Exposures associated with making or playing with viscoelastic polymer toys known as Slime: a retrospective case series from French Poison Control Centres.

Context: Slime is a slow-flowing material with viscoelastic properties which is attractive to children. Its preparation is based on the crosslinking of polyvinyl alcohol, polyvinyl acetate or starch with boric acid.Objectives: The goal of this study was to describe the adverse effects of Slime.Materials and methods: This is a descriptive retrospective study of cases of exposure reported to French Poison Control Centres between January 2014 and May 2018. The following parameters were used: age and sex, date and circumstances of exposure, symptoms and severity.Results: Two hundred and eight (208) cases of exposure were recorded, 93 cases happened in 2017, and 88 cases in the first four and a half months of 2018. The average age was of 8 years old; 190 patients were younger than 15. Fifty-seven percent (57%) were female. Regarding routes of exposure, 168 were oral, 30 cutaneous, eight ocular, one inhalation and one ear exposure. Eighty-two (82) patients were symptomatic, including 81 cases of low severity and one of average severity (keratitis). All cases lead to recovery.Conclusion: No significant adverse health effects are expected to develop if only small amounts are swallowed; making Slime with home ingredients is a potential cause of boric acid exposure that must be supervised by adults.

Poisoning by non-edible squash: retrospective series of 353 patients from French Poison Control Centers.

CONTEXT: Among the numerous varieties of squash that exist, some are edible while other bitter-tasting ones are not fit for human consumption. Cases of confusion seem to be multiplying and are characterized by digestive problems (diarrhea, vomiting, and abdominal pain). METHODS: This is a descriptive retrospective study of cases of exposure reported to French Poison Control Centers between 1 January 2012 and 12 December 2016. RESULTS: 353 patients were included, with 71.7% belonging to collective cases of poisoning. The male to female sex ratio was 0.75 for an average age of 38.2 ± 23.6 years. The circumstances of exposure were dietary for 337 patients (95.5%). The majority of the squash consumed was purchased at a store (55.8%) but some also came from the garden (25.5%). 204 patients (57.8%) mostly presented with diarrhea, vomiting, abdominal pain, sometimes with the consequent dehydration, hypotension, tachycardia, headaches, or vertigo. There were no deaths or severe (Poisoning Severity Score (PSS) 3) cases, but there were 14 patients (4.0%) of moderate severity, 190 patients (53.8%) of minor severity (PSS 1), and 149 patients (42.2%) without severity (PSS 0) but among which we include the bitter taste of the squash. The average age of PSS 2 patients was significantly (p = .003) older than that of the PSS <2 patients. CONCLUSION: As the first consequential series in Europe, our study shows that exposure to non-edible squash is frequent. Usually benign, poisoning could be the consequence of the irritating effect of certain cucurbits, the molecules responsible for the taste and toxicity of the fruits. In terms of prevention therefore, we recommend disposing of any squash with a bitter taste.

[Atypical onset of Churg and Strauss syndrome in a child]. / Révélation atypique d'un syndrome de Churg et Strauss chez l'enfant.

We report the case of a 13-year-old boy who had been treated since the age of 6 for moderate asthma. Except asthma, his past medical history was uneventful. The patient was referred for the sudden onset of bilateral leg edemas with peripheral purpuric lesions. Blood tests showed increased blood eosinophilia (9000/mm(3)) with no fever. The antineutrophil cytoplasmic antibodies (ANCA) were negative. The skin biopsy showed extensive ischemic subcutaneous necrosis related to necrotizing vasculitis. The general secondary symptoms occurred with multiorgan involvement (pulmonary infiltrates, peripheral neuropathy, gastrointestinal tract symptoms, and arthralgia). Genital infiltration was also noted. The child's general health was preserved. Neither cardiac nor renal involvement were found. The patient showed favorable clinical progression after oral prednisone therapy.

Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures.

OBJECTIVE: The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. METHODS: We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. RESULTS: The mean MSD and DAP were respectively 389 mGy and 65 Gy cm(-2) for CAs, and 916 mGy and 69 Gy cm(-2) for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r=0.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. CONCLUSION: Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions.

[Guillain-Barré syndrome in a child with normal tendon reflexes]. / Un cas pédiatrique de syndrome de Guillain-Barré à réflexes conservés.

We describe the case of a 10-year-old child with the acute motor axonal neuropathy (AMAN) form of Guillain-Barré syndrome (GBS) with preserved tendon reflexes, 6 days after a bout of gastroenteritis. The child quickly showed weakness of the distal muscles of his four limbs, with preserved tendon reflexes and a raised CSF protein concentration with no cells. Nerve conduction studies showing motor axonal degeneration confirmed the diagnosis of GBS in spite of preserved tendon reflexes. The serum was positive for IgG antibodies to gangliosides GM1 and GD1b. The child received intravenous immunoglobulins, which resulted in a favorable progression. This case proves that GBS with normal tendon reflexes exists. The other cases of SGB with preserved tendon reflexes already described in the literature were the AMANs form with antibodies to gangliosides in the serum and only adults were affected.

