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Khan AA, Josse R, Kannu P, Villeneuve J, Paul T, Van Uum S, Greenberg CR. Hypophosphatasia: Canadian update on diagnosis and management. Osteoporos Int 2019; 30:1713-1722. [PMID: 30915507 DOI: 10.1007/s00198-019-04921-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/27/2019] [Indexed: 12/22/2022]
Abstract
UNLABELLED Hypophosphatasia (HPP) is a rare inherited disorder of bone and mineral metabolism caused by loss of function mutations in the ALPL gene. The presentation in children and adults can be extremely variable and natural history is poorly understood particularly in adults. Careful patient evaluation is required with consideration of pharmacologic intervention in individuals meeting criteria for therapy. INTRODUCTION The purposes of this review are to present current evidence regarding the diagnosis and management of hypophosphatasia in children and adults and provide evidence-based recommendations for management. METHOD A MEDLINE, EMBASE, and Cochrane database search and literature review was completed. The following consensus recommendations were developed based on the highest level of evidence as well as expert opinion. RESULTS Hypophosphatasia is a rare inherited disorder of bone and mineral metabolism due to loss of function mutations in the tissue non-specific alkaline phosphatase (ALPL) gene causing reductions in the activity of the tissue non-specific isoenzyme of alkaline phosphatase (TNSALP). Deficient levels of alkaline phosphatase result in elevation of inhibitors of mineralization of the skeleton and teeth, principally inorganic pyrophosphate. The impaired skeletal mineralization may result in elevations in serum calcium and phosphate. Clinical features include premature loss of teeth, metatarsal and subtrochanteric fractures as well as fragility fractures. Poor bone healing post fracture has been observed. Myalgias and muscle weakness may also be present. In infancy and childhood, respiratory and neurologic complications can occur. CONCLUSIONS HPP is associated with significant morbidity and mortality. Pharmacologic intervention can result in significant clinical improvement. This Canadian position paper provides an overview of the musculoskeletal, renal, dental, respiratory, and neurologic manifestations of hypophosphatasia. The current state of the art in the diagnosis and management of hypophosphatasia is presented.
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Affiliation(s)
- A A Khan
- McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
| | - R Josse
- St. Michael's Hospital and University of Toronto , Toronto, Canada
| | - P Kannu
- Hospital for Sick Kids , Toronto, Canada
| | - J Villeneuve
- Le Centre Hospitalier Universitaire de Quebec, Quebec, Canada
| | - T Paul
- St. Joseph's Health Care London, London, Ontario, Canada
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Abstract
In the article mentioned above an author's name was misspelled.
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Affiliation(s)
- A A Khan
- McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.
| | - R Josse
- St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - P Kannu
- Hospital for Sick Kids, Toronto, Canada
| | - J Villeneuve
- Le Centre Hospitalier Universitaire de Quebec, Quebec, Canada
| | - T Paul
- St. Joseph's Health Care London, London, Ontario, Canada
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Ferrari SL, Abrahamsen B, Napoli N, Akesson K, Chandran M, Eastell R, El-Hajj Fuleihan G, Josse R, Kendler DL, Kraenzlin M, Suzuki A, Pierroz DD, Schwartz AV, Leslie WD. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int 2018; 29:2585-2596. [PMID: 30066131 PMCID: PMC6267152 DOI: 10.1007/s00198-018-4650-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk.
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Affiliation(s)
- S L Ferrari
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 1205, Geneva, Switzerland.
| | - B Abrahamsen
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
| | - K Akesson
- Department of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Lund University, Malmö, Sweden
| | - M Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - R Eastell
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - G El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - R Josse
- Department of Medicine and Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - M Kraenzlin
- Endonet, Endocrine Clinic and Laboratory, Basel, Switzerland
| | - A Suzuki
- Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - A V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - W D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Diez-Perez A, Naylor KE, Abrahamsen B, Agnusdei D, Brandi ML, Cooper C, Dennison E, Eriksen EF, Gold DT, Guañabens N, Hadji P, Hiligsmann M, Horne R, Josse R, Kanis JA, Obermayer-Pietsch B, Prieto-Alhambra D, Reginster JY, Rizzoli R, Silverman S, Zillikens MC, Eastell R. International Osteoporosis Foundation and European Calcified Tissue Society Working Group. Recommendations for the screening of adherence to oral bisphosphonates. Osteoporos Int 2017; 28:767-774. [PMID: 28093634 PMCID: PMC5302161 DOI: 10.1007/s00198-017-3906-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 01/02/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Adherence to oral bisphosphonates is low. A screening strategy is proposed based on the response of biochemical markers of bone turnover after 3 months of therapy. If no change is observed, the clinician should reassess the adherence to the treatment and also other potential issues with the drug. INTRODUCTION Low adherence to oral bisphosphonates is a common problem that jeopardizes the efficacy of treatment of osteoporosis. No clear screening strategy for the assessment of compliance is widely accepted in these patients. METHODS The International Osteoporosis Foundation and the European Calcified Tissue Society have convened a working group to propose a screening strategy to detect a lack of adherence to these drugs. The question to answer was whether the bone turnover markers (BTMs) PINP and CTX can be used to identify low adherence in patients with postmenopausal osteoporosis initiating oral bisphosphonates for osteoporosis. The findings of the TRIO study specifically address this question and were used as the basis for testing the hypothesis. RESULTS Based on the findings of the TRIO study, specifically addressing this question, the working group recommends measuring PINP and CTX at baseline and 3 months after starting therapy to check for a decrease above the least significant change (decrease of more than 38% for PINP and 56% for CTX). Detection rate for the measurement of PINP is 84%, for CTX 87% and, if variation in at least one is considered when measuring both, the level of detection is 94.5%. CONCLUSIONS If a significant decrease is observed, the treatment can continue, but if no decrease occurs, the clinician should reassess to identify problems with the treatment, mainly low adherence.
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Affiliation(s)
- A Diez-Perez
- Department of Internal Medicine, Hospital del Mar-IMIM-Universitat Autònoma and CIBERFES-ISCIII, P Maritim 25-29, 08003, Barcelona, Spain.
| | - K E Naylor
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - B Abrahamsen
- Institute of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - D Agnusdei
- Independent Scientific Consultant, Florence, Italy
| | - M L Brandi
- Mineral and Bone Metabolic Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, and CIBERFES-ISCIII, Oxford, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - E F Eriksen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - D T Gold
- Duke University Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - N Guañabens
- Rheumatology Department, Hospital Clínic, University of Barcelona, CIBERehd, Barcelona, Spain
| | - P Hadji
- Department of Bone Oncology, Endocrinology and Reproductive Medicine, Nordwest Hospital, Frankfurt, Germany
| | - M Hiligsmann
- Department of Health Services Research, School for Public Health & Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - R Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK
| | - R Josse
- Department of Nutritional Sciences and Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - J A Kanis
- Centre for Metabolic Bone Diseases, Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
| | - B Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - D Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - R Rizzoli
- Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - S Silverman
- Cedars-Sinai/University of California, Los Angeles, USA
| | - M C Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - R Eastell
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
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Jenkins DJA, Jones PJ, Frohlich J, Lamarche B, Ireland C, Nishi SK, Srichaikul K, Galange P, Pellini C, Faulkner D, de Souza RJ, Sievenpiper JL, Mirrahimi A, Jayalath VH, Augustin LS, Bashyam B, Leiter LA, Josse R, Couture P, Ramprasath V, Kendall CWC. The effect of a dietary portfolio compared to a DASH-type diet on blood pressure. Nutr Metab Cardiovasc Dis 2015; 25:1132-1139. [PMID: 26552742 DOI: 10.1016/j.numecd.2015.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/07/2015] [Accepted: 08/12/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Compared to a DASH-type diet, an intensively applied dietary portfolio reduced diastolic blood pressure at 24 weeks as a secondary outcome in a previous study. Due to the importance of strategies to reduce blood pressure, we performed an exploratory analysis pooling data from intensively and routinely applied portfolio treatments from the same study to assess the effect over time on systolic, diastolic and mean arterial pressure (MAP), and the relation to sodium (Na(+)), potassium (K(+)), and portfolio components. METHODS AND RESULTS 241 participants with hyperlipidemia, from four academic centers across Canada were randomized and completed either a DASH-type diet (control n = 82) or a dietary portfolio that included, soy protein, viscous fibers and nuts (n = 159) for 24 weeks. Fasting measures and 7-day food records were obtained at weeks 0, 12 and 24, with 24-h urines at weeks 0 and 24. The dietary portfolio reduced systolic, diastolic and mean arterial blood pressure compared to the control by 2.1 mm Hg (95% CI, 4.2 to -0.1 mm Hg) (p = 0.056), 1.8 mm Hg (CI, 3.2 to 0.4 mm Hg) (p = 0.013) and 1.9 mm Hg (CI, 3.4 to 0.4 mm Hg) (p = 0.015), respectively. Blood pressure reductions were small at 12 weeks and only reached significance at 24 weeks. Nuts, soy and viscous fiber all related negatively to change in mean arterial pressure (ρ = -0.15 to -0.17, p ≤ 0.016) as did urinary potassium (ρ = -0.25, p = 0.001), while the Na(+)/K(+) ratio was positively associated (ρ = 0.20, p = 0.010). CONCLUSIONS Consumption of a cholesterol-lowering dietary portfolio also decreased blood pressure by comparison with a healthy DASH-type diet. CLINICAL TRIAL REG. NO.: NCT00438425, clinicaltrials.gov.
