Évolution de la résistance aux antibiotiques de 1997 à 2005 à la Réunion

Objective

The groupe hospitalier Sud Reunion (GHSR) is a 1130-bed hospital center, located on the Reunion Island, (Indian Ocean). We studied the profiles of antibiotic resistance in 2005, and compared those with previous data collected in 1997–1998, and with Metropolitan France and European data.

Material and methodology

All bacteriological strains isolated from diagnostic samples in 2005 were analyzed according to CA-SFM recommendations.

Results

Since 1997, the rates of resistance to enterobacteria (betalactam, aminoside, quinolone, trimethoprim-sulfamethoxazole), Pseudomonas aeruginosa (ticarcillin, amikacin, ciprofloxacin, fosfomycin), Acinetobacter baumanii (amikacin) has decreased significantly. The rate of methicillin-resistant Staphylococcus aureus (1997: 3.6 %, 2005: 13.4 %) has increased but less than in Metropolitan France. The rate of Streptococcuspneumonia with decreased susceptibility to penicillin has increased (1997: 25.5 %, 2005: 42.9 %), as for Haemophilusinfluenzae which present an important increase of betalactam resistance (1997: 15.5 %, 2005: 37.8 %).

Conclusion

By comparing our data to 1997 and Metropolitan French data, it seems that the GHSR has managed to protect its hospital-based microbial ecology. However, community germs showed increasing resistance, probably because of an increasing antibiotic pressure, but with resistance rates often inferior to Metropolitan French ones.     

Un outil à découvrir en nutrition humaine : la programmation linéaire

Linear programming (LP) makes it possible to devise, from a list of foods of known nutritional composition, food rations which conform to a set of nutritional recommendations whilst satisfying various requirements as regards cost, preferences and eating habits. Using the “solver” function in the “Tools” drop-down menu, the Excel program can solve LP problems. The principle of LP and its practical implementation are explained here in detail using a simple example based on just two foods. The listing of numerous possible uses of LP in human nutrition illustrates the value of this tool to take account of the fundamentally multifactorial aspect of the problems posed in this domain, in particular the existence of numerous foods made up of numerous nutrients and the wide diversity of human dietary behaviours and food availability contexts.     

Tétanos néonatal et de la femme en âge de procréer à la clinique des maladies infectieuses de Dakar

Objectives

This study had for aim to describe and compare the epidemiological, clinical and outcome features of tetanus in neonates (NT) and women of child bearing age (WCBAT) in Dakar.

Patients and method

This retrospective study was made on NT (3 to 28 days of age) and WCBAT (15 to 49 years of age) patient files, admitted in the Fann University Hospital Infectious Diseases Clinic from 2000 to 2007.

Results

One hundred and thirty-eight WCBAT (11.9%) and 103 NT (8.9%), for a total of 1156 cases of tetanus were admitted. A decrease of the annual rate of these populations was noted over this 8 year period.The majority (59.4%) of WCBAT was between 15 and 25 years of age and the mean age of NT was 9.3 days. Most of the patients in both groups came from suburban areas (78%). The tetanus immunization status was not updated for 92% of WCBAT. The most frequent portals of entry were cutaneous wounds for WCBAT (77.4%) and umbilical stumps for NT (85.4%). On admission, 64% of NT presented with severe tetanus (stage III on the Mollaret scale) compared to 11.6% for WCBAT. The death rate was significantly higher in NT (48.5%) than in WCBAT (26.8%); p = 0.0005.

Conclusion

To eliminate neonatal tetanus, the prognosis of which is worse in Dakar, an intensification of the large vaccination program is needed with supplementary vaccination campaigns including women of child bearing age in areas of risk.     

