Medical check-up of newly arrived unaccompanied minors: A dedicated pediatric consultation service in a hospital.

BACKGROUND AND AIMS: Healthcare for the increasing number of migrants in Europe, and particularly of unaccompanied minors (UMs) seeking asylum, has become a major challenge. We aimed to describe the health issues of UMs managed in a dedicated pediatric consultation service in a care center in Paris. METHODS: All UMs attending a dedicated migrant medical consultation service in Robert Debré Hospital, Paris, France, were included in a single-center retrospective observational study from September 1, 2017, to September 30, 2018. RESULTS: Out of the 107 UMs who were included, 87% had a health problem (n=93) and 52% had an infectious disease (n=56). The main infectious diagnoses were schistosomiasis (22%), latent tuberculosis (22%), intestinal parasitosis (16%), and chronic hepatitis B (8%). Posttraumatic stress disorder (PTSD) and overweight were common (35% and 20%, respectively). The median age was 15 years old (IQR, 14-16), the male/female ratio was 95/12. Most of the children were from sub-Saharan Africa (n=67), 46% had crossed Libya (n=49) and, when compared to the other migration routes, faced an increasing risk of violence (69%, p=0.04), imprisonment (53%, p=0.03), and forced labor (48%, p=0.02). The median duration of the trip before reaching France was 6 months (IQR, 2-13), the median time to consultation was 2 months (0-5) and was not associated with an increased risk of health problems. A total of 43 UMs were lost to follow-up. CONCLUSION: Health problems, particularly infectious diseases and PTSD, are common among UMs and should prompt an early medical consultation with psychiatric evaluation. Follow-up is problematic and could be improved by an on-line health book.

Effect of food restriction on reproductive-related genes and reproductive hormones in adult female rats.

OBJECTIVES: A number of factors involved in the control of energy balance and metabolism act as modulators of gonadal axis. Ghrelin, a peptide secreted from the stomach and hypothalamus, has emerged as an orexigenic food intake controlling signal acting upon hypothalamus. Recently, the potential reproductive role of ghrelin has received great attention. This study was designed to investigate the influence of food restriction and consequent metabolic hormone (ghrelin) on the level and gene expression of female reproductive hormones in adult rats. MATERIALS AND METHODS: To study the effect of chronic food restriction on ghrelin level in adult female rats and its relation to female reproductive hormones, 32 adult female Sprague Dawley rats divided into 4 groups: Group I (control group) comprised 8 rats fed ad libitum for 30 days, Group II, III and IV (food-restricted groups for 10, 20 and 30 days respectively) each consisted of 8 rats fed 50% of ad libitum intake determined by the amount of food consumed by the control group. RESULTS: Mean body weight of food restricted rats was observed to decrease during the period of the experiment. Food restriction produced significant increase of serum ghrelin with significant decrease of both gastric and hypothalamic ghrelin accompanied with significant increase in its gene expression in stomach and hypothalamus. Estradiol (E2), follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels showed significant decrease correlated with down-regulation of gonadotropins, cyclin-dependent kinase (cdc2), cyclin B and kisspeptin (Kiss1) genes in food restricted rats compared with control group. CONCLUSIONS: Ghrelin could be one of the hormones responsible for the suppression of female reproductive axis in case of negative energy balance. Thus, ghrelin may operate as an autocrine/paracrine regulator of ovarian function. Overall, ghrelin may represent an additional link between body weight homeostasis and reproductive function.

Potential role of leptin against glucocorticoid-induced secondary osteoporosis in adult female rats.

OBJECTIVES: The present study assessed the potential role of leptin administration in the protection and intervention against glucocorticoid-induced secondary osteoporosis in female rats. MATERIALS AND METHODS: For this purpose five groups of female Sprague Dawley rats were classified into: (1) negative control group in which the healthy rats received saline as vehicle, (2) a group orally administered with prednisolone (5 mg kg b.wt.-1) daily for six months (osteoporotic group), (3) a group subcutaneously administered with leptin (400 microg kg b.wt.-1) three times weekly for six months (positive control), (4) a group orally administered with prednisolone daily with simultaneous subcutaneous administration of leptin three times weekly for six months (protective group), and (5) a group orally administered with prednisolone daily for six months then subcutaneously administered with leptin three times weekly for other six months (therapeutic group). RESULTS: The obtained data revealed that prednisolone administration resulted in significant decrease in serum osteoprotegerin (OPG) level accompanied with significant increase in serum receptor activator of nuclear factor-κB ligand (RANKL) and beta2-microglobulin levels in comparison with the negative control group. Moreover, prednisolone significantly decreased bone mineral density and content of different areas of the right femur bones as compared to the negative control group. Furthermore, administration of leptin with/after stopping prednisolone administration resulted in a marked modulation in the majority of bone biomarkers as well as improvement in bone mineral density and content. CONCLUSIONS: Leptin provided promising effect on bone through its direct action on bone and matrix mineralization.

