge ethanol group was significantly higher than that of the vehicle group in trial blocks 2 and 4. There were no significant differences in the target visits (expressed as mean zone difference [MZD]) during the probe trial between the injured animals of binge ethanol and vehicle groups. However, there was only a minor trend towards worsened MZD score in the binge-injured animals. Histologic analysis of injured animals from both injured ethanol and vehicle groups revealed similar extents of ipsilateral cortical and observable hippocampal damage. These results suggest that 4 weeks of binge ethanol treatment followed by ethanol intoxication at the time of injury worsens some aspects of the spatial learning ability of rats. This worsening is probably caused by subtle, undetectable morphologic damage by binge ethanol administration.