1
|
Chinain M, Gatti Howell C, Roué M, Ung A, Henry K, Revel T, Cruchet P, Viallon J, Darius HT. Ciguatera poisoning in French Polynesia: A review of the distribution and toxicity of Gambierdiscus spp., and related impacts on food web components and human health. Harmful Algae 2023; 129:102525. [PMID: 37951623 DOI: 10.1016/j.hal.2023.102525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 11/14/2023]
Abstract
Ciguatera Poisoning (CP) is a seafood poisoning highly prevalent in French Polynesia. This illness results from the consumption of seafood contaminated with ciguatoxins (CTXs) produced by Gambierdiscus, a benthic dinoflagellate. Ciguatera significantly degrades the health and economic well-being of local communities largely dependent on reef fisheries for their subsistence. French Polynesia has been the site of rich and active CP research since the 1960's. The environmental, toxicological, and epidemiological data obtained in the frame of large-scale field surveys and a country-wide CP case reporting program conducted over the past three decades in the five island groups of French Polynesia are reviewed. Results show toxin production in Gambierdiscus in the natural environment may vary considerably at a temporal and spatial scale, and that several locales clearly represent Gambierdiscus spp. "biodiversity hotspots". Current data also suggest the "hot" species G. polynesiensis could be the primary source of CTXs in local ciguateric biotopes, pending formal confirmation. The prevalence of ciguatoxic fish and the CTX levels observed in several locales were remarkably high, with herbivores and omnivores often as toxic as carnivores. Results also confirm the strong local influence of Gambierdiscus spp. on the CTX toxin profiles characterized across multiple food web components including in CP-prone marine invertebrates. The statistics, obtained in the frame of a long-term epidemiological surveillance program established in 2007, point towards an apparent decline in the number of CP cases in French Polynesia as a whole; however, incidence rates remain dangerously high in some islands. Several of the challenges and opportunities, most notably those linked to the strong cultural ramifications of CP among local communities, that need to be considered to define effective risk management strategies are addressed.
Collapse
Affiliation(s)
- M Chinain
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 30, Papeete, Tahiti 98713, French Polynesia.
| | - C Gatti Howell
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 30, Papeete, Tahiti 98713, French Polynesia
| | - M Roué
- Institut de Recherche pour le Développement (IRD), UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 6570, Faa'a, Tahiti 98702, French Polynesia
| | - A Ung
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 30, Papeete, Tahiti 98713, French Polynesia
| | - K Henry
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 30, Papeete, Tahiti 98713, French Polynesia
| | - T Revel
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 30, Papeete, Tahiti 98713, French Polynesia
| | - P Cruchet
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 30, Papeete, Tahiti 98713, French Polynesia
| | - J Viallon
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 30, Papeete, Tahiti 98713, French Polynesia
| | - H T Darius
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, UPF), P.O. Box 30, Papeete, Tahiti 98713, French Polynesia
| |
Collapse
|
2
|
Darius HT, Revel T, Viallon J, Sibat M, Cruchet P, Longo S, Hardison DR, Holland WC, Tester PA, Litaker RW, McCall JR, Hess P, Chinain M. Comparative Study on the Performance of Three Detection Methods for the Quantification of Pacific Ciguatoxins in French Polynesian Strains of Gambierdiscus polynesiensis. Mar Drugs 2022; 20:md20060348. [PMID: 35736151 PMCID: PMC9229625 DOI: 10.3390/md20060348] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
Gambierdiscus and Fukuyoa dinoflagellates produce a suite of secondary metabolites, including ciguatoxins (CTXs), which bioaccumulate and are further biotransformed in fish and marine invertebrates, causing ciguatera poisoning when consumed by humans. This study is the first to compare the performance of the fluorescent receptor binding assay (fRBA), neuroblastoma cell-based assay (CBA-N2a), and liquid chromatography tandem mass spectrometry (LC-MS/MS) for the quantitative estimation of CTX contents in 30 samples, obtained from four French Polynesian strains of Gambierdiscus polynesiensis. fRBA was applied to Gambierdiscus matrix for the first time, and several parameters of the fRBA protocol were refined. Following liquid/liquid partitioning to separate CTXs from other algal compounds, the variability of CTX contents was estimated using these three methods in three independent experiments. All three assays were significantly correlated with each other, with the highest correlation coefficient (r2 = 0.841) found between fRBA and LC-MS/MS. The CBA-N2a was more sensitive than LC-MS/MS and fRBA, with all assays showing good repeatability. The combined use of fRBA and/or CBA-N2a for screening purposes and LC-MS/MS for confirmation purposes allows for efficient CTX evaluation in Gambierdiscus. These findings, which support future collaborative studies for the inter-laboratory validation of CTX detection methods, will help improve ciguatera risk assessment and management.
