Publications by authors named "Mathieu Nacher"

240 Publications

Levers and Barriers to Vaccinate against COVID-19 in the Multicultural Context of French Guiana: A Qualitative Cross-Sectional Survey among Health Care Workers.

Vaccines (Basel) 2021 Oct 20;9(11). Epub 2021 Oct 20.

Centre d'Investigation Clinique Antilles Guyane, CIC Inserm 1424, DRISP, Centre Hospitalier de Cayenne, Av des Flamboyants, 97300 Cayenne, France.

In French Guiana, a French overseas territory in South America facing a fourth wave of COVID-19, vaccination coverage is very low, both in the population and among health care workers (HCWs). Vaccine hesitancy concerned 35.7% of the latter in early 2021. The objective of this complementary study is to understand barriers and levers and to adapt messages to increase vaccination coverage among HCWs. We conducted a regional cross-sectional survey of HCWs with a questionnaire containing open-ended questions exploring factors associated with vaccine hesitancy and the needs to adapt the vaccination campaign in French Guiana. The discourses were analyzed using a qualitative approach based on grounded theory, with open coding of data by themes and construction of abstract categories. The analysis of the 357 responses collected from January to March 2021 reveals several trends. The ethical aspect of the HCWs' role emphasizes the importance of getting vaccinated themselves (to protect patients, to set an example...) and of vaccinating as many people as possible, including the most geographically or socially distant, such as undocumented migrants. However, some HCWs remain suspicious of the vaccine with concerns over the efficacy and side effects, of health institutions, and of the pharmaceutical industry. The role of fake news circulating on social networks has been widely discussed. Efforts to explain and convince HCWs must be continued in French Guiana using the identified levers to improve the acceptability of vaccination.
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http://dx.doi.org/10.3390/vaccines9111216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8622149PMC
October 2021

A call to start hydroxyurea by 6 months of age and before the advent of sickle cell disease complications.

Pediatr Blood Cancer 2021 Nov 24:e29423. Epub 2021 Nov 24.

Pediatric Hematology and Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.

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http://dx.doi.org/10.1002/pbc.29423DOI Listing
November 2021

Sexual and reproductive health of incarcerated women in French Guiana: a qualitative approach.

Int J Prison Health 2021 Nov;ahead-of-print(ahead-of-print)

UCSA, Centre Hospitalier de Cayenne, Cayenne, French Guiana.

Purpose: Incarcerated women are a vulnerable population in terms of sexual and reproductive health. In French Guiana, most incarcerated women come from unsafe environments and are incarcerated because of drug trafficking. Medical follow-up processes used in prison (medical assessment on arrival, and then two half-days per week upon request but without an obstetrician-gynecologist) does not allow for a thorough assessment of the impact of incarceration on women prisoners' health to take place. In the absence of data, the purpose of this study was to describe incarcerated women's experiences in relation to sexual and reproductive health.

Design/methodology/approach: Semi-structured interviews were conducted among French-speaking adult women who had been incarcerated for at least four months in a French Guianan prison. Menstruation, contraception, pregnancy, abortion, sexually transmitted infections and sexuality were described by means of interpretative phenomenological analysis.

Findings: A total of 14 women were interviewed. They suffered from menstrual cycle disorders, poor hygiene and menstrual insecurity. They appeared to have emotionally disinvested sexuality. However, intra-prison sexual activity existed for some (masturbation, conjugal prison visits, homosexual intercourse between fellow prisoners). Homosexual relations were a source of discrimination. Being pregnant while incarcerated was viewed negatively. A lack of knowledge about sexual and reproductive health and high-risk behaviors such as piercing and tattooing practices were widespread.

Originality/value: Incarceration is a vulnerable time for women's sexual and reproductive health. Sexual activity exposes women to risks and discrimination that should be taken into account in a multidisciplinary approach adapted to the prison environment.
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http://dx.doi.org/10.1108/IJPH-05-2021-0039DOI Listing
November 2021

Risk factors for hypoglycaemia in people with diabetes admitted to the Emergency Department of a Hospital in French Guiana.

Diabet Med 2021 Nov 4:e14736. Epub 2021 Nov 4.

Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana.

Aims/introduction: Strict management of glucose levels in elderly people with diabetes or with comorbidities exposes them to the risk of severe hypoglycaemia (capillary or venous glucose ≤3.3 mmol/L) and the associated morbidity and mortality. We aimed to describe the clinical, laboratory, and epidemiological characteristics of people with diabetes admitted to the Emergency Department in Cayenne, French Guiana for severe hypoglycaemia and identify avoidable behaviours in this population.

Materials And Methods: An observational epidemiological study of adults with diabetes who presented to the Emergency Department with severe hypoglycaemia was conducted between 2015 and 2018. Their medical history, clinical and laboratory data were collected. The primary outcome was the association between therapeutic misuse and age ≥65 years.

Results: Overall, 178 admissions were analysed. The main cause of hypoglycaemia was insulin dosing-error or inappropriate glycaemic targets. Among those ≥65 years, 59% had a glycated haemoglobin ≤48 mmol/mol (6.5%), and the median duration of their diabetes was 20 years. Among them, 60% were treated with sulfonylurea, repaglinide, biphasic insulin, or mixed drugs, and 48% were on non-diabetes related treatments that had a hypoglycaemic effect. Furthermore, 23% of the elderly treated with oral antidiabetics had chronic kidney disease.

Conclusion: Many avoidable risk factors for severe hypoglycaemia have been highlighted, in particular insulin dosing errors or non-compliance with recommendations for participants ≥ 65 years. Primary care physicians and homecare nurses need to provide preventive interventions and undergo training.
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http://dx.doi.org/10.1111/dme.14736DOI Listing
November 2021

Outbreak of Oropouche Virus in French Guiana.

