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PubMed2005

[Should mechanical ventilation be used in ICU patients in developing countries?].

The purpose of this monocentric prospective cohort study was to assess mortality in intensive care unit (ICU) patients requiring more than 6 hours of mechanical ventilation (MV) in a developing country. The study setting was a 10-bed polyvalent ICU at the Centre Hospitalier Régiona1 in El Maarouf, Comoros Islands. The study population included a total of 106 patients requiring MV out of 633 consecutive patients admitted to the ICU over a 10-month period. Study parameters included demographic data, simplified acute physiology score version 2 (SAPS II), reason for admission, urgency of MV, duration of MV, complications of MV need for sedation and mortality in hospital and at one year. In-hospital mortality was 59%. Mortality was significantly higher in patients presenting elevated SAPS II and requiring myorelaxant drugs. Age, gender, reason of admission, emergency, sedation, complications of MV, duration of MV were not correlated with mortality. The best prognosis was associated with the following indications: severe malaria, meningitis, eclampsia and poisoning. All patients who left the ICU (41) were alive at one year. Mortality associated with use of MV for resuscitation in a developing country was similar to that observed in developed countries. The young age of patients, acute nature of manifestations and reversibility of diseases encountered may explain the favorable outcome observed in this study. The initial diagnosis and associated risk factors (using a severity score if necessary) must be taken into account in deciding the indication for starting and stopping MV. The results of this study show that MV is feasible and effective in a developing country, but requires experience, inventiveness and realism.

Adult↗
PubMed2006

[Combination of three cutaneous diseases in Mayotte].

This report describes the case of a young woman from Mayotte (Comoros Islands) who presented a combination of three cutaneous diseases, i.e. pityriasis versicolor, scabies, and multibacillary leprosy. Symptoms of leprosy were concealed by those of the other two diseases. After multidrug therapy for leprosy, the patient developed erythema nodosum leprosum that was successfully treated using pentoxifylline. Combination of cutaneous diseases can alter usual presentations and lead to misdiagnosis. It is important to take into account possible disease combination to establish proper diagnosis and prescribe effective treatment.

Adolescent↗
PubMedDate not supplied

[Equity and exclusion from health care. From research to action, the experiences from one non-government organization].

Poverty is an important issue for health services needing to meet costs, but not wanting to exclude the poorest from health cover. This article describes the main themes and conclusions of the analysis performed by the International Center for Development and Research (CIDR) at the request of, and supported by Unicef. The work included a research program initiated by the BIMU aimed at identifying strategies adapted to favoring "access to health services for all". Surveys were conducted in the Comoro Islands, Conakry in Guinea, and Ethiopia to determine the extent to which the communities themselves could find solutions to the problem of access to health care for the poor. Quantitative data, and the analysis by the community studies were consistent with the view that poverty is only one of several reasons for exclusion from health cover. Seasonal exclusion affected a larger proportion of the population. Although the communities were able to identify the poorest members, the idea of helping them when ill was not acceptable. Indeed, other community members feel that they themselves are often excluded from health care cover. This makes it inappropriate to propose a system to cover only the poorest. For the communities generally, the right to health care implies finding appropriate solutions for the community as a whole, and not only for the poorest. This study highlights the need to establish systems appropriate for the different forms of exclusion, both seasonal and permanent.

Community Participation↗
PubMed1997

[AIDS and HIV infection in the Federal Islamic Republic of Comores (1988-1995)].

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.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Angiostrongylus in the infant at Reunion and Mayotte. Apropos of 3 cases of eosinophilic meningitis including 1 fatal radiculomyeloencephalitis with hydrocephalus].

