Graph Attention Site Prediction (GrASP): Identifying Druggable Binding Sites Using Graph Neural Networks with Attention

Identifying and discovering druggable protein binding sites is an important early step in computer-aided drug discovery, but it remains a difficult task where most campaigns rely on a priori knowledge of binding sites from experiments. Here, we present a binding site prediction method called Graph Attention Site Prediction (GrASP) and re-evaluate assumptions in nearly every step in the site prediction workflow from data set preparation to model evaluation. GrASP is able to achieve state-of-the-art performance at recovering binding sites in PDB structures while maintaining a high degree of precision which will minimize wasted computation in downstream tasks such as docking and free energy perturbation.

Graph Attention Site Prediction (GrASP): Identifying Druggable Binding Sites Using Graph Neural Networks with Attention

Identifying and discovering druggable protein binding sites is an important early step in computer-aided drug discovery but remains a difficult task where most campaigns rely on a priori knowledge of binding sites from experiments. Here we present a novel binding site prediction method called Graph Attention Site Prediction (GrASP) and re-evaluate assumptions in nearly every step in the site prediction workflow from dataset preparation to model evaluation. GrASP is able to achieve state-of-the-art performance at recovering binding sites in PDB structures while maintaining a high degree of precision which will minimize wasted computation in downstream tasks such as docking and free energy perturbation.

[Regional distribution of the cochlear implant (CI) centers in Germany]

The treatment of patients with severe hearing loss or deafness with a cochlear implant (CI) represents a standard in Germany today. However, there is hardly any data on the current number of clinical CI centers (CI clinics) and their geographical distribution. The patient self-help organization, German Cochlear Implant Society (DCIG), and the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) have therefore initiated a survey to determine the regional distribution, the range of services, the consideration of existing quality standards and cooperation with patient self-help organizations of the individual clinical CI centers.For this purpose, a total number of 170 ENT departments or their directors (37 professors and 133 chief physicians), respectively, were contacted by e-mail and provided with a questionnaire. The survey took place from October 2019 to February 2020.Of the 170 departments contacted, 71 (41.8 %) took part in the survey. Of these, 70 departments (98.6 %) confirmed to perform CI surgeries. Thus, 41.8 % of all clinics contacted reported to perform CI surgeries (70 of 170 clinics), while this information was not available from 99 clinics. All 70 clinical CI centers (100 %) reported to conduct CI surgeries on adults, 60 centers (85.7 %) also on children (< 18 years). 36 departments (51.4 %) reported that the total number of CI surgeries at their facility in 2018 was more than 50. In 64 departments (91.4 %), the recommendations of the DGHNO-KHC on CI care (according to the White Paper CI care 2018) were followed. A collaboration between the department and patient self-help organization was confirmed by 67 institutions (95.7 %). The geographical distribution of the clinical CI centers showed a heterogeneous distribution pattern between the individual federal states and also within the respective federal state.The work presented here is a first assessment of the situation with regard to the regional distribution of clinical CI centers in Germany. A clustering of CI centers was noticeable in metropolitan areas, sometimes with several facilities in one city. The predominant attention to quality-related aspects, such as the consideration of the DGHNO-KHC white paper and the cooperation with patient self-help, is gratifying. The limitations of the study result from limited participation in the survey (41.8 % of the contacted clinics).

Low and disparate seroprotection after pentavalent childhood vaccination in the Lao People's Democratic Republic: a cross-sectional study

OBJECTIVE

In Lao People's Democratic Republic, the high burden of vaccine-preventable diseases is thought to be mainly due to low vaccine coverage. We investigated the seroprotective response against diphtheria-tetanus-whole cell pertussis-hepatitis B-Haemophilus influenzae type b (DTPw-HepB-Hib) vaccine in children.

METHODS

Serum was collected from 1131 children aged 9 to 50 months and their mothers in a cross-sectional study between December 2013 and July 2014. All children had records of three injections of the DTPw-HepB-Hib vaccine. Serum was analysed for hepatitis B surface antigen (HBsAg), anti-HBsAg (anti-HBs), anti-hepatitis B virus core antigen (anti-HBc), anti-diphtheria and anti-tetanus antibodies. Stool samples were collected for detection of parasites. Demographic and nutritional information were also obtained.

RESULTS

Protective levels of anti-HBs antibodies were found in 394 (37.9%) of 1039 children; 529 (55.7%) of 950 and 809 (85.2%) of 950 children were seroprotected against diphtheria and tetanus. Time since vaccination, age, home birth and malnutrition only partially explained the poor vaccine responses. Overall, 81 (7.8%) of 1039 children and 445 (40.3%) of 1105 of mothers were anti-HBc positive. Ten (1.0%) of 1039 of the children and 77 (7.0%) of 1105 of the mothers were HBsAg carriers.

CONCLUSIONS

After a full documented course of vaccination, seroprotective rates were unusually low and disparate against components of the pentavalent vaccine. These can only partially be explained by the negative predictors identified. Although many children had been infected, only few were chronic carriers of HBsAg. Our study demonstrates an urgent need to monitor the serologic response to vaccination, particularly in resource-poor countries.