Emerg Infect Dis 2021 10;27(10):2711-2714

Oropouche fever is a zoonotic dengue-like syndrome caused by Oropouche virus. In August-September 2020, dengue-like syndrome developed in 41 patients in a remote rainforest village in French Guiana. By PCR or microneutralization, 23 (82.1%) of 28 tested patients were positive for Oropouche virus, documenting its emergence in French Guiana.
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http://dx.doi.org/10.3201/eid2710.204760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462337PMC
October 2021

Allergy to Mammalian Meat Linked to Alpha-Gal Syndrome Potentially After Tick Bite in the Amazon: A Case Series.

Am J Trop Med Hyg 2021 Sep 20. Epub 2021 Sep 20.

Tenon Hospital, Dermatology-Allergology Department, Sorbonne University, Paris, France.

The past decade has seen the emergence of a new type of food allergy occurring after ingestion of mammalian meat. This allergy is related to immunoglobulin (Ig)E specific for galactose-alpha-1,3 galactose (α-Gal). Originally described in the United States in 2009, other cases have subsequently been described in Australia and in Europe, but still very few in Latin America. The purpose of this study was to show the existence of this pathology in French Guiana and to describe the historical, clinical, and biological characteristics of these patients. Patients reporting an allergy to mammalian meat were included between September 2017 and August 2019. Eleven patients were included, nine of whom exhibited digestive symptoms; four, urticaria reactions; three, respiratory reactions; and angioedema. The time between ingestion of red meat and reaction varied between 1.5 and 6 hours. The implicated meats were most often beef and pork. All patients had been regularly exposed to tick bites before the appearance of symptoms. All the samples (n = 7) were positive for anti-α-Gal anti-mammalian meats IgE. All the patients were Caucasian French expatriates. This study confirms the presence of this new entity in French Guiana and is the largest reported in Latin America. Our results do not clearly allow us to state that tick bites are the cause of this allergy, but all patients reported being exposed regularly to these arthropods.
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http://dx.doi.org/10.4269/ajtmh.20-1630DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592224PMC
September 2021

Diagnostic accuracy and acceptability of molecular diagnosis of COVID-19 on saliva samples relative to nasopharyngeal swabs in tropical hospital and extra-hospital contexts: The COVISAL study.

PLoS One 2021 13;16(9):e0257169. Epub 2021 Sep 13.

Laboratoire, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.

A prospective study was conducted among different intra and extra-hospital populations of French Guiana to evaluate the performance of saliva testing compared to nasopharyngeal swabs. Persons aged 3 years and older with mild symptoms suggestive of COVID-19 and asymptomatic persons with a testing indication were prospectively enrolled. Nasopharyngeal and salivary samples were stored at 4°C before analysis. Both samples were analyzed with the same Real-time PCR amplification of E gene, N gene, and RdRp gene. Between July 22th and October 28th, 1159 persons were included, of which 1028 were analyzed. When only considering as positives those with 2 target genes with Ct values <35, the sensitivity of RT-PCR on saliva samples was 100% relative to nasopharyngeal samples. Specificity positive and negative predictive values were above 90%. Across a variety of cultures and socioeconomic conditions, saliva tests were generally much preferred to nasopharyngeal tests and persons seemed largely confident that they could self-sample. For positive patients defined as those with the amplification of 2 specific target genes with Ct values below 35, the sensitivity and specificity of RT-PCR on saliva samples was similar to nasopharyngeal samples despite the broad range of challenging circumstances in a tropical environment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257169PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437265PMC
September 2021

What Is the Part of Tropical Diseases Among Infectious Complications in Renal Transplant Recipients in the Amazon? A 12-Year Multicenter Retrospective Analysis in French Guiana.

Transplant Proc 2021 Sep 31;53(7):2242-2251. Epub 2021 Aug 31.

Infectious and Tropical Medicine Department, Hospital Center of Cayenne, Cayenne, French Guiana, France; EA3593, Epidémiologie des Parasitoses et des Mycoses Tropicales, Medicine University of the West Indies and French Guiana, Cayenne, French Guiana, France.

Background: Infectious complications in kidney transplant recipients (KTRs) are well studied in temperate countries but remain barely known in tropical ones. The main objective of this study was to describe infection-related hospitalizations in patients living in the Amazon, where it has never been described.

Methods: All KTRs residing in French Guiana between 2007 and 2018 were included retrospectively. Infection-related hospitalizations were collected in the main medical centers of the territory.

Results: Eighty-two patients were included, and 42 were infected during the study period (51%). Eighty-seven infections were identified. The main sites of infection were urinary, in 29% of cases (25/87), and pulmonary, in 22% of cases (19/87). When documented (48/87), bacterial infections were predominant (35/48), followed by viral (8/48), fungal (4/48), and parasitic infections (1/48). Endemic so-called tropical infections accounted for 6% of infections (5/87). Histoplasma capsulatum was the most commonly isolated fungus (2/4).

Conclusions: This study suggests that the spectrum of infections in KTRs in French Guiana differs little from that of temperate countries. Nevertheless, some tropical infections are described. More studies on fungal infections in KTRs should be undertaken to clarify the weight of histoplasmosis in these patients.
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http://dx.doi.org/10.1016/j.transproceed.2021.07.038DOI Listing
September 2021

Spatial variations in Leishmaniasis: A biogeographic approach to mapping the distribution of species.

One Health 2021 Dec 12;13:100307. Epub 2021 Aug 12.