Collapse
Affiliation(s)
- Hélène Taiana Darius
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, French Polynesia; (T.R.); (J.V.); (P.C.); (S.L.); (M.C.)
- Correspondence: ; Tel.: +689-40-416-484
| | - Taina Revel
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, French Polynesia; (T.R.); (J.V.); (P.C.); (S.L.); (M.C.)
| | - Jérôme Viallon
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, French Polynesia; (T.R.); (J.V.); (P.C.); (S.L.); (M.C.)
| | - Manoëlla Sibat
- IFREMER, PHYTOX, Laboratoire METALG, F-44000 Nantes, France; (M.S.); (P.H.)
| | - Philippe Cruchet
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, French Polynesia; (T.R.); (J.V.); (P.C.); (S.L.); (M.C.)
| | - Sébastien Longo
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, French Polynesia; (T.R.); (J.V.); (P.C.); (S.L.); (M.C.)
| | - Donnie Ransom Hardison
- National Oceanic and Atmospheric Administration, Center for Coastal Fisheries and Habitat Research, Beaufort, NC 28516, USA; (D.R.H.); (W.C.H.)
| | - William C. Holland
- National Oceanic and Atmospheric Administration, Center for Coastal Fisheries and Habitat Research, Beaufort, NC 28516, USA; (D.R.H.); (W.C.H.)
| | | | - R. Wayne Litaker
- CSS, Inc. Under Contract to National Oceanic and Atmospheric Administration, National Centers for Coastal Ocean Science, National Ocean Service, Beaufort, NC 28516, USA;
| | - Jennifer R. McCall
- Center for Marine Science, University of North Carolina Wilmington, 601 South College Road, Wilmington, NC 28403, USA;
| | - Philipp Hess
- IFREMER, PHYTOX, Laboratoire METALG, F-44000 Nantes, France; (M.S.); (P.H.)
| | - Mireille Chinain
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, French Polynesia; (T.R.); (J.V.); (P.C.); (S.L.); (M.C.)
| |
Collapse
|
3
|
Darius HT, Paillon C, Mou-Tham G, Ung A, Cruchet P, Revel T, Viallon J, Vigliola L, Ponton D, Chinain M. Evaluating Age and Growth Relationship to Ciguatoxicity in Five Coral Reef Fish Species from French Polynesia. Mar Drugs 2022; 20:md20040251. [PMID: 35447924 PMCID: PMC9027493 DOI: 10.3390/md20040251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Ciguatera poisoning (CP) results from the consumption of coral reef fish or marine invertebrates contaminated with potent marine polyether compounds, namely ciguatoxins. In French Polynesia, 220 fish specimens belonging to parrotfish (Chlorurus microrhinos, Scarus forsteni, and Scarus ghobban), surgeonfish (Naso lituratus), and groupers (Epinephelus polyphekadion) were collected from two sites with contrasted risk of CP, i.e., Kaukura Atoll versus Mangareva Island. Fish age and growth were assessed from otoliths’ yearly increments and their ciguatoxic status (negative, suspect, or positive) was evaluated by neuroblastoma cell-based assay. Using permutational multivariate analyses of variance, no significant differences in size and weight were found between negative and suspect specimens while positive specimens showed significantly greater size and weight particularly for E. polyphekadion and S. ghobban. However, eating small or low-weight specimens remains risky due to the high variability in size and weight of positive fish. Overall, no relationship could be evidenced between fish ciguatoxicity and age and growth characteristics. In conclusion, size, weight, age, and growth are not reliable determinants of fish ciguatoxicity which appears to be rather species and/or site-specific, although larger fish pose an increased risk of poisoning. Such findings have important implications in current CP risk management programs.
Collapse
Affiliation(s)
- Hélène Taiana Darius
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, Tahiti, French Polynesia; (A.U.); (P.C.); (T.R.); (J.V.); (M.C.)
