(73/413) Cutaneous tuberculosis in Morocco.
OBJECTIVE: To describe the salient epidemiologic, clinical, histopathologic, and bacteriologic aspects of cutaneous tuberculosis in Morocco. METHODS: A retrospective review of all cases of cutaneous tuberculosis at our hospital from January 1981 through December 2004. RESULTS: Two-hundred and sixteen cases of cutaneous tuberculosis were identified and included. Men and women were equally affected. The mean patient age was 29 years. Major clinical types of cutaneous tuberculosis were scrofuloderma and gumma (72%), lupus vulgaris (12%), tuberculosis verrucosa cutis (7%), tuberculids (6%), orificial tuberculosis (1%), and tuberculous chancre (1%). Systemic involvement was seen in 35%. Where performed (66%), 81% of subjects had positive Mantoux skin tests. Lesion biopsy for histopathologic study was performed in 81% of patients and showed classical tuberculous findings in 57%. Mycobacterium tuberculosis was isolated in culture from 9% of patients. CONCLUSION: Cutaneous tuberculosis is still a common disease in Morocco, and scrofuloderma and gumma are the most common clinical presentations. (+info)
(74/413) High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands.
BACKGROUND: Vitamin D deficiency is common in dark-skinned persons living in northern countries. Vitamin D deficiency during pregnancy may have serious consequences for both mother and child. OBJECTIVE: The objective was to ascertain the prevalence of vitamin D deficiency in pregnant women of several ethnic backgrounds who were living in The Hague, a large city in the Netherlands. DESIGN: Midwives whose practice was visited by a large number of non-Western immigrants added the assessment of serum 25-hydroxyvitamin D [25(OH)D] to the standard blood test given to women who visited the practice during week 12 of pregnancy. Subsequently, the Municipal Health Service collected additional data from the midwives' files (June 2002 through March 2004): background variables, use of tobacco or alcohol or drugs, and infectious diseases. The women were grouped ethnically as Western, Turkish, Moroccan, and other non-Western. RESULTS: The vitamin D concentrations of 358 women were found in the midwives' files. Of these women, 29% were Western, 22% were Turkish, and 19% were Moroccan. Mean serum 25(OH)D concentrations in Turkish (15.2 +/- 12.1 nmol/L), Moroccan (20.1 +/- 13.5 nmol/L), and other non-Western women (26.3 +/- 25.9 nmol/L) were significantly (P = 0.001) lower than those in Western women (52.7 +/- 21.6 nmol/L). Serum 25(OH)D was below the detection limit in 22% of the Turkish women. The differences between ethnic groups were not confounded by other determinants such as age, socioeconomic status, or parity. CONCLUSIONS: The prevalence of vitamin D deficiency in pregnant non-Western women in the Netherlands is very high, and screening should be recommended. (+info)
(75/413) Vitamin A supplementation in children with poor vitamin A and iron status increases erythropoietin and hemoglobin concentrations without changing total body iron.
BACKGROUND: Vitamin A deficiency impairs iron metabolism; vitamin A supplementation of vitamin A-deficient populations may reduce anemia. The mechanism of these effects is unclear. In vitro and in animal models, vitamin A treatment increases the production of erythropoietin (EPO), a stimulant of erythropoiesis. OBJECTIVE: We measured the effect of vitamin A supplementation on hemoglobin, iron status, and circulating EPO concentrations in children with poor iron and vitamin A status. DESIGN: In a double-blind, randomized trial, Moroccan schoolchildren (n = 81) were given either vitamin A (200,000 IU) or placebo at baseline and at 5 mo. At baseline, 5 mo, and 10 mo, hemoglobin, indicators of iron and vitamin A status, and EPO were measured. RESULTS: At baseline, 54% of children were anemic; 77% had low vitamin A status. In the vitamin A group at 10 mo, serum retinol improved significantly compared with the control group (P < 0.02). Vitamin A treatment increased mean hemoglobin by 7 g/L (P < 0.02) and reduced the prevalence of anemia from 54% to 38% (P < 0.01). Vitamin A treatment increased mean corpuscular volume (P < 0.001) and decreased serum transferrin receptor (P < 0.001), indicating improved iron-deficient erythropoiesis. Vitamin A decreased serum ferritin (P < 0.02), suggesting mobilization of hepatic iron stores. Calculated from the ratio of transferrin receptor to serum ferritin, overall body iron stores remained unchanged. In the vitamin A group at 10 mo, we observed an increase in EPO (P < 0.05) and a decrease in the slope of the regression line of log10(EPO) on hemoglobin (P < 0.01). CONCLUSION: In children deficient in vitamin A and iron, vitamin A supplementation mobilizes iron from existing stores to support increased erythropoiesis, an effect likely mediated by increases in circulating EPO. (+info)
(76/413) Ethnic minorities and prescription medication; concordance between self-reports and medical records.
