Trends in incidence and early outcomes in a Black Afro-Caribbean population from 1999 to 2012: Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents Vasculaires Cérébraux II Study.

BACKGROUND AND PURPOSE: Seldom studies are available on trends in stroke incidence in blacks. We aimed to evaluate whether stroke risk prevention policies modified first-ever stroke incidence and outcomes in the black Afro-Caribbean population of Martinique. METHODS: Etude Réalisée en Martinique et Centrée sur l'Incidence des Accidents Vasculaires Cérébraux (ERMANCIA) I and II are 2 sequential prospective population-based epidemiological studies. There have assessed temporal trends in first-ever stroke incidence, risk factors, pathological types, and early outcomes in the black Afro-Caribbean population of Martinique comparing two 12-month periods (1998-1999 and 2011-2012). Crude and age-standardized incidence and 30-day outcomes for stroke in the 2 study periods were compared using Poisson regression. RESULTS: We identified 580 and 544 first-ever strokes in the 2 studies. World age-standardized incidence rates decreased by 30.6% in overall (111 [95% confidence interval, 102-120] versus 77 [95% confidence interval, 70-84]). Rate decline was greater in women than in men (34% versus 26%) particularly in women aged 65 to 74 years (-69%) and 75 to 84 years (-43%). Frequencies of hypertension and diabetes mellitus were unchanged, whereas dyslipidemia, smoking, and atrial fibrillation significantly increased. Only ischemic stroke types showed significant rate reduction in overall and in women, incidence rate ratio (95% confidence intervals) of 0.69 (0.50-0.97) and 0.61 (0.42-0.88), respectively. The overall 30-day case-fatality ratio remained stable (19.3%/17.6%), whereas a better 30-day outcome was found (modified Rankin Score, ≤2 in 47%/37.6%; P=0.03). CONCLUSIONS: Over 13 years, there has been a significant decrease (30.6%) in the age-specific first-ever stroke incidence in our Afro-Carribean population. Although prevention policies seem effective, we need to focus on new risk factors limitation and on male population adherence to prevention program.

Dengue surveillance in the French armed forces: a dengue sentinel surveillance system in countries without efficient local epidemiological surveillance.

Surveillance of travel-acquired dengue could improve dengue risk estimation in countries without ability. Surveillance in the French army in 2010 to 2011 highlighted 330 dengue cases, mainly in French West Indies and Guiana: DENV-1 circulated in Guadeloupe, Martinique, French Guiana, New Caledonia, Djibouti; DENV-3 in Mayotte and Djibouti; and DENV-4 in French Guiana.

Postcolonial Freud: psychoanalysis in the French Antilles.

While Martinique and Guadeloupe were assimilated into the French state in 1946, traces of colonial power relations and economic structures persist despite the islands' current status as French 'départements' equal to any other. This article examines the contributions of Freud's thought to the shift in critical perspective that has allowed the continued "colonial" status of these islands, and the cultural alienation of its people, to be identified as a problem or phenomenon requiring analysis and rectification. Speaking of "postcolonial Freud" in this context is tantamount to asking: which postcolony for the French Antillean future, and which Freud for the thought emerging from this space?

Jean-Baptiste Labat and the buccaneer barbecue in seventeenth-century Martinique.

If, as the sociologist Pierre L. van den Berghe has suggested, cuisine is a significant expression of man's sociability, one might say that the seventeenth-century missionary Jean-Baptiste Labat was the single most social animal in the Caribbean islands in the 1690s. Although his primary responsibility on the island of Martinique was to serve the island's multiethnic population as a spiritual leader, le père Labat's memoirs chronicle the diverse culinary experiences of the missionary as he literally eats his way around the island, learning to prepare such delicacies as cocoa confit, roasted manatee, lizard en brochette, and parakeet en daube. Positing his unbridled interest in the culinary arts as a mark of his "obedience" to the duties assigned him as missionary, Labat's taxonomy of island delicacies and exotic tastes no doubt titillated the curiosity of his mainland readers while nevertheless grounding itself strongly in the values of order, authenticity, and industry so essential to Labat's apostolic mission. This article focuses on two "buccaneer barbecues" as examples of gastronomical experiences through which Labat was able to construct and negotiate new social, cultural, and symbolic meanings, exploring identity politics through the frame of the culinary arts in seventeenth-century Martinique.

Is African descent an independent risk factor of peripartum cardiomyopathy?