- Correspondence: ; Tel.: +689-40-416-484
| | - Christelle Paillon
- ENTROPIE, IRD-Université de la Réunion-CNRS-Université de la Nouvelle-Calédonie-IFREMER, Labex Corail, 98848 Nouméa, New Caledonia, France; (C.P.); (G.M.-T.); (L.V.)
| | - Gérard Mou-Tham
- ENTROPIE, IRD-Université de la Réunion-CNRS-Université de la Nouvelle-Calédonie-IFREMER, Labex Corail, 98848 Nouméa, New Caledonia, France; (C.P.); (G.M.-T.); (L.V.)
| | - André Ung
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, Tahiti, French Polynesia; (A.U.); (P.C.); (T.R.); (J.V.); (M.C.)
| | - Philippe Cruchet
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, Tahiti, French Polynesia; (A.U.); (P.C.); (T.R.); (J.V.); (M.C.)
| | - Taina Revel
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, Tahiti, French Polynesia; (A.U.); (P.C.); (T.R.); (J.V.); (M.C.)
| | - Jérôme Viallon
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, Tahiti, French Polynesia; (A.U.); (P.C.); (T.R.); (J.V.); (M.C.)
| | - Laurent Vigliola
- ENTROPIE, IRD-Université de la Réunion-CNRS-Université de la Nouvelle-Calédonie-IFREMER, Labex Corail, 98848 Nouméa, New Caledonia, France; (C.P.); (G.M.-T.); (L.V.)
| | - Dominique Ponton
- ENTROPIE, IRD-Université de la Réunion-CNRS-Université de la Nouvelle-Calédonie-IFREMER, c/o Institut Halieutique et des Sciences Marines (IH.SM), Université de Toliara, Rue Dr. Rabesandratana, P.O. Box 141, Toliara 601, Madagascar;
| | - Mireille Chinain
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, Université de Polynésie Française), P.O. Box 30, Papeete 98713, Tahiti, French Polynesia; (A.U.); (P.C.); (T.R.); (J.V.); (M.C.)
| |
Collapse
|
4
|
Darius HT, Revel T, Cruchet P, Viallon J, Gatti CMI, Sibat M, Hess P, Chinain M. Deep-Water Fish Are Potential Vectors of Ciguatera Poisoning in the Gambier Islands, French Polynesia. Mar Drugs 2021; 19:md19110644. [PMID: 34822515 PMCID: PMC8621427 DOI: 10.3390/md19110644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Ciguatera poisoning (CP) cases linked to the consumption of deep-water fish occurred in 2003 in the Gambier Islands (French Polynesia). In 2004, on the request of two local fishermen, the presence of ciguatoxins (CTXs) was examined in part of their fish catches, i.e., 22 specimens representing five deep-water fish species. Using the radioactive receptor binding assay (rRBA) and mouse bioassay (MBA), significant CTX levels were detected in seven deep-water specimens in Lutjanidae, Serranidae, and Bramidae families. Following additional purification steps on the remaining liposoluble fractions for 13 of these samples (kept at -20 °C), these latter were reanalyzed in 2018 with improved protocols of the neuroblastoma cell-based assay (CBA-N2a) and liquid chromatography tandem mass spectrometry (LC-MS/MS). Using the CBA-N2a, the highest CTX-like content found in a specimen of Eumegistus illustris (Bramidae) was 2.94 ± 0.27 µg CTX1B eq. kg-1. Its toxin profile consisted of 52-epi-54-deoxyCTX1B, CTX1B, and 54-deoxyCTX1B, as assessed by LC-MS/MS. This is the first study demonstrating that deep-water fish are potential ciguatera vectors and highlighting the importance of a systematic monitoring of CTXs in all exploited fish species, especially in ciguatera hotspots, including deep-water fish, which constitute a significant portion of the commercial deep-sea fisheries in many Asian-Pacific countries.
Collapse
Affiliation(s)
- Hélène Taiana Darius
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, University of French Polynesia), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (T.R.); (P.C.); (J.V.); (C.M.i.G.); (M.C.)
