Évaluation d’une consultation mobile d’infectiologie

Objectives

The aims of our study were to characterize the activity of a remote infectious diseases consultation (RIDC) in a teaching hospital and to assess physician observance to advice.

Design

All demands received by the RIDC for initial advice and the given answers were recorded during one month. Advice given for inpatients was followed up 72 hours after to evaluate the physician's observance.

Results

Six hundred and nineteen demands were recorded: 47% came from our teaching hospital and 53% came from community practice. Hospital demands came mostly from surgical (47%) and medical (41%) units. Most of them (92%) were related to the treatment of an infection or diagnostic help. Outside calls came from doctors (85%) either private or working in a health care institution. Prophylaxis (47%) and treatment of an infection or a diagnostic help (43%) were the most frequent issues. Among the 176 pieces of advice requested for inpatients, 87% were completely observed. Advice was more followed when it was given by experienced specialists (p = 0.02) or by phone (p = 0.03) and less followed for patients presenting a nosocomial infection (p = 0.03).

Conclusions

The RIDC is very useful for the medical community and its advice is usually followed. Informal consultations account for an important part of its activity.     

Syndrome d’activation macrophagique et infection à virus d’Epstein-Barr chez l’enfant

Objective

The authors had for aim to review pediatric cases of EBV-associated hemophagocytic lymphohistiocytosis observed, between January 1999 and December 2007, to compare their characteristics to literature data, and to suggest a pragmatic strategy for diagnosis and treatment.

Design

The following were analyzed for each patient: age at diagnosis, family history, revised Henter diagnostic criteria, EBV serology and/or PCR, results of genetic studies when available, treatment, short and long-term outcome.

Results

Four patients 11 months to seven years of age were admitted for high and prolonged fever, hepato and/or splenomegaly, and biological markers of hemophagocytic lymphohistiocytosis. They were all initially treated with corticosteroids. The outcome was severe for the two younger patients, with acute hepatocellular failure leading to death for the first, and severe neurological impairment for the second. The two older patients responded well to corticosteroids alone, and are alive. There was no recurrence at the end of the study.

Conclusions

Hemophagocytic lymphohistiocytosis is the most severe complication of infectious mononucleosis. A primary cytotoxicity deficiency must be ruled out, especially in children under two years of age. Treatment is consensus free, but many studies report interesting results in terms of outcome with regimens including etoposide.     

Tuberculose compliquée d’un syndrome hémophagocytaire ou syndrome d’activation macrophagique

Introduction

The hemophagocytic syndrome is rare and sometimes associated with tuberculosis.

Observation

We report the case of a 30-year-old migrant from Congo presenting with a recurrent right pleuropneumonia, cachexia and night sweat. Blood tests revealed bicytopenia with a normal myelogram. Thorax CT-scan showed large mediastinal lymph nodes and pleuritis. Mediastinal lymph node biopsy concluded to granulomatosis lymphadenopathy with necrosis and bone marrow biopsy suggested hemophagocytic syndrome. The outcome was favorable with antibiotics and corticosteroids.     

Nutrition et maladie d’Alzheimer

Deterioration of memory function and ultimately establishment of Alzheimer's disease (AD) severely debilitates the affected individual, uncompromisingly decreasing the quality of life of both patients and their caregivers. The global prevalence of cognitive impairment and dementia including Alzheimer's disease is expected to rise significantly in proportion to increased life expectancy. Weight loss is a common problem among patients with AD and is associated with mortality, morbidity, disease progression, and poor quality of life. The aim of this article is: (1) to emphasize the importance of malnutrition in Alzheimer's disease and (2) to review published evidences for the role of nutrition as a risk factor of the disease.     

Connaissances et attentes d’une communauté d’internautes hypercholestérolémiques sur leur prise en charge nutritionnelle

Hygienodietetic recommendations are poorly followed by hypercholesterolemic subjects despite general practitioners’ advices. We aimed at determining the reasons for this failure. We studied an Internet community made of hypercholesterolemic subjects in order to assess their level of knowledge, their wish to learn and to take care of themselves. The nutritional solution of hypercholesterolemia is perceived as a daily effort. In that context, doctor's advices are crucial. However, mainly due to lack of time and tools, these advices are not adequately delivered to the subjects. Patients are therefore ready to look for information on Internet. The dietary changes are therefore limited rather because of a lack of knowledge than a lack of will. Internet became a daily and essential reference for searching information, which should be considered as complementary to the doctor. Our study showed that patients are ready to use the Internet in order to learn how to better manage their cholesterol and to be better informed.     

