[Serologic markers used for hepatitis B surveillance in Togo: status report and action proposals]

The hepatitis B surface antigen (HBsAg) is the only marker used for diagnosis and follow-up of hepatitis B infection in Togo. The purpose of this study was to evaluate the use of HBsAg testing for follow-up of hepatitis B infection. This study was conducted in 230 patients referred to the National Institute of Hygiene for HBsAg testing. In all cases the requested test was performed and the request and results were evaluated.

RESULTS

The study group included 159 women (69%) and 71 men (31%). The overall prevalence of HBsAg was 10.87%. Prevalence was higher in men than in women. Highest prevalence rates were observed in the age groups 20 to 50, which corresponds to the peak period of sexual activity. The indication for testing was often not clearly specified by Laboratory engineers (85.71%), Clinical officers (73.68%) and physicians (61.24%). When mentioned, the indication was suspicion of hepatitis B (20.87%), work-up for pregnancy (8.70%), testing prior to vaccination (8.26%) and surveillance of an infected patient (1.30%). The prevalence of HBsAg was 0.00% in prevaccination tests, 5% in pregnancy workup tests, and 10.42% in hepatitis B suspicion tests. Test results were negative in one infected patient referred for follow-up. None of the patients with positive results returned for therapeutic follow-up testing and no marker other than HBsAg was requested regardless the indication.

CONCLUSION

the laboratory of serology is under-used for hepatitis B surveillance. Hepatitis B follow-up using antigen HBsAg alone is inadequate and the equipment required for testing other markers is the same.

Effects of a combination of evening primrose oil (gamma linolenic acid) and fish oil (eicosapentaenoic + docahexaenoic acid) versus magnesium, and versus placebo in preventing pre-eclampsia

In a placebo controlled, partially double-blinded, clinical trial, a combination of evening primrose oil and fish oil was compared to Magnesium Oxide, and to a Placebo in preventing Pre-Eclampsia of Pregnancy. All were given as nutritional supplements for six months to a group of primiparous and multiparous pregnant women. Some of these women had personal or family histories of hypertension (21%). Only those patients who received prenatal care at the Central Maternity Hospital for Luanda were included in the study. Compared to the Placebo group (29%), the group receiving the mixture of evening primrose oil and fish oil containing Gamma-linolenic acid (GLA), Eicosapentaenoic acid (EPA), and Docosahexaenoic acid (DHA) had a significantly lower incidence of edema (13%, p = 0.004). The group receiving Magnesium Oxide had statistically significant fewer subjects who developed hypertension of pregnancy. There were 3 cases of eclampsia, all in the Placebo group.

Joint position sense: the effects of muscle contraction

The effects of isometric and isotonic force production on perceived static joint position were investigated in 12 adult subjects. The joint examined was the proximal interphalangeal joint of one index finger, and its perceived position was determined from matching movements of the equivalent joint on the other hand. When the perturbed joint was free to move, even when supporting substantial loads, the position was accurately estimated; however, when the subject was required to exert substantial isometric force against the device imposing the joint movement, significant errors occurred: these errors were in the direction of the increasing force. Similar effects were evident during increasing isometric flexion force in anaesthetized fingers. It is suggested that force-related afferent discharge from muscle, presumably originating in tendon organ receptors, contributes to static joint position sense. This force-feedback may allow the nervous system to accommodate for the effects of changing fusimotor bias, but it also appears to induce errors when afferent information of force and length provide potentially conflicting information.