Prenatal therapy in transient abnormal myelopoiesis: a systematic review.

OBJECTIVE: To systematically review current evidence regarding prenatal diagnosis and management of transient abnormal myelopoiesis (TAM) in fetuses with trisomy 21. A novel case of GATA1-positive TAM, in which following serial in utero blood transfusion clinical improvement and postnatal remission were observed, is included. SEARCH STRATEGY AND DATA COLLECTION: A systematic search of electronic databases (inception to October 2014) and reference lists, hand-searching of journals and expert contact. All confirmed cases of prenatal TAM were included for analysis. Data on study characteristics, design and quality were obtained. RESULTS: Of 73 potentially relevant citations identified, 22 studies were included, describing 39 fetuses. All studies included comprised single case or small cohort studies; overall quality was 'very low'. Fetal/neonatal outcome was poor; 12 stillbirths (30.8%), 4 neonatal deaths (10.2%) and 7 infant deaths (17.9%). In two cases, the pregnancy was terminated (5.1%). TAM was primarily detected in the third trimester (79.4%), and in 14 a retrospective diagnosis was made postpartum. Ultrasound features indicative of TAM included hepatomegaly±splenomegaly (79.5%), hydrops fetalis (30.8%), pericardial effusion (23.1%) and aberrant liquor volume (15.4%). When performed, liver function tests were abnormal in 91.6% of cases. CONCLUSIONS: Prenatal TAM presents a challenging diagnosis, and prognosis is poor, with consistently high mortality. A low threshold to measure haematological and biochemical markers is advised when clinical features typical of TAM are detected in the context of trisomy 21. Larger prospective studies are warranted to accurately ascertain the role of GATA1 analysis and potential value of prenatal therapy.

Serological evidence of human infection with the paramyxovirus Yucaipa in Senegal, West Africa.

Sera from 353 people resident in Dakar, Senegal, West Africa, were tested for hemagglutination-inhibiting antibodies against the avian paramyxovirus Yucaipa. Antibodies were demonstrated in five sera (1.4%), providing new evidence that this virus may infect humans.

[Comparative study of 2 commercial tests for the detection of HIV-1 antigens in blood and cerebrospinal fluid using immunoenzymology]. / Etude comparative de deux trousses commerciales pour la recherche de l'antigène HIV I en immunoenzymologie (EIA) dans le sérum et le liquide céphalorachidien.

The authors have carried out, on 150 sera of patients seropositive for the human immunodeficiency virus type I (HIV I) and 11 cerebrospinal fluid of which 5 were patient infected by the HIV I, a comparative study of two commercial tests for the detection of HIV I antigen (Diagnostic Pasteur and Abbott laboratories). A much greater sensitivity was obtained with the specificity being practically identical for the sera with the two tests (100% with Abbott laboratories test, 96.11% with the diagnostic Pasteur test). 4 sera appeared "false negatives" with the Abbott Laboratories test; their optical density was situated between 80 and 100 p. cent of the cut-off level value, whereas that of the "real" negatives was situated between 30 and 60 p. cent of the cut-off level value. 10 of the 11 cerebrospinal fluids appeared false positive with the Diagnostic Pasteur. This seems to be connected with an insufficiency of saturation of protein receptors in the wells. The Diagnostic Pasteur test is not adapted for the detection of HIV I antigen in the body fluids with a weak protein concentration. Contrary to the results obtained with the Encavor test (Abbott laboratories) the analysis in western-blot does not show an inverse prevalence of anti p24 GAG antibodies with regard to antigen HIV I in seropositive patients. On the other hand, the statistical analysis of the positive HIV I sera which are at the same time antigen HIV I positive and antibodies HIV I positive suggests an earlier disappearance of anti p17 GAG antibodies than of anti p24 GAG antibodies.

[Prevention of poliomyelitis: live or killed vaccine? Remarks apropos of 2 cases of poliomyelitis]. / Prévention de la poliomyélite: vaccin vivant ou tué? Réflexions à propos de 2 cas de poliomyélite.

The attenuated poliovirus vaccine is remarkably effective in preventing the disease but its innocuity has always been questioned. It seems to be responsible for occasional cases of spinal paralysis occurring in developed countries where poliomyelitis has virtually been eradicated. The authors report two cases of acute anterior poliomyelitis in young adults, in which the poliovirus recovered from the faeces might have been of vaccinal origin. Virological techniques do not always characterize the strains isolated, nor distinguish between a vaccinal mutant and a wild poliovirus. These data, together with previously published cases, have prompted the authors to discuss whether the use of a live poliovaccine is justified.

A perspective for understanding moral commitment: the physicians' case.

For an exchange to occur in a commercial setting between a salesperson and a customer is one thing; for an exchange to occur in a health care setting between a physician and a patient is another matter. Traditional marketing exchange literature is mostly concerned about discrete relationships in commercial settings. Such concern has encouraged a narrow view of loyalty toward the customer. This paper borrows ideas from marketing and other related sources, and examines the physician's commitment to the patient, stressing in the process the importance of moral commitment.

Determinant of hospital marketing effectiveness: the importance of conflict.

As hospitals and health organizations become more marketing oriented, and more interwoven into the environment, the more they face internal resistance. The careful handling of conflict not only helps the health care marketer to overcome hostility and antagonism, but also rewards the health care institution with the "productivity of confrontation."

In search of superior hospital management: a comparative analysis.

In post-socialist Europe, the emergence of a consumer-oriented change in health care management will take time, given the outdated framework in which centralized systems stagnated over the years. Based on personal interviews in two European countries, this study compares the experience of hospital unit general managers (HUGMs) in England and hospital medical superintendents (HMSs) in post-socialist Malta.

[Serological study of the occurrence of Herpesviridae in French Guyana]. / Etude sérologique de la prévalence des Herpesviridae en Guyane française.

300 samples of serum (in seven age-groups) from the "creole" population of french Guiana were tested for antibodies to the four human herpesviruses (HSV, VZV, CMV and EBV). Results show the higher prevalence of CMV and EBV in early childhood, HSV primary infection appears to take place earlier in life than in temperate and developed countries, but later than in other tropical countries. The pattern of VZV epidemiology in french Guiana is consistent with what is known in tropical countries: varicella is also a disease of adolescents and young adults. CMV appears to be more prevalent in women than in men between 21 and 40.

[Comparative study of the prevalence of Herpesviridae in an African population and a European population]. / Etude comparative de la preévalence des herpesviridae dans une population africaine et dans une population européenne.

We have looked for long-term antibodies to Herpesviridae (HSV, VZV, CMV, EBV) in an African population (suburban area of Dakar, Senegal, West Africa) and in a European population (urban area of Bordeaux, France) in order to determine the prevalence of these viruses. The studied sera have been dispatched into 5 age-groups: 6 months to 4 years, 5 years to 9 years, 10 years to 14 years, 15 years to 44 years and greater than 45 years. We note that primary infection with Herpesviridae occurs sooner in life in Africa and that the prevalence rates of these viruses are higher in Africa with the exception of EBV, the prevalence of which is almost identical within the fifth age-group of the African and European populations. The prevalence rates of each individual virus are in agreement with previous studies except for VZV which we describe as the least prevalent virus of the family. The interest of this work is a simultaneous comparison of the prevalence of all viruses of the family Herpesviridae within two different populations.