Risk factors for peripartum cardiomyopathy (PPCM) are controversial. PPCM seems to be more prevalent in women of African descent, the highest observed incidence is in Haiti (1 per 300 live births). Our retrospective study conducted in Martinique showed an incidence of 1 per 5500 live births. This incidence is significantly lower than in Haiti. Women from Martinique and Haiti do not differ for most classical risk factors: African descent, age, pregnancy-associated hypertension, multiple pregnancy and pre-eclampsia. However, the parity rate and the socioeconomic level are different. Thus, African descent could be confounded by high parity rate and socioeconomic status.

Evaluation of the 2005 McDonald MRI criteria for dissemination in space in Afro-Caribbean patients with clinically isolated syndromes.

BACKGROUND: In 2005, the McDonald MRI criteria for dissemination in space were revised to improve diagnosis of multiple sclerosis (MS) in non-Caucasians. METHODS: We included patients with a first clinically isolated syndrome (CIS) to assess their performance in the Afro-Caribbean population. Baseline brain and spine MRI examinations were available within 3 months after onset of CIS. The development of a second clinical event was used as the main outcome indicating clinically definite MS. RESULTS: A total of 66 patients (52F/14M) were included between January 1998 and January 2008 (mean age: 34.7; median follow-up: 34 months). CIS was classified as spinal cord (30.3%), optic neuritis (28.8%), brainstem (24.2%), multiregional (10.6%), hemispheric (4.5%), or undetermined (1.5%). Overall conversion rate was 42.4% (median: 11 months). The McDonald criteria revised for dissemination in space were fulfilled in 33.3% (sensitivity: 0.39 (+/-0.18); specificity: 0.66 (+/-0.15), positive predictive value: 0.46 (+/-0.20), negative predictive value: 0.60 (+/-0.15). CONCLUSION: The Afro-Caribbean population is characterized by a strong proportion of CIS in the spinal cord and a lower burden of disease on the baseline brain MRI. This may explain the low sensitivity of the 2005 McDonald criteria for dissemination in space. Further prospective studies emphasizing MRI spinal cord features are needed to improve diagnostic criteria in a population of African descent.

[Thyrotoxic periodic paralysis: two new cases in Blacks]. / Paralysie périodique thyréotoxique: deux nouveaux cas chez des patients de race noire.

INTRODUCTION: Thyreotoxic hypokalemic periodic paralysis (THPP) has mainly been described in Asian people. It is rare in Caucasians, and only 12 cases were reported in Blacks. EXEGESIS: We report two cases of THPP in black patients. Hypokalemia was important in case number 1, leading to severe flaccid tetraplegia with respiratory and cardiac complications, but was only mild in case number 2. Complete relief of paralysis was observed under potassic treatment in the first case and spontaneously in the second one. Hyperthyroidism was established only on the basis of biological tests in case number 1, and had been previously diagnosed but undertreated in case number 2. CONCLUSION: Whatever the patient's race, acute paralysis with hypokalemia requires testing for hyperthyroidism, even in the absence of suggestive clinical signs.

Ossification of the ligamenta flava with severe myelopathy in a black patient. A case report.

STUDY DESIGN: A case of symptomatic ossification of ligamenta flava in a black man from Martinique (French West Indies) is reported. OBJECTIVES: To show that ossification of ligamenta flava may be observed in racial groups other than Japanese people and that the postoperative prognosis of symptomatic ossification of ligamenta flava is not always excellent. SUMMARY OF BACKGROUND DATA: Ossification of ligamenta flava causing slowly progressive myelopathy or radiculopathy is rare. It usually occurs in the lower thoracic spine. Ossification of ligamenta flava has mainly been described as occurring in Japanese people and very rarely in Caucasians. Diagnosis is based on a computed tomographic scan or magnetic resonance imaging, and postoperative prognosis is usually good. METHODS: Low thoracic ossification of ligamenta flava was diagnosed in a black man from Martinique, based on the computed tomographic scan data and on the histopathologic examination of the removed tissue. The patient was clinically evaluated before and 1 year after the operation. A postoperative computed tomographic scan was performed. A magnetic resonance image was not available in this case. RESULTS: The patient exhibited severe subacute myelopathy. After decompression, the neurologic recovery was incomplete. A postoperative computed tomographic scan showed complete excision of ossification of ligamenta flava and decompression of the spinal cord. CONCLUSIONS: Ossification of ligamenta flava may occur in black people. An incomplete postoperative recovery may be observed in such cases of unusual subacute compressive myelopathy.

[Sjögren's syndrome and HTLV-I myelopathy]. / Syndrome de Sjögren et myélopathie HTLV-I.

