Poisson, acides gras oméga 3 et risque cardiovasculaire : données épidémiologiques

Thirty years ago Bang and Dyerberg have found for the first time an inverse relation between the low coronary heart disease rate and the high fish and marine products consumption in Eskimos and to this high long chain omega 3 fatty acids content. Then, almost all the epidemiological studies (ecological studies, case-control studies, prospective studies) have shown that a small intake of fish (one or twice a week), fatty fish mainly, was linked to a low cardiovascular mortality and morbidity, without a greatest benefit of an higher consumption. This effect disappears on some conditions as a simultaneous high mercury intake. Epidemiological studies have also shown a correlation between omega 3 fatty acids and increase of HDL cholesterol and decrease of triglycerides.Interventional studies in secondary prevention have confirmed that there is a causal relationship between the omega 3 fatty acids intake and a short term reduction in cardiovascular mortality mainly on sudden death. This suggests that the involved mechanism is due to an improve in thrombosis risk through prostaglandins and its effects on platelet aggregation and to a decrease of arrhythmia correlated to the omega 3 phospholipid tissue incorporation.     

Actualités épidémiologiques de la leishmaniose viscérale en Tunisie

Objective

Visceral leishmaniasis is an important health problem in Tunisia. The aim of this study was to update the epidemiological and clinical features of the disease.

Design

We performed a retrospective systematic sampling of epidemiological and clinical data collected from the medical records of 1,096 cases of visceral leishmaniasis diagnosed between 1996 and 2006 all over the country.

Results

The mean annual incidence of cases was 99.6 cases/year. The mean annual incidence rate was 1.04 cases/100,000 inhabitants, showing an important increase compared to former studies. As expected, children under 5 years (866 cases) were the most affected with a mean annual incidence rate of 9.6 cases/100,000 (p < 0.001). The geographical distribution of cases revealed the spreading of the disease from the Northern parts of the country to the Central and even to Southern ones. Rural cases (65.3%) were significantly more numerous than urban ones (34.7%), p < 0.001. The sex ratio was 1.03. The diagnostic delay (average of 54 days) was considerably shortened during the study period compared to previous reports, and explains the decrease of the lethality rate (2.9%).

Conclusions

Visceral leishmaniasis has been present in central Tunisia since the early 1990s. Its incidence and the distribution area have increased. This evolution is probably linked to the development of irrigation and agriculture favorable to the multiplication of vector sandflies and dogs reservoirs of Leishmania infantum.     

Épidémiologie de la tuberculose en Bretagne : les cas déclarés entre 2000 et 2007

The authors studied the reported cases of tuberculosis diseases in Brittany between 2000 and 2007 via the mandatory notification scheme. One thousand nine hundred and seventy-five cases were notified during the study period. The incidence in French Brittany (eight cases per 100,000) was the third highest in France. A statistically significant negative trend was observed later, mainly attributable to a decrease between 2000 and 2001. The mean patient age at notification was 55 in Brittany versus 46 years of age for the rest of France (p < 0.001). Eighty per cent of the patients were born in France versus 46% for the rest of the country. The rate of multiresistance to antibiotics was 1.3% versus 4.6% for the rest of France (p < 0.001). The estimated completeness of notification was 80% compared to 70% for the whole country. Despite a decrease of tuberculosis incidence in Brittany, the withdrawal of mandatory vaccination suggests strengthening tuberculosis monitoring in the future.     

Impact de la vaccination de routine de l’enfant contre la varicelle sur l’épidémiologie du zona

Objective

This literature review addresses the following question: what elements point to an impact of routine chicken pox vaccination of children on the incidence of shingles?

Design

The search strategy involved an electronic search (Medline database via PubMed) and crossed references. Articles were selected by reading their abstracts.