- Correspondence: ; Tel.: +689-40-416-484
| | - Taina Revel
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, University of French Polynesia), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (T.R.); (P.C.); (J.V.); (C.M.i.G.); (M.C.)
| | - Philippe Cruchet
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, University of French Polynesia), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (T.R.); (P.C.); (J.V.); (C.M.i.G.); (M.C.)
| | - Jérôme Viallon
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, University of French Polynesia), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (T.R.); (P.C.); (J.V.); (C.M.i.G.); (M.C.)
| | - Clémence Mahana iti Gatti
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, University of French Polynesia), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (T.R.); (P.C.); (J.V.); (C.M.i.G.); (M.C.)
| | - Manoëlla Sibat
- Ifremer, DYNECO, Laboratoire Phycotoxines, F-44000 Nantes, France; (M.S.); (P.H.)
| | - Philipp Hess
- Ifremer, DYNECO, Laboratoire Phycotoxines, F-44000 Nantes, France; (M.S.); (P.H.)
| | - Mireille Chinain
- Institut Louis Malardé (ILM), Laboratory of Marine Biotoxins, UMR 241-EIO (IFREMER, ILM, IRD, University of French Polynesia), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (T.R.); (P.C.); (J.V.); (C.M.i.G.); (M.C.)
| |
Collapse
|
5
|
Chinain M, Gatti CMI, Ung A, Cruchet P, Revel T, Viallon J, Sibat M, Varney P, Laurent V, Hess P, Darius HT. Evidence for the Range Expansion of Ciguatera in French Polynesia: A Revisit of the 2009 Mass-Poisoning Outbreak in Rapa Island (Australes Archipelago). Toxins (Basel) 2020; 12:E759. [PMID: 33271904 PMCID: PMC7759781 DOI: 10.3390/toxins12120759] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 01/14/2023] Open
Abstract
Ciguatera poisoning (CP) results from the consumption of seafood contaminated with ciguatoxins (CTXs). This disease is highly prevalent in French Polynesia with several well-identified hotspots. Rapa Island, the southernmost inhabited island in the country, was reportedly free of CP until 2007. This study describes the integrated approach used to investigate the etiology of a fatal mass-poisoning outbreak that occurred in Rapa in 2009. Symptoms reported in patients were evocative of ciguatera. Several Gambierdiscus field samples collected from benthic assemblages tested positive by the receptor binding assay (RBA). Additionally, the toxicity screening of ≈250 fish by RBA indicated ≈78% of fish could contain CTXs. The presence of CTXs in fish was confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS). The potential link between climate change and this range expansion of ciguatera to a subtropical locale of French Polynesia was also examined based on the analysis of temperature time-series data. Results are indicative of a global warming trend in Rapa area. A five-fold reduction in incidence rates was observed between 2009 and 2012, which was due in part to self-regulating behavior among individuals (avoidance of particular fish species and areas). Such observations underscore the prominent role played by community outreach in ciguatera risk management.
Collapse
Affiliation(s)
- Mireille Chinain
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Clémence Mahana iti Gatti
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - André Ung
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Philippe Cruchet
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Taina Revel
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Jérôme Viallon
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| | - Manoëlla Sibat
- Institut Français de Recherche Pour l’Exploitation de la Mer, Phycotoxins Laboratory, 44311 Nantes, France; (M.S.); (P.H.)
| | - Patrick Varney
- Météo France, Direction Inter-Régionale en Polynésie Française, P.O. Box 6005, 98702 Faa’a, Tahiti, French Polynesia; (P.V.); (V.L.)
| | - Victoire Laurent
- Météo France, Direction Inter-Régionale en Polynésie Française, P.O. Box 6005, 98702 Faa’a, Tahiti, French Polynesia; (P.V.); (V.L.)
| | - Philipp Hess
- Institut Français de Recherche Pour l’Exploitation de la Mer, Phycotoxins Laboratory, 44311 Nantes, France; (M.S.); (P.H.)
| | - Hélène Taiana Darius
- Institut Louis Malardé, Laboratory of Marine Biotoxins—UMR EIO (IFREMER-ILM-IRD-UPF), P.O. Box 30, 98713 Papeete, Tahiti, French Polynesia; (C.M.i.G.); (A.U.); (P.C.); (T.R.); (J.V.); (H.T.D.)
