Health in Seychelles - an overview

Health in Seychelles has improved significantly over the past three decades, largely as a result of investment not only in the health services, but also in other social sectors that have direct impact on child survival and the health of individuals. Through different stages of the evolution of the health care system there have been close links between health policy and strategy, the overall national development efforts and the wider social and economic environment. Awareness of these links are useful in the understanding of current health issues such as the lifestyle related patterns of morbidity and mortality, characterised by non-communicable diseases and HIV/AIDS, the high demands for health care services, and evolving relationships between the public and private sectors.

Neuropathology associated with exposure to different concentrations and species of mercury: A review of autopsy cases and the literature

BACKGROUND

Human exposure to mercury (Hg) is widespread and both organic and inorganic Hg are routinely found in the human brain. Millions of people are exposed to methyl Hg (MeHg) due to the consumption of fish and to inorganic Hg from dental amalgams, small scale gold mining operations, use of Hg containing products, or their occupations. Neuropathology information associated with exposures to different species of Hg is primarily based on case reports of single individuals or collections of case studies involving a single species of Hg at toxic exposure levels such as occurred in Japan and Iraq.

METHODS/RESULTS

This study brings together information on the neuropathological findings and deposition of Hg in the central nervous system of people exposed to different species of Hg at varying concentrations. The low dose exposures were lifetime exposures while the high dose exposures were generally acute or short term by different exposure routes with survival lasting various lengths of time. Total and inorganic Hg deposits were identified in formalin-fixed, paraffin embedded tissues from both low and high exposure Hg cases. Low concentration exposures were studied in adult brains from Rochester, New York (n = 4) and the Republic of Seychelles (n = 17). Rochester specimens had mean total Hg concentrations of 16-18 ppb in the calcarine, rolandic, and cerebellar cortices. Inorganic Hg averaged between 5-6 ppb or 30-37% for the cerebral and cerebellar cortices of the Rochester subjects. Total Hg was approximately 10-fold higher in specimens from Seychelles, where consumption of ocean fish is high and consequently results in exposure to MeHg. The predominant Hg species was MeHg in both the Rochester and Seychelles brain specimens. Histologically, cerebral and cerebellar cortices from Rochester and Seychelles specimens were indistinguishable. High concentration exposures were studied in brains from four adults who were autopsied at variable time periods after exposure to organic Hg (methyl or dimethyl) or inorganic Hg (inhaled vapor or intravenous injection of metallic Hg). In contrast to the Seychellois adults, these individuals had acute or subacute exposures to lethal or significantly higher concentrations. The pattern of Hg deposition differed between subjects with high organic Hg exposure and high inorganic Hg exposure. In the organic Hg cases, glia (astrocytes and microglia) and endothelial cells accumulated more Hg than neurons and there were minimal Hg deposits in cerebellar granule and Purkinje cells, anterior horn motor neurons, and neocortical pyramidal neurons. In the inorganic Hg cases, Hg was seen predominantly in neurons, vascular walls, brainstem, and cerebellar and cerebral deep gray nuclei. The presence of inorganic Hg in neural and neural supporting cells in the four high exposure Hg cases was not closely correlated with cellular pathology; particularly in the inorganic Hg cases.

CONCLUSIONS

Different Hg species are associated with differing neuropathological patterns. No neuropathological abnormalities were present in the brains of either Rochester or Seychelles residents despite substantial differences in dietary MeHg exposure. Increasing concentrations of inorganic Hg were present in the brain of relatively low exposure subjects with increasing age.

Molecular neuro-biological and systemic health benefits of achieving dopamine homeostasis in the face of a catastrophic pandemic (COVID- 19): A mechanistic exploration

In the face of the global pandemic of COVID 19, approaching 1.75 Million infected worldwide (4/12/2020) and associated mortality (over 108, 000 as of 4/12/2020) as well-as other catastrophic events including the opioid crisis, a focus on brain health seems prudent [1] (https://www.coronavirus.gov). This manuscript reports on the systemic benefits of restoring and achieving dopamine homeostasis to reverse and normalize thoughts and behaviors of Reward Deficiency Syndrome (RDS) dysfunctional conditions and their effects on behavioral physiology; function of reward genes; and focuses on digestive, immune, eye health, and the constellation of symptomatic behaviors. The role of nutrigenomic interventions on restoring normal brain functions and its benefits on these systems will be discussed. We demonstrate that modulation of dopamine homeostasis using nutrigenomic dopamine agonists, instead of pharmaceutical interventions, is achievable. The allied interlinking with diverse chronic diseases and disorders, roles of free radicals and incidence of anaerobic events have been extensively highlighted. In conjunction, the role of dopamine in aspects of sleep, rapid eye movement and waking are extensively discussed. The integral aspects of food indulgence, the influence of taste sensations, and gut-brain signaling are also discussed along with a special emphasis on ocular health. The detailed mechanistic insight of dopamine, immune competence and the allied aspects of autoimmune disorders are also highlighted. Finally, the integration of dopamine homeostasis utilizing a patented gene test and a research-validated nutrigenomic intervention are presented. Overall, a cutting-edge nutrigenomic intervention could prove to be a technological paradigm shift in our understanding of the extent to which achieving dopamine homeostasis will benefit overall health.