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Affiliation(s)
- D J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - P J Jones
- Richardson Center for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB, Canada
| | - J Frohlich
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - B Lamarche
- School of Nutrition, Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - C Ireland
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - S K Nishi
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - K Srichaikul
- Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - P Galange
- Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - C Pellini
- Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - D Faulkner
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - R J de Souza
- Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
| | - J L Sievenpiper
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - A Mirrahimi
- Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - V H Jayalath
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - L S Augustin
- Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - B Bashyam
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada
| | - L A Leiter
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - R Josse
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - P Couture
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - V Ramprasath
- Richardson Center for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, MB, Canada
| | - C W C Kendall
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, ON, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
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Bellwon P, Truisi G, Bois F, Wilmes A, Schmidt T, Savary C, Parmentier C, Hewitt P, Schmal O, Josse R, Richert L, Guillouzo A, Mueller S, Jennings P, Testai E, Dekant W. Kinetics and dynamics of cyclosporine A in three hepatic cell culture systems. Toxicol In Vitro 2015; 30:62-78. [DOI: 10.1016/j.tiv.2015.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 06/30/2015] [Accepted: 07/06/2015] [Indexed: 01/08/2023]
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Ollivier L, Tifratene K, Josse R, Keundjian A, Boutin JP. The relationship between body weight and tolerance to mefloquine prophylaxis in non-immune adults: results of a questionnaire-based study. Annals of Tropical Medicine & Parasitology 2013; 98:639-41. [PMID: 15324471 DOI: 10.1179/000349804225021262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- L Ollivier
- Department of Epidemiology and Public Health, Institute of Tropical Medicine of the French Forces Medical Services, B.P. 46, 13 998 Marseilles Armées, France.
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Mithal A, Bonjour JP, Boonen S, Burckhardt P, Degens H, El Hajj Fuleihan G, Josse R, Lips P, Morales Torres J, Rizzoli R, Yoshimura N, Wahl DA, Cooper C, Dawson-Hughes B. Impact of nutrition on muscle mass, strength, and performance in older adults. Osteoporos Int 2013; 24:1555-66. [PMID: 23247327 DOI: 10.1007/s00198-012-2236-y] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 09/20/2012] [Indexed: 12/25/2022]
Abstract
Muscle strength plays an important role in determining risk for falls, which result in fractures and other injuries. While bone loss has long been recognized as an inevitable consequence of aging, sarcopenia-the gradual loss of skeletal muscle mass and strength that occurs with advancing age-has recently received increased attention. A review of the literature was undertaken to identify nutritional factors that contribute to loss of muscle mass. The role of protein, acid-base balance, vitamin D/calcium, and other minor nutrients like B vitamins was reviewed. Muscle wasting is a multifactorial process involving intrinsic and extrinsic alterations. A loss of fast twitch fibers, glycation of proteins, and insulin resistance may play an important role in the loss of muscle strength and development of sarcopenia. Protein intake plays an integral part in muscle health and an intake of 1.0-1.2 g/kg of body weight per day is probably optimal for older adults. There is a moderate [corrected] relationship between vitamin D status and muscle strength. Chronic ingestion of acid-producing diets appears to have a negative impact on muscle performance, and decreases in vitamin B12 and folic acid intake may also impair muscle function through their action on homocysteine. An adequate nutritional intake and an optimal dietary acid-base balance are important elements of any strategy to preserve muscle mass and strength during aging.
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Affiliation(s)
- A Mithal
- Medanta Medicity, Sector 38, Gurgaon, India.
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Kaufman JM, Audran M, Bianchi G, Braga V, Diaz-Curiel M, Francis RM, Goemaere S, Josse R, Palacios S, Ringe JD, Felsenberg D, Boonen S. Efficacy and safety of strontium ranelate in the treatment of osteoporosis in men. J Clin Endocrinol Metab 2013; 98:592-601. [PMID: 23341486 DOI: 10.1210/jc.2012-3048] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Strontium ranelate reduces vertebral and nonvertebral fracture risk in postmenopausal osteoporosis. OBJECTIVE The objective of this study was to determine the efficacy and safety of strontium ranelate in osteoporosis in men over 2 years (main analysis after 1 year). DESIGN This was an international, unbalanced (2:1), double-blind, randomized placebo-controlled trial (MALEO [MALE Osteoporosis]). SETTING This international study included 54 centers in 14 countries. PARTICIPANTS PARTICIPANTS were 261 white men with primary osteoporosis. INTERVENTION Strontium ranelate at 2 g/d (n = 174) or placebo (n = 87) was administered. MAIN OUTCOME MEASURES Lumbar spine (L2-L4), femoral neck, and total hip bone mineral density (BMD), biochemical bone markers, and safety were measured. RESULTS Baseline characteristics were similar in both groups in the whole population (age, 72.9 ± 6.0 years; lumbar spine BMD T-score, -2.7 ± 1.0; femoral neck BMD T-score, -2.3 ± 0.7). Men who received strontium ranelate over 2 years had greater increases in lumbar spine BMD than those who received placebo (relative change from baseline to end, 9.7% ± 7.5% vs 2.0% ± 5.5%; between-group difference estimate (SE), 7.7% (0.9%); 95% confidence interval, 5.9%-9.5%; P < .001). There were also significant between-group differences in relative changes in femoral neck BMD (P < .001) and total hip BMD (P < .001). At the end of treatment, mean levels of serum cross-linked telopeptides of type I collagen, a marker of bone resorption, were increased in both the strontium ranelate group (10.7% ± 58.0%; P = .022) and the placebo group (34.9% ± 65.8%; P < .001). The corresponding mean changes of bone alkaline phosphatase, a marker of bone formation, were 6.4% ± 28.5% (P = .005) and 1.9% ± 25.4% (P = .505), respectively. After 2 years, the blood strontium level (129 ± 66 μmol/L) was similar to that in trials of postmenopausal osteoporosis. Strontium ranelate was generally well tolerated. CONCLUSIONS The effects of strontium ranelate on BMD in osteoporotic men were similar to those in postmenopausal osteoporotic women, supporting its use in the treatment of osteoporosis in men.