[Diabetes among new cases of pulmonary tuberculosis in Hanoï, Vietnam]

The aim of this study was to analyze all new pulmonary tuberculosis cases and to assess the frequency and consequences of associated diabetes mellitus. Although apparently distinct, these two diseases could be linked, as suspected since decades. The context is the persistent endemicity of tuberculosis and the recent emergence of diabetes, two major health events for developing countries. The study was conducted at National TB hospital in Hanoï, Vietnam, and retrospectively included tuberculosis patients, cases with diabetes and controls without diabetes, collected during a three-year period 2006-2008. Cases associated with HIV infection or other comorbidities potentially affecting mortality were excluded. Among 2867 new pulmonary TB cases, 254 (8.8%) had associated diabetes. Eighty-six cases and 86 matched controls were included. Among cases mean blood glucose at admission was 14.4 mmol/dl, and patients were mostly urban (50% cases vs 32.5% controls, p=0.03). Clinical symptoms were similar in both groups. However, chest X-Ray cavitary images were significantly more frequent among cases (38.3% vs 16.3%, p=0.002, OR=4.1), as did infiltrative images (78% vs 62%, p=0.017, OR=2.55) and positive sputum smears (67.4% vs 47.8%, p=0.014, OR=2.21). In Vietnam, DM is found in quasi 9% of patients with a new diagnosis of primary pulmonary TB. The diabetes-TB patients may have more severe radiologic findings and a higher smear positivity rate. We suggest that in addition to the systematic HIV screening, all new TB patients should also be screened for diabetes.

Post-invasion events after infection with Staphylococcus aureus are strongly dependent on both the host cell type and the infecting S. aureus strain

Host cell invasion is a major feature of Staphylococcus aureus and contributes to infection development. The intracellular metabolically active bacteria can induce host cell activation and death but they can also persist for long time periods. In this study a comparative analysis was performed of different well-characterized S. aureus strains in their interaction with a variety of host cell types. Staphylococcus aureus (strains 6850, USA300, LS1, SH1000, Cowan1) invasion was compared in different human cell types (epithelial and endothelial cells, keratinocytes, fibroblasts, osteoblasts). The number of intracellular bacteria was determined, cell inflammation was investigated, as well as cell death and phagosomal escape of bacteria. To explain strain-dependent differences in the secretome, a proteomic approach was used. Barrier cells took up high amounts of bacteria and were killed by aggressive strains. These strains expressed high levels of toxins, and possessed the ability to escape from phagolysosomes. Osteoblasts and keratinocytes ingested less bacteria, and were not killed, even though the primary osteoblasts were strongly activated by S. aureus. In all cell types S. aureus was able to persist. Strong differences in uptake, cytotoxicity, and inflammatory response were observed between primary cells and their corresponding cell lines, demonstrating that cell lines reflect only partially the functions and physiology of primary cells. This study provides a contribution for a better understanding of the pathomechanisms of S. aureus infections. The proteomic data provide important basic knowledge on strains commonly used in the analysis of S. aureus-host cell interaction.

Penicilliosis and AIDS in Haiphong, Vietnam: evolution and predictive factors of death

OBJECTIVES

The study objective was to assess the lethality rates and the predictive factors for death in AIDS patients infected by Penicillium marneffei (Pm) in Hai Phong, Vietnam.

METHODS

A retrospective cohort study was conducted by reviewing 103 medicals records of confirmed cases from June 2006 to August 2009.

RESULTS

Penicilliosis-related mortality was very high (33%). The majors risk factors of death were: (i) patient lacking complete treatment, a regimen with both of secondary prophylaxis by itraconazole and HAART (OR=52.2, P<0.001); (ii) patients having received only secondary prophylaxis (OR=21.2, P<0.001); (iii) patients coinfected by hepatitis C (OR=2.3, P=0.02) and tuberculosis (OR=1.97, P=0.04). Penicilliosis occurred in 28 cases after initiation of ART, probably caused by IRIS, with the same signs and symptoms as "common" penicilliosis. However, the diagnosis of IRIS was ruled out because the viral load could not be assessed.

CONCLUSIONS

Penicilliosis is very frequent in the North of Vietnam. A good compliance to a complete treatment with healing antifungal (Amphotericin B) then secondary prophylaxis (Itraconazole) associate with ART, prolongs survival, prevents relapse, and also allows discontinuing a secondary prophylaxis in a half of the cases.

Structural properties of a new device for graft fixation in cruciate ligament reconstruction: the shim technique

INTRODUCTION

In ACL reconstruction using a soft tissue graft, aperture fixation with interference screws (IFS) can lacerate and rotate the graft and cause primary tunnel widening. To overcome these downsides, a new wedge-shaped implant (MegaShim, Karl Storz, Germany) was developed. We hypothesized that aperture fixation of hamstring ACL reconstruction using the MegaShim technique shows comparable structural properties when compared to interference screw fixation.

