Overcoming the Legacy of Mistrust: African Americans’ Mistrust of Medical Profession

Recent studies show that racism still exists in the American medical profession, the fact of which legitimizes the historically long-legacy of mistrust towards medical profession and health authorities among African Americans. Thus, it was suspected that the participation of black patients in end-of-life care has always been significantly low stemmed primarily from their mistrust of the medical profession. On the other hand, much research finds that there are other reasons than the mistrust which makes African Americans feel reluctant to the end-of-life care, such as cultural-religious difference and genuine misunderstanding of the services. If so, two crucial questions are raised. One is how pervasive or significant the mistrust is, compared to the other factors, when they opt out of the end-of-life care. The other is if there is a remedy or solution to the seemingly broken relationship. While no studies available answer these questions, we have conducted an experiment to explore them. The research was performed at two Philadelphia hospitals of Mercy Health System, and the result shows that Black patients’ mistrust is not too great to overcome and that education can remove the epistemic obstacles as well as overcome the mistrust

Discordant transmission of bacteria and viruses from mothers to babies at birth

BACKGROUND: The earliest microbial colonizers of the human gut can have life-long consequences for their hosts. Precisely how the neonatal gut bacterial microbiome and virome are initially populated is not well understood. To better understand how the maternal gut microbiome influences acquisition of the infant gut microbiome, we studied the early life bacterial microbiomes and viromes of 28 infant twin pairs and their mothers. RESULTS: Infant bacterial and viral communities more closely resemble those of their related co-twin than unrelated infants. We found that 63% of an infant\u27s bacterial microbiome can be traced to their mother\u27s gut microbiota. In contrast, only 15% of their viral communities are acquired from their mother. Delivery route did not determine how much of the bacterial microbiome or virome was shared from mother to infant. However, bacteria-bacteriophage interactions were altered by delivery route. CONCLUSIONS: The maternal gut microbiome significantly influences infant gut microbiome acquisition. Vertical transmission of the bacterial microbiome is substantially higher compared to vertical transmission of the virome. However, the degree of similarity between the maternal and infant gut bacterial microbiome and virome did not vary by delivery route. The greater similarity of the bacterial microbiome and virome between twin pairs than unrelated twins may reflect a shared environmental exposure. Thus, differences of the inter-generation transmissibility at birth between the major kingdoms of microbes indicate that the foundation of these microbial communities are shaped by different rules. Video Abstract

Management of neuropathic pain in Senegal: Expertise of National Center of Orthopedic Equipment, Dakar

IntroductionNeuropathic pain is serious and its treatment difficult. Treatment is efficient, when quality of life is increased [1].ObjectiveTo determine the frequency of neuropathic pain at the National Centre of Orthopaedic Equipment, Dakar, Senegal and to study the difficulties of management of neuropathic pain according to international guidelines.MethodologyA prospective study was undergone in the National Centre of Orthopaedic Equipment in Dakar, Senegal. Study took place from October 2014 to January 2015. Patients with pain over one month answered the neuropathic pain questionnaire and those with over 4 points were enrolled. Pain intensity was evaluated with Visual Analogic Scale, motor function with Medical Research Council Test. Major function (prehension, work, daily activity, professional activity and sleep) were appreciated. We verified the conformity of complementary exams. Evaluation was done before treatment, three weeks and two months after. Treatment was based on international guidelines.ResultsForty-three patients suffered neuropathic pain. The sex-ratio was 0.96. The mean age was 52.22. The mean score of Visual Analogic Scale was 5.75. Working was difficult (33.96%), impossible (4 cases), and up and down stair climbing impossible (18.83%). Among the patients 18.86% could not walk more than 1000 meters and 13.20% of patients could not pick something up. Professional activity was stopped in 2 cases. Sleep disorders were noted in 33.96%. Complementary exams were done in 54.71% and 9.43% were not compliant with international guidelines. Most of the patients received Amitryptiline (54. 71%) and adverse effects were noted only in 3 cases. With a two months follow-up, dimensions of quality of life were improved in 94.53% of cases.Discussion and ConclusionTreatment of neuropathic pain improved quality of life. In African country, the choice of molecule must take into account its efficacy and its accessibility. Rehabilitation is important in management of neuropathic pain. It increases function and improves quality of life. The unnecessary complementary exams increase the cost, and general practitioners need a specific piece of information about the neuropathic pain and its treatment

Transmission properties of slanted annular aperture arrays. Giant energy deviation over sub-wavelength distance

International audienceThis paper is devoted to the study of the transmission properties of Slanted Annular Aperture Arrays made in perfectly conducting metal. More precisely, we consider the transmission based on the excitation of the cutoff-less guided mode, namely the TEM mode. We numerically and analytically demonstrate some intrinsic properties of the structure showing a transmission coefficient of at least 50% of an unpolarized incident beam independently of the illumination configuration (angle and plane of incidence). The central symmetry exhibited by the structure is analytically exploited to demonstrate the existence of a polarization state for which all the incident energy is transmitted through the sub-wavelength apertures when the eigenmode is excited, whatever are the illumination and the geometrical parameters. For this state of polarization, the laminar flow of the energy through the structure can exhibit giant deviation over very small distances. An example of energy flow deviation of 220 degrees per wavelength is presented for illustration. The results presented in this paper could be considered as an important contribution to the understanding of the enhanced transmission phenomenon based on the excitation of guided modes. (C) 2015 Optical Society of Americ