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Affiliation(s)
- J-M Kaufman
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, Josse R, Kanis JA, Mithal A, Pierroz DD, Stenmark J, Stöcklin E, Dawson-Hughes B. A global representation of vitamin D status in healthy populations: reply to comment by Saadi. Arch Osteoporos 2013; 8:122. [PMID: 23371520 DOI: 10.1007/s11657-013-0122-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/18/2013] [Indexed: 02/03/2023]
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Wahl DA, Cooper C, Ebeling PR, Eggersdorfer M, Hilger J, Hoffmann K, Josse R, Kanis JA, Mithal A, Pierroz DD, Stenmark J, Stöcklin E, Dawson-Hughes B. A global representation of vitamin D status in healthy populations. Arch Osteoporos 2012; 7:155-72. [PMID: 23225293 DOI: 10.1007/s11657-012-0093-0] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 08/06/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE This paper visualizes the available data on vitamin D status on a global map, examines the existing heterogeneities in vitamin D status and identifies research gaps. METHODS A graphical illustration of global vitamin D status was developed based on a systematic review of the worldwide literature published between 1990 and 2011. Studies were eligible if they included samples of randomly selected males and females from the general population and assessed circulating 25-hydroxyvitamin D [25(OH)D] levels. Two different age categories were selected: children and adolescents (1-18 years) and adults (>18 years). Studies were chosen to represent a country based on a hierarchical set of criteria. RESULTS In total, 200 studies from 46 countries met the inclusion criteria, most coming from Europe. Forty-two of these studies (21 %) were classified as representative. In children, gaps in data were identified in large parts of Africa, Central and South America, Europe, and most of the Asia/Pacific region. In adults, there was lack of information in Central America, much of South America and Africa. Large regions were identified for which the mean 25(OH)D levels were below 50 nmol/L. CONCLUSIONS This study provides an overview of 25(OH)D levels around the globe. It reveals large gaps in information in children and adolescents and smaller but important gaps in adults. In view of the importance of vitamin D to musculoskeletal growth, development, and preservation, and of its potential importance in other tissues, we strongly encourage new research to clearly define 25(OH)D status around the world.
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Affiliation(s)
- D A Wahl
- International Osteoporosis Foundation, Nyon, Switzerland
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Josse R, Rogue A, Lorge E, Guillouzo A. An adaptation of the human HepaRG cells to the in vitro micronucleus assay. Mutagenesis 2011; 27:295-304. [DOI: 10.1093/mutage/ger076] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Fraser LA, Langsetmo L, Berger C, Ioannidis G, Goltzman D, Adachi JD, Papaioannou A, Josse R, Kovacs CS, Olszynski WP, Towheed T, Hanley DA, Kaiser SM, Prior J, Jamal S, Kreiger N, Brown JP, Johansson H, Oden A, McCloskey E, Kanis JA, Leslie WD. Fracture prediction and calibration of a Canadian FRAX® tool: a population-based report from CaMos. Osteoporos Int 2011; 22:829-37. [PMID: 21161508 PMCID: PMC5101064 DOI: 10.1007/s00198-010-1465-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 09/03/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED A new Canadian WHO fracture risk assessment (FRAX®) tool to predict 10-year fracture probability was compared with observed 10-year fracture outcomes in a large Canadian population-based study (CaMos). The Canadian FRAX tool showed good calibration and discrimination for both hip and major osteoporotic fractures. INTRODUCTION The purpose of this study was to validate a new Canadian WHO fracture risk assessment (FRAX®) tool in a prospective, population-based cohort, the Canadian Multicentre Osteoporosis Study (CaMos). METHODS A FRAX tool calibrated to the Canadian population was developed by the WHO Collaborating Centre for Metabolic Bone Diseases using national hip fracture and mortality data. Ten-year FRAX probabilities with and without bone mineral density (BMD) were derived for CaMos women (N = 4,778) and men (N = 1,919) and compared with observed fracture outcomes to 10 years (Kaplan-Meier method). Cox proportional hazard models were used to investigate the contribution of individual FRAX variables. RESULTS Mean overall 10-year FRAX probability with BMD for major osteoporotic fractures was not significantly different from the observed value in men [predicted 5.4% vs. observed 6.4% (95%CI 5.2-7.5%)] and only slightly lower in women [predicted 10.8% vs. observed 12.0% (95%CI 11.0-12.9%)]. FRAX was well calibrated for hip fracture assessment in women [predicted 2.7% vs. observed 2.7% (95%CI 2.2-3.2%)] but underestimated risk in men [predicted 1.3% vs. observed 2.4% (95%CI 1.7-3.1%)]. FRAX with BMD showed better fracture discrimination than FRAX without BMD or BMD alone. Age, body mass index, prior fragility fracture and femoral neck BMD were significant independent predictors of major osteoporotic fractures; sex, age, prior fragility fracture and femoral neck BMD were significant independent predictors of hip fractures. CONCLUSION The Canadian FRAX tool provides predictions consistent with observed fracture rates in Canadian women and men, thereby providing a valuable tool for Canadian clinicians assessing patients at risk of fracture.
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Affiliation(s)
- L-A Fraser
- Department of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada
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Fraser LA, Ioannidis G, Adachi JD, Pickard L, Kaiser SM, Prior J, Brown JP, Hanley DA, Olszynski WP, Anastassiades T, Jamal S, Josse R, Goltzman D, Papaioannou A. Fragility fractures and the osteoporosis care gap in women: the Canadian Multicentre Osteoporosis Study. Osteoporos Int 2011; 22:789-96. [PMID: 20683706 PMCID: PMC5101074 DOI: 10.1007/s00198-010-1359-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 06/16/2010] [Indexed: 01/06/2023]
Abstract
UNLABELLED Canadian women over 50 years old were studied over a 10-year period to see if those who sustained a fracture (caused by minimal trauma) were receiving the recommended osteoporosis therapy. We found that approximately half of these women were not being treated, indicating a significant care gap in osteoporosis treatment. INTRODUCTION Prevalent fragility fracture strongly predicts future fracture. Previous studies have indicated that women with fragility fractures are not receiving the indicated treatment. We aimed to describe post fracture care in Canadian women using a large, population-based prospective cohort that began in 1995-1997. METHODS We followed 5,566 women over 50 years of age from across Canada over a period of 10 years in the Canadian Multicentre Osteoporosis Study. Information on medication use and incident clinical fragility fractures was obtained during a yearly questionnaire or interview and fractures were confirmed by radiographic/medical reports. RESULTS Over the 10-year study period, 42-56% of women with yearly incident clinical fragility fractures were not treated with an osteoporosis medication. During year 1 of the study, 22% of the women who had experienced a fragility fracture were on treatment with a bisphosphonate and 26% were on hormone therapy (HT). We were not able to differentiate HT use for menopause symptoms vs osteoporosis. Use of bisphosphonate therapy increased over time; odds ratio (OR) for use at year 10 compared to use at year 1 was 3.65 (95% confidence interval (CI) 1.83-7.26). In contrast, HT use declined, with an OR of 0.07 (95%CI 0.02-0.24) at year 10 compared to year 1 of the study. CONCLUSION In a large population-based cohort study, we found a therapeutic care gap in women with osteoporosis and fragility fractures. Although bisphosphonate therapy usage improved over time, a substantial gap remains.