Results

There were few published studies dealing with the question. A total of 13 publications reported seven longitudinal studies on the incidence of shingles and six mathematical models. The population studies were all American, and reported discordant results, four reporting an increase, and three, stability in the incidence of shingles. Four of the six mathematical models concerned the impact of routine chicken pox vaccination on shingles epidemiology. All showed a transitory short-term increase in the incidence of shingles (on condition that vaccine was effective and coverage high) and a long-term incidence of shingles lower than the current rate.

Conclusions

The currently available data is insufficient for any conclusion to be drawn as to the impact of routine pediatric chicken pox vaccination on the incidence of shingles. Monitoring the incidence of shingles in countries either recommending or not such vaccination should be maintained.     

Orion (Outbreak Reports and Intervention Studies of Nosocomial Infection) pour l’évaluation des interventions et des investigations d’épidémie dans le domaine des infections nosocomiales

Introduction

British colleagues have developed the Outbreak Reports and Intervention studies of Nosocomial Infection (Orion) guidelines with the aim to promote transparency of publications in the field of health-care associated infections and particularly for reports of outbreak investigation or intervention studies. The aim of this study was to translate the Orion criteria and to promote their use in France.

Results

The Orion guidelines include a checklist of 22 commented items related to the title, abstract, introduction, methods, results, and discussion sections of a scientific article. Specific points for each item are developed to enhance its relevance.

Conclusion

The use of Orion guidelines by authors and editors should be encouraged and should improve the quality of standards in research, intervention studies, and publications on nosocomial infections and health-care associated infections.     

Consommation d’huiles et matières grasses en France : relations avec le niveau d’étude et la région de résidence dans la cohorte SU.VI.MAX

The relationships between intake of added oils and fats with region of residence and educational level were also assessed. Our objective was to describe the relative contribution of ten created food groups to total fat intake in middle-aged subjects.Subjects were participants of the SU.VI.MAX study who completed at least six 24-h dietary records after inclusion into the study (n=6572).Added oils and fats were the main source of total fat intake. Animal fat (AF) and margarine intakes showed a significant inverse association with educational level, whereas oils with mono-unsaturated fatty acids (MUFA) were positively associated with education level. AF intake was significantly higher in the Western and Northern parts of France (54.2 and 50.4%) and lower in the Mediterranean Coast (39.0%). A significant inverse gradient was found with oils with poly-unsaturated fatty acids (PUFA) or MUFA in the Southwest and the Mediterranean Coast compared to the Northern part of France.We showed a north to south gradient for animal fat intake and the opposite for oils with MUFA and PUFA in France This gradient parallels the known disparities for cardiovascular mortality in this country. This should contribute to adapt dietary guidelines for dietary change in a public-health perspective.     

Surveillance épidémiologique de la rage humaine dans un contexte d’endémie de rage canine en Cote d’Ivoire

Aim

The objective of this study was to analyze the epidemiologic monitoring of human rabies in the rabies medical center of Abidjan.

Patient

A cross-sectional study was undertaken based on files of patients having consulted in the rabies center after exposure and suspicion of human rabies between January 2001 and June 2009.

Results

Twenty-six cases of human rabies were reported in 10,706,136 inhabitants (annual incidence of 0.028 cases per 100,000). The number of detected cases increased considerably after reinforcing the monitoring of the disease. Most cases occurred in an urban environment and concerned both sexes. The most concerned age range was under 31 years. The patients’ were mostly school children and housewives. In all cases, the rabid animal was a dog and the type of exposure was a bite. Fifty-six percent of the victims had not received any local treatment and almost all no post-exposure prophylaxis. The mean delay before the first symptoms was 49.5 days after exposure and for death, 4 days after the onset of symptoms. Virological diagnosis was made in four cases.

Conclusion

In spite of the increase of cases observed since 2006, certainly due to reinforcement of the monitoring network, improvement is needed to assess the real incidence of rabies in the Ivory Coast.     

