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Biomedical subjects

M Dramaix

Publications and source records attributed to M Dramaix.

At least 73 records · Page 4Linked to original sources
PubMed1996

Vitamin A deficiency and protein-energy malnutrition in a sample of pre-school age children in the Kivu Province in Zaire.

OBJECTIVE: To assess pre-school age children's vitamin A status in a population where protein-energy malnutrition is endemic and serum retinol binding protein and transtyretin concentrations are low. DESIGN: A cross-sectional study. SETTING: Health district of Katana, South-Kivu, Zaire. SUBJECTS: 415 pre-school age children. METHODS: Three methods were used to assess vitamin A status: ophtalmological examination, retinol serum concentration and Relative Dose Response (RDR) test. RESULTS: The only ophthalmological signs of vitamin A deficiency appeared in two cases of night blindness, which represents a prevalence of 0.7%. Deficient serum retinol concentration (< 0.35 mumol/l) was found in 19.7% of the whole study population and in 10.4% of non-infected children in good nutritional status. RDR test carried out on a reduced sample of 79 subjects was abnormal for 7.6% of the children but showed a low sensitivity when compared with serum retinol concentration. CONCLUSION: This survey suggests that in this population of the South-Kivu Province in Zaire, vitamin A deficiency co-exists with protein-energy malnutrition and is a public health problem even with non-malnourished and non-infected children.

Anthropometry↗
PubMed1995

Combined use of nicotine patch and gum in smoking cessation: a placebo-controlled clinical trial.

BACKGROUND: Smoking is considered as an addiction to nicotine for most subjects consuming 10 cigarettes or more per day. Hence, nicotine replacement therapy by way of gum, patch, or spray has been advocated. The rationale of this study is to evaluate the possible beneficial effects of adding nicotine gum to the routine of subjects using the nicotine patch. The effect of the nicotine patch against the placebo, both groups receiving placebo nicotine gum, has also been assessed. METHODS: Healthy subjects (374) were randomized at their work-setting in a 1-year double-blind placebo-controlled trial: 149 subjects to active nicotine patch + active gum (group 1), 150 to active nicotine patch + placebo gum (group 2), and 75 to placebo patch + gum (group 3). Treatment duration was 12 weeks with a 16-hr transdermal patch of 15 mg, followed by a 6 + 6-weeks weaning period on respectively 10 and 5 mg patches. Gum use was not restricted during the first 6 months, with recommendations to use at least four pieces a day. A strict definition of smoking abstinence was used in this study, which did not allow smoking any cigarette after Week 1. Nonsmoking status at each visit, as reported by the subjects, was verified by CO below 10 ppm in expired air. RESULTS: Abstinence rates in group 1 against group 2 were 34.2 and 22.7% (P = 0.027) at 12 weeks, 27.5 and 15.3% (P = 0.010) at 24 weeks, and 18.1 and 12.7% (P = 0.191) at 52 weeks. In group 3, abstinence rates were 17.3, 14.7, and 13.3% respectively at 12, 24, and 52 weeks. Using logistic regression with adjustment for six baseline covariates, odds ratios for abstinence (with 95% CI) were computed. For group 1/group 2, OR at 12, 24, and 52 weeks were 1.72 (1.03-2.94) (P = 0.039), 2.04 (1.14-3.57) (P = 0.018), and 1.47 (0.76-2.76) (P = 0.125). No significant differences in OR were observed when comparing groups 2 and 3. Time to relapse is significantly longer in group 1 as compared to that of group 2 (P = 0.041), whereas no significant differences between groups 2 and 3 were observed. No significant differences between the three groups in systemic and local adverse drug events were observed. CONCLUSION: Adding active gum use to active patch use in subjects smoking 10 cigarettes or more a day increased abstinence rates, which are statistically significant up to 24 weeks.

Administration, Cutaneous↗
PubMed1995

Ankle/arm pressure index in asymptomatic middle-aged males: an independent predictor of ten-year coronary heart disease mortality.