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Affiliation(s)
- L-A Fraser
- Departments of Epidemiology and Medicine, Hamilton Health Sciences-Chedoke Site, McMaster University, 1200 Main Street West, Hamilton, ON L8N3Z5, Canada
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Le Hegarat L, Dumont J, Josse R, Huet S, Lanceleur R, Mourot A, Poul JM, Guguen-Guillouzo C, Guillouzo A, Fessard V. Assessment of the genotoxic potential of indirect chemical mutagens in HepaRG cells by the comet and the cytokinesis-block micronucleus assays. Mutagenesis 2010; 25:555-60. [DOI: 10.1093/mutage/geq039] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Langsetmo LA, Morin S, Richards JB, Davison KS, Olszynski WP, Prior JC, Josse R, Goltzman D. Effectiveness of antiresorptives for the prevention of nonvertebral low-trauma fractures in a population-based cohort of women. Osteoporos Int 2009; 20:283-90. [PMID: 18581034 PMCID: PMC5101049 DOI: 10.1007/s00198-008-0656-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Accepted: 05/05/2008] [Indexed: 01/06/2023]
Abstract
UNLABELLED Observational studies are needed to quantify real-life effectiveness of antiresorptive therapy in the prevention of clinical fractures. Antiresorptive therapies were associated with an overall 32% reduction in low-trauma nonvertebral fracture risk among women 50 and older. Effectiveness may be lower among older women and those without risk factors. INTRODUCTION Randomized controlled trials have shown that antiresorptive therapies reduce the risk of fracture in selected populations, but further study is needed to quantify their real-life effectiveness. The study objective was to determine the association between antiresorptive use and low-trauma nonvertebral fracture in women 50 and older. METHODS The design was a retrospective nested case-control study (density-based sampling) within the Canadian Multicentre Osteoporosis Study. There were 5,979 eligible women with 453 cases and 1,304 matched controls. RESULTS The current use of antiresorptives was associated with a decreased risk of fracture with OR = 0.68, 95% CI: 0.52-0.91; where OR is the adjusted odds ratio and CI is the confidence interval. Subgroup analysis yielded OR = 0.61, 95% CI: 0.42-0.89 for ages 50-74; OR = 0.76, 95% CI: 0.50-1.17 for ages 75+; OR = 0.58, 95% CI: 0.40-0.83 for those with a major risk factor; and OR = 0.92; 95% CI: 0.59-1.42 for those without a major risk factor. Major risk factors were prevalent low-trauma fracture, vertebral deformity (grade 2+), and BMD T-score < or = -2.5. CONCLUSIONS Antiresorptive therapy is associated with a clinically important reduction in low-trauma nonvertebral fracture risk among community-dwelling women aged 50 and older. Antiresorptive therapy may be less effective for women 75 and older and women without major risk factors.
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Affiliation(s)
- L A Langsetmo
- CaMos National Coordinating Centre, Montreal, Canada
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Josse R, Hymery N, Sibiril Y, Batina P, Parent-Massin D. In vitro effects of trichothecene metabolites on human hematopoietic progenitors. Toxicol Lett 2006. [DOI: 10.1016/j.toxlet.2006.07.119] [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: 10/24/2022]
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Josse R, Tanimomo-Kledjo B, Johnson RC, Guedenon A, Anagonou S, Portaels F. [Buruli ulcer in 2004]. Med Trop (Mars) 2004; 64:133-5. [PMID: 15460140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- R Josse
- Service de Médecine des Collectivités de l'HIA R. Picqué a Bordeaux.
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Jeandel P, Josse R, Durand JP. [Exotic viral arthritis: role of alphavirus]. Med Trop (Mars) 2004; 64:81-8. [PMID: 15224565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Only six of the many alphavirus known to affect humans can cause articular manifestations. They are the Ross River and Barmah Forest viruses from the South Pacific, the Chikungunya, O'Nyong Nyong and Sindbis viruses from tropical Africa, and the Mayaro virus from South America. In most cases, articular manifestations involve arthralgia or transient arthritis and are usually minor. However in some cases especially involving Ross River virus acute polyarthritis may be the most prominent clinical feature and even develop before fever. Although these joint symptoms may be severe and persist for weeks or months in a subacute mode with slightly inflammatory episodes that can be relieved using analgesics, they never cause permanent damage. Differential diagnosis of alphavirsus-related polyarthritis is simple to diagnosis especially in epidemic outbreaks as is frequently the case for Ross River virus epidemics in Australia. Imported cases should be suspected in patients presenting acute or subacute polyarthritis after a recent stay of any length of time in a tropical country and can be confirmed by ordering serology from a specialized reference laboratory.
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Affiliation(s)
- P Jeandel
- Service de Santé des Armées, Hôpital d'instruction des armées Robert Picqué, Bordeaux, France
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20
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Jacquemart Y, Josse R. [Papua New Guinea]. Med Trop (Mars) 2003; 62:583-8. [PMID: 12731300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Papua New Guinea is an independent country located in Oceania with a population of 4.9 million. Urban development is low and the estimated population density is 9 inhabitants per square kilometre. The terrain is mountainous and accessibility for health care services is difficult in some locations. Medical care facilities are organized in 18 provinces that are divided into 2 to 8 districts in which basic health care and hospital services are delivered through 1765 first aid units, 319 dispensaries, 189 specialized clinics and centers and 19 hospitals. There are no local schools for training medical and paramedical personnel who come from outside the country. Malaria, filariasis, leprosy, tuberculosis, infant diarrheal diseases, viral hepatitis, and envenomation are major public health problems. Buruli ulcer, dengue fever and arboviruses are emerging diseases.
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Affiliation(s)
- Y Jacquemart
- Régiment d'Infanterie de Marine du Pacifique, Service médical, Plum BP 1060, 98842 Nouméa, Nouvelle Calédonie
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Migliani R, Josse R, Hovette P, Keundjian A, Pages F, Meynard JB, Ollivier L, Sbai Idrissi K, Tifratene K, Orlandi E, Rogier C, Boutin JP. [Malaria in military personnel: the case of the Ivory Coast in 2002-2003]. Med Trop (Mars) 2003; 63:282-6. [PMID: 14579467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
French troops were sent to the Ivory Coast on September 22, 2002 within the framework of Operation Unicorn in response to the political unrest. From September 22 to October 20, a total of 37 cases of malaria were reported, i.e., 35.7 cases per 1000 man-months. As of October 11, the central headquarters of the Armed Services Health Corps decided to use doxycycline as the exclusive agent for drug prophylaxis in military personnel on duty in the Ivory Coast and to enhance vector control measures. The incidence of malaria decreased to 2 cases per 1000 man-months at the sixth month. A recrudescence of malaria to 15 cases per 1000 man-months was observed with the rainy season in April. During this period one person presenting severe malaria with coma required emergency evacuation to France. In May 2003, several studies were undertaken to determine the factors that caused this recrudescence. These studies included surveys to evaluate awareness concerning malaria and monitor compliance with drug prophylaxis and tolerance of doxycycline, a case-control study to identify factors related to malarious episodes and an entomological study. Awareness of malaria was high with 75% of the 477 respondents stating that malaria could be transmitted by single mosquito bite. The case-control study showed a correlation between occurrence of malarious bouts and non-compliance with drug prophylaxis (p < 10(-5)). The odds-ratio was 3.05 (95% confidence interval, 1.52-6.14) for subjects claiming zero to one incident of non-compliance per week and 7.51 (IC95%, 3.24-17.40) for those claiming more than one incident of non-compliance per week. Tolerance of doxycyline was good since 72% of respondents reported no adverse effects. The main vector was Anopheles gambiae. The number of bites per man per night ranged from 25 to 2 and the number of infected bites ranged from 2 to 3 per week. Treatment was initiated promptly using quinine at a total dose of 25 mg/kg in 3 daily doses for 7 days by the intravenous then oral route. This experience shows that malaria remains a major concern for military forces, that standardization of preventive measures in emergency situations is needed, and that enhanced vector control, verification of compliance with drug prophylaxis and prompt treatment based on the presence of a physician in each emergency outpost is crucial. These recommendation must be applied to all French military personnel in the Ivory Coast.
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Affiliation(s)
- R Migliani
- Service de Médecine des Collectivités, l'Institut de Médecine Tropicale du Service de Santé des Armées, Le Pharo, BP 46, 13998 Marseille-Armées.
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Khan AA, Brown J, Faulkner K, Kendler D, Lentle B, Leslie W, Miller PD, Nicholson L, Olszynski WP, Watts NB, Hanley D, Hodsman A, Josse R, Murray TM, Yuen K. Standards and guidelines for performing central dual X-ray densitometry from the Canadian panel of International Society for Clinical Densitometry. J Clin Densitom 2002; 5:247-57. [PMID: 12357062 DOI: 10.1385/jcd:5:3:247] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2002] [Accepted: 03/04/2002] [Indexed: 11/11/2022]
Abstract
The International Society for Clinical Densitometry (ISCD) is a multidisciplinary nonprofit global organization formed to ensure excellence in densitometry imaging, interpretation, and application. The Canadian panel of the ISCD represents ISCD in Canada and oversees Canadian bone densitometry certification programs. The standards of care from the Canadian panel of the ISCD have been developed in order to establish the minimum level of acceptable performance for the practice of bone densitometry in Canada. A variety of techniques are available for skeletal assessment of bone mineral density, which vary in accuracy, precision, and clinical utility as well as availability. This article focuses on central dual X-ray absorptiometry in adults and does not address densitometry in the pediatric population. Other technologies will be addressed in a subsequent article.