METHODS

In a porcine knee model, ACL reconstructions with a tunnel diameter of 6, 7, 8 and 9 mm were performed and human hamstring grafts were fixed using the MegaShim technique (group I). In group 2, grafts were fixed in a hybrid fixation using a MegaShim and cortical flip button (FlippTack, Karl Storz, Germany). Interference screw graft fixation served as a control group (group III). Maximum load, yield load and stiffness were recorded using material testing machine. Grafts were cyclically preconditioned between 0 and 20 N for 10 cycles before the graft-bone complex was loaded to failure. Statistical evaluation was performed using SPSS Version 11.0.

RESULTS

Mean maximum load to failure for the hybrid fixation was significantly higher than after interference screw or MegaShim fixation. The difference between MegaShim and interference screw fixation showed no significant difference for 6 and 7 mm sizes. An 8 and 9 mm MegaShim fixation resulted in significantly lower ultimate failure load compared to interference screw fixation. Stiffness of grafts fixed using 6 mm MegaShim was significantly lower than grafts fixed with hybrid or interference screw fixation, whereas no significant differences were found in the 7, 8, and 9 mm fixations.

CONCLUSION

Aperture fixation using the MegaShim technique provides comparable structural properties compared to interference screw fixation. Hybrid fixation using MegaShim and cortical flip button results in significantly higher ultimate failure loads than both aperture fixation approaches. Smaller grafts (6 mm) showed significantly lower ultimate failure load and stiffness than interference screw fixation. The "MegaShim technique" is an alternative to interference screw fixation concerning initial fixation strength.

Understanding ion beam synthesis of nanostructures: Modeling and atomistic simulations

Ion implantation, specified by parameters like ion energy, ion fluence, ion flux and sub-strate temperature, has become a well-established tool to synthesize buried low-dimensional nanostructures. In general, in ion beam synthesis the evolution of nanostructures is determined by the competition between ballistic and thermodynamic effects. A kinetic 3D lattice Monte-Carlo model is introduced, which allows for a proper incorporation of collisional mixing and phase separation within supersaturated solid-solutions. It is shown, that for both the ballistically and thermodynamically dominated regimes, the Gibbs-Thomson relation is the key ingredient in understanding nanocluster evolution. Various aspects of precipitate evolution during implantation, formation of ordered arrays of nanophase domains by focused ion implantation and compound nanocluster synthesis are discussed.

[Two outbreaks of eosinophilic meningitis in Yunann (China) clinical, epidemiological and therapeutical issues]

Eosinophilic meningitis is an uncommon clinical entity, which is mostly caused by Angiostrongylus cantonensis, a nematode which parasitizes rat's lungs. Humans represent a dead-end in the parasite's lifecycle and become infected by ingesting snails, slugs or transport hosts. Due to uncontrolled proliferation and circulation of snails and rats, human angiostrongyliasis has emerged in new foci in continental China. The treatment, which relies upon a combination of albendazole and corticosteroids, is still a matter of debate. In order to assess the epidemiological features of two outbreaks which occurred in Kunming, capital of the Yunnan province, 2003 and 2005, along with the clinical and treatment issues, a retro-prospective study was carried out among thirty-four clinical cases of eosinophilic meningitis. Furthermore, a parasitological survey was carried out on randomized samples of snails sold in the markets of the city On admission, all cases were found to have acute headaches and an eosinophilic pleocytosis rate > 5% in the cerebro spinal fluid (CSF). All patients reported the consumption of raw snails Pomacea canaliculata, 14 days on average before the onset of headaches (range 1-30 days). Hyperesthesia due to radiculitis was observed in 68% of the cases and the meningitis syndrome was present in 41%. The average value of blood eosinophil count in CSF and in peripheral blood was 38% and 900/ml, respectively. Two treatment schedules were used (without randomization): one with progressive doses over 4 weeks; the other with immediate high doses for 10 days with 3 sessions separated by 14-day intervals. The results were compared by the Kaplan Meier log rank test. All the cases had a favorable evolution. The analysis suggested better effectiveness and tolerance of the albendazole - dexamethasone combination used at the highest dosage, namely 20mglkg daily and 10mg daily respectively. Eosinophilic meningitis appeared to be recently emerging or re-emerging in Kunming. Deep-rooted culinary habits of eating raw food, and large amount of snails sold on local markets (about one ton per day) provide ideal conditions for the outbreak, or occurrence of this disease. According to the resdjlts of this study Chinese local authorities should be urged to improve information to the population about the risks of eating raw snails, in order to strengthen the control of both rat and snail populations and reinforce the supervision of local food markets.

Postpartum traditions and nutrition practices among urban Lao women and their infants in Vientiane, Lao PDR

BACKGROUND/OBJECTIVE

To assess the traditional postpartum practices, mother and child nutritional status and associated factors.