BACKGROUND: Ethnic differences in health care utilisation are frequently reported in research. Little is known about the concordance between different methods of data collection among ethnic minorities. The aim of this study was to examine to which extent ethnic differences between self-reported data and data based on electronic medical records (EMR) from general practitioners (GPs) might be a validity issue or reflect a lower compliance among minority groups. METHODS: A cross-sectional, national representative general practice study, using EMR data from 195 GPs. The study population consisted of Dutch, Turks, Surinamese, Antilleans and Morrocans. Self-reported data were collected through face-to-face interviews and could be linked to the EMR of GPs. The main outcome measures were the level of agreement between annual prescribing rate based on the EMRs of GPs and the self-reported receipt and use of prescriptions during the preceding 14 days. RESULTS: The pattern of ethnic differences in receipt and use of prescription medication depended on whether self-reported data or EMR data were used. Ethnic differences based on self-reports were not consistently reflected in EMR data. The percentage of agreement above chance between EMR data and self-reported receipt was in general relative low. CONCLUSION: Ethnic differences between self-reported data and EMR data might not be fully perceived as a cross-cultural validity issue. At least for Moroccans and Turks, compliance with the prescribed medication by the GP is suggested not to be optimal. (+info)
(77/413) Smoking in immigrants: do socioeconomic gradients follow the pattern expected from the tobacco epidemic?
OBJECTIVES: Although socioeconomic patterns of smoking across the different stages of the tobacco epidemic have been well researched, less is known about these patterns among immigrant populations. This paper aims to assess the smoking prevalence and its socioeconomic gradients among three immigrant populations. METHODS: Three cross-sectional studies, using structured face-to-face interviews, were conducted in three representative (for socioeconomic status) samples of 385 Turkish, 316 Moroccan, and 1072 Surinamese first-generation immigrants aged 35-60 years in Amsterdam, The Netherlands. Information gathered included information about smoking behaviour, educational level and background characteristics. The associations between educational level and smoking rates were assessed using logistic regression analyses stratified by age and sex, for each ethnic group separately. RESULTS: The prevalence of smoking differed per group, being highest among Turkish and Surinamese men (63% and 55%, respectively), followed by Moroccan men and Turkish and Surinamese women (30%, 32% and 27%, respectively). Higher smoking rates were found among women with higher educational levels, except for Surinamese women aged 35-44 years. However, among Turkish and Moroccan men aged 35-44 years and Surinamese men, smoking rates were higher in lower socioeconomic groups. CONCLUSIONS: The prevalence figures and educational associations suggest that the socioeconomic gradient changes in earlier stages of the epidemic in immigrant populations than in the Western host populations, particularly in men. This provides indications to suggest that smoking prevention measures in male immigrant groups need to be tailored to lower socioeconomic groups in particular throughout the tobacco epidemic, and to higher socioeconomic groups among women. (+info)
(78/413) Predictors of asthma control in children from different ethnic origins living in Amsterdam.