PURPOSE OF THE STUDY: to evaluate the predictive power of a reduced ankle/brachial pressure index (ABPI) (< or = .90) in an asymptomatic middle-aged male working population free of coronary heart disease. MATERIALS AND METHODS: 2023 subjects forty to fifty-five years old were screened at their work place. Standard techniques were used. Blood was drawn in the fasting state. Ankle and brachial blood pressures were measured by Doppler signals and all measures were done by one observer, duly trained in epidemiologic methodology. RESULTS: in univariate analysis, an ABPI < or = .90 was significantly associated with age, total serum cholesterol, body mass index, smoking, and awareness of diabetes. In multivariate analysis, it was associated with awareness of diabetes, age, Ln triglycerides (P = .073), and smoking (P = .088). Relative risks for reduced versus normal ABPI are 2.77 (P = .010), 4.16 (P = .011) and 4.97 (P = .006) for ten-year all causes, cardiovascular, and coronary mortality, respectively. In a multiple logistic regression analysis, the following variables were significant independent predictors of coronary mortality: smoking (odds ratio [OR] = 4.84), reduced ABPI (OR = 3.63), and low density lipoprotein cholesterol (OR for 1 SD = 1.69). Reduced ABPI is also an independent predictor of cardiovascular mortality. CONCLUSION: a reduced ABPI is an independent risk factor for coronary and cardiovascular mortality in asymptomatic middle-aged Belgian males.

Adult↗
PubMed1994

Efficacy and tolerance of 200 mg micronised fenofibrate administered over a 6-month period in hyperlipidaemic patients: an open Belgian multicenter study.

The authors report the results of a large open multicenter study using 200 mg micronised fenofibrate once a day. Among 1545 selected patients who underwent a 3-month period with nutritional advice, 1334 were included in a 6-month drug study. Inclusion criteria were total serum cholesterol equal to or above 250 mg/dl and/or serum triglycerides equal to or above 200 mg/dl. At 6 months, average changes from inclusion levels were -20.5, -26.1. -7.5 and +15.2% for total cholesterol, LDL-cholesterol > or = 160 mg/dl on inclusion, plasma fibrinogen and HDL-cholesterol, respectively. Median decrease of serum triglycerides was 46.5%. Trial discontinuation for clinical and biological adverse events were 5 and 1%, respectively. In conclusion, micronised fenofibrate at a daily dose of 200 mg had significant lipid-modifying properties but also exhibited a beneficial effect on other related risk factors such as fibrinogen reduction. The safety profile was very satisfactory providing an excellent benefit/risk ratio.

Adolescent↗
PubMed1994

TSH response to TRH and EEG sleep in non-bipolar major depression: a multivariate approach.

The TSH response to TRH and selected sleep EEG variables were studied in a homogeneous sample of 280 non-bipolar major depressed inpatients (95 males and 185 females). The TSH response to TRH was blunted in 28% of the sample. delta max TSH was correlated negatively with age, Hamilton rating scale, Newcastle scale, percentage of wake, and positively with basal TSH, percentage of stage II, slow wave sleep, REM sleep and REM latency. delta max TSH was also lower in male patients and in patients suffering from an endogenous or a psychotic subtype of major depression. Basal TSH was only correlated negatively with the Newcastle score. In view of intercorrelations between all these variables, and because of the confounding effect of age, gender and severity on both the TSH response to TRH and sleep EEG variables, a multiple regression analysis was performed and demonstrated that basal TSH and gender were the two variables with the highest contribution to the delta max TSH variance, followed by age and the presence of psychotic symptoms. When controlling strictly for these significant effects, correlation with the severity or with the endogenous character of depression, and with sleep EEG parameters disappeared.

Adult↗
PubMed1994

Biological risk factors for fatal protein energy malnutrition in hospitalized children in Zaire.

Biological markers were used in an attempt to predict mortality in children admitted to the hospital in Kivu, Zaire, for protein energy malnutrition. Data for 39 children who died (16.4%) showed significantly lower levels of albumin (1.61 vs. 2.53 g/dl; p < 0.001), transferrin (82.1 vs. 167.7 mg/dl; p < 0.001), and transthyretin (6.49 vs. 9.87 mg/dl; p < 0.001), but not or retinol-binding protein, than for the 199 survivors. Since albumin and transferrin were correlated, a Cox model was used to see whether albumin or transferrin has a significant predictive value independent of transthyretin. The relative risk predicted by each indicator was of the same order of magnitude, approximately 4. We conclude that specific biological markers help to discriminate among hospitalized subjects at risk and to identify those in need of more intensive nutritional support to prevent early death.

Biomarkers↗
PubMed1994

Human milk banking: influence of storage processes and of bacterial contamination on some milk constituents.

