[Mother-infant dengue transmission during the 2009-2010 dengue epidemic: report of four cases]. / Dengue materno-fœtale au cours de l'épidémie de 2009-2010 en Guadeloupe : à propos de 4 cas.

The risks related to dengue virus infection during pregnancy have been increasingly better described over the past 10 years. The possibility of maternal-fetal transmission is now recognized, but the diagnosis is still too late because of a wide range of clinical signs that the infected newborn child can present. From December 2009 to October 2010, Guadeloupe Island underwent an exceptional dengue epidemic. During this epidemic, at least four cases of vertical virus transmission were biologically proved. The purpose of this article is to describe the clinical aspects of these cases, some of which have rarely been described in this pathology. Of the four cases, one showed fetal growth restriction, one neonatal cholestasia, one twin pregnancy, and what seems to be the first case of hemophagocytic syndrome associated with a newborn child infected by this virus. Although the proportion of vertical transmission proved is low, compared with the number of adults affected during an epidemic, some severe cases urge us to be increasingly watchful with this emergent arbovirus, especially because its real incidence is still unknown.

The effect of modafinil on counter-regulatory and cognitive responses to hypoglycaemia.

AIMS/HYPOTHESIS: Our hypothesis is that reducing release of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) with modafinil will enhance symptomatic and hormonal responses to hypoglycaemia. METHODS: Nine healthy men received, in random order, two 100-mg doses of modafinil or placebo, followed by an insulin clamp in which plasma glucose was either reduced stepwise to 2.4 mmol/l or was sustained at euglycaemia (four studies). Catecholamines, symptom scores and cognitive function were measured. RESULTS: Modafinil had no effect on the measured parameters during euglycaemia. During hypoglycaemia, autonomic symptom scores were significantly higher with modafinil (increase at lowest plasma glucose concentration 271.3+/-118.9 vs 211.2+/-80.4/40 min, p=0.019), and the heart rate response was increased (12,928+/-184 vs 6773+/-148 bpm/140 min, p=0.016). Deterioration in performance of two cognitive tasks was reduced: Stroop colour-word test (613+/-204 vs 2375+/-161/65 min, p=0.009) and accuracy of a simple reaction task (11.3+/-1.8 vs 9.4+/-3.7, p=0.039). CONCLUSIONS/INTERPRETATION: We conclude that modafinil improves adrenergic sensitivity and some aspects of cognitive function at hypoglycaemia, possibly by reducing neuronal central GABA concentrations.

The role of hepatic portal glucose sensing in modulating responses to hypoglycaemia in man.

AIMS/HYPOTHESIS: The role of glucose sensing cells in the human hepatic portal system in the initiation of the neuroendocrine responses to acute hypoglycaemia is not known. We investigated the effect of raising blood glucose concentrations in the hepatic-portal vein on neurohumoral responses during induction of systemic hypoglycaemia in nine healthy male volunteers. METHODS: Each subject received an insulin infusion (3 mU.kg(-1).min(-1)) on two occasions, in random order. Variable rate glucose infusion was used to maintain plasma glucose at 5 mmol/l for 60 min, then 3.2 mmol/l for 60 min. At 20 min prior to hypoglycaemia, subjects drank 20 g of glucose in water or water sweetened with saccharin. In five of the volunteers, the oral glucose was labelled with U-13C6 glucose, which showed peak systemic glucose absorption between 90 and 110 min. Five volunteers also repeated the study with a euglycaemic clamp. RESULTS: Oral glucose was associated with a reduction in the early adrenaline response to hypoglycaemia, the area under the curve from 90 to 110 min falling from 24.02+/-20.84 (means +/- SD) to 15.26+/-13.65 nmol/l per 20 min, p<0.05. Symptom scores (area under curve) decreased from 99.72+/-91.86 to 16.39+/-94.71, p=0.008 (total), 51.8+/-68.61 to 7.78+/-41.61, p=0.03 (autonomic) and 54.17+/-50.61 to 8.6+/-57.99 with oral glucose, p=0.001 (neuroglycopenic). Oral glucose did not influence symptoms during euglycaemia. CONCLUSION/INTERPRETATION: Our data are compatible with the hypothesis that centrally mediated symptomatic and neuroendocrine responses are attenuated by glucose detection in the hepatic portal vein in humans.

The effect of acute hypoglycemia on brain function and activation: a functional magnetic resonance imaging study.

The authors' aim was to examine the regional anatomy of brain activation by cognitive tasks commonly used in hypoglycemia research and to assess the effect of acute hypoglycemia on these in healthy volunteers. Eight right-handed volunteers performed a set of cognitive tasks-finger tapping (FT), simple reaction time (SRT), and four-choice reaction time (4CRT)-twice during blood oxygen level-dependent (BOLD) functional magnetic resonance imaging of the brain on two occasions. In study 1 (n = 6), plasma glucose was maintained at euglycemia (5 mmol/l) throughout. In study 2 (n = 6), plasma glucose was reduced to 2.5 mmol/l for the second set. Performance of the tasks resulted in specific group brain activation maps. During hypoglycemia, FT slowed (P = 0.026), with decreased BOLD activation in right premotor cortex and supplementary motor area and left hippocampus and with increased BOLD activation in left cerebellum and right frontal pole. Although there was no significant change in SRT, BOLD activation was reduced in right cerebellum and visual cortex. The 4CRT deteriorated (P = 0.020), with reduction in BOLD activation in motor and visual systems but increased BOLD signal in a large area of the left parietal association cortex, a region involved in planning. Hypoglycemia impairs simple brain functions and is associated with task-specific localized reductions in brain activation. For a task with greater cognitive load, the increased BOLD signal in planning areas is compatible with recruitment of brain regions in an attempt to limit dysfunction. Further investigation of these mechanisms may help devise rational treatment strategies to limit cortical dysfunction during acute iatrogenic hypoglycemia.

[Pneumococcus: an unusual agent of maternal-fetal infection]. / Le pneumocoque: un agent inhabituel d'infection materno-foetale.

BACKGROUND: Since the advent of antibiotics, Streptococcus pneumoniae has become a very unusual agent of materno-fetal infection. We report two cases. CASE REPORTS: In case n(o) 1, early neonatal meningitis was caused by a penicillin-resistant strain. In case n(o) 2, the mother developed meningitis 16 days after delivery. In both cases, premature rupture of the membranes in otherwise asymptomatic mothers was the initial event and outcome was favorable under amoxicillin alone. The pneumococci were easily recovered fom placental, amniotic and neonatal samples, less easily from the maternal samples. DISCUSSION: The increasing prevalence of penicillin-resistant pneumococci is an emerging problem of real concern. It might increase the very low present incidence of pneumococcal neonatal materno-fetal infection which is a particularly serious infection with up to 60% neonatal mortality. Any type of S. pneumoniae infection, or even colonization, occurring in the peripartum should prompt adequate treatment and suggests considering first line vancomycin for the newborn.

Women health care managers: an economic update.

In 1980, a survey of women health care managers was performed that documented their career status at that time. This article reports the results of a follow-up survey, done five years later, demonstrating gains in salary and responsibility.

Women health care managers: an economic and employment profile.

For the past 20 years women have rapidly moved into the health care work force. It is hypothesized that the not-for-profit sector of America's economy has provided a more hospitable environment for women managers than the for-profit sector has. Accordingly the salary experience of women in not-for-profit industries is of great interest to many women managers.

Providers have failed to work for continuity.

Continuity of patient care between different health care settings has been advocated for nearly 20 years, but little has been done to effect it. The study described here emphasizes the current lack of effort by health care providers in hospitals and nursing homes to find a workable solution.