| |
Collapse
|
6
|
Weerasinghe S, Mirghani H, Revel T, Zidan FA. P473 The use of cumulative sum analysis in the assessment of trainee competence in fetal measurements. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Abstract
RATIONALE, AIMS AND OBJECTIVE To investigate whether the introduction of a programme of optimising drug treatment, intensive education and self-monitoring of patients diagnosed with gestational diabetes mellitus (GDM) at an early stage (<20 gestational weeks), will improve management outcomes as determined by objective measures of patient knowledge about diabetes, glycaemia control, maternal/neonatal complications, and health-related quality of life. METHODS The study was a randomized, controlled, longitudinal, prospective clinical trial performed at Al-Ain Hospital, Al-Ain, United Arab Emirates. Over an 18-month period, patients diagnosed with GDM were recruited and were randomly assigned to either an intervention or a control group, in a ratio of 3:2. Intervention patients received a structured pharmaceutical care service (including education and introduction of intensive self-monitoring) while control patients received traditional services. Patients were followed up from time of recruitment until 6 months postnatally at scheduled outpatient clinics. A range of clinical and humanistic outcome measures, including maternal and neonatal complications, were used to assess the impact of the intervention. RESULTS A total of 165 patients (99 intervention, 66 control) completed the study. The intervention patients exhibited a range of benefits from the provision of the programme when compared with control group patients. Statistically significant (P < 0.05) improvements were shown in the intervention group for knowledge of diabetes, health-related quality of life (as determined by the SF36), control of plasma glucose and HbA(1c), maternal complications [e.g. decreased incidence of pre-eclampsia (5.1% vs. 16.7%), eclampsia (1.0% vs. 7.6%), episodes of severe hyperglycaemia (3.0% vs. 19.7%) and need for Caesarean section (7.1% vs. 18.2%)], and neonatal complications [e.g. decreased incidence of neonatal hypoglycaemia (2.0% vs. 10.6%), respiratory distress at birth (4.0% vs. 15.2%), hyperbilirubinaemia (1.0% vs. 12.1%) and large for gestational age (9.0% vs. 22.7%)]. CONCLUSION The research provides clear evidence that provision of pharmaceutical care adds value to the management of GDM as exemplified by improved maternal and neonatal outcomes.
Collapse
Affiliation(s)
- A A Elnour
- Al Ain Hospital, United Arab Emirates, and Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | | | | | | | | |
Collapse
|
8
|
Darius HT, Ponton D, Revel T, Cruchet P, Ung A, Tchou Fouc M, Chinain M. Ciguatera risk assessment in two toxic sites of French Polynesia using the receptor-binding assay. Toxicon 2007; 50:612-26. [PMID: 17631928 DOI: 10.1016/j.toxicon.2007.05.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Revised: 04/14/2007] [Accepted: 05/29/2007] [Indexed: 11/30/2022]
Abstract
Ciguatera Fish Poisoning (CFP) is a tropical syndrome well known in remote archipelagos where the population is still dependent on fish resources. In order to assess the ciguatera risk in two islands of French Polynesia, Tubuai (Australes) and Nuku Hiva (Marquesas), a study was carried out on both Gambierdiscus populations as well as on various fish species using the receptor-binding assay (RBA) to detect and quantify ciguatoxins. Relationship between RBA data and size or weight of fish was evaluated, and when only few individuals for a particular species were available the trophic level was used to help comparisons between studied areas. According to epidemiological data, toxic versus safe areas were explored and compared in both islands. In Tubuai Island, Gambierdiscus cells were surprisingly absent in the north area, considered as a toxic area, but almost 94% of fishes were classified as RBA+. In contrast, the south area, supposed to be safe, was evolving to be a risky area because of the presence of Gambierdiscus cells and 74% of fishes being RBA+. In Nuku Hiva Island, Gambierdiscus cells were present in the toxic areas, Anaho, Taiohae and Taipivei, with two toxic blooms in Anaho Bay, but none in Terre Déserte, the fishing area of this island. With RBA data, fishes were analyzed to be RBA+ at a high percentage in Anaho and Taiohae, higher than in Taipivei and Terre Déserte areas. In general, our findings were congruent with epidemiological data and the knowledge of local people only for risky fish species.
Collapse
Affiliation(s)
- H T Darius
- Laboratoire des Microalgues Toxiques, Institut Louis Malardé, BP 30, Papeete Tahiti, French Polynesia, France.
| | | | | | | | | | | | | |
Collapse
|
9
|
Revel T. Job satisfaction, rural practice and the health reforms. N Z Med J 2000; 113:407. [PMID: 11062825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
10
|
Revel T. False hope. N Z Med J 1998; 111:83-4. [PMID: 9575064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|