[Report of adverse events related to treatments to Institute de Veille sanitaire]. / Déclaration des événements indésirables graves liés aux soins à l'Institut de Veille sanitaire.

The code de santé publique imposes to all health professionals an obligation to declare serious and undesirable events following cares applied during treatment investigations or prevention actions. An experimentation has been installed under the responsibility of the Institut de Veille sanitaire further to the 9 August 2004 bill. It aims to define how to declare undesirable adverse events to test its feasibility, its efficiency and to identify the necessary conditions to widespread its modalities. The field of these experimentations concerns all health professionals, working in public hospital or in private practice. The definition of undesirable adverse events should be clarified. Different ways to declare these events will be discussed with SFRO (Société française de radiothérapie oncologique) to improve the current management of incidents and adverse events.

Qualitative and quantitative investigation of chromium-polluted soils by laser-induced breakdown spectroscopy combined with neural networks analysis.

Laser-induced breakdown spectroscopy (LIBS) has been applied to the analysis of three chromium-doped soils. Two chemometric techniques, principal components analysis (PCA) and neural networks analysis (NNA), were used to discriminate the soils on the basis of their LIBS spectra. An excellent rate of correct classification was achieved and a better ability of neural networks to cope with real-world, noisy spectra was demonstrated. Neural networks were then used for measuring chromium concentration in one of the soils. We performed a detailed optimization of the inputs of the network so as to improve its predictive performances and we studied the effect of the presence of matrix-specific information in the inputs examined. Finally the inputs of the network--the spectral intensities--were replaced by the line areas. This provided the best results with a prediction accuracy and precision of about 5% in the determination of chromium concentration and a significant reduction of the data, too.

A methodological approach for the identification of arsenic bearing phases in polluted soils.

A methodological approach is used to characterize arsenic pollution in three soils and to determine arsenic speciation and association with solid phases in three polluted soils. HPLC-ICP-MS was used for arsenic speciation analysis, SEM-EDS and XRD for physical characterization of arsenic pollution, and sequential chemical extractions to identify arsenic distribution. Arsenic was concentrated in the finest size fractions also enriched in iron and aluminium. Total arsenic concentrations in soils are close to 1%. Arsenic was mainly present as arsenate, representing more than 90% of total arsenic. No crystallised arsenic minerals were detected by XRD analysis. SEM-EDS observations indicated arsenic/iron associations. Modified Tessier's procedure showed that arsenic was mainly extracted from amorphous iron oxide phase. The results of this methodological approach lead to predict the formation of iron arsenates in the case of one of the studied soils while arsenic sorption on iron amorphous (hydr)oxides seemed to be the determinant in the two other soils.

[Diversity of bedside pretransfusion ABO compatibility devices in metropolitan France]. / La diversité des dispositifs de contrôle ultime pré-transfusionnel utilisés en France métropolitaine.

To prevent the occurrence of the ABO incidental incompatibility, the bedside pretransfusion ABO control is mandatory in France since 37 years. If the quality of the reagents is regularly controlled, no technical specification exists concerning the type of support. To describe the different types of devices used by the French hospitals, a brief questionnaire was sent, from December 2000 to March 2001, to each hemovigilance correspondent working in the 1782 hospitals with transfusion activity in 1999. Every participant had to send back the device used in his establishment. The rate of replies was 29.4%, varying from a region to another. The devices distributed by laboratories were the most used (67.4%) vs. 25.6% for the devices provided by the regional establishments of the French Establishment of Blood and 6.7% for the devices manufactured by hospitals. The presence in the region of a local office of the French Establishment of Blood providing some devices was the only factor determining the choice of the device type (p < 10(-8)). Almost half of the hospitals (46.8%) declared to have renewed their devices after 1996, most often in favor of a device provided by a laboratory (p < 10(-8)). We evaluated 30 different devices taking into account the general presentation, the available information on the device. The results of this survey showed a large disparity and heterogeneity in the quality of the devices used by the French hospitals in the context of a lack of standardization.

Arsenic characterisation in industrial soils by chemical extractions.

The purpose of this research was to find a reliable and easy to use method to characterise As in iron-rich industrial or mining site soils. In this objective classical sequential extraction schemes and single extractions with EDTA and phosphate solutions were used. Results showed that classical Tessier's scheme overestimated residual As. A scheme specific to anionic species was also not really suitable to evaluate As distribution in these iron-rich soils. A more complex scheme using specific iron reagents indicated a correlation between iron dissolution and arsenic leaching and these results were confirmed by single extractions with EDTA and oxalate solutions. Finally a simplified and less time consuming scheme was established, tested on diverse industrial soils and validated on a certified sediment reference material. It allowed evaluation in 24 hours of the easily extractable fraction, amount solubilized under reducing conditions and As strongly bound to the soil.