Current practice of epidemiology in Africa: highlights of the 3rd conference of the African epidemiological association and 1st conference of the Cameroon society of epidemiology, Yaoundé, Cameroon, 2014

As the study of disease occurrence and health indicators in human populations, Epidemiology is a dynamic field that evolves with time and geographical context. In order to update African health workers on current epidemiological practices and to draw awareness of early career epidemiologists on concepts and opportunities in the field, the 3rd African Epidemiology Association and the 1st Cameroon Society of Epidemiology Conference was organized in June 2-6, 2014 at the Yaoundé Mont Febe Hotel, in Cameroon. Under the theme«Practice of Epidemiology in Africa: Stakes, Challenges and Perspectives», the conference attracted close to five hundred guest and participants from all continents. The two main programs were the pre-conference course for capacity building of African Early Career epidemiologists, and the conference itself, providing a forum for scientific exchanges on recent epidemiological concepts, encouraging the use of epidemiological methods in studying large disease burden and neglected tropical diseases; and highlighting existing opportunities

Influence of breast milk bacteria on breast milk macronutrient levels during lactation

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Influence of breast milk bacteria on breast milk macronutrient levels during lactation

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Blood product transfusions are associated with an increase in serum (1-3)-beta-d-glucan in infants during the initial hospitalization in neonatal intensive care unit (NICU)

International audienceIntroduction: Serum (1-3)-beta-d-glucan (BDG) assay has been proposed as an adjunct for the rapid diagnosis of invasive fungal infection (IFI). However, false-positive results have been reported following transfusion of blood products in adults. Aims: To assess the relationship between blood product transfusion and elevated BDG in neonates. Method: Retrospective study including neonates 32 weeks, with no fungal colonization or infection, in whom BDG assay was performed for suspicion of IFI. Patients were classified in Transfusion (n=78) and No Transfusion (n=55) groups depending on whether or not they were transfused. Clinical, biochemical and microbiological characteristics were recorded. A BDG assay >80pg/mL was considered as positive. Statistical analyses: bivariate and multivariate logistic regression. Results (median, IQR): One hundred and thirty-three infants were included (gestational age 28.4 weeks, 26.9-30; birth weight 1000g, 847-1300). BDG was higher in the Transfusion group (170pg/mL, 65-317) than in the No Transfusion group (57pg/mL, 34-108; p<0.001). False-positive BDG assay results were associated with red blood cells (RBC) and fresh frozen plasma (FFP) transfusions. Conclusion: BDG is increased after RBC and FFP transfusions in neonates, leading to overdiagnosis of IFI. Fungal colonization status in peripheral sites and central cultures could help to reduce the risk of misdiagnosis

Polyethylene bag wrapping to prevent hypothermia during percutaneous central venous catheter insertion in the preterm newborn under 32 weeks of gestation

International audienceAim: In preterm neonates, during nursing procedures, body temperature decreases. This study evaluates the interest of polyethylene bag wrapping to prevent this decrease during percutaneous central venous catheter (PCVC) insertion procedure, in preterm neonates under 32 weeks of gestation nursed in closed incubators. Methods: This prospective observational study compared two periods: [May 2009-September 2009]: ``without polyethylene bag wrapping'' and [October 2009-March 2010]: ``with polyethylene bag wrapping''. The main criterion was newborn skin temperature at the end of the procedure. Results: There was no difference between the two groups for skin temperature before the procedure (36.9 +/- 0.3 degrees C versus 36.9 +/- 0.3 degrees C; p = NS). The skin temperature at the end of the procedure was lower in the ``without bag wrapping'' group (36.0 +/- 0.5 degrees C) compared to the ``bag wrapping'' group (36.4 degrees C +/- 0.5 degrees C; p = 0.01). Furthermore, no skin temperature at the end was higher than 37.4 degrees C in the bag wrapping group. Conclusion: The use of a polyethylene bag was effective in decreasing skin temperature fall during a PCVC insertion procedure in our population. No side effects were observed. The benefit of prolonged wrapping or for shorter procedure should be evaluated

Evaluation of the (1,3)-beta-D-glucan assay for the diagnosis of neonatal invasive yeast infections

