Dietary lipids affect human ethanol-inducible CYP2E1 gene expression in vivo in mononuclear cells

We tested the hypothesis that dietary cholesterol modulate human ethanol-inducible CYP2E1 expression in vivo in circulating mononuclear cells. Healthy volunteers (n= 10) were submitted to a low fat low cholesterol diet for 4 days (day 0-day 3, LFLC). Cholesterol (595 +/- 56 mg/day) was then reintroduced for 7 days (day 4-day 10, LFHC). In the same time, controls subjects (n=7) did not change their habitual daily diet. CYP2E1 mRNA levels, evaluated in mononuclear cells, decreased in experimental subjects during both LFLC and LFHC from 100% to 53 +/- 5%, (p<0.001) with a main decrease during LFLC period (100% to 71 +/- 16%, p=0.05). Immunoreactive CYP2E1 showed a similar pattern and decreased from 100 to 62 +/- 12% during the trial (p<0.05). No significant change occured in control subjects. Between day 0 and day 11, changes in CYP2E1 mRNA correlated positively with plasma cholesterol (r2=0.67, p<0.001) and HDL cholesterol concentrations (r2=0.61, p<0.001). In contrast, no correlation was found between plasma fatty acids concentrations and CYP2E1 expression. The present results suggest that lipid factors regulate CYP2E1 expression, in vivo, in human mononuclear cells. In particular, plasma cholesterol concentrations may play an important role in this regulation.

[Surveillance of the in vivo sensitivity of Plasmodium falciparum to antimalarial agents: the results of initial tests of the OCEAC Malaria Network]

The Malaria Control Division of the Organization for Endemic Disease Control in Central Africa (OCEAC) has developed a standardized method to measure the in vivo sensitivity of Plasmodium falciparum to antimalarial drugs. Between May 1996 and February 1997, a first series of tests using this method was carried out to determine the sensitivity of Plasmodium falciparum to chloroquine and amodiaquine in infected school children in four capital cities: Yaoundé, Brazzaville, Malabo, and Libreville. As expected, only children presenting more than 100 parasites per 1000 leucocytes were enrolled. Results showed variable degrees of in vivo resistance to chloroquine and amodiaquine at each location: 25% and 13% respectively in Yaoundé, 19% and 11% in Malabo, 23% and 43% in Brazzaville, and 29% and 0% in Libreville. Overall results concerning chloroquine of this test series were similar to recent data in comparable populations and confirmed the idea that the situation has stabilized in Central Africa. Findings concerning amodiaquine raise the need for further study to validate and explain the contrasting findings in Libreville (0%) and Brazzaville (43%). This first experience shows that the method is simple and quick and that it can be used with minimal means. Results could provide important early warning data for national health officials.

[Evaluation of patient recruitment at the Yaounde Central Hospital]

A rehabilitation project at Yaounde Central Hospital (YCH) under way since 1990 will soon reach completion with renovation of the maternity ward. In May 1996 three surveys designed to assess recruitment were carried out in 660 patients admitted to the Outpatient Clinic (n = 241), Emergency Room (n = 183), and other departments (n = 236). The study questionnaire focused on familial, educational, and socio-economic background, home living conditions, reasons for admission, and treatment conditions. The findings of these studies indicated that the YCH is at the top-ranked treatment facility with recruitment covering the entire city and beyond. For people living in nearby areas the YCH is also the first care provider especially since income is low. Information campaigns for users, physicians, and health care workers are needed to reinforce confidence in the YCH. The YCH must do more to promote proper management, selection, and transport of patients from upstream facilities and continue its emphasis on wide access to health facilities for the population.

[Knowledge, attitudes and practice of populations faced with culicidae nuisances: results of 6 surveys taken in Cameroon in 1994]