ISEM, Université de Montpellier, CNRS, EPHE, IRD, Montpellier, France.

Cutaneous Leishmaniasis (CL) is the most prevalent form of Leishmaniasis and is widely endemic in the Americas. Several species of are responsible for CL, a severely neglected tropical disease and the treatment of CL vary according to the different species of . We proposed to map the distribution of the species reported in French Guiana (FG) using a biogeographic approach based on environmental predictors. We also measured species endemism i.e., the uniqueness of species to a defined geographic location. Our results show that the distribution patterns varied between spp. and were spatially dependent on climatic covariates. The species distribution modelling of the eco-epidemiological spatial patterns of spp. is the first to measure endemism based on bioclimatic factors in FG. The study also emphasizes the impact of tree cover loss and climate on the increasing distribution of in the most anthropized regions. Detection of high-risk regions for the different between spp. is essential for monitoring and active surveillance of the vector. As climate plays a major role in the spatial distribution of the vector and reservoir and the survival of the pathogen, climatic covariates should be included in the analysis and mapping of vector-borne diseases. This study underscores the significance of local land management and the urgency of considering the impact of climate change in the development of vector-borne disease management strategies at the global scale.
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http://dx.doi.org/10.1016/j.onehlt.2021.100307DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8368019PMC
December 2021

Frailty screening in older patients with cancer in French Guiana: The limits of the G8 tool.

J Geriatr Oncol 2021 Aug 17. Epub 2021 Aug 17.

Oncology Unit, General Hospital, Saint-Laurent du Maroni, French Guiana; Claude-Bernard Lyon-1 University, Lyon, France. Electronic address:

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http://dx.doi.org/10.1016/j.jgo.2021.08.006DOI Listing
August 2021

Cytological Spectrum of Pulmonary Histoplasmosis Diagnosed by Bronchoalveolar Lavage: 12 Years of Experience in French Guiana.

J Fungi (Basel) 2021 Jul 19;7(7). Epub 2021 Jul 19.

Centre d'Investigation Clinique «Inserm CIC 1424», Centre Hospitalier de Cayenne Andrée Rosemon, 97300 Guiana, France.

Disseminated histoplasmosis is a major cause of mortality in HIV-infected patients. Rapid and efficient diagnosis of is crucial. Cytopathology is available in most hospitals and represents a rapid diagnostic alternative. In this study, we reviewed 12 years of experience to describe the cytology of histoplasmosis diagnosed by bronchoalveolar lavage (BAL) in relation to patient characteristics. BAL-diagnosed pulmonary histoplasmosis concerned 17 patients (14 HIV+). BAL cellularity ranged from 76,000 to 125,000 cells/mL in HIV patients, and 117,000 to 160,000 cells/mL in non-HIV patients. Macrophages predominated in all HIV patients (from 60% to 88%), lymphocytic infiltrates ranged from 5% to 15%, and neutrophils were very heterogeneous (from 2% to 32%). The number of at hot spots seemed greater in HIV-infected than in immunocompetent patients (9 to 375 vs. 4 to 10) and were inversely proportional to the CD4 counts. Yeasts were both intracellular and extracellular in 85.7% of the HIV patients. This is the most comprehensive series detailing the cytological aspects of BAL in the diagnosis of , focusing on the number of yeasts and their clustering pattern. The cytological examination of the Gomori-Grocott-stained BAL allows a reliable diagnosis of histoplasmosis.
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http://dx.doi.org/10.3390/jof7070576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304076PMC
July 2021

Review of diagnostic methods and results for HIV-associated disseminated histoplasmosis: Pathologists are not sufficiently involved.

Trop Med Int Health 2021 Nov 2;26(11):1462-1469. Epub 2021 Sep 2.

Department of Pathology, Centre Hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana.

Objectives: Disseminated histoplasmosis is a major killer of HIV-infected persons in Latin America. Antigen detection, fungal culture and Polymerase Chain Reaction are often not available, but cytology and histology are present in most hospitals and may offer a diagnostic alternative. In this study, we review 34 years of clinical experience to describe the roles of cytology and histology in diagnosing disseminated histoplasmosis.

Methods: Retrospective multicentric study of 349 patients between 1 January 1981 and 1 October 2014 with confirmed disseminated histoplasmosis.

Results: Around 32/214 (14.9%) of samples were screened using cytopathology, as were 10/101 (9.9%) bronchoalveolar lavage samples and 5/61 (8.2%) of spinal fluid samples. The samples most commonly sent to pathology were liver biopsies, lower digestive tract and lymphnode biopsies; the greatest proportion of positive results were found in lower digestive tract (43/59 (72.9%) positives), lymph node (39/63 (66.1%)), and liver (38/75 (50.7%)) samples. Overall, 97.2% of bone marrow and 97% of bronchoalveolar lavage samples were directly examined by a mycologist. Positive direct examination was independently associated with death (aHR = 1.5 (95%CI = 1-2.2)).

Conclusions: Opportunities for a rapid diagnosis were regularly missed, notably for bone marrow samples, which could have been examined using staining methods complementary to those of the mycologist.
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http://dx.doi.org/10.1111/tmi.13663DOI Listing
November 2021

Breakthrough Infections of SARS-CoV-2 Gamma Variant in Fully Vaccinated Gold Miners, French Guiana, 2021.

Emerg Infect Dis 2021 Oct 21;27(10):2673-2676. Epub 2021 Jul 21.