BACKGROUND: Eosinophilic meningitis caused by Angiostrongylus cantonensis is widespread in Southeast Asia and Pacific islands. Adults develop a transient meningitis with a benign course but severe or fatal disease may occur in pediatric patients. CASE REPORT 1: A 11 months old boy living in Mayotte island was hospitalized some days after fever and skin rash with seizure status, coma, flaccid quadriplegia, absence of deep tendon reflexes, urinary retention and anal incontinence. Eosinophilia was observed in peripheral blood and in the cerebrospinal fluid. Secondary, he developed a triventricular hydrocephalus treated by a ventriculoperitoneal shunt. After 3 weeks, the child died. Retrospectively, the diagnosis of angiostrongylus infection was established with the help of serology. CASE REPORTS 2 AND 3: Two infants, 10 and 11 months old boys, living in Reunion island, developed fever and vomitings, irritability and, for one of them, a unilateral sixth cranial nerve palsy. There was eosinophilia in the peripheral blood and in the cerebrospinal fluid. All symptoms progressively disappeared with complete recovery. The suspected diagnosis of angiostrongylus infection was confirmed by the serology. CONCLUSION: We report the first case of Angiostrongylus cantonensis infection in the French island of Mayotte (Comoro Islands) and we confirm the presence of this disease in Reunion island. In this Indian Ocean area, eosinophilic meningitis occurs most of the time in infants with sometimes severe radiculomyeloencephalitic forms. The origin of these occasionally massive infections is the giant African snail Achatina fulica. For a child with meningitis living in Reunion or Mayotte, or coming back from these 2 islands, Angiostrongylus cantonensis infection must be evoked, especially if there is a blood eosinophilia. Since efficiency of antiparasitic treatment is nowadays not proved, information must be given to people living in exposed areas in view to limit incidence of this disease.

Angiostrongylus cantonensis↗
PubMed1999

Molecular phylogeny of the Ceratosolen species pollinating Ficus of the subgenus Sycomorus sensu stricto: biogeographical history and origins of the species-specificity breakdown cases.

The 14 species of Ficus of the subgenus Sycomorus (Moraceae) are invariably pollinated by Ceratosolen species (Hym. Chalcidoidea), which in turn reproduce in the fig florets. They are distributed mostly in continental Africa, Madagascar, and the Mascarene and Comoro Islands, but 1 species extends its geographical range all over the Oriental region. Fig-pollinator relationships are usually strictly species specific, but exceptions to the 'one-to-one' rule occur within the group we studied. In order to understand both the biogeographical history of the Ceratosolen species associated with Ficus of the subgenus Sycomorus and the origins of the specificity breakdown cases, we have used cytochrome b sequences to reconstruct a phylogeny of the fig wasps. The results show that the pollinators from the Malagasy region and those from continental Africa form two distinct clades, which probably diverged after the crossing of the Mozambique Channel by an ancestral population. The Oriental wasp species show strong affinities with the African species. The two species-specificity exceptions are due to different evolutionary events. The occurrence of the two West African pollinators associated with F. sur can be explained by successive speciation events of the mutualistic partner without plant radiation. In contrast, we hypothesize that C. galili shifted by horizontal transfer from an unknown, presumably extinct, Ficus species to F. sycomorus after this native Malagasy fig species colonized Africa.

Animals↗
PubMed2006

Mitogenomic analysis for coelacanths (Latimeria chalumnae) caught in Tanzania.

In recent years, a large number of individuals of the species Latimeria chalumnae, one of the living fossil coelacanths, have been landed off the coast of Tanzania. Although L. chalumnae specimens have also been landed at other localities in the western Indian Ocean, so far, viable populations of this species have been identified only at two localities, Comoros and South Africa. Therefore, the recent active catch off Tanzania suggests a new habitat for L. chalumnae. To examine the genetic background of the Tanzanian fish, we analyzed complete mtDNA sequences of two Tanzanian individuals (Kigombe-9 and Songo Mnara-1) collected from the north and south coasts of Tanzania. Using the recently reported criteria for six haplotypes established in a population genetic study for coelacanths living in the western Indian Ocean [Schartl, M., Hornung, U., Hissman, K., Schauer, J., Fricke, H., 2005. Relatedness among east African coelacanths. Nature 435, 901.], we characterized Songo Mnara-1 as haplotype 1 and Kigombe-9 as haplotype 5. We suggest that the Songo Mnara specimen is a member of the Comoran group, but was swept away by the South Equatorial current. The individual from Kigombe may be a member of an undiscovered population that exists near the boundary between Tanzania and Kenya. Further analysis using more than 19 individuals recently captured off the north coast of Tanzania will reveal whether a new population exists there. Our sequence data suggest additional variable sites in the mtDNA sequence that may define the population structure of coelacanths in the western Indian Ocean and also raise the possibility that the previously published Comoran coelacanth mtDNA sequence contains several critical errors including base changes and indels.

Animals↗
PubMed2005

[Residence permit for foreigners for healthcare in France: survey on the advice of the public health medical officers].