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Affiliation(s)
- A A Khan
- McMaster University, Oakville, Ontario, Canada
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Brown JP, Olszynski WP, Hodsman A, Bensen WG, Tenenhouse A, Anastassiades TP, Ste-Marie LG, Kendler DL, Hanley DA, Josse R, Hanly JG, Lentle B, Jovaisas A, Ioannidis G, Stephenson GF, Barton I, Pack S, Chines A, Dias R, Adachi JD. Positive effect of etidronate therapy is maintained after drug is terminated in patients using corticosteroids. J Clin Densitom 2001; 4:363-71. [PMID: 11748341 DOI: 10.1385/jcd:4:4:363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2001] [Revised: 05/03/2001] [Accepted: 05/07/2001] [Indexed: 11/11/2022]
Abstract
Following a 52-wk randomized controlled trial of intermittent cyclic etidronate therapy in patients using corticosteroids, we performed a 52-wk open-label trial of calcium alone in 114 corticosteroid-treated patients to determine whether the beneficial effect of etidronate is maintained after the drug is discontinued. All patients were given 500 mg/d of elemental calcium. Sixty-one and 53 patients made up the former placebo and etidronate groups, respectively. A total of 89 (98%) of patients in the former placebo and etidronate groups remained on corticosteroids throughout the second year. The mean (SE) percentage change in bone mineral density of the lumbar spine, femoral neck, and trochanter were compared between groups. The difference between groups in mean percentage change from baseline (wk 0, initiation of etidronate or placebo therapy) in the bone density of the lumbar spine, femoral neck, and trochanter, following 104 wk, was 3.8 (0.9), 3.0 (1.1), and 4.3 (1.1), respectively (p < 0.05, all sites), in favor of the former etidronate group. While not significant, the former placebo group demonstrated a slightly larger rate of decline in bone density over the second year than the former etidronate group at all three sites. Following the discontinuation of etidronate therapy, there was no accelerated bone loss and there was evidence of a residual protective effect in both the lumbar spine and femoral neck for up to 1 yr posttreatment.
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Affiliation(s)
- J P Brown
- Centre de Recherche du CHUL, Centre Hospitalier Universitaire de Quebec, 2705 boul Laurier #S-784, Ste-Foy, Québec, G1V 4G2 Canada.
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Ungar WJ, Josse R, Lee S, Ryan N, Adachi R, Hanley D, Brown J, Breton MC. The Canadian SCORE questionnaire: optimizing the use of technology for low bone density assessment. Simple Calculated Osteoporosis Risk Estimate. J Clin Densitom 2000; 3:269-80. [PMID: 11090234 DOI: 10.1385/jcd:3:3:269] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire is a tool to assist physicians to identify women who might require bone densitometry. The purpose of this study was to develop a Canadian SCORE and to assess validity and reliability. Twenty sites enrolled 307 postmenopausal women ages 50-70 yr. SCORE results were compared to hip and lumbar spine bone density assessed by dual X-ray absorptiometry. Sensitivity and specificity of a range of SCORE cut-points were assessed in a receiver operating characteristics analysis to determine the optimal cut-point for SCORE. With low bone density defined as a T-score < or = -2.0, a SCORE cut-point of 6 in women ages 50-59 yr displayed a sensitivity of 0. 96, 95% confidence interval (CI) (0.89, 1.00), a specificity of 0.51, 95% CI (0.43, 0.58). In women ages 60-70 yr, a SCORE cut-point of 8 displayed a sensitivity of 0.90, 95% CI (0.80, 0.97) and a specificity of 0.20, 95% CI (0.11, 0.29). The test-retest reliability (intraclass correlation coefficient) was 0.95. SCORE performed better in women in their fifties than women in ther sixties. Older women require higher SCORE cut-points. The use of SCORE as an initial measure for identifying those at risk for osteoporosis may reduce costs by limiting unnecessary tests.
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Affiliation(s)
- W J Ungar
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Jenkins DJ, Kendall CW, Vidgen E, Mehling CC, Parker T, Seyler H, Faulkner D, Garsetti M, Griffin LC, Agarwal S, Rao AV, Cunnane SC, Ryan MA, Connelly PW, Leiter LA, Vuksan V, Josse R. The effect on serum lipids and oxidized low-density lipoprotein of supplementing self-selected low-fat diets with soluble-fiber, soy, and vegetable protein foods. Metabolism 2000; 49:67-72. [PMID: 10647066 DOI: 10.1016/s0026-0495(00)90738-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An increased intake of soluble fiber and soy protein may improve the blood lipid profile. To assess any additional benefit on serum lipids of providing soy protein and soluble-fiber foods to hyperlipidemic subjects already consuming low-fat, low-cholesterol therapeutic diets, 20 hyperlipidemic men and postmenopausal women completed 8-week test and control dietary treatments in a randomized crossover design as part of an ad libitum National Cholesterol Education Program (NCEP) step 2 therapeutic diet (<7% saturated fat and <200 mg/d cholesterol). During the test phase, foods high in soy, other vegetable proteins, and soluble fiber were provided. During the control phase, low-fat dairy and low-soluble-fiber foods were provided. Fasting blood lipid and apolipoprotein levels were measured at 4 and 8 weeks of each phase. On the test diet, 12 +/- 2 g/d soy protein was selected from the foods chosen. Direct comparison of test and control treatments indicated an elevated high-density lipoprotein (HDL) cholesterol concentration on the test diet (6.4% +/- 2.4%, P = .013) and a significantly reduced total to HDL cholesterol ratio (-5.9% +/- 2.3%, P = .020). The proportion of conjugated dienes in the low-density lipoprotein (LDL) cholesterol fraction was significantly reduced (8.5% +/- 3.3%, P = .020) as a marker of oxidized LDL. A combination of acceptable amounts of soy, vegetable protein, and soluble-fiber foods as part of a conventional low-fat, low-cholesterol therapeutic diet is effective in further reducing serum lipid risk factors for cardiovascular disease.
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Affiliation(s)
- D J Jenkins
- Clinical Nutrition and Risk Factor Modification Center, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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Ho-Pun-Cheung T, Lamarque D, Josse R, Perez-Eid C, Niel L, Martenot G, Auzanneau G, Rey JL. [Protective effect of clothing impregnated with permethrin against D. reticulatus and D. marginatus in an open biotope of central western France]. Bull Soc Pathol Exot 1999; 92:337-40. [PMID: 10690472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
During the period of major tick activity, in April and May 1998, in the Saint-Maixent l'Ecole area of Poitou, a comparative study was carried out in order to evaluate the protective effect of garments impregnated with permethrin cis/trans 25/75. Three groups of soldiers made up respectively of 208, 218 and 427 men were involved for 2 or 3 days in this experiment. Respectively 107, 107 and 215 wore impregnated uniforms. Out of a total of 319 ticks, 3 were lxodes ricinus, 305 Dermacentor marginatus and 11 D. reticulatus. There was a significant difference in both the intensity (number of ticks per individual, P < 0.0001) and prevalence (number of individuals with ticks, P < 0.001) of ticks on individuals between impregnated and non impregnated uniforms. The repellent effect of permethrin on ticks was observed at the site of preferential tick attachment (normally the head of the host for these two species of Dermacentor in France) where the number of ticks was significantly lower in impregnated uniforms.