This paper reviews the effects of storage and bacterial content contaminating human milk on some milk constituents. Moreover, it reviews the inhibitory effect of refrigeration and freezing on bacterial growth. Our results suggest that the type and length of storage have an effect on some milk constituents, that this effect is modulated by the bacterial contamination of the milk and that refrigeration has a significant inhibitory effect on bacterial growth which is not observed after freezing. This stresses the importance of collecting noncontaminated milk and justifies the choice of refrigeration at 0-4 degrees C for storage up to 8 days.

Colony Count, Microbial↗
PubMed1994

Prenatal exposure to cigarettes in infants with obstructive sleep apneas.

OBJECTIVE: To investigate the effect of prenatal smoking on infant respiratory behavior during sleep. METHODS: A questionnaire concerning family habits and infants' history was completed for 550 healthy infants before a 9-hour night polysomnographic study. Because the data for 41 infants were not available for analysis, 509 subjects were studied: 115 were newborns evaluated within 1 week after birth, and 394 were healthy infants admitted at 11 weeks of life (range 5 to 29 weeks) after various research protocols. RESULTS: According to the smoking frequency of the mothers during pregnancy, the subjects were defined as "nonsmokers" (no cigarette smoked during pregnancy; n = 400), "light smokers" (1 to 9 cigarettes per day; n = 37), or "smokers" (10 or more cigarettes per day; n = 72). Compared with nonsmokers and light smokers, "smoking" mothers had a significant increase in the number of episodes of uterine bleeding during the pregnancy. Their infants had lower birth weights and more frequent episodes of profuse sweating during sleep. Infants of smokers also had more frequent and longer obstructive sleep apneas than those of the two other groups. For infants of smokers the relative risk for obstructive apneas was 2.76 (95% confidence interval: 1.63 to 4.69; P = .001). The relation between prenatal smoking and postnatal manifestation of obstructive sleep apneas demonstrated a dose-response pattern. Paternal smoking during pregnancy increased the risk of obstructive apneas only in the infants of smoking mothers, but not in those of the two other groups. Maternal smoking after birth did not add significantly to the risk of obstructive apneas. The effect of smoking was seen in older infants, as well as in the newborn not yet exposed to ambient cigarette smoke. A stepwise logistic regression, using obstructive sleep apneas as the dependent variable identified three significant independent variables: smoking during pregnancy (P = .001), profuse sweating during sleep (P = .001), and birth weight (P = .010). No explanation was found for the effect of prenatal smoking on obstructive sleep apneas. CONCLUSION: Prenatal smoking by mothers correlated with an increase in frequency and length of obstructive apneas and a decrease in birth weight of their infants. The infants were under greater risk for obstructive apnea if both parents smoked. Explanations for our results are unknown to us, but these findings may be of interest in the study of infant breathing behavior and epidemiological characteristics of sudden infant death syndrome.

Adolescent↗
PubMed1993

Serum albumin concentration, arm circumference, and oedema and subsequent risk of dying in children in central Africa.

OBJECTIVE: To measure the prognostic value of clinical, anthropometric, and biological indicators of protein energy malnutrition in hospitalised children. DESIGN: Hospital based follow up study from admission to discharge or death of a cohort of children. SETTING-Paediatric hospital in Zaire. SUBJECTS: 1129 children consecutively admitted between August 1986 and October 1988. MAIN OUTCOME MEASURES: Height, weight, arm circumference, skinfold thicknesses, serum albumin concentration, and mortality. RESULTS: Mortality was higher in wasted children and in those with a mid-upper arm circumference < 125 mm, a serum albumin concentration < 16 g/l, and oedema. After multivariate analysis, serum albumin concentration was the best predictor of subsequent risk of dying. Mid-upper arm circumference and oedema, however, still contributed considerably to evaluation of mortality. CONCLUSIONS: In this specific environment of central Africa an isolated clinical sign such as oedema is not enough to detect children with a high risk of dying among those admitted to paediatric wards with severe protein energy malnutrition. Measurement of additional indicators such as arm circumference and serum albumin concentration seems to be of crucial importance.

Anthropometry↗
PubMed1993

Clinical symptoms associated with brief obstructive sleep apnea in normal infants.