SUBJECTS/METHODS

A cross-sectional study in 41 randomly selected villages on the outskirts of Vientiane capital city, Lao PDR (Laos). 300 pairs of infants (< 6 months of age) and their mothers were enrolled. Information was collected about pregnancy, delivery and traditional practices through a standardized questionnaire. Dietary intake and food frequency were estimated using the 24 h recall method, calibrated bowls and FAO food composition tables. Mothers' and infants' anthropometry was assessed and multivariate analysis performed.

RESULTS

Contrasting with a high antenatal care attendance (91%) and delivery under health professional supervision (72%), a high prevalence of traditional practices was found, including exposure to hot beds of embers (97%), use of traditional herb tea as the only beverage (95%) and restricted diets (90%). Twenty-five mothers (8.3%) were underweight. Mothers had insufficient intake of calories (55.6%), lipids (67.4%), iron (92.0%), vitamins A (99.3%) and C (45%), thiamin (96.6%) and calcium (96.6%). Chewed glutinous rice was given to infants as an early (mean 34.6, 95% CI:29.3-39.8 days) complementary food by 53.7% of mothers, and was associated with stunting in 10% children (OR=1.35, 95% CI:1.04-1.75).

CONCLUSION

The high prevalence of traditional postpartum restricted diets and practices, and inadequate maternal nutritional intake in urban Laos, suggest that antenatal care may be an important opportunity to improve postpartum diets.

Initial fixation strength of a new hybrid technique for femoral ACL graft fixation: the bone wedge technique

BACKGROUND

Aperture fixation with interference screws matching the diameter of the tunnel is associated with the risk of graft laceration and graft rotation.

HYPOTHESIS

A hybrid fixation technique (extracortical and aperture fixation) with undersized interference screw placed behind a bone wedge provides a higher fixation strength as aperture fixation with a screw alone matching the size of the tunnel.

STUDY DESIGN

Experimental laboratory study.

METHODS

We evaluated the initial fixation strength (single cycle and cyclic loading tests) of hybrid and interference screw aperture fixation using different sized interference screws in porcine knees.

RESULTS

Analysis of yield load, maximum load and stiffness in the single cycle loading test showed no statistically significant differences for hybrid fixation with a 1 mm undersized screw and aperture fixation with a screw matching the size of the tunnel. The use of an undersized screw alone resulted in low fixation strength.

CONCLUSION

The initial fixation strength of the hybrid technique with undersized screws is comparable to that of interference screw fixation matching the size.

CLINICAL RELEVANCE

The new "bone wedge fixation" is an alternative for ACL graft fixation without the risk of graft laceration and graft rotation.

[Notes on dermatosis in the Lao People's Democratic Republic]

We present a descriptive analysis of dermatoses observed in Lao RDP. A total of 421 patients consulted in 3 provinces. A predominance of infectious dermatoses, rarity of acne and absence of skin cancer were notified. These observations are consistent with what has been observed in developing countries in the tropics. But, the causes of consultation are different from other more developed Asian countries.

Paragonimiasis and its intermediate hosts in a transmission focus in Lao People's Democratic Republic

Human cases of paragonimiasis have been reported in Lao People's Democratic Republic from several provinces, however, detailed descriptions of a focus of transmission including parasites species and intermediate hosts are lacking. Field investigations were carried out between February and July 2004 in three neighboring villages of the province of Vientiane. Persons with chronic cough (more than three weeks) were identified during a door-to-door survey and three sputum samples were examined for Paragonimus spp. and tuberculosis on two consecutive days. Potential intermediate snail and crustacean hosts were sampled among the populations' water-contact sites and examined for metacercarial infections or cercarial shedding. Four dogs were infected with metacercaria and the species of the subsequently retrieved adult parasites were identified. 12.7% (15 cases) of all chronic cough patients (0.6% of the total population) suffered from paragonimiasis. Samples of five species of freshwater snails, two species of crabs and one species of prawn were collected from the Nam Sêt River. None of the snails were infected. Metacercariae of P. harinasutai, P. bangkokensis and P. heterotremus were found in Potamon lipkei crabs while an infection with P. westermani was observed in a Chulathelphusa brandti crab. No paragonimid metacercaria was found in the Macrobrachium dienbienphuense prawns Dang and Nguyen 1972. This study demonstrates the importance of Paragonimus spp. as an etiological agent in patients with chronic cough and suggests that similar transmission might be widespread in Lao People's Democratic Republic. We document herein the transmission of several Paragonimus species indicating that paragonimiasis is an active zoonosis in Lao People's Democratic Republic.

[Animal and human Cryptosporidiosis in rural zone in Vietnam (Cu Chi district, Ho-Chi-Minh-City)]

A pilot study was carried out in May-June 2003 to evaluate the epidemiological situation of cryptosporidiosis in the Cu Chi district, a rural zone of Ho-Chi-Minh City Vietnam. The modified acid-fast stain of the stools revealed that 10/202 (5%) cows, 1/29 (3.5%) cattle breeders, and 2/53 (3.8%) under five year- old children with diarrhoea were infected by this germ. Unconfined cattle had a significantly higher risk of infection than penned animals (odds ratio [OR]: 8.3; 95% confidence interval [CI]: 1.06-64.7; p: 0.025).