BACKGROUND: Public health medical officers of the different French administrative districts are called in to advise the public authorities (Préfet) on requests for a residence permit from foreigners seeking healthcare asylum in France. Using a medical report chart, the medical officer specifies whether the foreigner requires treatment, whether lack of medical care can have exceptionally serious consequences and whether the patient can obtain a suitable treatment in his/her own country. Considering the marked increase in the number of requests for healthcare asylum and the potential subjective aspect of the medical officer's advice, a survey was conducted to assess medical officers'practices. METHODS: In March 2002, a questionnaire was addressed by email to the medical officers practising in the 94 administrative districts of metropolitan France. They were to give their advice about two fictional requests for healthcare asylum; the fictional requests closely mimicked real situations which frequently raise difficult issues. The two seekers were a 57-year-old man from Comoros treated for hypertension and noninsulin-dependent diabetes mellitus (case 1) and a 33-year-old woman from the Ivory Coast followed after treatment for tuberculosis (case 2). RESULTS: Among the 94 district medical officers contacted, 42 (45%) responded. Respectively 88% (case 1) and 67% (case 2) of the medical officers considered that the patient required medical care because lack of care would have serious consequences, but for 26% (cases 1 and 2), treatment could be delivered in the country of origin. Finally, the advise proposed by the different officers varied: for 33% (case 1) and 53% (case 2) of the medical officers, asylum in France for healthcare was unjustified. CONCLUSIONS: In spite of a low response rate, this survey shows the subjectivity of the advice provided by medical officers, raising the question of its fairness. Our study suggests that this subjectivity is related to the vagueness of the questions asked to the medical officers and the lack of a frame of reference on which to base their advice.

Delivery of Health Care↗
PubMed2005

[Mefloquine versus halofantrine in children suffering from acute uncomplicated falciparum malaria].

AIM OF THE STUDY: To evaluate mefloquine versus halofantrine in children suffering from acute uncomplicated falciparum malaria. MATERIAL AND METHODS: Prospective non randomized study in hospitalized children during one year. Acute falciparum malaria was defined by fever and a positive thin and/or thick smear. Malaria was presumed to have been contracted in Comoros archipelago and/or Madagascar 6 months previously. Patients were excluded, when quinine had to be used, according to World Health Organization's severity criteria. RESULTS: Forty-nine children were included: 29 were treated with halofantrine and 20 with mefloquine. Patients features in the two groups of treatment were identical, with exception for the mean time between first clinical signs and diagnosis (shorter in mefloquine group). Fever's and hospitalization's duration under treatment were similar. An increase in QTc interval was frequently observed in patients treated with halofantrine (56 versus 0%), although patients with mefloquine experienced vomiting (45 versus 0%). Relapses seemed to be more frequent with halofantrine (14 versus 0%). DISCUSSION: Halofantrine and mefloquine are efficient for falciparum malaria treatment in our pediatric series, despite a high rate of adverse events. Mefloquine's tolerance may probably be improved with changes in regimen and dose. Relapses are more frequent with a single first treatment of halofantrine, than with mefloquine. Unfortunately, features of a second halofantrine treatment are not defined.

Adolescent↗
PubMed1999

[Imported pediatric malaria in Marseille].

UNLABELLED: Imported malaria is frequently observed in pediatric practices within geographical areas which have a migrant population. MATERIAL AND METHODS: All the pediatric malaria cases of a university children's hospital (Marseilles, southern France) had been studied retrospectively. The period of the study was from January 1987 to December 1997. Inclusion criteria were based on clinical diagnosis criteria established by WHO. RESULTS: Three hundred and fifteen clinical cases were observed. Ninety-nine percent were confirmed by blood smears. Eighty-six percent of the patients came from the archipelago of the Comoro Islands in the Indian Ocean. Twenty percent were not given chemoprophylaxis, and 77% of the patients with chemoprophylaxis were not compliant. Fever (92%), splenomegaly (61%), vomiting and/or diarrhea (50%) were frequently observed. Neurological signs (23%), especially headaches (15%), were noted. The causative species was Plasmodium falciparum in 76%; coinfections with two species were observed in 9%. Halofantrine was commonly used for therapy (64%), but relapses were noted with this drug. No death was observed during the study. DISCUSSION: Imported pediatric malaria is rare in France. Clinical signs may lead to misdiagnosis when splenomegaly is not obvious, or when vomiting and/or diarrhea, cough or otitis occur. Diagnosis relies on blood smears. Curative medications are chloroquine or halofantrine, with special attention to heart troubles. Mefloquine is rarely used in children. Quinine is reserved for serious attacks. Concerning chimioprophylaxy, medical prescriptions should be adapted to the stay abroad, and patient compliance to medications could be improved.