Quelques aspects de la motivation à manger en fonction de l’index de masse corporelle (de la maigreur à l’obésité massive) dans un groupe de 2 509 adultes

This study examines how chronic dietary restraint, disinhibition, and hunger, as assessed by the Eating Inventory (also called the “Three Factor Eating Questionnaire”), vary over a broad range of Body Mass Index (BMI) values from leanness to massive obesity, in subjects with family obesity. EI factors were also studied as a function of personal weight history. Subjects were 2509 participants in a genetic study of obesity. BMIs ranged from 15 to 87kg/m². Multivariate analyses showed that restraint and disinhibition were significantly associated with the BMI in men, while only disinhibition was in women. Further analyses were performed after subdividing the population in 6 BMI groups. Disinhibition scores correlated strongly with hunger scores in both genders in all BMI categories; dietary restraint tended to correlate with the other two factors positively in leaner subjects, and negatively in highest BMI categories. The highest restraint scores were observed in nonobese adult women with previous obesity in childhood and/or adolescence, suggesting a beneficial influence of restraint on body weight loss. The role of behaviors associated with disinhibition in the development of body adiposity deserves further investigation.     

Démonstration scientifique des fonctions des aliments associées à la santé

Following the former paper where functional properties of some food/ingredients were remembered, the present paper summarizes the main steps of the scientific demonstration that allow to support the claimed functional properties. This demonstration is composed of four main elements: Identification and characterisation of the food/ingredient that will bear the claim; then building scientific arguments generated from human clinical studies using the relevant food/ingredient; selection and use of adequate markers in the key clinical studies and finally the analysis of the validity of the evidence. These demonstrated functional benefits for consumer, can support either the improvement of a physiological function or the reduction of some risks factors. However the first rule still remains to have a reasonable and diversified diet. A four-step scheme summarizes this paper for pedagogic purpose.     

Évolution des disponibilités alimentaires à la réunion Depuis 1975

In the last decades in Reunion Island, dramatic changes occurred in the way of life, especially in food consumption. We calculated annual food availability in kg/inhabitant/year, between 1975 and 2002. We evaluated for each year, mean daily energy availability per inhabitant and the nutritional structure of the meal. In 27 years, the increase of meat and milky products availability led to an increase of the part of fat and animal proteins. In the same time, part of carbohydrates decreased in spite of the rise of simple sugar. High prevalence of diabetes and obesity observed in Reunion Island is probably linked to rapid westernization of food. Actions of prevention based on the Programme National Nutrition Santé should continue to face this phenomenon.     

Opinions et pratiques des médecins généralistes face à la vaccination anti-Papillomavirus

Aims

The purpose of this study was to assess the standpoint of family physicians in the Southern French region Provence-Alpes-Cote d’Azur concerning human Papillomavirus vaccination and to evaluate the factors associated with a favorable standpoint.

Methodology

A questionnaire was sent to a random sample of 1,000 family physicians. The survey focused on their profile, their views on vaccination generally and on HPV vaccination, their knowledge of HPV, their standpoint concerning STD prevention and cervical cancer screening. Multivariable linear regression system was used to study the variations associated with a favorable response to HPV vaccination.

Outcome

Response was 36.6%. The responses were analyzed taking into account gender of the family physicians, location and size of their practice. There was reasonable similarity amongst those questioned. Around 89.6% of family physicians answers were in favor of HPV. The ideal age for vaccination was between 11 and 13 years of age for 34.4% and between 14 and 15 for 53.9%. The family physicians most in favor of vaccination were those involved in screening for STDs, those who did not think that the vaccine would have a negative effect on the image of sexuality and on screening for cervical cancer, and those who were confident about the vaccine safety.

Conclusion

The study identified the negative elements concerning HPV in order to optimize information strategies among family physicians.     

La grippe maligne vue à la lumière du passé

The first influenza pandemic of the xxist century is due to a novel A (H1N1) strain. The infection, which affects younger patients than seasonal influenza, presents most often under a benign form. But it can rarely and rapidly evolve to pulmonary parenchymal involvement, independently of any bacterial superinfection or co-infection. It becomes a true viral pneumonia, which can evolve to acute respiratory distress syndrome (ARDS). This phenomenon was well described for the three xxth century pandemics, especially for the 1968–1969 one. These cases of “malignant flu” benefitted from the great breakthroughs in medical intensive care made in the previous 15 years. The specificity of these pandemic strains to infect lower respiratory tract is of immunological origin: only patients with little or no immunity to the virus can develop viral pneumonia and ARDS. This is why trivalent vaccination against seasonal flu appears to be somewhat protective against severe presentations of the disease. During winter 2009–2010, an inflow of flu-related ARDS cases is expected in French ICUs. Aggressive oxygenation techniques, high dose and prolonged antiviral treatment, and steroid adjunctive therapy, could be used, adding to the experience acquired during previous pandemics.     