Hypolipidemic influence of Sargassum subrepandum: mechanism of action.

OBJECTIVES: This study aimed to elucidate the role and mode of action of Sargassum subrepandum methanolic extract in management of dyslipidemia in adult female rats. MATERIAL AND METHODS: Forty adult female Sprague Dawley rats were assigned into four groups: (1) lean control rats fed on standard diet, (2) dyslipidemia control fed on the atherogenic diet, (3) lean rats orally administered with 100 mg/kg b. wt of Sargassum subrepandum methanolic extract and (4) dyslipidemia rats orally administered with Sargassum subrepandum methanolic extract. Plasma lipid profile, serum MDA, NO, leptin, TNF-alpha and adiponectin levels were demonstrated in the all studied groups. RESULTS: The results showed that feeding of rats with athrogenic diet caused significant elevation in plasma cholesterol, triglyceride, LDL, serum MDA, NO, leptin and TNF-alpha levels while, it produced significant decline in plasma HDL and serum adiponectin levels compared with lean control rats. However, treatment of dyslipidemia rats with Sargassum subrepandum methanolic extract induced significant improvement of plasma lipid profile, marked decrease in serum MDA, NO, leptin, TNF-alpha level in concomitant with remarkable increase in serum adiponectin level. CONCLUSIONS: These results indicated that Sargassum subrepandum extract plays a vital role in ameliorating dyslipidemia and its complications particularly oxidative stress and implication. This could be attributed to the hypolipidemic effect, antilipidperoxidative activity and antinflammatory property of Sargassum subrepandum methanolic extract.

Effect of acrylamide on some hormones and endocrine tissues in male rats.

Acrylamide is oxidized by cytochrome P450 2E1 (CYP2E1) to its epoxide form, glycidamide, which is believed to be responsible for the mutagenic and carcinogenic activities. This study was carried out to investigate the early changes that may be related to the carcinogenic activity of acrylamide in thyroid, adrenal glands and testis in male rats. Forty adult Sprague Dawley male rats were divided equally into four groups, rats of Group I served as control, and rats of Groups II, III and IV were treated orally with acrylamide with doses 5, 10, 15 mg/kg/day body weight for 8 weeks. The results indicated that the plasma carcino embryonic antigen (CEA) and malondialdehyde (MDA) levels are higher, but free and total testosterone, triiodothyronine (T(3)) and thyroxine, or 3,5,3',5'-tetraiodothyronine (T(4)) and corticosterone levels are lower in rats treated with acrylamide than that in control rats. This study provides evidence of endocrine disturbance to the testis, thyroid and adrenal glands, which are also the organs in which acrylamide has been shown to cause tumors in experimental animals.

Saccharomyces cerevisiae intervention for relieving flutamide-induced hepatotoxicity in male rats.

The aim of this work was to investigate the protective role of baker's yeast Saccharomyces cerevisiae against the hepatotoxic effect of the drug flutamide that is widely used for treatment of metastatic prostate adenocarcinoma. Administration of flutamide to adult male rats in a dose of 100 mg/kg b.w. daily for 15 days resulted in serious hepatic injury. Highly significant increase in each of serum ALT, ALP, bilirubin, bile acids and cholesterol level, relative to the control group, was observed. Also, a highly significant increase in the serum glutathione-S-transferase isoforms: alpha-GST and pi-GST and each of TNF-alpha and NO levels was recorded. Moreover, highly significant decrease in hepatic glutathione peroxidase and superoxide dismutase activities was observed. In addition, the authors noticed a significant increase in serum testosterone levels with concomitant highly significant increase in serum acid phosphatase activity. Prophylactic treatment of male rats with baker's yeast in a dose of 4.8 mg/kg b.w. daily for 15 days, followed by a combination of flutamide (100 mg/kg b.w.) and yeast (4.8 mg/kg b.w.) daily for other 15 days resulted in marked improvement in rat's liver function, whereas the serum testosterone and acid phosphatase levels retained values parallel to those recorded for the flutamide-treated rats. Histological examination of liver tissues showed that flutamide caused hydropic degeneration, necrotic areas and marked increase in Kupffer cells. The central vein is congested with blood and signs of apoptosis appeared in the hepatocytes in the form of fragmentation of the nuclei and blebbing of the cytoplasm. On the other hand, in the rats treated with both yeast and flutamide, the hepatic cords were more regularly arranged, signs of degeneration or apoptosis were less pronounced and some hepatocytes appeared binucleated. The authors postulate that each one of the powerful antioxidative components in S. cerevisiae effectively participated in attenuation of the oxidative stress caused by flutamide metabolites, and in promoting regeneration of new hepatocytes and meanwhile could restore liver function beyond normal status.

