[Social anthropological approach to tuberculosis in Mopti (Mali): popular representations and use of treatment]

In Mali, there were 4508 new cases of tuberculosis in 2003, and 5222 in 2006. Tuberculosis (TB) is thus an important public health problem, decreasing the physical, financial and social capital of individuals, their families and society. Because responses to TB have not yet applied a sufficiently integrated approach that can improve patients' access to quality care, this FORESA project advocates a patient-centered approach. Before any intervention, FORESA thus sought to analyse the situation of TB in Mali and responses to it. The study aims to analyse the discourse about and popular representations of TB (its forms, its signs), the situations in which people are exposed to it or transmit it, and popular practices related to its prevention and the experience of having it. This qualitative, descriptive and analytical study includes a literature review, in-depth interviews with opinion leaders, community health workers and TB patients, focus groups, and the observations of practices. The interviews were recorded, transcribed, and analysed. Subjects provided informed consent to participation. This study showed that: * the terms for TB in local languages (Bambara, Dogon and Fulfuldé) include white cough, big cough, and long cough; * These communities differentiate between 2 main forms of cough (simple and wet); * TB is perceived as a transmissible disease, a disease of contact with a contaminated body or objects; * TB is seen as a serious, contagious, hereditary, shameful disease that may result from the transgression of social norms; * The prevention of TB consists of avoiding people who have the disease or transmitting factors; * Therapeutic remedies, in order, are self-medication, the use of traditional healers, and finally visits to health centres; * The population wants more information about TB and be involved in the fight against it. This study shows the many points of convergence about TB nosology, etiology and therapy between the Mopti population and other groups in Mali (including the Mande, Senoufo and Soso), between the population of Mali and some ethnic groups in Burkina Faso (such as the Dioula, Bobo, Tiéfo Vigué), and between the population of Mali and, Burkina Faso and others in Africa (Gambia, Nigeria, South Africa, etc.). There is also a difference between popular knowledge about TB and biomedical knowledge. The population does not know that TB is transmitted mainly, even exclusively, by nasal droplets or that patients are no longer contagious after two weeks of treatment. The widespread dissemination of this information may have a positive effect, reducing stigmatization and improving access to treatment. Mali must strengthen the skills of all participants in the fight against tuberculosis, to strengthen their framework and to monitor and evaluate their activities.

[Quality of care and sexually transmitted infections algorithm acceptability in Burkina Faso]

BACKGROUND

To assess sexually-transmitted infections (STIs) quality of care, syndromic approach acceptability and applicability by patients and health workers in Burkina Faso.

METHOD

Three approaches were used: simulated patients method to assess quality of STIs care, patients interview and focus discussion with health workers to assess syndromic approach acceptability and applicability.

RESULTS

Sixty-two anonymous visits were made in 17 Bobo-Dioulasso primary care clinics. Overall, history taking were assessed in 77.4% of visits, 47% patients were physically examined. Women (71%) were examined more frequently than men (41%) (P=0.01), 42% of patients were not examined in an isolated room. Medication was prescribed for 87.1% of the patients but only 37.5% of the treatments were applied according to national recommendations. Counselling was poor concerning critical messages regarding risk of HIV transmission, STI prevention. Patients and health workers found the syndromic approach acceptable and applicable, but the question of sexual behaviour was considered difficult to address.

CONCLUSION

Quality of STIs care is poor in Burkna Faso. Staff training must emphasize interpersonal communication and motivation, with introduction of a sexually-transmitted infection syndrome package consisting of drugs and condoms in order to improve syndromic case management.

Arginase release from red blood cells: possible link in transfusion induced immune suppression?