Adolescent↗
PubMed1997

Sodwanones K, L, and M; new triterpenes from the marine sponge Axinella weltneri.

Three new triterpenes, sodwanones M, K, and L (4, 5, 6), together with three known sodwanones (A, B, and D) have been isolated from the sponge Axinella weltneri from the Comoros Islands, in the Indian Ocean. The three new structures were determined by interpretation of NMR spectra and, in the case of sodwanone K, also by oxidation to the known sodwanone D. Sodwanone M, the major isolated compound, was found to be cytotoxic to P-388 murine leukemia cells at a concentration of 1 microgram/mL.

Animals↗
PubMed1998

Several new isoprenoids from the soft coral sinularia erecta

Eight compounds were isolated from the Indo-Pacific soft coral Sinularia erecta (Tixier-Durivault, 1945) collected from the lagoon of Mayotte, Comoros Islands, northwest of Madagascar. Four of the compounds, namely the sesquiterpene germacrene D, the diterpenoids nephthenol and decaryiol, and norcembrene, are known. The other four are the new secondary metabolites germacrene E (1), epi-norcembrene (3), and two bis-pukalide diterpenes, mayotolides A and B (4 and 5). The structure of each of the compounds was determined by means of 1D and 2D NMR and MS spectroscopy in addition to some chemical transformations.

Journal Article↗
PubMed2002

Chameleon radiation by oceanic dispersal.

Historical biogeography is dominated by vicariance methods that search for a congruent pattern of fragmentation of ancestral distributions produced by shared Earth history. A focus of vicariant studies has been austral area relationships and the break-up of the supercontinent Gondwana. Chameleons are one of the few extant terrestrial vertebrates thought to have biogeographic patterns that are congruent with the Gondwanan break-up of Madagascar and Africa. Here we show, using molecular and morphological evidence for 52 chameleon taxa, support for a phylogeny and area cladogram that does not fit a simple vicariant history. Oceanic dispersal--not Gondwanan break-up--facilitated species radiation, and the most parsimonious biogeographic hypothesis supports a Madagascan origin for chameleons, with multiple 'out-of-Madagascar' dispersal events to Africa, the Seychelles, the Comoros archipelago, and possibly Reunion Island. Although dispersal is evident in other Indian Ocean terrestrial animal groups, our study finds substantial out-of-Madagascar species radiation, and further highlights the importance of oceanic dispersal as a potential precursor for speciation.

Africa↗
PubMed1999

Adaptive evolution of color vision of the Comoran coelacanth (Latimeria chalumnae).

The coelacanth, a "living fossil," lives near the coast of the Comoros archipelago in the Indian Ocean. Living at a depth of about 200 m, the Comoran coelacanth receives only a narrow range of light, at about 480 nm. To detect the entire range of "color" at this depth, the coelacanth appears to use only two closely related paralogous RH1 and RH2 visual pigments with the optimum light sensitivities (lambdamax) at 478 nm and 485 nm, respectively. The lambdamax values are shifted about 20 nm toward blue compared with those of the corresponding orthologous pigments. Mutagenesis experiments show that each of these coadapted changes is fully explained by two amino acid replacements.

Adaptation, Physiological↗
PubMed2002

Revisiting sub-Saharan African countries' drug problems: health, social, economic costs, and drug control policy.

