Bases anatomiques de la prévention des hématomes de la paroi abdominale induits par le placement des trocarts

Conclusion N'ignorant pas que le choix des sites d'incision pour la chirurgie laparoscopique peut être influencé par une multitude de facteurs, afin de minimiser le risque de lésions des vaisseaux de la paroi abdominale, nous suggérons de placer les trocarts sur la ligne blanche et dans une zone de 5 cm de large en dehors du bord latéral de la gaine du m. droit

---

---

Traduction : O Armstrong et JF Delattre     

Automatisation de la préparation des produits sanguins labiles

The preparation of labile blood products in a blood bank is in permanent technological progress. Many operations, such as blood centrifugation, components separation, etc. are now performed by automated devices. A new generation of equipments is able to prepare blood products by reducing the number of manual operations. Therefore, buffy-coat platelet concentrate preparation and whole blood preparation can be prepared by these automated systems. Consequently, this directly impacts working conditions of employees, quality of blood products and process management.     

Séroépidémiologie de la rubéole, de la varicelle et des infections par le cytomégalovirus et le parvovirus B19 chez les femmes enceintes dans la région de Sousse, Tunisie

The aim of the study is to evaluate seroprevalence of rubella virus (RV), cytomegalovirus (CMV), varicella zoster virus (VZV), and parvovirus B19 (PB19) in 404 Tunisian pregnant women, and to determine reliability of maternal past history of eruption. Sociodemographic characteristics, risk factors, and past history of eruption were collected through a questionnaire. Serologic tests were performed using enzyme immunoassays. Risk factors were analyzed using univariate and multivariate logistic regression models. Seroprevalences were 79.7% for rubella, 96.3% for CMV, 80.9% for VZV, and 76.2% for PB19. In multivariate analysis, the number of persons per room (> 2) in the house during childhood was associated with CMV infection (P = 0.004), irregular professional husband's activity was correlated with VZV infection (P = 0.04), and an age of more than 30 years was associated with PB19 infection (P = 0.02). History of rubella, varicella, and PB19 infection was unknown for, respectively, 55.8%, 20%, and 100% of women. False history of rubella and varicella were found for 7.4% and 15% of women, respectively. The positive and negative predictive values (PPV and NPV) of rubella history were, respectively, 92.6% and 17.2%, and were, respectively, 84.9% and 20.9% for varicella history. Susceptibility to RV, VZV, and PB19 infection remains high in pregnancy in our population. Preventive strategies against congenital rubella must be reinforced. Vaccination against VZV should be considered in seronegative women. Systemic CMV screening is not warranted in our country where high immunity is acquired probably in childhood. Since maternal history of eruption is not reliable, we recommend serologic testing to determine immune status of women.     

Influence du mode de conservation et étude de quelques interférences sur le dosage de l’ostéocalcine par Kryptor-Osteo®

We evaluated the influence of pre-analytic factors on serum osteocalcin (Bone Gla protein) concentration measured by Kryptor-Osteo^®, Brahms, an immunofluorescent assay. Osteocalcin serum level is significantly decreased after a 2 h conservation at room temperature, after a 4 h conservation at 4 °C and by serum hemolysis. Osteocalcin concentration is relatively stable in serum with 1 to 6 freeze–thaw cycles and in turbid samples. Bilirubin does not influence osteocalcin concentration assayed in icteric serum. We advise to transport the sample on ice and to assay osteocalcin quickly after sample (less than 2 h). If not possible, serum should be frozen. Osteocalcin should not be assayed in hemolysed samples.     

Evaluation de la fonction glomérulaire par le dosage de la cystatine C. Absence d'influence de l'état nutritionnel

Cystatin C measurement for the assessment of glomerular filtration rate. Cystatin C is a non-glycosylated basic protein that is produced by all nucleated cells, filtered by the glomerular membrane and catabolized in the proximal tubular cells. Its serum concentration is influenced by age, in parallel with changes in glomerular filtration rate. We evaluated cystatin C, creatinine and renal function in patients with head and neck tumors before administration of chemotherapy with cisplatin. Results showed a relationship between cystatin C and creatinine, cystatin C and age. There was no correlation between cystatin C and nutritional status (albumin and prealbumin) of patients. These preliminary findings suggest that cystatin C could provide information in patients with denutrition to evaluate renal function.     

Procédure régionale de transport des produits sanguins labiles par le samu

Transfusions are exceptional while patients are rushed to hospital for sanitary reasons. The quality of care requires the collaboration with different partners (samu, blood bank centre, haemovigilance correspondents…). In response to dysfunctions that occurred during transports for sanitary reasons we have drawn up a regional procedure, which specifies how to get and use blood products. This procedure harmonizes our medical practice, states the role of the different participants (traceability of blood samples of immunohaematology tests, etc.), including a part dedicated to identity vigilance. The expected impacts of this procedure are: the decrease of dysfunctions and of destructions of red blood cells, the improvement of security while patients are transfused.     