International audienceMost newborns in the neonatal intensive care unit (NICU) are premature and at risk of invasive fungal infections (IFIs). Invasive yeast infections (IYIs) are the most common fungal infections in this population. These infections are difficult to diagnose because symptoms are nonspecific, and the sensitivity of blood cultures is low. The serum (1,3)-beta-D-glucan (BDG) assay provides a reliable marker for the diagnosis of IFIs in adults with haematological malignancies. We assessed the diagnostic performance of this test in neonatal IYIs and its contribution to the monitoring of antifungal treatment. A retrospective study was performed in the NICU of the French University Hospital of Amiens from February 2012 to February 2014. Forty-seven neonates (33 males, 14 females) with a median gestational age of 30 weeks (IQR: 27-31) and median birth weight of 1200 g (IQR: 968-1700) were included and divided into three groups: 21 control neonates (CTRL), 20 neonates with probable IYI (PB), and six with proven IYI (PV). Median BDG levels were significantly higher in the global IYI group (PB + PV): 149 pg/ml (IQR: 85-364) vs. CTRL group: 39 pg/ml (IQR: 20-94) (P < .001). The optimal cut-off was 106 pg/ml (sensitivity 61.5%; specificity 81%). BDG levels decreased with antifungal treatment. BDG was detectable in cerebrospinal fluid, but the interest of this for diagnostic purposes remains unclear. Our results suggest that the BDG assay may be useful for the early identification of IYIs in neonates and for monitoring antifungal therapy efficacy

Caffeine citrate effects on gastrointestinal permeability, bacterial translocation and biochemical parameters in newborn rats after long-term oral administration

International audienceBACKGROUND: Caffeine is a potent central and respiratory acting agent used in neonatology to treat apnea in premature newborns. OBJECTIVE: This study investigates the effects of caffeine orally administered to newborn rats on gastrointestinal permeability, bacterial translocation and different biochemical parameters. METHODS: Newborn rats were divided into different groups (N= 06). The treated newborn rats were orally administered with standard caffeine doses (12 mg/kg per day), and the control groups received a placebo. The animals were weighed daily until sacrifice. Blood samples, mesenteric lymph nodes (MLN) and organs were aseptically collected. Furthermore, different biochemical (D-Lactate) and oxidative stress biomarkers (MDA, CAT, SOD and GSH) were examined. Microbiological analyses were performed to assess microbiota alterations and bacterial translocation. RESULTS: Preliminary results showed that caffeine administration decreased the level of bacterial translocation over time. The treatment reduced plasma D-lactate levels (p < 0.05). Additionally, caffeine induced a disturbance in the concentrations of biochemical parameters and oxidative stress biomarkers. Indeed, liver enzymes (AST and ALT) were significantly (p < 0.05) risen after caffeine treatment. Glutathione (GSH) levels were significantly higher in caffeine treated groups (75.12 +/- 0.32; 51.98 +/- 1.12 U/mg; p < 0.05) comparing to control ones (40.82 +/- 0.25; 42.91 +/- 0.27 U/mg; p < 0.05) in the ileum and the colon, respectively. CONCLUSIONS: Thus, besides improving gastrointestinal permeability, our data show that caffeine has beneficial effects on the intestinal antioxidant system

Isolated hypospadias: The impact of prenatal exposure to pesticides, as determined by meconium analysis

International audienceAlthough endocrine-disrupting chemicals (EDCs, including pesticides) are thought to increase the risk of hypospadias, no compounds have been formally identified in this context. Human studies may now be possible via the assessment of meconium as a marker of chronic prenatal exposure. The objective of the present study was to determine whether or not prenatal exposure to pesticides (as detected in meconium) constitutes a risk factor for isolated hypospadias. In a case-control study performed between 2011 and 2014 in northern France, male newborns with isolated hypospadias (n = 25) were matched at birth with controls (n = 58). Newborns with obvious genetic or hormonal anomalies, undescended testis, micropenis, a congenital syndrome or a family history of hypospadias were not included. Neonatal and parental data were collected. Foetal exposure was assessed by determining the meconium concentrations of the pesticides or metabolites (organophosphates, carbamates, phenylurea, and phenoxyherbicides) most commonly used in the region. Risk factors were assessed in a multivariate analysis. The pesticides most commonly detected in meconium were organophosphates (in up to 98.6% of samples, depending on the substance) and phenylurea (>85.5%). A multivariate analysis revealed an association between isolated hypospadias and the presence in meconium of the phenylurea herbicide isoproturon and of the phenoxyherbicide 2-methyl-4-chlorophenoxyacetic acid (odds ratio [95% confidence interval]: 5.94 [1.03-34.11] and 4.75 [1.20-18.76]) respectively). We conclude that prenatal exposure to these two herbicides (as assessed by meconium analysis) was correlated with the occurrence of isolated hypospadias. The results of our case-control study (i) suggest that prenatal exposure to pesticides interferes with the development of the male genitalia, and (ii) emphasize the importance of preventing pregnant women from being exposed to EDCs in general and pesticides in particular