Bactériémies à Kluyvera : à propos d’une épidémie dans un CHU au Maroc

Kluyvera Spp is an enterobacterium rarely isolated in medical microbiology, an opportunistic pathogen the clinical significance of which remains unclear. Four strains of Kluyvera Spp were isolated for the first time in the Ibn Rochd Teaching Hospital microbiology laboratory. These strains were isolated in hemocultures of four patients hospitalized in the same medical ward, at the same time, and presenting with bacteriemia. An antibiotic susceptibility study allowed identifying the wild phenotype in the first isolate, the three next isolates had acquired resistance to trimethoprim-sulfamethoxazole, gentamycin, tobramycin, and ciprofloxacin, and produced broad-spectrum betalactamase. The epidemiological investigation in the patients’ environment made after isolating the fourth strain was negative. The four patients evolved uneventfully without antibiotic treatment. This raises the question of the real pathogenic capacity of these strains, their epidemic power, and their ability to acquire resistance.     

Consommation de fruits et légumes et risque d’accident vasculaire cérébral et cardiaque : méta-analyse des études épidémiologiques prospectives

Background

Fruit and vegetable consumption is recommended for prevention of cardiovascular disease.

Objective

To summarize evidence from prospective studies on fruit and vegetable intake and risk of strokes or coronary heart disease (CAD) DESIGN: Results from cohort studies were collected by a MEDLINE search and pooled in a meta-analysis.

Results

The RR of stroke is 0.95 [0.92-0.97] and the RR of CAD is 0.98 [0.96-0.99] for one additional portion per day of “fruits and vegetables”. The RR of stroke is 0.90 [0.86-0.95] and the RR of CAD is 0.92 [0.89-0.96] one additional portion per day of fruit. Finally, the RR of stroke is 0.97 [0.92-1.02] and the RR of CAD is 0.94 [0.91-0.97] one additional portion per day of vegetables.

Conclusions

These results show an inverse association between “fruits and vegetables” intake and stroke or CAD. However the lack of any nutritional trial preclude any conclusion on the putative mechanisms of the relationship.     

De l’épizootie à l’épidémie : perception et gestion d’un risque dans l’ancien régime

Recent events, from mad cow disease to bird flu, suggest that modern societies are exposed to novel food-associated risks. This impression of novelty is illusory. History has been marked by several alimentary crises, among which critical situations associated with meat intake during times of epizooties. The first of such crises that was well documented, thanks to physicians’ reports, was the cattle plague that spread over Europe in the years 1711-1714. In France and Italy, it thus becomes possible to analyze reactions to animal disease, in particular among consumers and public authorities. In all cases, a hyper-responsiveness is noted to potential dangers associated with meat, in line with the intellectual context of the time: limited scientific knowledge, and also popular representations of nutrition. While concerns are shared, prevention policies vary in different places. Individual behaviors as well as public policies are rational, aiming to establish a favorable risk to benefit ratio, given that a “no risk” situation cannot be obtained.     

Phytoestrogènes et os : de nouvelles données

Osteoporosis is a greater public health problem.Ecological studies have shown that femoral neck fractures was lesser in asian populations.It has been suggested that diet might play a role in this observation. Among foods, soybean and soyfoods seemed able to play this role because of their isoflavones content. They are experimentally weak estrogens which may bind to bone estrogen receptors (β especially). They also probably act through others mechanisms such as enzymes, particularly tyrosine kinase.In vitro studies and in vivo studies in animal models and in humans have shown two kinds of effects, a bone resorption inhibiting effect and a bone formation stimulating effect. A beneficial effect is not observed in non human female primate.Observational studies give inconsistent results, according to age, kind of bone, population, isoflavones dosage. Asian epidemiologic studies, and in a lesser extend western studies, show within these populations a positive correlation between isoflavones intakes and bone mineral density. Recently a Chinese prospective study has established a relationship between isoflavones intakes and bone fracture during a four years follow-up.Some clinical trials with defectives methodology demonstrate a lack of effect on bone mineral density; most of clinical trials show favourable results on femoral and spinal bone mineral density, sometimes on forearm, never of calcaneum. Two recent studies with red clover are also positive. Results in clinical trials are provided with higher dosages than in epidemiologic studies. The variability of observed effects could be due to producers or non-equol producers. These data are discussed.However we are still lacking for histological and histomorphometric data and for clinical trials on the fractures’ risk.To-day phytoestrogens cannot be considered as an anti-osteoporotic treatment. But it is not excluded than soy and/or soy isoflavones may become future means used in bone-loss prevention.     