La lèpre,pilier de la génétique des maladies infectieuses

Despite a natural reservoir of Mycobacterium leprae limited to humans and free availability of an effective antibiotic treatment, more than 200,000 people develop leprosy each year. This disease remains a major cause of disability and social stigma worldwide. The cause of this constant incidence is currently unknown and indicates that important aspects of the complex relationship between the pathogen and its human host remain to be discovered. An important contribution of host genetics to susceptibility to leprosy has long been suggested to account for the considerable variability between individuals sustainably exposed to M. leprae. Given the inability to cultivate M. leprae in vitro and in the absence of relevant animal model, genetic epidemiology is the main strategy used to identify the genes and, consequently, the immunological pathways involved in protective immunity to M. leprae. Recent genome-wide studies have identified new pathophysiological pathways which importance is only beginning to be understood. In addition, the prism of human genetics placed leprosy at the crossroads of other common diseases such as Crohn's disease, asthma or myocardial infarction. Therefore, novel lights on the pathogenesis of many common diseases could eventually emerge from the detailed understanding of a disease of the shadows.     

Prévalence de l’infection par le parvovirus B19 humain au cours des éruptions fébriles de l’enfant dans le Nord tunisien

The aim of the study is to evaluate the prevalence of specific antibodies anti-human parvovirus B19 (PVB19) immunoglobulin M (IgM) and IgG in children with fever and rash. This study involved 257 children aged from 7 months to 15 years with febrile rash unrelated to measles and rubella (seronegative for IgM). The sera were examined by immunoenzymatic assay. Detection of antibodies of PVB19 was done by enzyme-linked immunosorbent assay (Elisa). In our study, prevalence of immunoglobulin G (IgG) and IgM were 44 and 11.3%, respectively. Clinically, children with positive IgM serology had submitted an erythema infectiosum (13/29 cases), myocarditis (1 case), encephalitis (1 case), severe sickle cell anemia (7 cases), and immunocompromised (7 cases). The incidence rate of viral infection was 11.3%; most of the cases of PVB19 infection occurred between the months of May and August. Incidence was higher in the 10–15 years age group (21%). The prevalence of IgG antibody varied and increased with age, it rises from 38.2% in preschool children (19 months–4 years) to 53.5% in those aged between 4.5 and 15 years, reaching 58% in the 10–15 years age group. The four risk factors of PVB19 infection are: (1) those aged between 4.5 and 9 years, which is the most affected age group (P = 0.0018); (2) female gender in children aged between 19 months and 4 years (P = 0.037); (3) transfusion and (4) immune deficiency (P = 0.022 and P = 0.001, respectively). The study of the prevalence of PVB19 infection shows that viral infection is acquired early in childhood, increases with age; viral transmission is favored by the community life. Because of the widespread vaccination program against measles and rubella, the systematic search of PVB19 in front of eruptive fevers becomes important.     

Évaluation du bénéfice apporté par des examens complémentaires pour le diagnostic de la tuberculose chez des patients infectés par le VIH mis sous ARV à Niamey,Niger

In Niger, the tuberculosis (TB) screening among people living with human immunodeficiency virus (HIV) (PLHIV) is nonsystematic and the use of additional tests is very often limited. The objective of this research is to evaluate the performance and the cost-effectiveness of various paraclinical testing strategies of TB among adult patients with HIV, using available tests in routine for patients cared in Niamey. This is a multicentric prospective intervention study performed in Niamey between 2010 and 2013. TB screening has been sought in newly diagnosed PLHIV, before ART treatment, performing consistently: a sputum examination by MZN (Ziehl-Nielsen staining) and microscopy fluorescence (MIF), chest radiography (CR), and abdominal ultrasound. The performance of these different tests was calculated using sputum culture as a gold standard. The various examinations were then combined in different algorithms. The cost-effectiveness of different algorithms was assessed by calculating the money needed to prevent a patient, put on ART, dying of TB. Between November 2010 and November 2012, 509 PLHIV were included. TB was diagnosed in 78 patients (15.3%), including 35 pulmonary forms, 24 ganglion, and 19 multifocal. The sensitivity of the evaluated algorithms varied between 0.35 and 0.85. The specificity ranged from 0.85 to 0.97. The most costeffective algorithm was the one involving MIF and CR. We recommend implementing a systematic and free direct examination of sputum by MIF and a CR for the detection of TB among newly diagnosed PLHIV in Niger.