This article takes an international perspective on the drug problem in sub-Saharan Africa. This analysis borrows ideas from physical and economic geography as a heuristic device to conceptualize the global narcoscapes in which drug trafficking occurs. Both the legitimate and the illegal drug trade operate within the same global capitalist system and draw on the same technological innovations and business processes. Central to the paper's argument is evidence that sub-Saharan African countries are now integrated into the political economy of drug consumption due to the spill-over effect. These countries are now minor markets for "hard drugs" as the result of the activities of organizations and individual traffickers that use Africa as a staging point in their trade with Europe and the United States. As a result, sub-Saharan African countries have drug consumption problems that were essentially absent prior to 1980, along with associated health, social, and economic costs. The emerging drug problem has forced African countries to develop their own drug control policy. The sub-Saharan African countries mentioned below vary to some extent in the level of drug use and misuse problems: Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mozambique, Reunion, Rwanda, Seychelles, Somalia, Tanzania, Uganda, Zambia, Angola, Cameroon, Central African Republic, Chad, Congo, Congo (Zaire), Equatorial Guinea, Gabon, Sao Tome and Principe, Botswana, Lesotho, Namibia, South Africa, Swaziland, Benin, Burkina Faso, Cape Verde, Cote d'Ivoire, Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, and Togo. As part of this effort, African countries are assessing the health, social, and economic costs of drug-use-related problems to pinpoint methods which are both effective and inexpensive, since their budgets for social programs are severely constrained. Many have progressed to the point of adopting anti-drug laws or legislation, or of establishing a drug control agency. They are also cooperating regionally to coordinate drug control measures and working with the Organization of African Unity (OAU). In addition, almost all the sub-Saharan African countries are signatories to all United Nations drug conventions. Since the drug problem in Africa has international origins, it will take concerted international cooperation and coordinated effort to combat the "social cancer" of drugs.

Africa South of the Sahara↗
PubMedDate not supplied

Color vision of the coelacanth (Latimeria chalumnae) and adaptive evolution of rhodopsin (RH1) and rhodopsin-like (RH2) pigments.

The coelacanth, a "living fossil," lives at a depth of about 200 m near the coast of the Comoros archipelago in the Indian Ocean and receives only a narrow range of light at about 480 nm. To see the entire range of "color" the Comoran coelacanth appears to use only rod-specific RH1 and cone-specific RH2 visual pigments, with the optimum light sensitivities (lambda max) at 478 nm and 485 nm, respectively. These blue-shifted lambda max values of RH1 and RH2 pigments are fully explained by independent double amino acid replacements E122Q/A292S and E122Q/M207L, respectively. More generally, currently available mutagenesis experiments identify only 10 amino acid changes that shift the lambda max values of visual pigments more than 5 nm. Among these, D83N, E1220, M207L, and A292S are associated strongly with the adaptive blue shifts in the lambda max values of RH1 and RH2 pigments in vertebrates.

Adaptation, Physiological↗
PubMed1993

Enzyme variation at the aspartate aminotransferase locus in members of the Anopheles gambiae complex (Diptera: Culicidae).

The enzyme aspartate aminotransferase (AAT) currently is used to identify Anopheles quadriannulatus Theobald, the animal-biting, nonmalaria vector species of the Anopheles gambiae complex. Samples of An. quadriannulatus from South Africa and An. gambiae Giles s.str. from the island of Grand Comoros and the People's Republic of Congo have shown variation in electromorph frequencies that indicate that AAT has five alleles. The three slowest alleles are found in An. quadriannulatus and the three fastest in An. gambiae, An. arabiensis Patton and An. merus Dönitz. One of these is common to both An. quadriannulatus and An. gambiae. This overlap indicates a potential misidentification of 0.3% of unknown females with a further 2.1% being unidentifiable. However, all of the specimens in the overlap area were classified correctly using octanol dehydrogenase (ODH). Variation at the ODH locus in An. quadriannulatus is recorded for the first time, with four of 157 specimens being heterozygous for the fast allele. The probability of both AAT and ODH giving an incorrect or indecisive identification is 0.0005. The slowest AAT alleles were present in samples from a single locality, indicating the lack of gene flow between subpopulations of An. quadriannulatus in close geographic proximity in the Shingwedzi area, South Africa. A modified method for multiple gel casting is given.

Alleles↗
PubMed1980

Some advances in coelacanth biology.

Participants in the British-French-American Expedition to the Comoro Islands in 1972 were able to observe a living coelacanth and to obtain fresh tissue from two specimens, which were processed in the field for subsequent research. This work, by many people in several countries, still continues, and this lecture gives a condensed account of some of the investigations so far published and in progress. Separate accounts of the French contributions, by J. Anthony, of the chemistry of the body fluids, by R. W. Griffith, and of the respiration, by G. M. Hughes, are being published concurrently, the four papers being complementary to each other. A bibliography on Latimeria is included.

Animals↗