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Affiliation(s)
- T Ho-Pun-Cheung
- Service médical de l'ENSOA (Ecole nationale des sous officiers d'active), France
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Vuksan V, Jenkins DJ, Spadafora P, Sievenpiper JL, Owen R, Vidgen E, Brighenti F, Josse R, Leiter LA, Bruce-Thompson C. Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial. Diabetes Care 1999; 22:913-9. [PMID: 10372241 DOI: 10.2337/diacare.22.6.913] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether Konjac-mannan (KJM) fiber improves metabolic control as measured by glycemia, lipidemia, and blood pressure in high-risk type 2 diabetic patients. RESEARCH DESIGN AND METHODS A total of 11 hyperlipidemic and hypertensive type 2 diabetic patients treated conventionally by a low-fat diet and drug therapy participated. After an 8-week baseline, all were randomly assigned to take either KJM fiber-enriched test biscuits (0.7 g/412 kJ [100 kcal] of glucomannan) or matched placebo wheat bran fiber biscuits during two 3-week treatment phases separated by a 2-week washout period. The diet in either case was metabolically controlled and conformed to National Cholesterol Education Program Step 2 guidelines, while medications were maintained constant. Efficacy measures included serum fructosamine, lipid profiles, apolipoproteins, blood pressure, body weight, and nutritional analysis. RESULTS Compared with placebo, KJM significantly reduced the metabolic control primary end points: serum fructosamine (5.7%, P = 0.007, adjusted alpha = 0.0167), total:HDL cholesterol ratio (10%, P = 0.03, adjusted alpha = 0.05), and systolic blood pressure (sBP) (6.9%, P = 0.02, adjusted alpha = 0.025). Secondary end points, including body weight, total, LDL, and HDL cholesterol, triglycerides, apolipoproteins A-1, B, and their ratio, glucose, insulin, and diastolic blood pressure, were not significant after adjustment by the Bonferroni-Hochberg procedure. CONCLUSIONS KJM fiber added to conventional treatment may ameliorate glycemic control, blood lipid profile, and sBP in high-risk diabetic individuals, possibly improving the effectiveness of conventional treatment in type 2 diabetes.
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Affiliation(s)
- V Vuksan
- Department of Nutritional Sciences, St. Michael's Hospital, Faculty of Medicine, University of Toronto, Ontario, Canada.
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Jenkins DJ, Kendall CW, Vuksan V, Augustin LS, Mehling C, Parker T, Vidgen E, Lee B, Faulkner D, Seyler H, Josse R, Leiter LA, Connelly PW, Fulgoni V. Effect of wheat bran on serum lipids: influence of particle size and wheat protein. J Am Coll Nutr 1999; 18:159-65. [PMID: 10204832 DOI: 10.1080/07315724.1999.10718844] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Wheat fiber appears to protect from cardiovascular disease despite its lack of consistent effect on serum lipids. We therefore wished to determine whether reported inconsistencies in the effect of wheat bran resulted from differences in particle size or its high gluten content. METHODS Two studies were conducted. In one-month metabolic diets, 24 hyperlipidemic subjects consumed breads providing an additional 19 g/d dietary fiber as medium or ultra-fine wheat bran and extra protein (10% of energy as wheat gluten). In two-week ad libitum diets, 24 predominantly normolipidemic subjects consumed breakfast cereals providing an additional 19 g/d of dietary fiber as coarse or a mixture of ultra-fine and coarse wheat bran with no change in gluten intake. Both studies followed a randomized crossover design with control periods when subjects ate low-fiber breads and cereals respectively with no added gluten. Fasting blood lipids were measured on day zero and at the end of each phase. RESULTS Wheat bran had no effect on total, LDL or HDL cholesterol irrespective of particle size or level of gluten in the diet. However, consumption of increased gluten in the metabolic study was associated with a 13+/-4% reduction in serum triglycerides (p = 0.005) which was not seen in the normal-gluten ad libitum study. CONCLUSIONS The protective effect of wheat fiber in cardiovascular disease cannot be explained by an effect of wheat bran in reducing serum cholesterol although in hyperlipidemic subjects displacement of carbohydrate by gluten on the high-fiber phases was associated with lower serum triglycerides.
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Affiliation(s)
- D J Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Ontario, Canada
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29
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Abstract
We report the results of a seroepidemiological study on the prevalence of cysticercosis in Bénin. Cluster sampling at 3 levels was performed in the 6 départements (Atacora, Borgou, Zou, Mono, Atlantique and Oueme) and 2625 serum samples, from 1329 adult females and 1296 adult males, were collected. Antibodies against Taenia solium cysticerci were first searched for by enzyme-linked immunosorbent assay and the 41 seropositive samples were then examined by enzyme-linked electroimmunotransfer blot assay (EITB). Thirty-five samples gave positive results in the EITB. The overall seroprevalence of cysticercosis was therefore 1.3% (95% confidence interval [95% CI] 0.9-1.9). The seroprevalence was 1.9% in males (95% CI 1.2-2.7) and 0.8% (95% CI 0.4-1.5) in females (P < 0.05). A progressive increase in seroprevalence with increasing age was found. The highest seroprevalences were observed in Atacora and Atlantique, 2 non-Muslim départements (3.3% and 3.0%, respectively). This study demonstrated the public health importance of cysticercosis in Bénin.
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Affiliation(s)
- D Houinato
- Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, Limoges, France.
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30
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31
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Josse R, Prost C. [Image of the sand flea]. Med Trop (Mars) 1998; 57:343. [PMID: 9612771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- R Josse
- Ministère de la Santé du Bénin, Cotonou, Bénin
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32
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Houinato D, Verdier M, Preux PM, Josse R, Letenneur L, Ayed Z, Avodé G, Massit B, Boutros-Toni F, Denis F, Zohoun T, Salamon R, Dumas M. Intrafamilial clustering and 4-year follow-up of asymptomatic human T-cell leukaemia virus type I (HTLV-I) infection in Benin (West Africa). Int J Epidemiol 1998; 27:146-52. [PMID: 9563709 DOI: 10.1093/ije/27.1.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Few data exist concerning familial human T-cell leukaemia virus type I (HTLV-I) carrier states and transmission in African countries. Two previous surveys performed in Benin in 1989 and 1990 using a three-level cluster sampling method allowed us to identify HTLV-I positive subjects. The evolution of HTLV-I within the families of these subjects is described over a 4-year period, 1991-1995. METHODS Since 1991, 37 HTLV-I seropositive subjects, six subjects with indeterminate Western-Blot pattern, and their relatives have been followed up once a year clinically and biologically. RESULTS Twenty-three mothers in the study group gave birth to 27 children between 1991 and 1995. Among the 13 infants born to the 12 seropositive mothers, two seroconverted before their second birthday. One adult woman whose husband was seropositive developed seropositivity 4 years after marriage. In March 1992, a family case-control study (proband study) was conducted. A seroprevalence of 27.5% was found among 138 relatives of 32 infected subjects and 1.4% among 142 relatives of 32 control subjects. CONCLUSIONS There is clearly an intrafamilial clustering of HTLV-I in Benin. The annual incidence density of HTLV-I in this cohort is estimated at 6 per thousand.