Superior compressive strength of a calcaneal fracture construct augmented with remodelable cancellous bone cement.

Twenty-six paired, fresh-frozen cadaveric feet were disarticulated at the ankle joint, and the dome of the talus was potted. Stress-risers were placed along the medial, lateral, and posterior aspects of the calcaneus, and the specimen was loaded rapidly to failure in a testing machine to produce a type-IIB displaced intra-articular fracture according to the classification system of Sanders et al. One specimen of each pair was treated with standard internal fixation with bone-grafting (the control group), and the other was treated with similar fixation but with SRS (Skeletal Repair System) calcium phosphate bone cement placed in any osseous defect. All of the specimens were cured for twenty-four hours in a bath of saline solution at 37 degrees Celsius. The specimens were tested cyclically for ten cycles from zero to 100 newtons at one hertz and for 1010 cycles from zero to 350 newtons at one hertz. The deformation per cycle (millimeters per cycle), first-cycle deformation (millimeters), number of cycles to failure, and number of specimens withstanding the cyclical testing were calculated. The specimens were examined radiographically before and after fracture and after reconstruction and testing. A large difference in the results of the cyclical testing was noted. The specimens that had been augmented with the SRS bone cement had an average deformation of 0.00195 millimeter per cycle compared with 1.013 millimeters per cycle in the control group (p < 0.005). A similar magnitude of difference was noted when the results were stratified for good and poor-quality bone. Visual examination and radiographs demonstrated that a type-IIB displaced intra-articular fracture had been created reproducibly, and computed tomographic scans showed that nearly anatomical reconstruction had been achieved in all of the specimens. The computerized tomographic scans revealed good filling of the osseous voids and no evidence of failure of the cement after cyclical loading.

Phase I study combining tumor necrosis factor with interferon-alpha and interleukin-2.

We evaluated the effects of the addition of escalating doses of tumor necrosis factor (TNF) to two fixed doses and schedules of a combination of interleukin-2 (IL-2) and interferon-alpha (IFN-alpha) to determine the maximum tolerated dose of this three-cytokine combination and its feasibility as an outpatient regimen. Eighteen patients with metastatic cancer were enrolled. Each course consisted of 3 consecutive weeks of treatment with IFN-alpha 9 x 10(6) IU/m2/day intramuscularly (i.m.) or subcutaneously (s.c.) days 1, 3, and 5 each week for 3 weeks plus IL-2 continuous infusion 1 x 10(6) IU/m2/day (group A) or 3 x 10(6) IU/m2/day (group B) days 1-5 each week for 3 weeks. TNF was administered only during the first week of each course intravenously (i.v.) for 2 h on days 1-5. The dose of TNF was escalated (40, 80, 120 micrograms/m2) in cohorts of 3 patients. The most common side effects were fever, chills, and fatigue in all patients. Grade 3-4 toxicity included anemia (3 patients), thrombocytopenia (1 patients), arrhythmia (2 patients), pulmonary edema (3 patients),- and weight loss (1 patient). Five patients withdrew from study due to toxicity. The combination of the three cytokines is feasible as an outpatient regimen in one of the following combinations: (a) TNF 80 micrograms/m2/day as 2-h infusion on days 1-5 + IL-2 1 x 10(6) IU/m2/day continuous infusion on days 1-5 for 3 weeks + IFN-alpha 9 x 10(6) IU/m2/day s.c. or i.m. on days 1, 3, and 5 for 3 weeks, or (b) TNF 40 micrograms/m2/day as a 2-h infusion on days 1-5 + IL-2 3 x 10(6) IU/m2/day continuous infusion on days 1-5 for 3 weeks + IFN-alpha 9 x 10(6) IU/m2/day s.c. or i.m. on days 1, 3, and 5 for 3 weeks.

Detection of mutant K-ras DNA in plasma or serum of patients with colorectal cancer.