The objective of this study is to describe the clinical and immunological aspects observed in patients with both "tropical spastic paraparesis/HTLV-I associated myelopathy" (TSP/HAM) and ocular dryness. In 10 such patients clinical and biological examinations completed with a biopsy of secondary salivary glands were performed to assess the etiology of the ocular dryness. According to the Chisholm's scale, 70% of the patients had a biopsy grade 3 or grade 4. Polyclonal hypergammaglobulinemia was found in 90% of patients and lymphocytic alveolitis in 80%. Three patients had past medical history of chronic uveltis. All the findings were compatible with Sjögren's syndrome, however no characteristic immunological disorders were found. Antinuclear antibodies and rheumatoid factor proved negative in all cases.

Sex ratio of human T-lymphotropic virus type I infection and blood transfusion.

The prevalence of human T-lymphotropic virus type I (HTLV-I) infection is higher for females than for males. Blood transfusion is a potential confounding factor which might contribute to this high female:male ratio. Two studies were performed in Martinique (French West Indies) to clarify this issue: a case-control survey comparing the experience of previous blood transfusion among 62 HTLV-I-seropositive and 88 HTLV-I-seronegative blood donors, and a retrospective study of the sex of recipients of blood. Blood transfusion was strongly associated with HTLV-I infection (odds ratio = 6.4, p less than 0.001). Females were more often given blood transfusions (57.9 percent, p less than 0.001) and received a higher percentage of blood units (53.5 percent, p less than 0.05) than could be expected from their proportion in the general population (51.6 percent). Thus, the high female:male sex ratio of HTLV-I-infected subjects might be due partially to a sex difference for blood transfusion.

Characterization of HTLV-I isolates and T lymphoid cell lines derived from French West Indian patients with tropical spastic paraparesis.

Lymphoid cell lines derived from the peripheral blood of French West Indian patients with HTLV-I sero-positive Tropical Spastic Paraparesis and HTLV-I isolates were characterized. While patients' peripheral blood lymphocytes did not express detectable HTLV-I antigens when uncultured, they did so after short-term culture. Established cell lines were of T-cell lineage: CD2+, CD3+, CD4+, CD7+, WT31+ with activated T-cell markers CD25+, DR+ and a clonal rearrangement of the beta and gamma genes of the T-cell receptor. HTLV-I antigens were detected in cell lines by indirect immunofluorescence, Western blot and radio-immunoprecipitation assays. After 4 months in culture, low levels of Mg2+ dependent reverse transcriptase activity were detected and electron microscopy revealed numerous type-C retroviral particles similar to HTLV-I virions. Western blot and radio-immunoprecipitation analysis of purified viruses revealed gp46, p24, p19 and Pr53gag proteins similar to those detected in HUT 102 and MT2 cell lines. Deep analysis of env-coded precursor of one TSP versus ATL isolates revealed minor differences in their molecular weights. Southern blot analysis using 32P HTLV-I env gene as a probe showed the presence of HTLV-I proviral fragments clonally integrated into the genome of the cell lines. Our data suggest that HTLV-I isolated from Tropical Spastic Paraparesis does not differ significantly from the leukemogenic prototypes. Does HTLV-I induce either acute lymphoproliferative diseases or chronic neuromyelopathies depending upon as yet unknown co-factors? This question remains to be determined.

[Current risks in the introduction of schistosomiasis into French Guiana]. / Les risques actuels de l'introduction de la schistosomiase en Guyane francaise.

At the moment, it seems unlikely that there is a possibility for schistosomiasis implantation in French Guiana. The reasons to this are both the number of the immigrants infested by Schistosoma mansoni which is quite low and the disappearance of the intermediate host Biomphalaria glabrata. The disappearance of the species may be a temporary one.

Ethnic difference in duration of pregnancy.

It is suggested that the observed difference in duration of pregnancy between Blacks and Whites is partly physiological since it is not entirely explained by social inequities alone. This study compares women with well-defined gestational periods seeking attention at the Antoine Béclère Maternity Clinic. Group A consists of French women of European ancestry, Group B, those born in the French Antilles of mixed ancestry, and Group C black African women with insignificant European admixture. When compared to Group A, within each socio-economic class, group B and C have shorter gestational periods. These differences persist after adjustment for socio-economic variables, so that other explanations should be considered, specifically genetic determinants.

Ethnic difference in duration of pregnancy

It is suggested that the observed difference in duration of pregnancy between Blacks and Whites is partly physiological since it is not entirely explained by social inequities alone. This study compare women with well-defined gestational periods seeking attention at the Antoine Beclere Maternity Clinic . Group A consist of French women of European ancestry, Group B, those born in the French Antilles of mixed ancestry, and Group C Black African women with insignificant European admixture. When compared to Group A, within each socio-economic class, group B and C have shorter gestational periods. These differences persist after adjustment for socio-economic variables, so that other explanations should be considered, specifically genetic determinants.(AU)