Arginine stimulates lymphocyte function and is degraded by arginase, an enzyme that is abundantly present in red blood cells. Arginase impairs lymphocyte function and responses in vitro. Leakage of arginase from stored red blood cells may be involved in the lymphocyte dysfunction associated in allogenic blood transfusion. In the present study, arginase activity was determined in bags of red cells stored for transfusion. Buffy coat depleted red blood cells were obtained routinely from four healthy donors and stored in bags for a maximum period of five weeks at 4 degrees C. The bags were sampled for determination of arginase, lactate dehydrogenase, and potassium. In addition, a random sample of 36 bags of red blood cells about to be transfused to patients were studied. Levels of arginase, lactate dehydrogenase, and potassium showed a time dependent increase in the bags of the four donors. This time dependent increase in arginase activity could be confirmed in the additional bags sampled (P < 0.0001, r = 0.78). The results for the first time show that arginase is released from red blood cells during storage for transfusion. Arginase infusion may play an important role in the immune suppression observed after blood transfusion.

Effects of human recombinant erythropoietin on differentiation and distribution of erythroid progenitor cells on murine medullary and splenic erythropoiesis during hypoxia and post-hypoxia

Hemopoietic cells, the extracellular matrix, growth factors and the microenvironment are involved in the regulation of hemopoiesis. Although the regulation of erythropoiesis is well understood at the cellular level in vivo and in vitro, the role of hemopoietic sites of erythroid progenitors production has not been well defined in both steady state conditions and in stress erythropoiesis. In this study we examined the qualitative erythroid differentiation and quantitative changes of the erythroid progenitors in different erythropoietic organs during erythropoiesis of stress in a hypoxia-induced polycythemia and post-hypoxic changes in a mice model. Chronic intermittent exposure to hypobaric hypoxia induced polycythemia in mice and the post-hypoxic period was characterized by total suppression of erythropoiesis. The number and distribution in hemopoietic sites of Immature Erythroid Burst (BFU-EI), Mature Erythroid Burst (BFU-EM) and Erythroid Colony Forming Units (CFU-E) was evaluated in bone marrow and spleen of hypoxic and post-hypoxic mice after removal from the chamber. The number of BFU-EI and CFU-E, was evaluated in both femoral bone marrow and spleen of ex-hypoxic polycythemic mice, at two times intervals after the end of hypoxia. We found that in both bone marrow and spleen, the kinetics of the CFU-E pool was characterized by a sharp fall from above normal to lower than normal levels. BFU-EM increased from normal to higher than normal levels. These results have been correlated with both erythropoietin (EPO) and the erythropoietic activity. The results show that EPO levels largely control both the differentiation and the amplification of the CFU-E pool and they suggest that EPO may acts as a "survival factor" at the CFU-E level and/or increase the flow of cells from BFU-E to CFU-E. After the termination of the period of hypoxia and during post-hypoxia there was a reduction in EPO production which subsequently caused a depletion of the CFU-E population, indicating that the size of the CFU-E pool is EPO-dependent. After the injection of 1U of recombinant human erythropoietin (rHuEPO) the size of that pool was increased and the pool of BFU-EI was decreased. It is noteworthy that our studies show that the spleen functions as a large reservoir of erythroid precursors for hypoxia-induced stress erythropoiesis.

Rethinking methods for the study of sexual behaviour

During the past five years, researchers from the Medical Research Council and Uganda Virus Research Institute (MRC/UVRI) Programme on AIDS have studied sexual behaviour to better understand the risk and the spread of HIV infection in a rural Ugandan community. This paper aims at a reflective critique of the application of various methods of studying sexual behaviour in a series of six studies within the programme. The objectives of these various studies have been different: ranging from the natural history of HIV-infection to marital instability to household coping. This variety of foci has led to multiple research strategies. Three methodological factors influencing the research and the results were identified: the research model; the meanings of research questions; and personal factors affecting the interview relationship. Although the impact of these factors could not be entirely eliminated, precautions could be taken to diminish these biases. Comparing data obtained through different methods proved useful not only as a validity test but also as a mean to more deeply interpret the data according to culture, linguistics and society. Lessons learned during this piece of work include the importance to the quality of data by inviting local communities to participate in the research process; broadening the field of sexuality from a health-oriented model to reach an anthropological perspective; considering the influence of research organization on the context in which sexual behaviour takes place as a part of the study objectives and promoting an inter-disciplinary dialogue overcoming dogma and prejudices.

