Epidemiology of infectious encephalitis causes in 2016

We performed a literature search in the Medline database, using the PubMed website. The incidence of presumably infectious encephalitis is estimated at 1.5–7 cases/100,000 inhabitants/year, excluding epidemics. Infectious encephalitis and immune-mediated encephalitis share similar clinical signs and symptoms. The latter accounts for a significant proportion of presumably infectious encephalitis cases without any established etiological diagnosis; as shown from a prospective cohort study where 21% of cases were due to an immune cause. Several infectious agents are frequently reported in all studies: Herpes simplex virus (HSV) is the most frequent pathogen in 65% of studies, followed by Varicella-zoster virus (VZV) in several studies. Enteroviruses are also reported; being the most frequent viruses in two studies, and the 2nd or 3rd viruses in five other studies. There are important regional differences, especially in case of vector-borne transmission: Asia and the Japanese encephalitis virus, Eastern and Northern Europe/Eastern Russia and the tick-borne encephalitis virus, Northern America and Flavivirus or Alphavirus. Bacteria can also be incriminated: Mycobacterium tuberculosis and Listeria monocytogenes are the most frequent, after HSV and VZV, in a French prospective study. The epidemiology of encephalitis is constantly evolving. Epidemiological data may indicate the emergence and/or dissemination of new causative agents. The dissemination and emergence of causative agents are fostered by environmental, social, and economical changes, but prevention programs (vaccination, vector controls) help reduce the incidence of other infectious diseases and associated encephalitis (e.g., measles).     

L’examen clinique psychiatrique standardisé pour l’étudiant,c’est possible !

The systematic approach and the examination of patients are central for the teaching of medicine. However, a very large proportion of medical students are not taught to examine patients with psychiatric disorders. This article summarizes the didactic reflection behind the development of a guide for medical observation in psychiatry for medical students. This guide was built from the framework of a classic medical examination (history of illness, biography, etc.). It also incorporates the different steps from the Mental Status Examination (MSE) as well as questions from several standardized tools. This guide document is intended to be simple and easy to use (check box system) to facilitate the interviews of medical students and residents in psychiatry. Master the clinical examination is an essential step in the process of learning medicine that will then allow to integrate, with experience, the flexibility and adaptability necessary for a psychiatric interview.     

Épidémiologie de l’insuffisance rénale aiguë

The acute renal failure is common in the hospitalized patients with the incidence is increasing. This results from the aging of the population and the widespread use of nephrotoxic therapies or diagnostic techniques. The acute renal failure is associated with an increased length of stay in hospital and the short and long-term mortality. The most common histological injury is the acute tubular necrosis. Although the most of acute renal failure is recovering, recent works have shown that there is a strong association between an acute renal failure and the increased risk of developing a chronic kidney disease.     

Méningo-encéphalites : étude rétrospective sur 4 ans au CHRU Bretonneau de Tours

Introduction

Meningoencephalitis (ME) are central nervous system inflammations with many etiologies. The etiology remains unknown in nearly half of the cases. The last French study was performed in 2007. Besides some rare or emerging causes, such as limbic ME, which are curable, infectious ME are the most frequent. Long term ME outcome remains partly known. The study objectives were to assess etiologies and outcome of ME in a University hospital between 01/01/2011 and 31/12/2014.

Épidémiologie et pharmacoépidémiologie du purpura thrombopénique immunologique

During the last decade, the development of large clinical and population-based cohorts led to new findings in the epidemiology and the pharmacoepidemiology of immune thrombocytopenia (ITP). The incidence is estimated to 3–4 for 10⁵ inhabitants/year, with a slight female predominance and peaks in children and patients after 60 years. The incidence rate is 9 for 10⁵ inhabitants/year in males after 75 years. Variations across ethnic groups are discussed. In France, there is a North-South gradient and a peak of incidence during winter suggesting the role of viruses in ITP pathophysiology. Myelodysplastic syndromes are an emergent cause of secondary ITP. The incidence of intracranial bleeding is about 1% by year and the risk increases with aging. Exposure to splenectomy decreases while rituximab and thrombopoietin receptor agonists (TPO-RA) are the most used second-line drugs for persistent ITP. Mortality is slightly increased in primary ITP as compared with the general population. ITP patients have an increased risk of infection, thrombosis and hemorrhage. Aging, lung diseases, splenectomy, corticosteroids and rituximab are risk factors for infection while influenza and pneumococcal vaccines are associated with a 50% decrease of infection risk. Aging, cardiovascular risk factors, lupus anticoagulant and splenectomy are risk factors for thrombosis. The risk of thrombosis associated with corticosteroids and TPO-RAs must be further investigated.     

Épidémiologie et histoire naturelle de l’artérite à cellules géantes (Horton)

Knowledge of the natural history and epidemiology of giant cell arteritis (GCA) is growing. With the recent conceptual change, GCA is no longer considered a disease with mandatory cranial symptoms but, rather, a larger disease spectrum also including idiopathic aortitis in people older than 50 and polymyalgia rheumatica with large-vessel involvement. The incidence peak between age 70 and 80 years, greater frequency in females and greater occurrence in Nordic countries are well-established epidemiological characteristics. Conversely, the notion that the incidence of GCA is increasing is challenged by several recent population-based studies suggesting a trend reversal for about 15 to 20 years. The known link with the allele HLA-DRB1*04 was confirmed by a genome-wide association study that also found associations with two other genetic polymorphisms. Recent studies indicating a link with varicella zoster virus infection have invigorated the hypothesis of an infectious cause for GCA. Smoking is the most solidly recognized environmental risk factor, but other traditional cardiovascular risk factors do not seem to predispose to GCA. Evidence is mounting that overall mortality in GCA patients is at best slightly higher than expected in relation to general population mortality data, but GCA is associated with an increase in morbidity and mortality specifically related to aortic aneurysm or other cardiovascular causes. Further studies are needed to integrate the current knowledge into a single etiological model.     

Trends of Zambia's tuberculosis burden over the past two decades

Objectives To study trends in Zambia’s TB notification rates between 1990 and 2010 and to ascertain progress made towards TB control. Methods Retrospective review of TB notification returns and TB programme reports for the period from 1990 to 2010. Results Two distinct TB trend periods were identified: a period of rising trends up to a peak between 1990 and 2004 and a period of moderately declining trends between 2004 and 2010. Treatment outcomes improved over the two decades. Data on trends in paediatric TB, TB in prisoners and TB in pregnant women remain scanty and unreliable owing to poor diagnostic capability. There were no data available on trends on drug‐resistant TB because of the lack of laboratory services to perform drug sensitivity testing. Conclusions The period of increasing TB between 1990 and 2000 coincided with an increase in HIV/AIDS. The period of slightly decreasing TB between 2004 and 2010 can be attributed to improved TB care, sustained DOTS implementation and improvement in TB diagnostic services. Newer diagnostics technologies for the rapid diagnosis of active TB cases and for drug‐resistant testing, recently endorsed by the WHO, need to be implemented into the national TB programmes to detect more cases and to provide epidemiological and surveillance data from which to obtain an evidence base for guided investments for TB control. Alignment of TB and HIV services is required to achieve improved management outcomes.