Increased understanding of the molecular basis of colorectal cancer and recognition that extracellular DNA circulates in the plasma and serum of cancer patients enables new approaches to detection and monitoring. We used a polymerase chain reaction (PCR) assay to demonstrate mutant K-ras DNA in the plasma or serum of patients with colorectal cancer. Plasma or serum was fractionated from the blood of 31 patients with metastatic or unresected colorectal cancer and from 28 normal volunteers. DNA was extracted using either a sodium chloride or a gelatin precipitation method and then amplified in a two-stage PCR assay using selective restriction enzyme digestion to enrich for mutant K-ras DNA. Mutant K-ras DNA was detected in the plasma or serum of 12 (39%) patients, all confirmed by sequencing, but was not detected in any of the normal volunteers. K-ras mutations were detected in plasma or serum regardless of sex, primary tumour location, principal site of metastasis or proximity of chemotherapy and surgery to blood sampling. Tumour specimens available for 19 of the patients were additionally assayed for ras mutations and compared with blood specimens. Our results indicate mutant K-ras DNA is readily detectable by PCR in the plasma or serum of patients with advanced colorectal cancer. Thus, plasma- or serum-based nucleic acid amplification assays may provide a valuable method of monitoring and potentially detecting colorectal cancer.

Lipid composition and de novo cholesterogenesis in normal and neoplastic rat mammary tissues.

Female Wistar rats were given 5 mg of 7,12-dimethylbenz[a]anthracene (DMBA) and fed either a control diet (AIN), a 4% cholestyramine (CHST) diet, a 2% corn oil plus 18% coconut oil (saturated fat) diet, a 20% corn oil [unsaturated fatty acid (USF)] diet, or a USF + 4% cholestyramine (USF + CHST) diet. The mammary glands, tumors, livers, and sera were analyzed for lipids, de novo cholesterogenesis, and serum lecithin-cholesterol acyltransferase (LCAT) activity levels. Level and type of fat in the diet, DMBA, CHST, and length of feeding influenced the lipid composition of liver and mammary tissues. Stimulation of de novo cholesterogenesis in the mammary gland and depression in circulating LCAT activity levels correlated with the incidence and growth of mammary tumors, suggesting that stimulation of de novo cholesterogenesis plays an important role in mammary cancer development.

Cholestyramine promotes 7,12-dimethylbenzanthracene induced mammary cancer in Wistar rats.

The promotion of 7,12-dimethylbenzanthracene (DMBA) induced mammary cancer in Wistar rats by a 4% cholestyramine (CHST) diet was investigated. The rats, 50 days of age, were divided into six groups. First two groups were given an intragastric dose of 0.8 ml of corn oil whereas the remaining four groups were given a single intragastric dose of 5 mg of DMBA dissolved in 0.8 ml of corn oil. After 1 week on laboratory chow the first two groups and two groups treated with DMBA were fed a control diet and the two remaining groups treated with DMBA were fed a 4% CHST diet. Half the animals were killed at 100 days and the remainder at 200 days. A detailed histologic examination of grossly normal mammary tissue as well as any tumour mass was made for each rat. The serum lipids were extracted and the individual neutral lipid composition was determined. In rats treated with DMBA and fed a 4% CHST diet, the incidence of malignant tumours increased by 5 fold, and the tumour weight by 12 fold. In addition, the serum total lipids, cholesterol esters and triglycerides decreased significantly when compared with rats fed a control diet. These results suggest that CHST diet promotes DMBA induced mammary cancers in Wistar rats.

Acinar cell carcinoma of rat pancreas: regulation of cholesterol esterification.

The regulation of cholesterol esterification during cell proliferation was studied. The serum free cholesterol, cholesterol esters and lecithin: cholesterol acyltransferase (LCAT) activity of nude mice with and without pancreatic acinar cell tumours and rats with proliferating tissues were determined. In addition, the apparent activity of acyl-CoA: cholesterol acyltransferase (ACAT) in homogenates of nude mouse tumours and proliferating rat tissues were determined and compared with those of normal nude mouse and rat tissues. Serum cholesterol ester levels were significantly lower in host nude mice with tumours and in rats with regenerating liver, and increased significantly in pregnant rats when compared with respective controls. Circulating LCAT activity levels decreased in host nude mice, in pregnant rats, and in rats with regenerating pancreas and regenerating liver. Apparent ACAT activity levels increased significantly in nude mouse tumours and in foetal and postnatal rat pancreata and also in postnatal liver. At the same time, apparent ACAT activity levels decreased in foetal and regenerating rat livers when compared with respective control tissues. These results suggest that serum cholesterol esters, circulating LCAT and cellular ACAT levels are modulated during cell proliferation.