An outbreak of severe acute respiratory syndrome coronavirus 2 caused by the Gamma variant of concern infected 24/44 (55%) employees of a gold mine in French Guiana (87% symptomatic, no severe forms). The attack rate was 60% (15/25) among fully vaccinated miners and 75% (3/4) among unvaccinated miners without a history of infection.
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http://dx.doi.org/10.3201/eid2710.211427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462339PMC
October 2021

Attitudes towards the COVID-19 Vaccine and Willingness to Get Vaccinated among Healthcare Workers in French Guiana: The Influence of Geographical Origin.

Vaccines (Basel) 2021 Jun 21;9(6). Epub 2021 Jun 21.

Centre d'Investigation Clinique Antilles Guyane, CIC Inserm 1424, DRISP, Centre Hospitalier de Cayenne, Av des Flamboyants, 97300 Cayenne, France.

In the context of the global COVID-19 pandemic and the expansion of the more transmissible 20J/501Y.V3 (Gamma) variant of concern (VOC), mRNA vaccines have been made available in French Guiana, an overseas French territory in South America, from mid-January 2021. This study aimed to estimate the willingness to be vaccinated and the socio-demographic and motivational correlates among Health Care Workers (HCWs) in French Guiana. A cross-sectional survey was conducted from January 22 to March 26, 2021 among a sample of HCWs in French Guiana. They were asked about their willingness to get vaccinated against COVID-19 and vaccine hesitancy, vaccine uptake and vaccines attitudes. Factors associated with willingness to get vaccinated have been analyzed with ordinal logistic regression, using Stata software. A total of 579 HCWs were interviewed, including 220 physicians and 200 nurses most often working in hospital (54%) or in the liberal sector (22%). Overall, 65.6% of respondents reported that they were willing or had already been vaccinated against COVID-19, while 24.3% of respondents reported that they did not want to get vaccinated against COVID-19 and 11.2% were unsure. HCWs were more willing to get vaccine if they were older, were worried about COVID-19 and were confident in the management of epidemic. Conversely, participants were less likely to have been vaccinated or willing to if they were nurses or of another non-medical profession, born in French Guiana, feared adverse effects, or if they did not trust pharmaceutical companies and management of the epidemic by authorities. Negative attitudes towards vaccines are a major public health concern among HCWs in French Guiana when considering the current active epidemic with Gamma VOC. General vaccine hesitancy and concerns about future side effects in particular represent important barriers. Low confidence in government and science are significant in COVID-19 vaccine refusal among non-medical staffs. Public health messaging with information on vaccine safety should be tailored to address these concerns. The specific challenges of HCWs from French Guiana must be taken into account.
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http://dx.doi.org/10.3390/vaccines9060682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234955PMC
June 2021

Does Universal Screening for Gestational Diabetes Mellitus Improve Neonatal Outcomes in a Socially Vulnerable Population: A Prospective Study in French Guiana.

Front Endocrinol (Lausanne) 2021 21;12:644770. Epub 2021 May 21.

Department of Endocrinology and Metabolic Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.

Aims/introduction: French Guiana has a high prevalence of metabolic diseases, which are risk factors for gestational diabetes mellitus. Despite routine screening for gestational diabetes, treatment is still challenging because of health inequalities and different cultural representations of disease and pregnancy. This study was conducted to assess the role of early and universal GDM screening on obstetrical and neonatal complications in a socially deprived population.

Materials And Methods: A prospective study was conducted, in the level III maternity in French Guiana. Of 2136 deliveries, 223 had gestational diabetes mellitus, 110 of whom were followed-up for 6 month to detail their social and laboratory parameters.

Results: The prevalence of gestational diabetes in French Guiana (Cayenne Hospital) was estimated at 10.3%. The study population was very precarious with 70% of patients on welfare (universal health coverage or state medical assistance). The following obstetrical complications were observed: cesarean delivery (32%), history of miscarriage (26%) and preeclampsia (7.4%). Nevertheless, neonatal complications were rarely present and included hypoglycemia (2.8%) and macrosomia (2.8%).

Conclusion: In French Guiana, gestational diabetes mellitus is very common. However, in a context of widespread poverty and diverse cultural representations, universal screening and monitoring limited the risk of macrosomia.
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http://dx.doi.org/10.3389/fendo.2021.644770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176854PMC
May 2021

Invasive Fungal Infections in Persons Living with HIV in an Amazonian Context: French Guiana, 2009-2019.

J Fungi (Basel) 2021 May 27;7(6). Epub 2021 May 27.

Centre d'Investigation Clinique, Inserm CIC 1424, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana.

Although the burden of histoplasmosis in patients with advanced HIV has been the focus of detailed estimations, knowledge about invasive fungal infections in patients living with HIV in an Amazonian context is somewhat scattered. Our goal was thus to adopt a broader view integrating all invasive fungal infections diagnosed over a decade in French Guiana. All patients hospitalized at Cayenne hospital from 1 January 2009 to 31 December 2018 with a proven diagnosis of invasive fungal infection were included (N = 227). was the most common (48.2%), followed by Cryptococcus infection (26.3%), and pneumocystosis (12.5%). For cryptococcal infection, there was a discordance between the actual diagnosis of cryptococcal meningitis n = (26) and the isolated presence of antigen in the serum (n = 46). Among the latter when the information was available (n = 34), 21(65.6%) were treated with antifungals but not coded as cryptococcocosis. Most fungal infections were simultaneous to the discovery of HIV (38%) and were the AIDS-defining event (66%). The proportion of major invasive fungal infections appeared to remain stable over the course of the study, with a clear predominance of documented infections. Until now, the focus of attention has been histoplasmosis, but such attention should not overshadow other less-studied invasive fungal infections.
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http://dx.doi.org/10.3390/jof7060421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228128PMC
May 2021

Ecology, evolution, and epidemiology of zoonotic and vector-borne infectious diseases in French Guiana: Transdisciplinarity does matter to tackle new emerging threats.