Biotechnical development of genetic addiction risk score (GARS) and selective evidence for inclusion of polymorphic allelic risk in substance use disorder (SUD)

Research into the neurogenetic basis of addiction identified and characterized by Reward Deficiency Syndrome (RDS) includes all drug and non-drug addictive, obsessive and compulsive behaviors. We are proposing herein that a new model for the prevention and treatment of Substance Use Disorder (SUD) a subset of RDS behaviors, based on objective biologic evidence, should be given serious consideration in the face of a drug epidemic. The development of the Genetic Addiction Risk Score (GARS) followed seminal research in 1990, whereby, Blum’s group identified the first genetic association with severe alcoholism published in JAMA. While it is true that no one to date has provided adequate RDS free controls there have been many studies using case –controls whereby SUD has been eliminated. We argue that this deficiency needs to be addressed in the field and if adopted appropriately many spurious results would be eliminated reducing confusion regarding the role of genetics in addiction. However, an estimation, based on these previous literature results provided herein, while not representative of all association studies known to date, this sampling of case- control studies displays significant associations between alcohol and drug risk. In fact, we present a total of 110,241 cases and 122,525 controls derived from the current literature. We strongly suggest that while we may take argument concerning many of these so-called controls (e.g. blood donors) it is quite remarkable that there are a plethora of case –control studies indicating selective association of these risk alleles ( measured in GARS) for the most part indicating a hypodopaminergia. The paper presents the detailed methodology of the GARS. Data collection procedures, instrumentation, and the analytical approach used to obtain GARS and subsequent research objectives are described. Can we combat SUD through early genetic risk screening in the addiction field enabling early intervention by the induction of dopamine homeostasis? It is envisaged that GARS type of screening will provide a novel opportunity to help identify causal pathways and associated mechanisms of genetic factors, psychological characteristics, and addictions awaiting additional scientific evidence including a future meta- analysis of all available data –a work in progress.

Sudden unexpected death from natural diseases: Fifteen years' experience with 484 cases in Seychelles

The aim of this study is to identify and subclassify sudden natural death (sudden death from natural diseases) cases in Seychelles. A total of 484 sudden natural death cases with autopsy at the Clinical Pathology Laboratory, Victoria Hospital, Seychelles between 1997 through 2012 were retrospectively reviewed. Among them, 363 cases (75%) were male and 121 (25%) were female. The most frequent sudden deaths were attributed to cardiovascular diseases (78.5%), and then followed by infectious diseases (9.9%), and gastrointestinal diseases (9.1%). This is the largest population-based study on sudden natural deaths in Seychelles.

Diabetic thoracic radiculopathy: an unusual cause of post-thoracotomy pain

Persistent pain is common following thoracotomy. A 64-year-old retired electrician with Type 2 diabetes presented with chest wall and abdominal pain 3 months following video-assisted thoracoscopic surgery (VATS). Postoperatively the patient had suffered pain despite a functioning thoracic epidural catheter. Following investigation, his persistent pain was due to diabetic thoracic radiculopathy (DTR). The disorder is characterized by pain, sensory loss, abdominal and thoracic muscle weakness in patients with diabetes. As in this patient, the pain and sensory loss usually resolve within one year after onset. The disorder may be distinguished from intercostal neuralgia based upon clinical and electromyographic features.

Enhanced inactivation of Listeria monocytogenes by nisin in the presence of ethanol

AIMS

The effect of combinations of nisin and ethanol on the survival of Listeria monocytogenes was investigated.

METHODS AND RESULTS

Killing by nisin was enhanced during simultaneous exposure to ethanol (2-7% v/v). For example, while 10 IU ml(-1) nisin reduced viability by 1 log unit in 20 min, a combination of this antimicrobial peptide and 5% ethanol, reduced numbers of surviving cells by 3 log units. Increasing the concentrations of either ethanol (2-7%) or nisin (10-50 IU ml(-1)) led to increased cell death with synergy being demonstrated for all combinations tested and at a range of temperatures from 5 to 37 degrees C.