Évaluation des apports alimentaires d’adolescents obèses et post-obèses : comparaison de la méthode iconographique SU.VI.MAX à la méthode de pesée des aliments

The objectives of this study were 1) to validate the SU.VI.MAX iconographic method against the weighed diet record method to assess food and nutrient intakes in obese and post-obese adolescents, and ; 2) to determine the effects of dietetic education on the precision of this method. Energy and nutrient intakes were determined by both methods in 26 institutionalised obese adolescents over 7-day-periods before the beginning and at the end of a weight-reduction programme, and 4 months later. The mean food, energy, carbohydrate, protein, and lipid intakes as assessed by the two methods were not significantly different, but the limits of agreement between the two methods were high. Obese and post-obese adolescents underestimated intake of their favourite meals (pasta, fried potatoes…) but often overvalued intake of vegetables, milk and hard cheese. The SU.VI.MAX iconographic method is, therefore, a reliable method to assess energy and nutrient intakes of obese and post-obese adolescents in epidemiologic studies, but it is unappropriate for assessment in individuals. In addition, dietetic education resulted in 50% decreases in the mean difference, and in the inter-individual differences in energy intake between the two methods.     

Étude comparative des primo-infections à Epstein-Barr virus et à cytomégalovirus chez 52 patients immunocompétents

Objective

The objective of this study was to compare epidemiological, clinical, and biological data of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) primary infections in immunocompetent adults, admitted in the infectious disease department of the Reims Teaching Hospital between 2000 and 2005.

Patients and methods

Inclusion criteria were the presence of anti-VCA IgM antibodies or the presence of CMV specific IgM antibodies and the absence of any other positive serology. Differences in reported percentage were compared with a Khi² test or Fischer's exact test, when appropriate. Continuous variables were compared with the Mann-Whitney Test.

Results

There were no significant changes over the years in the numbers of EBV (n = 32) and CMV (n = 20) primary infections. The patient's mean age was 22.7 years (14-48 years) in EBV primary infections and 38.6 years (13-66 years) in CMV primary infections (P < 0.01). The clinical variables significantly associated with primary EBV infection were sore throat and cervical lymphadenopathy (P < 0.01). Arthromyalgia and respiratory manifestations were less frequent in EBV primary infection (P < 0.01). The biological variables significantly associated with EBV primary infection were a marked alanine aminotransferase elevation and a marked lymphocytosis with atypical lymphocytes (P < 0.001). Thrombopenia was less frequently associated with EBV primary infection (P < 0.001).

Conclusion

Clinical and biological presentations of EBV and CMV primary infections were similar. The simultaneous serologic diagnosis of these two infections remains necessary to provide a specific diagnosis, for the most efficient patient care.     

La tuberculose à la Réunion : caractéristiques épidémiologiques issues des déclarations obligatoires, 2000–2007

Located in the South West Indian Ocean, Reunion island is close to countries with a strong incidence of tuberculosis disease: Madagascar, 246 per 100,000, Comoros, 44 per 100,000 or Mayotte, 22 per 100,000 in 2006. However, the epidemiology of tuberculosis in Reunion is poorly documented.     

Défaillance multiviscérale et infection disséminée à adénovirus

Background

Peripheral blood stem cell transplantation is a frequent option, especially for patients with hematological malignancies.

Case reports

A first patient received this treatment for acute myeloblastic leukemia, the second for Richter's syndrome (follicular lymphoma). In both cases, allograft (unrelated donor, non myeloablative conditioning) was followed by graft versus host disease (GVH) requiring an immunosuppressive treatment. Respectively 15 and three months after graft, these two patients presented with multiple organ failure including very severe hepatic dysfunction. The diagnosis was made according to positive blood PCR, positive BAL, and hepatic histological findings.

Discussion

Adenoviruses, frequent in pediatrics, can be responsible for extremely severe infections among immunocompromised adults. T lymphocyte depletion plays a key role.

Conclusion

Adenoviral infections can be fatal among immunocompromised patients. Diagnostic improvement should lead to early treatment, which however, remains to be clearly defined.