Relatively little data exist concerning the manifestations of repeated obstructive sleep apnea in normal infants. A questionnaire concerning daytime and sleep habits was completed by the parents of 4,100 healthy infants before they underwent a 9-hour night monitoring study. One hundred infants with an obstructive apnea index above 1.2 were randomly selected. They formed the "apnea" group. From the initial population, 300 infants with no apnea were also selected to form the "no-apnea" group. Both groups were matched for sex, gestational age, post conceptional age, birth weight, mother's age, parity and a family history of sudden infant death. Five variables from the questionnaires significantly differentiated the two groups of infants. When awake, the infants with apnea were characterized by a greater frequency of breathholding spells (22% of apnea infants) and episodes of fatigue during feeding (28%) than the non-apnea infants. During sleep, they exhibited a greater frequency of profuse sweating (15%), snoring (26%) or noisy breathing (44%). Multiple symptoms were present in some infants. A stepwise logistic regression resulted in two significant independent variables: profuse sweating during sleep (p = 0.008) and noisy breathing (p = 0.002). The predictive value of these two symptoms was tested on a new group of 650 healthy infants. The two independent variables led to the correct classification of 60 of the 67 infants with apnea (89.67%) and 382 of the 583 non-apnea infants (65.5%). A positive history alone had a positive predictive value of 0.21.(ABSTRACT TRUNCATED AT 250 WORDS)

Electrocardiography↗
PubMed1993

Twenty-five-year mortality follow-up in the Belgian Bank Study.

Two cohorts of male bank employees aged 40-59 at baseline and free of coronary heart disease were pooled and followed during 25 years for all-cause and coronary mortality. The vital status was known for all 1,227 subjects, but in both banks, 8% of all deaths occurred without any clue to a possible cause. All-cause and coronary mortality were 36.9 and 10.5 per 100 subjects, respectively. In bivariate analysis (adjusting for age), systolic blood pressure, diastolic blood pressure, serum cholesterol and cigarette smoking predicted all-cause mortality. The same variables predicted coronary mortality. Body mass index was neither a predictor of all-cause nor of coronary mortality. In multivariate analysis, age, systolic blood pressure and cigarette smoking predicted independently all-cause mortality whereas the same variables and serum cholesterol predicted coronary mortality. For coronary mortality, the odds ratio (OR) of systolic blood pressure > or = 160 against < 140 mm Hg was 2.68 (95% confidence interval, CI: 1.41-5.08). The OR for subjects with baseline serum cholesterol > or = 260 versus < 260 mg/dl was 1.68 (95% CI: 1.31-2.51). The OR for cigarette smokers versus never smokers was 2.54 (95% CI: 1.39-4.64). Age-adjusted relative risk for all-cause mortality for subjects in the highest versus the lowest quintile of a multiple logistic function was 1.72 whereas for coronary mortality the relative risk was 4.94. These results confirm the long-term predictive power of the three major modifiable coronary risk factors when measured once in middle-aged male subjects.

Adult↗
PubMed1993

Gestational malaria: assessment of its consequences on fetal growth.

In a region of Africa (Nord-Kivu, Zaire) where malaria is endemic, circulating malaria parasites, malaria-associated placental lesions, and a low hemoglobin level (< 10 g/dl) were observed, either singly or in combination, in 73.1% of women (n = 461) delivering at the maternity hospital. These pathologic findings were associated with low birthweight in 18.1% of the newborns, whereas the prevalence of low birthweight was 6.4% among cases without these findings (P < 0.05). Parasitemia was observed in 17.4% of all mothers and was associated with a significant decrease in birthweight. Malaria-associated lesions were found in 52.5% of all placentas and were associated with a decrease in birthweight, head circumference, and ponderal index of the newborns. Such lesions were more frequently observed among primiparae (60.5%) than among multiparae (49.5%; P < 0.05). Lastly, a low hemoglobin level, found in 38.6% of the mothers, was associated with a decrease in birthweight, length, and head circumference. The differences in the physical effects associated with each of the pathologic conditions suggest that parasitemia, placental lesions, and anemia result in acute, subacute, and chronic impairment of fetal growth, respectively. Moreover, their deleterious effects may be cumulative, since the most dramatically affected physical patterns were found when the pathologic findings were associated in the same patient. Frequent antenatal monitoring of maternal hemoglobin and parasitemia, accompanied, when necessary, with curative treatments, may help to reduce the prevalence of intrauterine growth retardation and its procession of perinatal complications.

Anthropometry↗
PubMed1993

Evaluation of immunization coverage at local level.