Infect Genet Evol 2021 09 15;93:104916. Epub 2021 May 15.

ESPACE-DEV (Institut de Recherche pour le Développement, Université de la Réunion, Université des Antilles, Université de Guyane, Université de Montpellier, Montpellier, France; International Joint Laboratory "Sentinela" Fundação Oswaldo Cruz, Universidade de Brasília, Institut de Recherche pour le Développement, Rio de Janeiro RJ-21040-900, Brazil.

French Guiana is a European ultraperipheric region located on the northern Atlantic coast of South America. It constitutes an important forested region for biological conservation in the Neotropics. Although very sparsely populated, with its inhabitants mainly concentrated on the Atlantic coastal strip and along the two main rivers, it is marked by the presence and development of old and new epidemic disease outbreaks, both research and health priorities. In this review paper, we synthetize 15 years of multidisciplinary and integrative research at the interface between wildlife, ecosystem modification, human activities and sociodemographic development, and human health. This study reveals a complex epidemiological landscape marked by important transitional changes, facilitated by increased interconnections between wildlife, land-use change and human occupation and activity, human and trade transportation, demography with substantial immigration, and identified vector and parasite pharmacological resistance. Among other French Guianese characteristics, we demonstrate herein the existence of more complex multi-host disease life cycles than previously described for several disease systems in Central and South America, which clearly indicates that today the greater promiscuity between wildlife and humans due to demographic and economic pressures may offer novel settings for microbes and their hosts to circulate and spread. French Guiana is a microcosm that crystallizes all the current global environmental, demographic and socioeconomic change conditions, which may favor the development of ancient and future infectious diseases.
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http://dx.doi.org/10.1016/j.meegid.2021.104916DOI Listing
September 2021

Setting-up a cross-border action-research project to control malaria in remote areas of the Amazon: describing the birth and milestones of a complex international project (Malakit).

Malar J 2021 May 11;20(1):216. Epub 2021 May 11.

Centre d'Investigation Clinique Antilles-Guyane, Inserm 1424, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.

Background: In French Guiana, gold miners working illegally represents a major reservoir of malaria. This mobile population, mainly of Brazilian descent, enters the French Guianese forest from neighbouring countries, Suriname and Brazil. A complex and innovative intervention was piloted as a cooperation with the three involved countries involved to control malaria in this specific population. The principle was that health workers called "facilitators" provide the participants with a self-diagnosis and self-treatment kit along with adequate training and material to rapidly manage an episode of malaria symptoms on their own, when they find themselves isolated from health care services.

Methods: This paper describes the design, development, content of the intervention and players' organization of this multi-country project, the opportunities and constraints encountered, and the lessons learnt at this stage.

Results: The choice not to implement the usual "Test and Treat" approach within the community is mainly driven by regulatory reasons. The content of medical messages tends to balance the tension between thoroughness, accuracy and efficacy. The wide range of tools developed through a participatory approach was intended to cope with the challenges of the literacy level of the target population. Despite the difficulties encountered due to language, regulation differences and distance between partners, cooperation was fruitful, due to the complementary of stakeholders, their involvement at all important stages and regular face-to-face meetings.

Discussion And Conclusion: This experience shows the feasibility of an ambitious project of action-research in a border malaria context, involving several countries and with a mobile and undocumented population. It reveals some factors of success which may be transferable in analogous settings.
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http://dx.doi.org/10.1186/s12936-021-03748-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111981PMC
May 2021

Histoplasmosis of the Central Nervous System: A Case Series between 1990 and 2019 in French Guiana.

Am J Trop Med Hyg 2021 May 10. Epub 2021 May 10.

2CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana.

Disseminated histoplasmosis is the most frequent acquired immunodeficiency syndrome-defining illness in French Guiana. Paradoxically, central nervous system (CNS) involvement has been scarcely described. We aimed to identify CNS histoplasmosis in our territory. We conducted an observational, multicentric, descriptive, and retrospective study including patients with proven or probable CNS histoplasmosis according to the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MGS). The study population consisted of patients admitted in one of the hospitals of French Guiana between January 1, 1990 and December 31, 2019. During the study period, 390 cases of HIV-associated histoplasmosis were recorded, in which six of them had CNS infections with Histoplasma capsulatum. The male to female sex ratio was 0.25, and the median age at diagnosis was 37.5 years. The median CD4 count was 42 cells/mm3 ([IQR: 29-60]). All patients had disseminated histoplasmosis. Usual signs of meningitis were observed in three patients and focal signs in four patients. One patient had no neurological signs. The median time between the first cerebral symptoms and diagnosis was 22.4 days (IQR 9.5-36.2). Two patients died within a month after diagnosis. In conclusion, few proven CNS localizations of histoplasmosis were observed on 30-year study in French Guiana. This low proportion suggests that the documentation of CNS involvement is often not ascertained for lack of awareness of this particular presentation, and for lack of rapid and sensitive diagnostic tools.
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http://dx.doi.org/10.4269/ajtmh.20-1486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274758PMC
May 2021

HIV-Associated Disseminated Histoplasmosis and Rare Adrenal Involvement: Evidence of Absence or Absence of Evidence.

Front Cell Infect Microbiol 2021 15;11:619459. Epub 2021 Mar 15.

Département Formation Recherche (DFR) Santé, Université de Guyane, Cayenne, French Guiana.