In 1994, six KAP studies were carried out in Cameroon to assess the importance of protective methods used by different population groups against culicine nuisance. The objective of these surveys was to evaluate the importance of the use of preventive measures by family against the parasite. The results show that in spite of a strongly resistant parasite in a hyperendemic malaria zone, the use of average protection remains very heterogeneous. Mosquito nets, identified as efficient protection, are used to varying degrees depending on the sites. In Douala, mosquito nets were found in 47% of households visited, with 65% of the inhabitants regularly using them. These figures rose to 75% and 82% respectively in a particularly exposed area of the city. In rural areas very few mosquito nets were identified with an average of one inhabitant per residence using them. The report of the study on the free distribution of mosquito nets and the reimpregnation of the nets six months later in Mbebe-Kikot village, showed that three years after the distribution of the nets, only 68% of the residences still had one mosquito net. In addition, only 9% of these nets were still in good condition. The results of these surveys showed that mosquito nets are more widely used in urban areas, with a higher number of inhabitants per household sleeping under them. They also showed that the free distribution of nets alone does not improve the protection of the population as they are not educated on the maintenance and care of the nets. So we can suggest to use different promotion and distribution strategies in urban area, where lot of people has got the experience of bed nets, and in rural area.

[Part of health costs related to malaria in a Cameroon enterprise]

In 1995 a survey was conducted in a metallurgical company in Cameroon to determine the percentage of health-related costs attributed to malaria. Both direct (consultation, hospitalizations, laboratory tests, and drugs) and indirect (sick pay, overtime, and lost production) costs were included. Total annual health-related expenditures were 4,125,000 FF. The average amount spent was 5,800 FF per family or 900 FF per eligible person. Malaria accounted for 1,272,000 FF or 31% of these expenditures. Thus the average amount spent for malaria was 1780 FF per family and 275 FF per eligible person. These figures indicate that a prevention program based mainly on use of impregnated mosquito nets, would be a highly cost-effective approach especially within the context of a well-organized health care system, a stable local population, a high mosquito biting nuisance, a good awareness of this nuisance, the possibility of social upheaval, and probable company support. Since a malaria-prevention program running at 50% efficiency would only decrease the malaria-related costs by about 12.5% of overall annual health expenditures, careful monitoring of cost-effectiveness would be necessary.

[Prevention and control of malaria in pregnant women in an urban setting (Yaoundé, Cameroun)]

The aim of this study was to evaluate the methods of preventing malaria (chemoprophylaxis, vector control) and of fever management (presumptive treatment of malaria) used for pregnant women in Yaounde, Cameroon and to identify the most important factors for assessing these practices. The 221 women studied were selected by cluster sampling. All had made extensive use of health services during pregnancy and 77% were using chemoprophylaxis. The number of febrile episodes in pregnant women who claimed to have used chemoprophylaxis was not significantly different to that in the women who did not use it. However, the mean birth weight of the babies of women who had used chemoprophylaxis was significantly higher. The women did not systematically use vector control measures; 21% used insect repellents (electric plaques, coil burners) and 20% used aerosol insecticides. Only 10% of the women slept under simple, untreated mosquito nets and none used mosquito nets impregnated with insecticide. Fifty per cent of the women had at least one episode of fever during pregnancy and 77% were treated for presumed malaria. However, the treatment was not standardized and was unsuitable in a third of cases. Possible changes in the chemoprophylaxis strategy are discussed.

[Perception of the Central Hospital by the urban population of Yaoundé: quantitative and qualitative methods]

Two studies, using different methods, were used to assess the opinions of the local population on Yaounde Central Hospital (YCH), the changes made as part of a restructuring program and use of health care facilities. The study population comprised YCH patients and the urban population of Yaounde as a whole. One study used personal interviews, according to standard epidemiological survey methods (1,267 inhabitants). The other used focus group discussions involving 8 to 12 people each (10 groups). There was no significant difference in the results recorded by these two methods. Focus group discussions are cheaper and easier to implement and are thus valuable for use alone or prior to more extensive studies using questionnaires. Classic epidemiological survey methods produce results which are reproducible and suitable for statistical analysis, and will make it possible to follow the progress of the new working policies of the YCH.