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Affiliation(s)
- D Houinato
- Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, Limoges, France
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33
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Papadimitropoulos E, Shea B, Wells GA, Tugwell P, Cranney A, Gillespie WJ, Josse R, Coyte P, Greenwood. Vitamin D with or without calcium for treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews 1997. [DOI: 10.1002/14651858.cd000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Beverley Shea
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa Canada
| | - George A Wells
- School of Epidemiology and Public Health; University of Ottawa; Ottawa Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine; University of Ottawa; Ottawa Canada
| | - Ann Cranney
- Division of Rheumatology; Ottawa Hospital; Ottawa Canada
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34
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Adachi JD, Bensen WG, Brown J, Hanley D, Hodsman A, Josse R, Kendler DL, Lentle B, Olszynski W, Ste-Marie LG, Tenenhouse A, Chines AA. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med 1997; 337:382-7. [PMID: 9241127 DOI: 10.1056/nejm199708073370603] [Citation(s) in RCA: 515] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND METHODS Osteoporosis is a recognized complication of corticosteroid therapy. Whether it can be prevented is not known. We conducted a 12-month, randomized, placebo-controlled study of intermittent etidronate (400 mg per day for 14 days) followed by calcium (500 mg per day for 76 days), given for four cycles, in 141 men and women (age, 19 to 87 years) who had recently begun high-dose corticosteroid therapy. The primary outcome measure was the difference in the change in the bone density of the lumbar spine between the groups from base line to week 52. Secondary measures included changes in the bone density of the femoral neck, trochanter, and radius and the rate of new vertebral fractures. RESULTS The mean (+/-SE) bone density of the lumbar spine and trochanter in the etidronate group increased 0.61 +/- 0.54 and 1.46 +/- 0.67 percent, respectively, as compared with decreases of 3.23 +/- 0.60 and 2.74 +/- 0.66 percent, respectively, in the placebo group. The mean differences between the groups after one year were 3.72 +/- 0.88 percentage points for the lumbar spine (P = 0.02) and 4.14 +/- 0.94 percentage points for the trochanter (P = 0.02). The changes in the femoral neck and the radius were not significantly different between the groups. There was an 85 percent reduction in the proportion of postmenopausal woman with new vertebral fractures in the etidronate group as compared with the placebo group (1 of 31 patients vs. 7 of 32 patients, P = 0.05), and the etidronate-treated postmenopausal women also had significantly fewer vertebral fractures per patient (P = 0.04). CONCLUSIONS Intermittent etidronate therapy prevents the loss of vertebral and trochanteric bone in corticosteroid-treated patients.
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Affiliation(s)
- J D Adachi
- Department of Medicine, St. Joseph's Hospital, McMaster University, Hamilton, ON, Canada
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35
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Toyb M, Lombart JP, Binti Abdou A, Oumadi A, Molines C, Josse R. [AIDS and HIV infection in the Federal Islamic Republic of Comores (1988-1995)]. Med Trop (Mars) 1997; 57:59-61. [PMID: 9289612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Since 1991 AIDS and HIV infection in the Federal Islamic Republic of the Comoros have been monitored through a network of sentinel sites including predetermined target populations. In all cases seropositivity for HIV was confirmed by western blotting after two ELISA screening tests. AIDS was diagnosed on Bangui clinical criteria and positive western blotting results. As of June 30, 1996, the cumulative number of AIDS cases reported to the World Health Organization was 7 for a prevalence of 1.4 per 100000 inhabitants. The prevalence of HIV antibodies has remained at less than 1% in target populations, i.e. women undergoing prenatal examinations, patients with newly diagnosed tuberculosis, blood donors, and patients presenting sexually transmitted diseases (STD). This low stable prevalence rate which is similar to those reported in other Indian Ocean countries is in sharp contrast with the high incidence of syphilis and STD in the region.
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Affiliation(s)
- M Toyb
- Programme National de Lutte contre le Sida et les MST, RFI des Comores, Moroni, République Fédérale Islamique des Comores
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36
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Houinato D, Verdier M, Josse R, Zohoun T, Letenneur L, Salamon R, Denis F, Preux PM. Seroepidemiological study of retroviruses (HTLV-I/II, HIV-1, HIV-2) in the Department of Atacora, northern Benin. Trop Med Int Health 1996; 1:205-9. [PMID: 8665385 DOI: 10.1111/j.1365-3156.1996.tb00027.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A seroepidemiological survey to determine the prevalence of retrovirus infection (HTLV-I/II, HIV-1, HIV-2) by representative sampling of the general population in the Department of Atacora in north-western Benin is reported. The seroprevalence rate of HTLV-I in this sample was at 1.86% (95% CI 1.20-2.52%). This is in agreement with prevalence rates reported from neighbouring countries of the sub-region. No sera were found positive for HTLV-II. Seropositivity to HIV-1 was 0.3%; HIV-2 seropositivity was not encountered.
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Affiliation(s)
- D Houinato
- Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, Faculté de Médecine, Université de Limoges, France
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37
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Feyaerts P, Thaoubani D, Aboubacar O, Molines C, Josse R. [Tuberculosis in the Federal Islamic Republic of Comores in 1995]. Med Trop (Mars) 1996; 56:303-7. [PMID: 9026602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tuberculosis is still a major health concern in the Federal Islamic Republic of the Comoros. An effective nationally organized program has been set up to fight against the disease. It is based on bacteriologic screening (105 new cases of BK+ disease since 1995) and quadruple chemotherapy in patients identified (2RZHE 4RH) with in-hospital starter treatment for 2 months and supervised outpatient treatment for 4 months. Patients are followed up monthly. Because of these measures and given the fact that access to health care is excellent (small island nation), compliance has been over 90% for several years and the overall rate of cure was around 92% in 1995. From an epidemiologic standpoint the endemic status of tuberculosis in the Comoros has been stable with an overall incidence of about 25 cases per 100,000 inhabitants in the last 5 years. Extrapulmonary forms and relapses are uncommon (5.4% and 6.2% respectively in 1995). The incidence of positive HIV1 serology in the general population of the Comoros is low and has not been a complicating factor since no seropositive BK+ patient has been identified since the beginning of systematic surveillance in 1988.
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Affiliation(s)
- P Feyaerts
- Centre Hospitalier Régional, Maarouf, République Fédérale Islamique des Comores
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38
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Guédénom A, Zinsou C, Josse R, Andélé K, Pritze S, Portaels F, Meyers WM. Traditional treatment of Buruli ulcer in Bénin. Arch Dermatol 1995; 131:741-2. [PMID: 7778939] [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: 01/27/2023]
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39
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Josse R, Djoumoi A, Ouledi A, Oumadi A, Chaibou Bedja A. [New approach to health in the Federal Islamic Republic of Comoros]. Med Trop (Mars) 1995; 55:205-208. [PMID: 8559010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- R Josse
- Service de Santé des Armées, Conseiller Technique auprès du Ministère de la Santé Publique, Moroni, RFI des Comores
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40
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Le Hesran JY, Delaporte E, Gaudebout C, Trebuck A, Schrijvers D, Josse R, Peeters M, Cheringou H, Dupont A, Larouze B. Demographic factors associated with HTLV-1 infection in a Gabonese community. Int J Epidemiol 1994; 23:812-7. [PMID: 8002196 DOI: 10.1093/ije/23.4.812] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
An epidemiological study of human T-lymphotropic virus type 1 (HTLV-1) and syphilis has been carried out in a multiethnic community of seven neighbouring villages located in eastern Gabon on 1240 subjects over 5 years old (82.7% of the population in this age range). Antibodies to HTLV-1 (anti-HTLV-1) were detected by ELISA with confirmation by Western Blot and antibodies to syphilis by Venereal Diseases Research Laboratory assay with confirmation by the Treponema pallidum haemaglutination assay. The prevalence rate of anti-HTLV-1 was 8.5% and increased from 3.7% in the 5-14 years age group to 23.8% in the over 60 years age group. Logistic regression showed that the positivity for anti-HTLV-1 was associated with age, ethnic group and sex (higher prevalence in females). The seroprevalence rate of syphilis was 8.2%. Seropositivity for syphilis and HTLV-1 were related but age was a confounding variable in this relationship. This study showing a highly heterogeneous distribution of HTLV-1 in a geographically limited area suggests the role of environmental and behavioural factors in HTLV-1 transmission.
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Affiliation(s)
- J Y Le Hesran
- INSERM U13 et Fondation Léon M'ba, Hôpital Claude Bernard, Paris, France
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41
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Gbedonou P, Moussa Y, Floury B, Josse R, Ndiaye JM, Diallo S. [The Bamako initiative: hope or illusion? Observations on the Benin experience]. Sante 1994; 4:281-8. [PMID: 7921702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In various countries in Africa, community financing has become the main source of finance for health services. In Benin, the "Bamako Initiative" experiment started in 1988 for many health structures and has subsequently been greatly expanded. After three years experience, the authors try to answer some important questions about community financing: To what extent does payment of fees have an influence on the use of health services? How are the funds collected and used and is embezzlement a serious problem? The question of equity is also considered as well as cost recovery, allowing an economics-based assessment of the Bamako Initiative which suggests that it has a promising future in Benin.