Initial fixation strength of a hybrid technique for femoral ACL graft fixation

Aperture fixation with interference screws matching the diameter of the tunnel is associated with the risk of graft laceration and graft rotation. A hybrid fixation technique (extracortical and aperture fixation) with undersized interference screws provides a higher fixation strength when compared to an aperture fixation using only a screw matching the size of the tunnel and also reduces the risk of graft laceration. This research is an experimental laboratory study. We evaluated the initial fixation strength at time-zero of an extracortical-, a hybrid- and an aperture fixation in ACL reconstruction using extracortical buttons and different sized interference screws in porcine knees. The tests were performed using a single cycle and cyclic loading protocol. Analysis of yield load, maximum load and stiffness in the single cycle loading test showed no statistically significant differences for hybrid fixation with a 1 mm undersized screw and aperture fixation with a screw matching the size of the tunnel. Cyclic loading tests showed a statistically significant difference between hybrid and aperture fixation. The use of an undersized screw alone in aperture fixation resulted in insufficient fixation strength. The initial fixation strength of the hybrid technique with undersized screws is higher compared to an interference screw fixation alone. The hybrid fixation technique is an alternative for ACL graft fixation.

[Anaemia in a school of rural Cambodia: detection, prevalence, and links with intestinal worms and malnutrition]

According to WHO, half of the world's children suffers from anaemia, which is a silent and neglected endemic resulting from three major causes: iron deficiency intestinal worms and malaria. A two month transversal study was conducted in a rural primary school in Battambang Province, Cambodia, in a malaria-free area. The main objective of the study was to assess the prevalence of anaemia and two of its possible driving factors, intestinal parasites and general malnutrition; a secondary objective was to assess the accuracy of haemoglobin colour scale, an easy and cheap visual technique compared to spectrophotometry used as the reference. Among 168 school children (average age: 11), the prevalence rates of moderate and severe anaemia were 24% and nil respectively; average haemoglobin was 12.6 g/dl. These results compared favourably with previous data from Cambodia. In our study's conditions, the haemoglobin colour scale grossly overestimated the anaemia prevalence: 83 vs. 24%, specificity 22%. Despite its simplicity and very low cost, this technique appeared inaccurate. Anaemia was independently associated with Ancylostoma carriage (p = 0.05), and stunting (p = 0.01), which prevalences were 54% et 40% respectively; and this, despite a mebendazole 500 mg dose given 9 months prior to the study as part of a regular deworming school program. Although periodical mass deworming in schools does not prevent early Ancylostoma reinfection, it may reduce the severity of anaemia. It therefore appears fully justified, and may be strengthened, notably by switching from mebendazole to albendazole.

Infection à virus Chikungunya : revue générale par temps d'épidémie

The Chikungunya virus is an alpha arbovirus, first identified in 1953, transmitted by Aedes, mosquitoes, responsible for a little documented uncommon acute specifically tropical disease. Its main symptoms are fever, a rash, and debilitating arthralgia. An unprecedented Chikungunya epidemic is ongoing on the Reunion Island (775,000 inhabitants) with over 244,000 reported and 205 deaths (directly or indirectly linked) as of April 20 2006. Aedes albopictus, long present on the island, is the assumed vector. It had already been identified as the vector for type 2 Dengue fever in 1997-1978 (200,000 cases) for type 1 Dengue fever in 2004 (300 cases). After the Grande Comore Island epidemic, the first cases were reported in the Reunion Island in March 2005. The epidemic was a surprise because of its unexpected emergence, its magnitude, and clinical cases rarely or never described before: severe forms, central neurological involvement, hepatic cytolyse, severe lymphopenia, severe dermatological involvement, deaths, and neonatal infections. This is the first manifestation of the intrusion CHK virus on the island, which benefits from a sub-tropical climate, but also of an occidental healthcare environment, with a non-immune population. This is also the first time that a Chikungunya epidemic is described in this part of the world.

Joint kinematics and in situ forces after single bundle PCL reconstruction: a graft placed at the center of the femoral attachment does not restore normal posterior laxity

INTRODUCTION

Femoral tunnel placement has a great influence on the clinical outcome after PCL reconstruction.

MATERIALS AND METHODS

Using a robotic/universal force moment sensor (UFS) testing system, we examined joint kinematics and in situ forces of human knees following soft-tissue single bundle PCL reconstruction fixed at the center of the femoral attachment.

RESULTS

Posterior tibial translation significantly increased at all flexion angles after transsection of the posterior cruciate ligament (p<0.05). PCL reconstruction resulted in significantly less posterior tibial translation at all flexion angles when compared to the PCL deficient knee (p<0.05). The differences in the in situ force between the intact ligament and the reconstructed graft were statistical significant (p<0.05).

CONCLUSION

Single bundle PCL reconstruction with a soft-tissue graft fixed at the center of the femoral attachment is able to reduce the posterior tibial translation significantly. However, it cannot restore kinematics of the intact knee and in situ forces of the intact PCL.