To identify factors associated with asthma control in a multi-ethnic paediatric population. We interviewed 278 children with paediatrician diagnosed asthma (aged 7-17 years) and one of their parents. Asthma control was assessed with the Asthma Control Questionnaire (ACQ). Detailed information about sociodemographic variables, asthma medication, knowledge of asthma, inhalation technique and environmental factors were collected. Turkish and Moroccan parents were interviewed in their language of choice. Logistic regression analyses were used to identify correlates of asthma control. Of the 278 children, 85 (30.6%) were Dutch, 84 (30.2%) were Moroccan, 58 (20.9%) were Turkish and 51 (18.3%) were Surinamese. Overall, almost 60% had a status of well-controlled asthma, as indicated by the ACQ. Only 51 of the 142 (35.9%) Moroccan and Turkish parents had a good comprehension of the Dutch language. In logistic regression analyses the risk of having uncontrolled asthma was significantly higher among Surinamese children (OR 2.3; 95% CI 1.06-4.83), respondents with insufficient comprehension of the Dutch language (OR 2.3; 95% CI 1.08-4.78), children using woollen blankets (OR 9.8; 95% CI 1.52-63.42), and significantly lower among male (OR 0.5; 95% CI 0.31-0.91) and non-daily users of inhaled corticosteroids (OR 0.6; 95% CI 0.38-1.07). In conclusion, ethnicity as well as insufficient comprehension of the Dutch language appeared to be independent risk factors for uncontrolled asthma. Special attention should be given to children from immigrants groups for example by calling in an interpreter by physicians when comprehension is insufficient. (+info)
(79/413) A new locus for autosomal dominant posterior polar cataract in Moroccan Jews maps to chromosome 14q22-23.
BACKGROUND: Posterior polar cataract is a clinically distinctive opacity located at the back of the lens. It is commonly acquired in age related cataract, and may infrequently occur in pedigrees with congenital cataract. To date, five loci for autosomal dominant congenital posterior polar cataract have been identified. These include two genes, CRYAB and PITX3, on chromosomes 11q and 10q respectively, and three loci with as yet unknown genes on chromosomes 1p, 16q and 20p. PURPOSE: To find the chromosomal location of a gene causing autosomal dominant congenital posterior polar cataract in three Moroccan Jewish families. METHODS: A whole genome scan was performed using microsatellite markers spaced at approximately 10 cM intervals. For fine mapping, five additional microsatellite markers were genotyped. Two-point lod scores were calculated using MLINK software, from the LINKAGE program package. After linkage was established, several positional candidate genes were assessed by PCR based DNA sequencing. RESULTS: The new cataract locus was mapped to an 11.3 cM interval between D14S980 and D14S1069 on chromosome 14q22-23. A maximum two point lod score of 5.19 at theta = 0 was obtained with the markersD14S274. The positional and functional candidate genes SIX1, SIX4, SIX6, OTX2, and ARHJ were excluded as the cause of cataract in these families. CONCLUSION: An as yet unidentified gene associated with posterior polar cataract maps to the long arm of chromosome 14q22-23. (+info)
(80/413) Study of the RET gene and his implication in thyroid cancer: Morocco case family.
BACKGROUND: Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant inherited cancer syndrome that affects multiple tissues derived from the neural crest. Inheritance of MTC is related to the presence of specific mutations in the RET proto-oncogene. Almost all mutations in MEN 2A involve one of the cysteines in the extracellular domain of the RET receptor. AIMS: The objective of the present study was the biochemical and molecular characterization of the first Moroccan clinically established MEN 2A patient and at-risk family members. SETTINGS AND DESIGN: This is a study on a family presented with MTC referred to our institute in 2004. MATERIALS AND METHODS: Peripheral blood leukocyte DNA samples were isolated and amplified by polymerase chain reaction followed by restriction enzyme analysis and DNA sequencing. RESULTS: We identified a heterozygous germ line missense mutation at codon 634 of exon 11 in the RET gene that causes a cysteine to arginine amino acid substitution in the DNA of the proband; this mutation was not found in the DNA of the parents or relatives. CONCLUSIONS: The detection of mutated MEN 2A gene carriers enables us to differentiate high-risk members from those who bear the wild-type gene. Occasionally, application of RET proto-oncogene testing may lead to the detection of unexpected de novo mutation that could be transmitted to children. (+info)