Adrenal histoplasmosis and primary adrenal insufficiency are mostly described in immunocompetent patients. This particular tropism is attributed to the presence of cortisol within the adrenal gland, a privileged niche for growth. In French Guiana, disseminated histoplasmosis is the main opportunistic infection in HIV patients. Our objective was to search in our HIV-histoplasmosis cohorts to determine how frequent adrenal insufficiency was among these patients. Between January 1, 1981 and October 1, 2014, a multicentric retrospective, observational study of histoplasmosis was conducted. Patients co-infected by HIV and histoplasmosis were enrolled in French Guiana's histoplasmosis and HIV database. Among 349 cases of disseminated histoplasmosis between 1981 and 2014, only 3 had adrenal insufficiency (0.85%). Their respective CD4 counts were 10, 14 and 43 per mm3. All patients had regular electrolyte measurements and 234/349 (67%) had abdominal ultrasonography and 98/349 (28%) had abdominopelvic CT scans. None of these explorations reported adrenal enlargement. Overall, these numbers are far from the 10% reports among living patients and 80-90% among histoplasmosis autopsy series. This suggests 2 conflicting hypotheses: First, apart from acute adrenal failure with high potassium and low sodium, less advanced functional deficiencies, which require specific explorations, may have remained undiagnosed. The second hypothesis is that immunosuppression leads to different tissular responses that are less likely to incapacitate the adrenal function. Furthermore, given the general immunosuppression, the adrenal glands no longer represent a particular niche for proliferation.
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http://dx.doi.org/10.3389/fcimb.2021.619459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005706PMC
July 2021

The Epidemiology of COVID 19 in the Amazon and the Guianas: Similarities, Differences, and International Comparisons.

Front Public Health 2021 11;9:586299. Epub 2021 Mar 11.

Département Formation Recherche (DFR) Santé, Université de Guyane, Cayenne, French Guiana.

The COVID 19 epidemic submerged many health systems in the Amazon. The objective of the present study was to focus on the epidemic curves of the COVID 19 epidemic in different centers, and to look at testing and mortality data. Publicly available datasets were used. The log of the daily cumulated number of cases starting from the day the territory reached 100 cumulated cases was plotted to compare the magnitude, shape and slope of the different curves. The maximum daily testing efforts were plotted for each territory in relation to the maximum daily number of diagnoses. The case fatality rate was computed by dividing the number of COVID 19 deaths by the number of confirmed cases. In the Amazonian regions in general the speed of growth was generally lower than in Europe or the USA, or Southern Brazil. Whereas, countries like South Korea or New Zealand "broke" the curve relatively rapidly the log linear trajectory seemed much longer with signs of a decline in growth rate as of early July 2020. After a very slow start, French Guiana had the lowest slope when compared to other Amazonian territories with significant epidemics. The Amazonian states of Roraima, Amazonas, Parà, and Amapà had among the highest number of cases and deaths per million inhabitants in the world. French Guiana had significantly fewer deaths relative to its number of confirmed cases than other Amazonian territories. French Guiana had a late epidemic surge with intense testing scale-up often exceeding 4,000 persons tested daily per million inhabitants. Brazil was an outlier with low daily testing levels in relation to the number of daily diagnoses. There were marked heterogeneities mortality rates suggesting that socioeconomic, political factors, and perhaps ethnic vulnerability led to striking outcome differences in this Amazonian context.
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http://dx.doi.org/10.3389/fpubh.2021.586299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990879PMC
April 2021

Prevalence and risk factors for micronutrient deficiencies during pregnancy in Cayenne, French Guiana.

Food Nutr Res 2021 22;65. Epub 2021 Feb 22.

Centre d'Investigation Clinique, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.

Background: Involved in physical and brain development, immunity and metabolism, micronutrients have profound health effects. The nutritional status of pregnant women is a major determinant of foetal health. French Guiana has a rapid population growth. Social inequalities, cultural practices and gastrointestinal nematode infections in French Guiana could affect the prevalence of these deficiencies. The main objective of the present study was to estimate the prevalence of micronutrient deficiency among pregnant women in French Guiana. The secondary objective was to identify socio-demographic, dietary, obstetrical and neonatal risk factors associated with deficiencies.

Methods: Pregnant women over 22 weeks of pregnancy hospitalized for delivery at the Obstetrical Emergency Department of the Hospital Center in Cayenne from May 2018 to March 2019 were included. A socio-demographic and food questionnaire was administered. Medical data were collected from the medical records. Blood and urine samples were taken. The descriptive analysis used Student and chi-squared tests.

Results: A total of 341 women were included. The majority were born in Haiti (39%) and French Guiana (34%). At least one micronutrient deficiency was observed in 81% of women. Precarious women had a significantly greater risk of micronutrient deficiency during pregnancy compared to those with both normal and complementary health insurance.

Conclusions: Micronutrient deficiencies in pregnant women in French Guiana are a public health problem, a fact that was previously overlooked in the context of rising obesity. With over half the women overweight or obese, and 81% with at least 1 micronutrient deficiency, balanced nutrition should be a major focus.
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http://dx.doi.org/10.29219/fnr.v65.5268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955516PMC
February 2021

Evaluating the impact of curfews and other measures on SARS-CoV-2 transmission in French Guiana.

Nat Commun 2021 03 12;12(1):1634. Epub 2021 Mar 12.

Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris, France.