CONCLUSIONS

Ethanol can act synergistically with nisin to reduce the survival of L. monocytogenes.

SIGNIFICANCE AND IMPACT OF THE STUDY

Combinations of ethanol and nisin may be feasible as an effective way of controlling this pathogen in the food processing environment.

The role of employee assistance programs in the era of rapid change in the health care delivery system

With the rapid changes occurring in the American healthcare system, questions regarding various aspects of care have arisen. These changes have led to the need for individuals working within an Employee Assistance Program (EAP) to respond quickly and effectively to crisis situations. This article summarizes the different roles and responsibilities of EAP workers in the healthcare marketplace.

The fate of the non-marital child: a challenge to the health system

Non-marital births present serious social and economic issues to American communities. This study examined attitudes and behaviors of low income unmarried young parents toward paternity establishment and the role of health care professionals in promoting paternity establishment. One hundred twenty-six matched dyads of young, impoverished unmarried fathers and mothers with a child age one year or less participated in face-to-face interviews, focusing on family, peer and community influences on paternity decision making. The representative sample was derived from a metropolitan county's AFDC and paternity files in Minnesota. While less than one-third of fathers lived with the mother and child, two-thirds were present at the child's birth. Eighty-five percent of fathers acknowledged fathering the child, 80% provided care and nurturance of the baby, and 86% indicated that the father's name on the birth certificate was important. Only 29% of White fathers and 20% of African-American fathers regarded marriage to the mother as a possibility, and less than one-third sought to establish paternity through the courts. Nonetheless, 52% of White and 63% of African-American fathers had signed the Declaration of Parentage at the hospital, although presentation of the Declaration by health personnel was haphazard. Presentation of the Declaration should become standard procedure within health settings, with paternity establishment removed from the court setting and permitted through signing of the Declaration. This would capitalize on the high level of interest in paternity establishment expressed by fathers, other than through formal court procedures, around the time of the baby's birth.

Two-step mucosal competitive exclusion flora treatment to diminish salmonellae in commercial broiler chickens

There is a need to control the intestinal colonization of broiler chickens by salmonellae in order to reduce the contamination of poultry products. A two-step treatment of broiler chicks with a mucosal competitive exclusion culture (MCE) was tested, in which the MCE was first sprayed on chicks in the hatchery followed by administration in the first drinking water. Three commercial flocks were treated and compared with parallel, untreated control flocks. Customary husbandry practices were employed. Environmental, hatchery, skin with feathers, and cecal samples were analyzed at 3 and 7 wk for the presence of salmonellae. Carcass rinse samples of fully processed birds were analyzed similarly. The results indicated that initial feed, water, and litter contamination was at a low frequency (< 10%). Eggshell fragments and chick paper pads were frequently contaminated (> 50%). After 3 wk growth, contamination of litter, skin with feathers, and ceca were significantly (P < .05) reduced in treated flocks as compared with control flocks. Salmonellae prevalence in ceca and in processed carcass rinses was also significantly (P < .05) reduced from 41% in control flocks to 10% in treated flocks. The study showed that treatment of chickens in a commercial setting with MCE cultures can serve as a useful means to reduce salmonellae contamination.

Child disablement, family dissolution and reconstitution

The results of a study of a nationally representative sample of disabled children and controls are presented. The findings suggest that although, at any one time, families containing a disabled child are not no more likely to be one-parent families, disabled children do appear to be more likely to experience a spell in a one-parent family at some time in their lives. Where these spells occur, they are of longer duration than for the general population, which suggests that family reconstitution may be more difficult where a disabled child is present.

Experience with intermittent catheterization in chronic spinal cord injury patients

Intermittent catheterization was used as a method to achieve reflex voiding and a catheter-free status in 111 chronic spinal cord injury patients. Of this group 70 patients achieved reflex (automatic) voiding within 90 days, or a mean of 19 days. Five patients required transurethral incision of the external urethral sphincter after achievement of automatic voiding because of elevated residual urine. Chronic urinary tract infection persisted in 16 per cent of the patients after completion of the program. No sequelae occurred because of the coexistent urinary tract infection. An 18-month followup disclosed stability in renal function and appearance of pyelograms. Urethral, scrotal and bladder complications secondary to chronic indwelling urethral catheters have been eliminated in these patients. Patient endorsement and enthusiasm have been spectacular and have overwhelmingly contributed to an ongoing, successful program.