Détection et quantification des infections génitales à papillomavirus humains : conséquences virologiques, épidémiologiques et cliniques

Human papillomaviruses (HPV) are the main risk factor for cervical cancer. By introducing its DNA into the genome of infected human cells, the virus expresses two oncoproteins (E6 and E7) that induce inactivation of tumour suppressors and telomerase. HPV infection is extremely common. But most of women will clear the infection over an 8-10-month period without developing any cervical lesion. In fact, it is the persistence of infection that truly exposes to the risk of cervical cancer. HPV testing, used for primary screening, has better sensitivity but lower specificity than cervical cytology. A secondary use of cytology would compensate the loss of HPV testing specificity. Thus, cervical cytology would be performed only in HPV positive women and colposcopy finally performed only in women with abnormal cytology. The characteristics of such screening would allow to increase interscreening intervals and therefore to reduce additional costs. The quantification of HPV viral load could be a way to differentiate significant infections from others. Despite proven significant association between high HPV viral load and the risk of CIN 2-3 and cervical cancer, crude variations within disease grades currently limit the clinical utility of viral load measurement. More than a just measure of HPV viral load, its evolution over time is what would really be of clinical relevance.     

La restauration en milieu scolaire : état des lieux en région Rhône-Alpes

A survey on school lunches has been carried out in primary and secondary schools in the Rhone Alpes area to assess if dietary guidelines of June 25^th 2001 French regulation are well applied or not and to try to identify the difficulties encountered.The results of the surveys which have been mailed to school administrators and the analysis of meals composition show that these guidelines are little applied in secondary schools and in primary schools of small towns, while big cities are able to propose better balanced lunches.In secondary schools, lunch time very often takes less than 30 minutes, and there are too many “à la carte” menus which are not favourable especially considering the low level of nutritional information given to pupils.In all school settings, the following points can be considered as well-controlled: the availability of bread, no soft drinks during lunch and a good frequency of raw fruits and vegetables. Weak points to be improved concern too many high fat protein foods and a lack of fish and of high calcium level dairy products.     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Le registre des cas de tuberculose signalés par l’ANAEM 2006

A yearly TB case collection system, in the form of a register, was implemented by the former International Immigration Agency (OMI) and continued by the National Agency for Foreigners and Immigrants (ANAEM). Year after year, it gives remarkably coherent results. The 2006 inquiry concerned 653 cases with a strongly male sex ratio. This male trend is sharply more marked than in the control samples in “given week” studies. The 653 cases were distributed in 440 sequel cases (62.9%) and 143 evolutive cases (21.9%), (unknown: 15.3%). The populations investigated during the “given week” and for the register differ strikingly: in their age distribution: the populations investigated for the register were much younger, especially those with contagious forms; by their geographical origin: sub-Saharan Africans and Asians were strongly overrepresented even more for contagious tuberculosis; in their mode of entrance to France as legal immigrants: family patterns prevail, students are very under represented. In 88.6% of the cases, the screening was based on radiology alone and in 8.2% of the cases radiology was correlated to the clinical examination. In 19% of the cases, the diagnosis of evolutive and contagious TB was proved after isolating BK. In 13%, the diagnosis was suggested by a treatment with two major ATB. The ratio sequel TB/contagious and evolutive TB has not changed much since 2001.