While general lockdowns have proven effective to control SARS-CoV-2 epidemics, they come with enormous costs for society. It is therefore essential to identify control strategies with lower social and economic impact. Here, we report and evaluate the control strategy implemented during a large SARS-CoV-2 epidemic in June-July 2020 in French Guiana that relied on curfews, targeted lockdowns, and other measures. We find that the combination of these interventions coincided with a reduction in the basic reproduction number of SARS-CoV-2 from 1.7 to 1.1, which was sufficient to avoid hospital saturation. We estimate that thanks to the young demographics, the risk of hospitalisation following infection was 0.3 times that of metropolitan France and that about 20% of the population was infected by July. Our model projections are consistent with a recent seroprevalence study. The study showcases how mathematical modelling can be used to support healthcare planning in a context of high uncertainty.
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http://dx.doi.org/10.1038/s41467-021-21944-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955077PMC
March 2021

Prospective Comparison of Saliva and Nasopharyngeal Swab Sampling for Mass Screening for COVID-19.

Front Med (Lausanne) 2021 23;8:621160. Epub 2021 Feb 23.

Laboratoire, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana.

Current testing for COVID-19 relies on reverse-transcriptase polymerase chain reaction from a nasopharyngeal swab specimen. Saliva samples have advantages regarding ease and painlessness of collection, which does not require trained staff and may allow self-sampling. We enrolled 776 persons at various field-testing sites and collected nasopharyngeal and pooled saliva samples. One hundred sixty two had a positive COVID-19 RT-PCR, 61% were mildly symptomatic and 39% asymptomatic. The sensitivity of RT-PCR on saliva samples vs. nasopharygeal swabs varied depending on the patient groups considered or on Ct thresholds. There were 10 (6.2%) patients with a positive saliva sample and a negative nasopharyngeal swab, all of whom had Ct values <25 for three genes. For symptomatic patients for whom the interval between symptoms onset and sampling was <10 days sensitivity was 77% but when excluding persons with isolated N gene positivity (54/162), sensitivity was 90%. In asymptomatic patients, the sensitivity was only 24%. When we looked at patients with Cts <30, sensitivity was 83 or 88.9% when considering two genes. The relatively good performance for patients with low Cts suggests that Saliva testing could be a useful and acceptable tool to identify infectious persons in mass screening contexts, a strategically important task for contact tracing and isolation in the community.
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http://dx.doi.org/10.3389/fmed.2021.621160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940378PMC
February 2021

Summary of Guidelines for Managing Histoplasmosis among People Living with HIV.

J Fungi (Basel) 2021 Feb 12;7(2). Epub 2021 Feb 12.

Department of Medicine, Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD 21201, USA.

Histoplasmosis is a frequent fungal opportunistic infection in people living with HIV (PLHIV), associated every year to a total of 5% to 15% of AIDS-related deaths among this population. In 2020, the first global guidelines for diagnosing and managing disseminated histoplasmosis among PLHIV was published. This document recommends (1) detection of circulating antigens as the recommended laboratory assay to diagnose histoplasmosis among PLHIV; (2) the use of liposomal amphotericin for induction therapy in severe or moderately severe disease, followed by a maintenance therapy with itraconazole for 12 months; a shorter maintenance therapy could be considered if the patient is clinically stable and if immune status has improved; (3) antiretroviral therapy initiation as soon as possible among patients with histoplasmosis without involvement of central nervous system; and (4) that for the treatment of co-infection with histoplasmosis and tuberculosis (TB), treatment of TB should be initiated according to the World Health Organization treatment guidelines. Appropriate health education of providers, supportive supervision, and policy guidance for the care of PLHIV are required.
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http://dx.doi.org/10.3390/jof7020134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918769PMC
February 2021

Burden of soil-transmitted helminth infection in pregnant refugees and migrants on the Thailand-Myanmar border: Results from a retrospective cohort.

PLoS Negl Trop Dis 2021 03 1;15(3):e0009219. Epub 2021 Mar 1.

Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.

Background: Soil-transmitted helminth (STH) infections are widespread in tropical and subtropical regions. While many STH infections are asymptomatic, vulnerable populations such as pregnant women face repercussions such as aggravation of maternal anaemia. However, data on prevalence and the effect of STH infections in pregnancy are limited. The aim of this analysis was to describe the burden of STH infections within and between populations of pregnant women from a local refugee camp to a mobile migrant population, and to explore possible associations between STH infection and pregnancy outcomes.

Methodology: This is a retrospective review of records from pregnant refugee and migrant women who attended Shoklo Malaria Research Unit antenatal care (ANC) clinics along the Thailand-Myanmar border between July 2013 and December 2017. Inclusion was based on provision of a stool sample during routine antenatal screening. A semi-quantitative formalin concentration method was employed for examination of faecal samples. The associations between STH mono-infections and maternal anaemia and pregnancy outcomes (i.e., miscarriage, stillbirth, preterm birth, and small for gestational age) were estimated using regression analysis.

Principal Findings: Overall, 12,742 pregnant women were included, of whom 2,702 (21.2%) had a confirmed infection with either Ascaris lumbricoides, hookworm, Trichuris trichiura, or a combination of these. The occurrence of STH infections in the refugee population (30.8%; 1,246/4,041) was higher than in the migrant population (16.7%; 1,456/8,701). A. lumbricoides was the predominant STH species in refugees and hookworm in migrants. A. lumbricoides and hookworm infection were associated with maternal anaemia at the first ANC consultation with adjusted odds ratios of 1.37 (95% confidence interval (CI) 1.08-1.72) and 1.65 (95% CI 1.19-2.24), respectively. Pregnant women with A. lumbricoides infection were less likely to miscarry when compared to women with negative stool samples (adjusted hazard ratio 0.63, 95% CI 0.48-0.84). STH infections were not significantly associated with stillbirth, preterm birth or being born too small for gestational age. One in five pregnant women in this cohort had STH infection. Association of STH infection with maternal anaemia, in particular in the event of late ANC enrolment, underlines the importance of early detection and treatment of STH infection. A potential protective effect of A. lumbricoides infection on miscarriage needs confirmation in prospective studies.
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http://dx.doi.org/10.1371/journal.pntd.0009219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7951971PMC
March 2021

Reduced Severity in Patients With HIV-Associated Disseminated Histoplasmosis With Deep Lymphadenopathies: A Trench War Remains Within the Lymph Nodes?