Two simple methods were employed for evaluating immunization activities in three rural health districts of Zaire, with a view to improving service delivery. One method involves the use of cumulative frequency graphs for monitoring progress at the health centre level towards the achievement of coverage targets. The other requires a clinic-based audit and a population-based survey of children aged 12-23 months to ascertain whether they have been immunized against measles at the appropriate time. These approaches can help to identify operational problems and to motivate the people in charge of immunization at local level.

Child, Preschool↗
PubMed1993

[Value of nutritional indicators for the prognosis of intrahospital mortality in children in Kivu].

From 1986 to 1988, 1,129 children were hospitalized in Lwiro (South-Kivu, Zaïre) 3/4 of which were severely malnourished. Anthropometric, clinical and biological indicators were measured at admission. Observed mortality rate was 17.4%. Survival curves differ significantly for each anthropometric parameter measured at inclusion. In multivariate analysis, weight for age calculated with local reference or arm circumference is significantly associated with survival. The addition of serum albumin concentration to the multivariate model, shows this variable to be important. However, the use of an anthropometric indicator, such as weight for age or arm circumference is still important because it maintains an independent and significant effect on survival.

Adolescent↗
PubMed1993

Prone or supine body position and sleep characteristics in infants.

OBJECTIVE: To evaluate the potential relation between body position and sleep characteristics in normal infants. PATIENTS: Two groups of 3-month-old healthy infants were evaluated: 40 infants who usually slept supine, and 40 who usually slept prone. The two groups were matched for gender, gestational age, postnatal age, birth weight, and total recording time. RECORDING TECHNIQUES: The 80 infants were studied polygraphically during one night in the pediatric sleep laboratory. They were allowed to fall asleep in their usual sleep position, and every 3 hours were gently turned from prone to supine, or from supine to prone. RESULTS: In each group, 6 infants were excluded from the analysis, because they woke up after having been turned over. In both groups, no significant difference was seen between the prone and the supine body positions for the following variables: number of sleep state changes; number of gross body movements; percent of rapid eye movement sleep; saturation with oxygen, arterial blood levels; number and duration of acid esophageal reflux; rectal temperature; mean respiratory rates; water evaporation rates from the forehead skin; and number or duration of central or of obstructive apneas. In both groups of infants, prone body position was associated with a significant increase in sleep duration (+16%) and in non-rapid eye movement sleep (+25%) and a significant decrease in number of arousals (-40%) and in their duration (-43%). CONCLUSIONS: No explanation has been found for the sleep-promoting effect of prone body positioning. The finding could be of interest to the study of infants' sleep quality, as well as to the potential relation between body positions and sudden death during sleep.

Female↗
PubMed1992

Does non-invasive ambulatory blood pressure monitoring disturb sleep?

OBJECTIVE: To assess the effects of non-invasive ambulatory blood pressure monitoring upon sleep in healthy men. METHODS: Spontaneous variations in the quality of sleep were assessed by taking polygraph recordings in 44 healthy men aged 17-69 years. Subjects were allowed one night to become accustomed to the laboratory environment, and then their sleep was recorded for 4 consecutive nights. On day 4 blood pressure was measured every 10 min for 24 h. RESULTS: The blood pressure recording procedure caused a small but significant decrease in the amount of slow-wave sleep and an increase in the duration of nocturnal awakenings. As a result, sleep efficiency was decreased. The number of nocturnal awakenings was not affected by the blood pressure measurements. The effects of ambulatory blood pressure monitoring were qualitatively similar in young and older volunteers. CONCLUSION: Non-invasive ambulatory blood pressure monitoring induces modest sleep disturbances which are unlikely to artifactually distort the physiological 24-h blood pressure profile.

Adult↗
PubMed1992

[Community health workers are capable of determining reliably the target population for health programs].

The target population is a key concept for the planning and evaluation of health services. However, in developing countries, health professionals in the field are often uneasy with the determination of the population denominator. In Zaire, where reliable demographic data are hardly available, we make use of two different methods aimed to the determination of the size of the target population: (1) an exhaustive population based survey performed by trained interviewers, and (2) a rapid census of the target population performed by community health workers. This paper presents both the results of a demographic survey organized in 1984, and two consecutive census performed by community health workers in 1986 an 1988, in the same area (Northern-Kivu, Zaire). Our results suggest that community health workers under close supervision are able to perform rapidly and at low cost a reliable collection of the demographic data needed for the implementation and monitoring of health programmes at the local level.

Adolescent↗