Expression of metallopanstimulin in condylomata acuminata of the female anogenital region induced by papilloma virus

We have identified by cDNA cloning a gene, denoted MPS-1, that is activated in cultured human transformed cells by growth factors. The MPS-1 gene contains one zinc finger domain similar to those present in the C4 family of DNA binding proteins. In this study, the expression of MPS-1 mRNA and protein were examined in HPV-induced human condylomata acuminata. Initially, we detected the presence of MPS-1 mRNA by message amplification phenotyping in all condylomata tissues examined. Subsequently, the cellular distribution and abundance of MPS-1 mRNA was studied by in situ hybridization with specific MPS-1 DNA and RNA probes. We found that MPS-1 mRNA is expressed at high levels in the cytoplasm of condylomata cells. In contrast, the MPS-1 mRNA is expressed at low levels in nonneoplastic tissues. Moreover, antibodies were raised against the predicted N-terminal sequence of the MPS-1 protein and used to detect MPS-1 in condylomata cells. MPS-1 immunoreactivity was detected in the cytoplasm and/or the perinuclear regions of condylomata cells, with marked staining in areas of active proliferation. In distinction, MPS-1 immunoreactivity was very weak in normal epithelial cells. The results support the contention that the MPS-1 protein may be a potentially important mediator of proliferative responses induced by HPV.

Possible interaction between central cholinergic muscarinic and opioid peptidergic systems during memory consolidation in mice

Naloxone (0.01-1.00 mg/kg, ip) facilitated retention of a one-trial inhibitory avoidance task, when administered to male Rockland mice immediately after training, as indicated by performance on a retention test 48 hr later. The dose-response curve was an inverted U in this range of dose. In these conditions naloxone did not lengthen latencies to step-through during the retest of unshocked mice. Higher doses of naloxone (3.00 and 10.00 mg/kg, ip) tended to increase latencies to step-through of both shocked and unshocked mice. These facts rule out an aversive effect of naloxone for low and moderate doses but not for high doses. The influence of naloxone (0.10 mg/kg, ip) on retention was time dependent, which suggests that naloxone facilitated memory consolidation processes. The effects of naloxone were prevented by morphine in both an amnesic and a nonamnesic dose (1.0 and 0.5 mg/kg, ip, respectively). Therefore, naloxone probably facilitated retention as a function of its opiate antagonist properties. The memory facilitation induced by naloxone (0.10 mg/kg, ip) was antagonized by atropine (0.5 mg/kg, ip) but not by methylatropine (0.5 mg/kg, ip), mecamilamine (5 mg/kg, ip), or hexametonium (5 mg/kg, ip). Further, there was a mutual potentiation for both naloxone (0.01 mg/kg, ip) and the muscarinic agonist oxotremorine (6.25 and 12.5 micrograms/kg, ip) administered simultaneously, in doses which had no effect on their own. Moreover, an amnesic dose of atropine (10.00 mg/kg, ip) prevented the enhancement of retention induced by naloxone, while an amnesic dose of morphine (1.00 mg/kg, ip) did not modify the facilitatory effect of oxotremorine (50 micrograms/kg, ip) on retention. An inhibitory modulatory role for endogenous opioid systems on the activity of central cholinergic muscarinic systems during memory consolidation is suggested.

Selective brain noradrenaline depletion induced by the neurotoxin N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP 4) does not prevent the memory facilitation induced by a muscarinic agonist in mice

These experiments investigated the effects of central noradrenaline (NA) depletion and its interaction with cholinergic and dopaminergic mechanisms upon retention of a passive-avoidance response in mice. The NA selective neurotoxin N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine (DSP 4) (50 mg/kg IP, 7 days) was injected into mice to produce depletion of NA in frontal cortex, hypothalamus, cerebellum, midbrain and brain stem without any significant change in dopamine (DA) levels in frontal cortex, striatum, hypothalamus and midbrain. Depletion of brain NA produced by DSP 4 was significantly but not completely prevented by the NA uptake inhibitor desmethylimipramine (DMI) (10 mg/kg IP, 30 min before DSP 4 injection). Despite the marked NA depletion, DSP 4 neither impaired the retention of a passive-avoidance response in mice nor prevented the enhancement of retention of this response induced by the central muscarinic agonist oxotremorine (OTM) (0.05 mg/kg IP, immediately after training. This lack of effect of DSP 4 on retention was prevented neither by DMI nor by the serotonin uptake inhibitor fluoxetine (5 mg/kg IP, 30 min before DSP 4 injection). The enhancement of retention induced by OTM in the groups of mice injected with either water or DSP 4 was prevented by atropine (0.5 mg/kg IP, 20 min before training) but not by methylatropine in the same experimental conditions. This suggests that both in controls and DSP 4-pretreated mice, the primary effect of OTM is due to an interaction with muscarinic brain receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Possible cholinergic-dopaminergic link in memory facilitation induced by oxotremorine in mice