[A french-speaking institute for tropical medicine in Asia: the IFMT in Vientiane, Lao PDR]

Since the year-2000, a French-speaking Institute for Tropical Medicine (French acronym, IFMT) has been operating in Lao PDR through funding provided by the Agence Universitaire de la Francophonie. The IFMT is a postgraduate teaching centre dedicated to improving skills of health care professionals in clinical sciences, epidemiology, public health and management as well as to research and health care intervention. These activities are conducted in the capital as well as provinces and districts throughout Laos with special focus on priority health issues facing developing countries in tropical regions. The IFMT organizes a 4-semester international course taught in French to medical doctors from Southeast Asia, mainly Laos, Cambodia, Vietnam and Southern China, but also from other countries. To date, a total of 72 students have graduated from the IFMT. In 2005 the Institute delivers a master degree. This article describes the course objectives and some features of the curriculum. It also presents a general overview of health, teaching, and research facilities in Southeast Asia as well as of the major challenges now confronting the region.

Mélioïdose

Melioidosis is an emerging zoonosis, due to Burkholderia pseudomallei, which is a highly invasive, resistant, and resilient soil bacteria, transmitted by cutaneous or airborne route, and is a potential weapon for bioterrorism. Although the agent has been identified all over the world, the human disease is endemic only in SE Asia and Northern Australia, and gained recent interest after the December 2004 tsunami. Human infection can be a very severe systemic disease (mortality 20 to 80%), with protean expression, but the lung is the most affected organ (50%). Pathophysiology remains unclear. Diabetes mellitus is a major risk factor, and is present in half the Asian patients with melioidosis. Recommended antibiotic regimens are expensive, and in severe disease should be prolonged to 20 weeks to reduce the risk of relapse. Prospects for prevention are limited, and no vaccine is available yet.

La paragonimose pleuropulmonaire

Paragonimiasis is a food borne zoonosis due to a trematode belonging to the genus Paragonimus. Although present throughout the world, about 90% of the cases occur in Asia where around 20 million people are infected. The parasitic cycle is complex with two different intermediate hosts. Man is infected by ingesting the raw or undercooked flesh of the second host - a freshwater crab or prawn - or possibly of a paratenic mammal host (wild boar), which contains the infective larval stage metacercariae that reaches the lung which is the main target organ. Epidemiological, pathological, and clinical aspects are reviewed. The main symptoms are protracted cough, and recurrent "benign" hemoptysis. Abnormal pleuro-pulmonary imaging features are constant, but protean and non-specific, leading to frequent confusion with tuberculosis. Diagnosis is easily achieved by ova search in the sputum or pleural fluid, or by serology. Evolution is usually considered benign, although not well known. Finally, praziquantel is the effective first choice treatment. Some paradoxical aspects of this disease are underlined such as: underdiagnosis despite a very simple diagnostic procedure, or opposite tendencies according to location, either extinction or re-emergence.

Arthroskopische Operationen

Die arthroskopische Chirurgie besitzt heute innerhalb der Gelenkchirurgie einen nicht mehr wegzudenkenden Stellenwert. Fast alle Gelenke sind der arthroskopischen Methode zugängig. Diese spezifische Chirurgie benötigt eine spezielle Fähigkeit und Fertigkeit des Operateurs, die eigens erworben werden muss. Die arthroskopische Chirurgie hat aber eine evidente Abhängigkeit von der Technologie und erfordert demzufolge eine gut funktionierende Infrastruktur und Kenntnis. Der große Vorteil der arthroskopischen Chirurgie liegt in der minimal invasiven Technik, welche die primäre postoperative Morbidität wesentlich verringert und dadurch bei adäquater und differenzierter Indikationsstellung entscheidende Vorteile für den Patienten sowie einen guten Aufwand/Nutzeneffekt aufweist.

[Squamous cell carcinoma on a leg ulcer in the West Indies]

INTRODUCTION

The epidemiology of carcinoma developing on a leg ulcer is poorly, although high incidence rates are reported in Africa.

PATIENTS AND METHODS

Retrospective study of cases reported in Guadeloupe, a tropical country with a large population from African descent and with high quality health care level.

RESULTS

Sixteen cases, mean age 71, were diagnosed over a 10-Year period in the only referral hospital. The annual incidence was an estimated 0.4/100,000. Preceding ulcers had a long course (mean of 27 Years) and had various causes. Social distress was the rule (14/16 patients). One third of the clearly differentiated (15/16) squamous cell-type tumors exhibited metastatic extension on presentation. At Year 3, the mortality rate was of 40 p. cent. The best survival rate (6 remissions/8 cases) was associated with primary limb amputation.

DISCUSSION

Malignant ulcers appeared more frequent in Guadeloupe than in the influent countries of the North, but with an instance 4-fold lower than in Africa. Like many other tropical diseases, socio-behavioral factors may play a major role.

[Short treatment of donovanosis with azithromycin]

INTRODUCTION

Azithromycine is recommended in the treatment of donovanosis with a 7-day treatment cycle. We report the efficacy of a single cure of 1 gram in two patients.