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42
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43
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Josse R, Guédénon A, Aguiar J, Anagonou S, Zinsou C, Prost C, Foundohou J, Touze JE. [Buruli's ulcer, a pathology little known in Benin. Apropos of 227 cases]. Bull Soc Pathol Exot 1994; 87:170-175. [PMID: 7827517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Cutaneous Mycobacterium infection is an endemic disease in Mono, Ouémé and Zou districts in the south of Benin, where it seems rarely known. The authors are reporting the results of a clinical, bacteriological, epidemiological and therapeutical study about 227 patients. Children are the principal targets of this disease. Ulceration are often seen in a critical step (3 or 4) and acid-fast bacilli have been found from 189 of 227 patients tested by bacilloscopy (smear microscopy). Medical treatments (antituberculosis and antileprosis drugs) are still disappointing. Also when necessary, surgery is done (broad excision, skin transplant afterwards) with promising results. However, complications like deformities and flexion contractors can persist after surgical treatment. In the south Benin, Buruli's ulcers are one of the major public health problems.
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Affiliation(s)
- R Josse
- Ministère de la Santé, Direction Nationale de la Protection Sanitaire, Cotonou, Bénin
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44
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Dazza MC, Trebucq A, Gaudebout C, Jarretou A, Le Hesran JY, Josse R, Delaporte E, Bréchot C, Larouze B. Population-based study of serum hepatitis B virus DNA in Gabon. Trans R Soc Trop Med Hyg 1993; 87:539-40. [PMID: 8266404 DOI: 10.1016/0035-9203(93)90078-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The prevalence of serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) was measured in a Gabonese community at high risk for HBV infection. Among 698 subjects 5 to 24 years old, the prevalence of HBsAg was 11.1% vs. 57.9% for anti-HBs and 7.2% for anti-HBc alone. The prevalence of HBeAg among HBsAg-positive subjects was 26.5% vs. 59.5% for anti-HBe. The prevalence of HBV DNA tested by a hybridization spot test was 2.1% in the overall population and 18.7% among HBsAg-positive subjects. HBV DNA was found in 15 of 21 HBeAg-positive subjects but in none of the subjects positive for anti-HBe or negative for both HBeAg and anti-HBe. HBV DNA was not detected in any HBsAg negative subjects. The prevalence of HBV DNA decreased with age. This low prevalence of HBV DNA contrasts with the high level of endemicity in the study population.
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Affiliation(s)
- M C Dazza
- INSERM U13, Hôpital Claude Bernard, Paris, France
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45
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Foundohou J, Josse R, Anagonou S, Comlanvi E, Mevel A, Catraye J, Izurietta H, Gbaguidi E, Diallo S, Dodin A. [Cholera in Benin (epidemic of 1991)]. Med Trop (Mars) 1993; 53:341-9. [PMID: 8289628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Authors report on epidemiologic, bacteriology and therapeutic data related to 1991 cholera outbreak in Benin in the general context of the 7th world pandemic. 7474 cases were notified from all over the country. Vibrio cholerae 01, El Tor biotype, was identified in many patients stools and in the surroundings. Control measures implemented in this situation are described: early parenteral and mainly oral rehydration, antibiotic treatments for patients and contacts, systematic home control around cases, wells disinfection and general hygiene promotion, mobilization of the Civil Service Authorities and population education. Authors conclude that strict epidemiologic monitoring is necessary in epidemic circumstances as well as during endemo-sporadic period.
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Affiliation(s)
- J Foundohou
- Direction Nationale de la Protection sanitaire, Cotonou, République du Bénin
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46
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Anagonou SY, Chabi Tamou C, Josse R, Helynck B, Gninafon M. [Seroprevalence of treponematosis among pregnant women in Cotonou (Benin)]. Bull Soc Pathol Exot 1993; 86:342-344. [PMID: 8124101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A study of frequency of treponematosis among pregnant women in Mother Hood of Zogbo (Cotonou) shows 5.1 +/- 2.8% of positivity with risk of 5% by TPHA and VDRL. The low level of endemicity, associated with the absence of cutaneous lesions of treponematosis in Cotonou may correspond to a syphilis infection. This study points out the necessity to strengthen the struggle against the all other sexually transmitted diseases (MST) in the same way that the HIV infection in Benin.
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Affiliation(s)
- S Y Anagonou
- Laboratoire de référence des Mycobactéries, Cotonou, Bénin
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47
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Anagonou SY, Koumakpai S, Josse R, Massougbodji A, Sadeler BC, Martet G. [Rotavirus gastroenteritis in a pediatric service at the National University Hospital Center of Cotonou (Benin)]. Med Trop (Mars) 1993; 53:105-7. [PMID: 8505880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors are reporting results from rotavirus research in diarrhoeal stools among 220 children under 5 years of age in Cotonou C.N.H.U. (Bénin). Among them, 64 (29%) are rotavirus carriers.
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Affiliation(s)
- S Y Anagonou
- Laboratoire de Microbiologie, B.P. 366, Centre National Hospitalier, Universitaire Cotonou, Bénin
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48
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Anagonou SY, Gninafon M, Kinde-Gazard D, Tawo L, Josse R. [Mycobacterium fortuitum in a patient with human immunodeficiency syndrome (AIDS) in Benin)]. Med Trop (Mars) 1992; 52:303-5. [PMID: 1435192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The authors report a case of Mycobacterium Fortuitum infection in one AIDS patient. This case underlines the interest for the clinicians to investigate systematically a possible infection by Mycobacterium fortuitum in all AIDS patients with pulmonary tuberculosis.
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Affiliation(s)
- S Y Anagonou
- Programme National de Lutte contre la Tuberculose, Cotonou, Bénin
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49
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Dumas M, Houinato D, Verdier M, Zohoun T, Josse R, Bonis J, Zohoun I, Massougbodji A, Denis F. Seroepidemiology of human T-cell lymphotropic virus type I/II in Benin (West Africa). AIDS Res Hum Retroviruses 1991; 7:447-51. [PMID: 1873079 DOI: 10.1089/aid.1991.7.447] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In 1988-1989, a national survey was conducted in Benin to determine the distribution of HTLV-I infection in a representative sample of adult individuals. This study comprised 2625 healthy subjects recruited in the six provinces of Benin and 1300 blood donors from Cotonou and from the other five provinces. Sera were screened for HTLV-I antibody by both immunofluorescence (IF) and enzyme immunoassay (EIA). Sera positive or doubtful by at least one technique were further analyzed by Western blot and radioimmunoprecipitation assay (RIPA) when indeterminate. Samples were considered as positive if they reacted with two gene products. No blood donor was positive. Over the 2625 subjects, 39 (1.5%) were positive. We observed a statistical difference between male and female (1%, 2%, p less than 0.05). A difference was also observed according to the areas studied: the HTLV-I antibody rate increased from coastal (0.3%) to northern (5.4%) provinces. HTLV-I seroprevalence increased significantly with age. This survey shows that HTLV-I infection exists in Benin but varies according to regions.
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Affiliation(s)
- M Dumas
- Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, Faculté de Médecine, Limoges, France
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50
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Larouze B, Peeters M, Monplaisir N, Trebucq A, Josse R, Le Hesran JY, Dazza MC, Gaudebout C, Delaporte E. [Epidemiology of HTLV-I infection in its hyperendemic foci (Japan, tropical Africa, Caribbean)]. Rev Prat 1990; 40:2120-3. [PMID: 2237215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
HTLV-1 infection is endemic in Japan, black Africa, the Caribbean and several regions of South America. In these foci, the infections is very heterogeneously distributed (variations from village to village, intrafamilial clustering). The virus is transmitted from mother to child, and breast feedings seems to play a major role. Sexual transmission is usually from man to woman. The frequency of transmission by blood transfusion must not be underestimated. It justifies the systematic detection of HTLV-1 infection in areas where it is economically feasible.
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Affiliation(s)
- B Larouze
- INSERM U13, hôpital Claude-Bernard, Paris
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