The immediate post-trial injection of the centrally active muscarinic agonist oxotremorine (0.025, 0.050 and 0.100 mg/kg, IP) can facilitate the retention of a passive-avoidance response in mice, as indicated by performance on a retention test 24 h later. Injections given 10 min after training also significantly facilitated retention, but given 120 min after training did not affect retention. These findings suggest an action of oxotremorine on memory mechanisms. The enhanced retention was neither the result of a punishing effect of oxotremorine nor of a nonspecific proactive pharmacological action of the drug. The memory facilitation produced by oxotremorine (0.050 mg/kg, IP) was not antagonized by pretreatment with phentolamine (10 mg/kg, 30 min, IP), phenoxybenzamine (10 mg/kg, 120 min, IP) or piperoxane (20 mg/kg, 30 min, IP). The alpha-noradrenergic blocking agents had no effect by themselves. On the other hand, the immediate post-trial injection of oxotremorine (0.050 mg/kg, IP) did not enhance retention when mice were pretreated with haloperidol (0.5 mg/kg, 120 min, IP). Haloperidol injected either before training or before the retention test did not alter performance during the retention test. This suggests that haloperidol impairs neither acquisition of the avoidance response nor its retrieval. Thus, it is probable that haloperidol pretreatment impaired oxotremorine-induced memory facilitation. We suggest a possible participation of brain catecholamines in memory facilitation induced by oxotremorine in mice.

Brain catecholamines modifications. The effects on memory facilitation induced by oxotremorine in mice

the immediate posttrial injection of oxotremorine (0.250 mu Mol/kg, IP) can facilitate the retention of a passive-avoidance response in mice. After the administration of alfa-methyl-p-tyrosine methylester (alpha-MPT) by intracerebroventricular injection at doses that had no effect on retention (100 microgram, 10 microliter, 60 min before trial), the immediate posttrial injection of oxotremorine did not enhance retention. The employed dose of alpha-MPT reduced brain levels of norepinephrine by about 40% and those of dopamine by about 25%. Pretreatment with nialamide (30 mg/kg, 20h IP), which prevents the catecholamine depletion induced by alpha-MPT, counteracted the effects depletion induced by alpha-MPT, counteracted the effects of alpha-MPT on the actions of oxotremorine on retention. These results suggest a participation of brain catecholamines on the actions of oxotremorine on retention and a possible interaction of cholinergic neurons with catecholaminergic system in memory processes.

Memory facilitation with posttrial injection of oxotremorine and physostigmine in mice

The immediate posttrial injection of oxotremorine (0.125, 0.250 and 0.500 muMol/kg i.p.) and equimolecular doses of physostigmine can facilitate the retention of a passive avoidance response in mice. Injections given 10 min after training also significantly facilitate retention, but injections given 30 or 120 min after training do not affect retention. These findings suggest an action of oxotremorine and physostigmine on mechanisms involved in memory storage. The enhanced retention produced by oxotremorine and physostigmine was blocked by pretreatment with atropine (2 muMol/kg, 20 min, i.p.) but was not affected by methylatropine (2 muMol/kg, 20 min, i.p.). The retention was not modified by posttrial injection of metoxotremorine (0.25 muMol/kg i.p.) or neostigmine (0.250 muMol/kg i.p.), quaternary analogs of oxotremorine and physostigmine, respectively. The results suggest a central action of both cholinergic agents attributable to an activation of muscarinic brain receptors.