OBSERVATIONS

Four patients, presenting with donovanosis, were treated with azithromycine according to 2 regimens. The first used 500 mg/d the molecule during 1 week, the second used azithromycine in single cure of 1 gram. The latter led to the complete cure of 2 patients.

DISCUSSION

Many antibiotics are used in the treatment of donovanosis. Since 1996, Australian authors have used azithromycine in this indication. A single dose of this molecule appears effective in recent and confined donovanosis.

Malaria in Guadeloupe (French West Indies) 1991-2000

The only islands in the Caribbean that still have endemic malaria are Haiti and the Dominican Republic. Cases of imported malaria occur on the other islands, particularly Martinique and Guadeloupe, due to the movement of people to and from endemic regions that are geographically and/or culturally close. The re-emergence of transmission cannot be ruled out due to the local persistence of the potential vectors, the anopheles mosquitoes. This retrospective study, over a ten year-period (1991-2000), included all of the cases of malaria confirmed by blood tests at Pointe-à-Pitre University Hospital. This hospital is the main healthcare facility in Guadeloupe. Fifty-nine bouts of malaria occurred in 56 patients. The annual incidence was estimated at 2 to 2.5 cases per 100,000 inhabitants. Plasmodium falciparum largely predominated, accounting for over 80% of cases. The only pernicious case observed resulted in the death of the patient. In all cases the patient had recently travelled to an endemic region, except in one case, caused by P ovale which has never been endemic in the Caribbean. African countries accounted for 43% of cases. No Asian or Pacific strains were identified. In all cases, anti-malarial drugs were not taken, taken incorrectly or were inappropriate. All of the cases of malaria reported in Guadeloupe in the last decade were imported and this region cannot be considered to be at risk of malaria infection. However, long-term epidemiological monitoring is necessary, together with specific entomological monitoring.

[Leprosy in Guadeloupe (French West Indies): declining disease, increasing diagnosis delay]

INTRODUCTION

Endemic for nearly three centuries, leprosy is declining in Guadeloupe: its prevalence has decreased by 75 p. 100 over the last decade. Because it has become rare, it may well be overlooked.

PATIENTS AND METHODS

Retrospective study of all the new cases of leprosy diagnosed in Guadeloupe from May 1996 to May 2001.

RESULTS

In 10 cases of the 41 reported in this study, diagnosis had been delayed by more than 6 months. Nine of these 10 cases presented with classical clinical signs. The mean delay before diagnosis in these 10 cases was of 22 months (range: 7-36 months); the mean number of consultations with a physician before the final diagnosis was of 3.2 (range: 2-8). The mean age at the time of diagnosis in patients in whom diagnosis was delayed was significantly greater than those in whom diagnosis was confirmed rapidly (55 vs. 37 years).

DISCUSSION

In Guadeloupe, one patient out of 4 presenting with leprosy is diagnosed with a delay of more than 6 months, despite a classical clinical presentation. This is deleterious to the patients and health economics. The patients in whom diagnosis was delayed were older. This epidemiological tendency appears inherent to this form of "residual leprosy". The present rareness of the disease is responsible for a lack of knowledge of the disease by the physicians through lack of experience. This phenomenon is also observed for syphilis and measles. There is a real risk of underestimation or erroneous diagnosis.

Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study

BACKGROUND

Endoscopic ultrasonography (EUS) is commonly agreed to be the best imaging method for diagnosing and differentiating between submucosal lesions in the gastrointestinal tract. However, most of the current evidence for this derives from retrospective multicenter studies. A prospective multicenter analysis of the performance of EUS in diagnosing submucosal lesions in everyday practice was therefore conducted.

METHODS

Over a 2-year period, this study included 150 patients (52% men, mean age 59.8 years) from 23 centers who had a presumptive diagnosis of a submucosal lesion on upper gastrointestinal endoscopy. The patients' symptoms and EUS results were recorded. Endoscopic and endosonographic findings regarding lesion size, layer of origin, and the presumptive diagnosis (benign or malignant) were recorded. The reference methods used were surgery, biopsy, other imaging tests, and a follow-up period of 6 months.

RESULTS

Of the 150 patients, 102 had an intramural lesion (84 tumors, 18 other lesions such as cysts, aberrant pancreas, etc.), and 48 had an extraluminal compression--in most cases (n = 35) by normal organs or structures. For differentiating between a submucosal and an extraluminal compression, the sensitivity and specificity of endoscopy were 87% and 29%, whereas those of EUS were 92% and 100%. However, the sensitivity and specificity of EUS for differentiating between malignant and benign submucosal tumors were only 64% and 80%, respectively.

CONCLUSIONS

The accuracy of EUS in differentiating between submucosal tumors and extraluminal compressions is substantially superior to that of endoscopy, but EUS is still inadequate for differential diagnosis between benign and malignant submucosal tumors. However, EUS is still the best method of visualizing submucosal lesions precisely. The influence of EUS on the further management in these patients remains to be examined in subsequent studies.

Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study

BACKGROUND

Endoscopic ultrasonography (EUS) is commonly agreed to be the best imaging method for diagnosing and differentiating between submucosal lesions in the gastrointestinal tract. However, most of the current evidence for this derives from retrospective multicenter studies. A prospective multicenter analysis of the performance of EUS in diagnosing submucosal lesions in everyday practice was therefore conducted.

METHODS

Over a 2-year period, this study included 150 patients (52% men, mean age 59.8 years) from 23 centers who had a presumptive diagnosis of a submucosal lesion on upper gastrointestinal endoscopy. The patients' symptoms and EUS results were recorded. Endoscopic and endosonographic findings regarding lesion size, layer of origin, and the presumptive diagnosis (benign or malignant) were recorded. The reference methods used were surgery, biopsy, other imaging tests, and a follow-up period of 6 months.

RESULTS

Of the 150 patients, 102 had an intramural lesion (84 tumors, 18 other lesions such as cysts, aberrant pancreas, etc.), and 48 had an extraluminal compression--in most cases (n = 35) by normal organs or structures. For differentiating between a submucosal and an extraluminal compression, the sensitivity and specificity of endoscopy were 87% and 29%, whereas those of EUS were 92% and 100%. However, the sensitivity and specificity of EUS for differentiating between malignant and benign submucosal tumors were only 64% and 80%, respectively.

CONCLUSIONS

The accuracy of EUS in differentiating between submucosal tumors and extraluminal compressions is substantially superior to that of endoscopy, but EUS is still inadequate for differential diagnosis between benign and malignant submucosal tumors. However, EUS is still the best method of visualizing submucosal lesions precisely. The influence of EUS on the further management in these patients remains to be examined in subsequent studies.

Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study

BACKGROUND

Endoscopic ultrasonography (EUS) is commonly agreed to be the best imaging method for diagnosing and differentiating between submucosal lesions in the gastrointestinal tract. However, most of the current evidence for this derives from retrospective multicenter studies. A prospective multicenter analysis of the performance of EUS in diagnosing submucosal lesions in everyday practice was therefore conducted.

METHODS

Over a 2-year period, this study included 150 patients (52% men, mean age 59.8 years) from 23 centers who had a presumptive diagnosis of a submucosal lesion on upper gastrointestinal endoscopy. The patients' symptoms and EUS results were recorded. Endoscopic and endosonographic findings regarding lesion size, layer of origin, and the presumptive diagnosis (benign or malignant) were recorded. The reference methods used were surgery, biopsy, other imaging tests, and a follow-up period of 6 months.

RESULTS

Of the 150 patients, 102 had an intramural lesion (84 tumors, 18 other lesions such as cysts, aberrant pancreas, etc.), and 48 had an extraluminal compression--in most cases (n = 35) by normal organs or structures. For differentiating between a submucosal and an extraluminal compression, the sensitivity and specificity of endoscopy were 87% and 29%, whereas those of EUS were 92% and 100%. However, the sensitivity and specificity of EUS for differentiating between malignant and benign submucosal tumors were only 64% and 80%, respectively.

CONCLUSIONS

The accuracy of EUS in differentiating between submucosal tumors and extraluminal compressions is substantially superior to that of endoscopy, but EUS is still inadequate for differential diagnosis between benign and malignant submucosal tumors. However, EUS is still the best method of visualizing submucosal lesions precisely. The influence of EUS on the further management in these patients remains to be examined in subsequent studies.

A case-control study of risk factors associated with human T-cell lymphotrophic virus type-I seropositivity in blood donors from Guadeloupe, French West Indies

BACKGROUND AND OBJECTIVES

An age- and gender-specific distribution characterizes human T-cell lymphotrophic virus type-I (HTLV-I) seropositivity in Guadeloupe (French West Indies). Further epidemiological studies are required to identify other possible risk factors associated with this retroviral infection.

MATERIALS AND METHODS

A nested case-control study was conducted between 1997 and 1999 among blood donors. A total of 102 HTLV-I-positive subjects were matched (at a ratio of 1 : 3) by gender, age (+/-5 years) and donor status (new or regular) to 306 HTLV-I-negative controls. Information was obtained through a questionnaire assessing both environmental and behavioural variables.

RESULTS

Factors independently associated with HTLV-I infection included a low level of education [odds ratio (OR) 6.61, confidence interval (CI) 2.89-15.15], black ethnicity (OR 3.28, CI 1.01-10.65), two or more sex partners in the previous 3 years (OR 2.43, CI 1.16-5.10), early age at first sexual intercourse (0.84 risk reduction per additional year, CI 0.76-0.93), a history of sexually transmitted diseases (OR 2.29, CI 1.0-5.34) and positive Chlamydia serology (OR 1.95, CI 1.03-3.68).

CONCLUSION

These data provide a wide spectrum of features associated with HTLV-I seropositivity, especially sexual risk factors. It strongly suggests that heterosexual intercourse is an important route of HTLV-I transmission in Guadeloupe, even among low-risk populations such as blood donors.