[Legal format and costs of prescriptions at the Central Hospital in Yaounde, Cameroon]

Prescribing treatment is the last act of a medical visit. A prescription is a written document that engages the medical and legal responsibility not only of the physician but of all those subsequently involved in its execution. In countries with weaker economies and more limited health care insurance the costs of filling a prescription can place a heavy financial burden on the families. In the present study we analyzed 285 prescriptions written in the Emergency Room and Outpatient Clinic of Central Hospital in Yaounde, Cameroon. In most cases prescribers were in compliance with legal requirements regarding their identity, but in 20 to 30% of cases neither the name nor function of the prescriber was mentioned. Most prescriptions were written legibly and coherently for both paramedical personnel and the patient. The number of products prescribed ranged from 2 to 5 depending on the issuing department. Practitioners in the outpatient clinic prescribed few brand-name products from the public outlet of the hospital pharmacy (16% of the prescriptions). In 68% of the cases a generic replacement was available. Practitioners in the emergency room were more apt to prescribe brand-name products (73% of the prescriptions). Five classes of drugs accounted for two thirds of prescriptions, i.e. analgesics-antipyretics, usual antibiotics, antimalarials, non-steroid anti-inflammatory drugs, and vitamins. Lawfully required information (drug presentation, route of administration, dose unit, directions and duration of treatment) was stated on 85% of prescriptions from the outpatient clinic and 50% from the emergency room. Although there were large variations, the mean cost of filling a prescription at the town pharmacy was identical in the two groups, i.e. 9500 CFA francs. The cost was 50% lower at the hospital pharmacy. All prescribers and in particular medical students should receive instruction in prescription writing. Careful selection of brand and non-brand-name drugs in agreement with practitioners should achieve further reductions in the cost of filling a prescription in hospital pharmacy.

Specific determination of cyanide in blood by headspace gas chromatography

An improved method has been developed for the quantitative determination of cyanide in human blood by headspace gas chromatography with electron-capture detection. In this novel method, cyanide was detected after conversion of hydrogen cyanide into cyanogen chloride by a reaction with chloramine T. The advantage of this new procedure lies in the fact that hydrogen cyanide formation and chlorination are carried out in a single step and in the same reaction medium. This method is simple, rapid, and specific for cyanide and does not suffer from any interference by cyanate and thiocyanate. The detection limit is 5 micrograms/L. The detection response is linear from 5 to 1000 micrograms/L, and the within-run coefficient of variation in this range is 8% or less. This method is particularly useful for routine diagnostic analysis of biological samples in case of acute cyanide poisoning.

Improved method for determination of polynuclear aromatic hydrocarbons in pharmacopoeial paraffin and mineral oils

An improved method has been developed for quantitative determination of polynuclear aromatic hydrocarbons (PAHs) in pharmacopoeial paraffin and medicinal white oil samples. This new method combines 2 liquid-liquid partition and adsorption chromatography procedures with a 2-step purification on Sephadex LH 20 and liquid chromatography with fluorometric determination. Selective elution of PAHs results in absence of background fluorescence. The minimum detectable level ranges from 0.2 ppt for benzofluoranthene isomers to 200 ppt for acenaphthene. Recoveries of PAHs added at 7 ppm varied from 92.1 to 111.4%. When a variety of medicinal white oil samples were analyzed by this improved method, 27 PAHs were identified, including 11 suspected carcinogens. Their identities were confirmed by capillary gas chromatography.

Capillary gas chromatographic determination with electron capture detector of beta-propiolactone in biological materials

A method has been developed for the determination of beta-propiolactone by derivatizing it to the volatile N-hexyl-3-heptafluorobutanoyloxypropanamide, which can be separated and identified by a capillary CP-Sil 8 column, and detected by an electron capture detector (ECD). First, beta-propiolactone is reacted with N-hexylamine to yield N-hexyl-3-hydroxypropanamide. The fluorobutanoyl ester derivative is next prepared by using heptafluorobutyric acid anhydride in the presence of trimethylamine. The method is very sensitive, simple, and specific, and can be used to detect and quantitate residual beta-propiolactone in lyophilized biological materials. The limit of detection is 0.2 ppm beta-propiolactone in a 50 mg sample; however, because of variability at low levels, the limit of quantitation is 1 ppm. Detector response was linear for 2-500 mg beta-propiolactone. Recoveries were 98% or greater from lyophilized vaccines spiked at the 2-20 ppm level. No side products or interference peaks were observed in the derivatization reaction.

[Crenotherapy of postphlebitic disease at Bagnoles-de-l'Orne studied by occlusive rheoplethysmography]

We have attempted to demonstrate by occlusive rheoplethysmography the action of crenotherapy on post-phlebitic syndrome. At the end of the study, it appears that, if it is possible to calculate the tissue disinfiltration obtained at the end of the cure, the method should be completed by diversified and repeated examinations after the cure in order to specify the beneficial effect of the cure.