Front Cell Infect Microbiol 2020 8;10:598701. Epub 2021 Feb 8.

DFR Santé, Université de Guyane, Cayenne, French Guiana.

Background: Disseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies.

Methods: A retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014.

Results: Among 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10-0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment.

Conclusions: The present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient's partially effective defense against .
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http://dx.doi.org/10.3389/fcimb.2020.598701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897652PMC
June 2021

Diabetes in French Guiana, adapting national standards of therapeutic education and care to the amazonian challenge.

World J Diabetes 2021 Feb;12(2):98-107

Department of Medicine, COREVIH Centre Hospitalier Andree Rosemon, Cayenne 97300, French Guiana.

French Guiana is a territory located more than 7000 km from France. It is also the largest French territory, with almost 84000 km and 90% of it is covered by forest. Some municipalities are isolated due to the scarcity of transportation and the poor road infrastructure. The population is extremely diverse ethnically and culturally, and includes more than thirty ethnic groups. Immigration is high because it is one of the richest countries in the area bordering northern Brazil, Suriname, Guyana, and as a result of socio-economic crises in some other countries such as Haiti, and it has permeable natural borders. Diabetes and obesity, are emerging issues, with double the prevalence of Mainland France, whereas infectious diseases, such as HIV, take second place. Therapeutic and educational management are challenging because they require the adaptation of tools and treatments to the mul-ticulturalism and precariousness often encountered in these populations. The French and European recommendations are unsuited to the needs of the territory and must take into account the epidemiological, sociological and cultural parameters of these populations in order to provide appropriate and graded management of diabetes in the French Amazon.
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http://dx.doi.org/10.4239/wjd.v12.i2.98DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839167PMC
February 2021

Relationship between influenza and dengue outbreaks, and subsequent bacterial sepsis in French Guiana: A time series analysis.

J Public Health Res 2021 Jan 21;10(1):1768. Epub 2021 Jan 21.

Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424.

Influenza has been shown to increase the risk for severe bacterial infection, in the tropics the seasonality of influenza epidemics is less marked, and this may not be the case. Dengue is often followed by prolonged asthenia and some physicians hypothesized increased susceptibility to infections based on anecdotal observations. Time series of influenza and dengue surveillance were confronted bacterial sepsis admissions to test the hypotheses. Monthly surveillance data on influenza and dengue and aggregated sepsis data in Cayenne hospital were matched between 24/10/2007 and 27/09/2016. An ARIMA (1,0,1) model was used. The series of the number of monthly cases of sepsis was positively associated with the monthly number of cases of influenza at time t (β=0.001, p=0.0359). Forecasts were imperfectly correlated with sepsis since influenza is not the only risk factor for sepsis. None of the ARIMA models showed a significant link between the dengue series and the sepsis series. There was thus no link between dengue epidemics and sepsis, but it was estimated that for every 1,000 cases of flu there was one additional case of sepsis. In this tropical setting, influenza was highly seasonal, and improved vaccination coverage could have benefits on sepsis.
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http://dx.doi.org/10.4081/jphr.2021.1768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856828PMC
January 2021

Spatio-Temporal Dynamics of and in French Guiana: 2005-2019.

Int J Environ Res Public Health 2021 01 26;18(3). Epub 2021 Jan 26.

Aix Marseille University, IRD, INSERM, APHM, La Timone Hospital, Biostatistics and ICT, 13385 Marseille, France.

This study examines the dynamics of malaria as influenced by meteorological factors in French Guiana from 2005 to 2019. It explores spatial hotspots of malaria transmission and aims to determine the factors associated with variation of hotspots with time. : Data for individual malaria cases came from the surveillance system of the Delocalized Centers for Prevention and Care (CDPS) ( = 17) from 2005-2019. Meteorological data was acquired from the NASA Goddard Earth Sciences Data and Information Services Center (GES DISC) database. The Box-Jenkins autoregressive integrated moving average (ARIMA) model tested stationarity of the time series, and the impact of meteorological indices (issued from principal component analysis-PCA) on malaria incidence was determined with a general additive model. Hotspot characterization was performed using spatial scan statistics. : The current sample includes 7050 eligible ( = 4111) and ( = 2939) cases from health centers across French Guiana. The first and second PCA-derived meteorological components (maximum/minimum temperature/minimum humidity and maximum humidity, respectively) were significantly negatively correlated with total malaria incidence with a lag of one week and 10 days, respectively. Overall malaria incidence decreased across the time series until 2017 when incidence began to trend upwards. Hotspot characterization revealed a few health centers that exhibited spatial stability across the entire time series: Saint Georges de l'Oyapock and Antecume Pata for , and Saint Georges de l'Oyapock, Antecume Pata, Régina and Camopi for : This study highlighted changing malaria incidence in French Guiana and the influences of meteorological factors on transmission. Many health centers showed spatial stability in transmission, albeit not temporal. Knowledge of the areas of high transmission as well as how and why transmission has changed over time can inform strategies to reduce the transmission of malaria in French Guiana. Hotspots should be further investigated to understand other influences on local transmission, which will help to facilitate elimination.
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http://dx.doi.org/10.3390/ijerph18031077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908074PMC
January 2021
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