Mise au point d’un questionnaire d’analyse des pensées et sentiments autour de l’alimentation

Purpose

It was to construct a questionnaire in French on the thoughts and the feelings in the respect of the food in the general population. We also wished to detect some eating disorders.

Methods

Eight experts selected nine major subjects concerning the thoughts and the feelings around the food and elaborated a questionnaire including 8 to 10 questions by subject. Having twice been revised by the experts, the questionnaire was criticized by a sample group of 20 persons of different circles, then by 42 medical students in Nutrition. The questionnaire was then handed in 88 medical students (4^th year). These various stages allowed to suppress, to modify and to add different questions. The questionnaire was then sent to 114 medical students and 112 subjects from the general population.

Results

The percentage of returned and totally informed questionnaires (from a sending of 202 questionnaires) was very satisfying (>85%). The concordance of the answers to the redundant questions was very high (>90%). In this population (74% of women), we noted that fear towards the food and eating disorder were frequent: binge eating: 11%, bulimia nervosa: 4,2%, anorexia nervosa: 5%, “the glance of the other one when I eat frightens me”: yes, absolutely: 15%.

Conclusion

This questionnaire concerning thoughts and feelings around the food was validated by the interest which was carried to it, its reproducibility, its understanding by the interrogated persons and the behavioral aspects which it brings. It will be send to 3 000 unselected people of Dijon to judge its interest in the general population. It will be accompanied with a validated inventory to detect eating disorders in order to test its sensitivity and its reproducibility.     

L’hyponatrémie hypotonique du sportif d’endurance

Rehydration during prolonged exercise is essential to replace the fluid losses, principally induced by sweating, which can, sometimes importantly, disturb the fluid and electrolyte balance with unfavourable effects on the well-being. However, as far back as 1985, the first cases of symptomatic hyponatremia have been described during ultraendurance events, due to the ingestion of excessive volumes of water compared to sodium intakes. Since then, with the success of such ultradistance events, further cases have been reported. The current data allow to better know the symptomatologic and epidemiologic aspects, and the physiopathological mechanisms of hyponatremia induced by the pratice of sports. Thus, the present paper, purposes to show the important role of the sodium to well understand the conditions of the appearance of hyponatremia, to take stock on the hyponatremia in the ultraendurance athletes, and to give recommendations of fluid and salt intakes in the practice of sports.     

Méningites bactériennes : facteurs associés au délai d’instauration d’une antibiothérapie adaptée aux urgences

Objectives

We had for aim to check the appropriateness of our practices according to French guidelines (17th consensus conference, SPILF 2008) and to identify variables associated with the delay before appropriate measures were implemented.

Methods

Our retrospective observational study (2009–2011) focused on acute bacterial meningitis (ABM) in adults. Data was collected on a standardized questionnaire from medical charts and nurse reports.

Results

We included 31 adults presenting with ABM; 29 (93.5%) received ceftriaxone or cefotaxime in the emergency department. Indications for corticosteroids and brain imaging complied with guidelines in respectively 71.0% and 83.9% of cases. The median delays (IQR) were: admission/lumbar puncture (LP), 2h43 [1h09–5h57]; admission/antimicrobials, 3h21 [1h34–5h11]. The indication of suspected ABM in the admission letter was associated with earlier LP (P = 0.01), and was almost significantly associated also with faster initiation of adequate antibiotic therapy (P = 0.05).

Conclusions

Suspicion of ABM mentioned in the admission letter was associated to a better management in the emergency department.     

Surveillance épidémiologique de la rage humaine dans un contexte d’endémie de rage canine en Cote d’Ivoire

Aim

The objective of this study was to analyze the epidemiologic monitoring of human rabies in the rabies medical center of Abidjan.

Patient

A cross-sectional study was undertaken based on files of patients having consulted in the rabies center after exposure and suspicion of human rabies between January 2001 and June 2009.

Results

Twenty-six cases of human rabies were reported in 10,706,136 inhabitants (annual incidence of 0.028 cases per 100,000). The number of detected cases increased considerably after reinforcing the monitoring of the disease. Most cases occurred in an urban environment and concerned both sexes. The most concerned age range was under 31 years. The patients’ were mostly school children and housewives. In all cases, the rabid animal was a dog and the type of exposure was a bite. Fifty-six percent of the victims had not received any local treatment and almost all no post-exposure prophylaxis. The mean delay before the first symptoms was 49.5 days after exposure and for death, 4 days after the onset of symptoms. Virological diagnosis was made in four cases.

Conclusion

In spite of the increase of cases observed since 2006, certainly due to reinforcement of the monitoring network, improvement is needed to assess the real incidence of rabies in the Ivory Coast.