Acute febrile illness and influenza disease burden in a rural cohort dedicated to malaria in Senegal, 2012-2013

Background African populations are considered to be particularly vulnerable to fever illnesses, including malaria, and acute respiratory disease, owing to limited resources and overcrowding. However, the overall burden of influenza in this context is poorly defined and incidence data for African countries are scarce. We therefore studied the fever syndrome incidence and more specifically influenza incidence in a cohort of inhabitants of Dielmo and Ndiop in Sokone district, Senegal. Methods Daily febrile-illness data were prospectively obtained from January 2012 to December 2013 from the cohort of the villages of Dielmo and Ndiop, initially dedicated to the study of malaria. Nasopharyngeal swabs were collected from, and malaria diagnosis tests (thick blood smears) carried out on, every febrile individual during clinical visits; reverse transcriptase- polymerase chain reaction was used to identify influenza viruses in the samples. Binomial negative regression analysis was used to study the relationship between the monthly incidence rate and various covariates. Results In Dielmo and Ndiop, the incidence ofmalaria has decreased, but fever syndromes remain frequent. Among the 1036 inhabitants included in the cohort, a total of 1,129 episodes of fever were reported. Influenza was present all year round with peaks in October-December 2012 and August 2013. The fever, ILI and influenza incidence density rates differed significantly between age groups. At both sites, the adjusted incidence relative risks for fever syndromes and ILI were significantly higher in the [6-24 months) than other age groups: 7.3 (95% CI: [5.7-9.3]) and 16.1 (95% CI: [11.1-23.3]) respectively. The adjusted incidence relative risk for influenza was significantly higher for the [0-6 months) than other age groups: 9.9 (95% CI: [2.9-33.6]). At both sites, incidence density rates were lowest among adults > = 50 years. Conclusions In this rural setting in Senegal, influenza was most frequent among the youngest children. Preventive strategies targeting this population should be implemented

Effect of Deep-Fat Frying on Chemical Properties of Edible Vegetable Oils Used By Senegalese Households

Deep-fat frying performed at high temperatures under atmospheric pressure is a common method of preparing dishes in Senegalese culinary practices. This operation can lead to deterioration of physical, chemical, nutritional and sensory properties of oil, which affects its frying performance. It also results in the production of volatile products such as aldehydes and non volatile fraction which remains in the frying medium. Some of these remaining products have been implicated in producing adverse health effects. Highly oxidized oils may also produce polyaromatic hydrocarbons, which have carcinogenic effect. This work was intended to evaluate the effect of frying on chemical properties of edible vegetable oils. Frying process was applied to meat, fish and potatoes in Senegalese culinary conditions. Ten (10) oil samples, each of three different brands, were purchased from wholesalers and retailers in different neighborhoods of Dakar. The samples were subjected to frying at 220°C for 40 min and then oils were withdrawn in amber bottles samples of which were taken for analysis. Acid value, peroxide value and total polar components were used to evaluate the quality of these oils after initial determination of the iodine value and the moisture and volatile matter content. Acid value increased after 40 min of frying and values ranged from 0.62 to 1.08 mg/kg after frying fish, while those for meat and potatoes ranged from 0.39 to 0.73 and 0.37 to 0.51 mg/kg, respectively. Peroxide value increased slightly for peanut oil (A) and sharply for peanut oil (B) and sunflower oil (C). Frying fish led to high values of total polar components whereas those obtained after frying meat and potatoes during 40 min did not exceed 15.27% except for peanut oil (A). Therefore, frying affects chemical parameter values of edible vegetable oils, which increase at a level depending on the product to be fried. A sharp Total Polar components increase was obtained after frying fish using the three types of oil with values exceeding, sometimes, the maximum level set by the Codex Alimentarius Commission. This latter chemical parameter is considered a good indicator of overall quality of frying oil. Thus in Senegalese culinary practices where frying oil is often reused in families with low-income, such a situation may lead to significant sanitary risks. In view of these results, investigations need to be extended to other types of oil marketed in Senegal.Keywords: edible-oils, quality, frying, fish, mea

Структурные изменения в системе гемостаза у больных меланомой кожи на ранней стадии ее развития

Мета дослідження – оцінка показників системи гемостазу у 27 хворих на меланому шкіри. Виявлено подовження активованого часткового тромбопластинового часу, подовження часткового тромбопластинового часу, подовження часу рекальцифікації, зниження рівня антитромбіну III, підвищення рівня розчинних фібрін-мономерних комплексів. Таким чином, мають місце серйозні структурні зміни системного гемостазу - гіпокоагуляція і гіперфібриноліз. Діагностика та корекція цих змін допоможе поліпшити клінічний перебіг і прогноз захворювання.A research aim is an estimation of indexes of the system of hemostasis at 27 patients by the melanoma of skin. Lengthening of the activated partial tromboplastin time, lengthening of partial tromboplastin time, lengthening of time of recalcification, decline of level of antithrombin of III, increase of level of soluble fibrinmonomers complexes is educed. Thus, the serious structural changes in the system of hemostasis - incoagulability and hyperfibrinolysis take place. Diagnostics and correction of these changes will help to improve a clinical flow and prognosis of disease