[Risk factors for hepatitis C virus transmission to Health Care Workers after occupational exposure: a European case-control study]. / Facteurs de risque de transmission accidentelle du VHC au personnel soignant au décours d'un accident exposant au sang: une étude cas-témoins européenne.

BACKGROUND: Factors that influence the risk for HCV infection after occupational exposure to hepatitis C virus (HCV) have not yet been determined. The objective of this study was to assess potential risk factors for Hepatitis C seroconversion after occupational exposure to HCV. METHODS: We conducted a European matched case-control study from 01/01/1991 through 31/12/ 2002. Cases were Health Care Workers (HCWs) who were HCV seronegative at the time of exposure, sustained a documented exposure to HCV, and present documented HCV seroconversion temporally associated with the exposure. Controls-HCWs had a documented exposure to HCV, were HCV seronegative at the time of exposure, and remained so at least 6 months later. Controls were matched to cases for the center and the time period of the exposure occurrence. RESULTS: 60 cases and 204 controls were included. All cases were exposed to HCV-infected materials through percutaneous injuries. Those for whom information was available (61.6%) were exposed to viremic source patients. Multivariate conditional logistic regression analysis, in which HCV viral load was not introduced because of missing values, identified needle placed in the source patient's vein or artery (Odds Ratio [OR]=100.1; 95% Confidence Interval [CI]=7.3-1365.7), deep injury (OR=155.2; 95%CI=7.1-3417.2), and HCW's gender (M vs. F: OR=3.1; 95%CI=1.0-10.0) as risk factors for HCV infection. In univariate unmatched analysis the risk of HCV transmission was increased 11-fold (C195%=1.1-114.1) in HCWs exposed to sources with a viral load>6 log10 copies/mL when compared to sources with a HCV viral load<4 log10 copies/mL. CONCLUSION: The risk of HCV transmission after percutaneous exposure increases with a larger volume of blood, and, a higher titer of HCV in the source patient's blood. The role of HCW's gender need to be further investigated. The results of this study have important implications for counselling and follow-up of HCWs after exposure.

Risk factors for hepatitis C virus transmission to health care workers after occupational exposure: a European case-control study.

BACKGROUND: Additional studies are required to identify risk factors for hepatitis C virus (HCV) transmission to health care workers after occupational exposure to HCV. METHODS: We conducted a matched case-control study in 5 European countries from 1 January 1991 through 31 December 2002. Case patients were health care workers who experienced seroconversion after percutaneous or mucocutaneous exposure to HCV. Control subjects were HCV-exposed health care workers who did not experience seroconversion and were matched with case patients for center and period of exposure. RESULTS: Sixty case patients and 204 control subjects were included in the study. All case patients were exposed to HCV-infected fluids through percutaneous injuries. The 37 case patients for whom information was available were exposed to viremic source patients. As risk factors for HCV infection, multivariate analysis identified needle placement in a source patient's vein or artery (odds ratio [OR], 100.1; 95% confidence interval [CI], 7.3-1365.7), deep injury (OR, 155.2; 95% CI, 7.1-3417.2), and sex of the health care worker (OR for male vs. female, 3.1; 95% CI, 1.0-10.0). Source patient HCV load was not introduced in the multivariate model. In unmatched univariate analysis, the risk of HCV transmission increased 11-fold for health care workers exposed to source patients with a viral load >6 log(10) copies/mL (95% CI, 1.1-114.1), compared with exposures to source patients with a viral load < or =4 log10 copies/mL. CONCLUSION: In this study, HCV occupational transmission was found to occur after percutaneous exposures. The risk of HCV transmission after percutaneous exposure increased with deep injuries and procedures involving hollow-bore needle placement in the source patient's vein or artery. These results highlight the need for widespread adoption of needlestick-prevention devices in health care settings, together with other preventive measures.

[Calcifying obstructive disease of the descending thoracic aorta]. / Maladie obstructive calcifiante de l'aorte thoracique descendante.

The authors present the first surgically treated case of calcifying obstructive disease of the descending thoracic aorta. The diagnosis was based upon the coexistence of an aortic isthmus coarctation syndrome together with massive calcifications seen by chest X-ray. The aetiology remains uncertain but the authors tend in favour of an atheromatous aetiology. Cure was obtained by simple surgical treatment.

[Study of the effect of dopamine on renal excretion in chronic renal failure (author's transl)]. / Effets de la dopamine sur l'excrétion rénale dans i'insuffisance rénale chronique.

The effects of dopamine on renal excretory function were studied in 20 patients with chronic renal failure (plasma creatinine higher than 30 mg/i). Effects were marked at a dose of 2 micrograms/kg/mn and were no greater at a dose of 5 micrograms/kg/mn (10 subjects in each case). In general, creatinine clearance increased by 28%, urea excretion by 45%, urine output by 77% and urinary sodium output by 164%. In ten patiens with terminal renal failure (plasma creatinine greater than 100 mg/i), the effects of dopamine were maintained. In these individuals, furosemide (250 mg by single intravenous injection) resulted in a higher total urine and urinary sodium output but had a less favourable effect upon creatinine.

[The abnormalities of carbohydrate and lipid metabolism in uremia. A study in 20 hemodialyzed patients (author's transl)]. / Les anomalies du métabolisme des glucides et des lipide chez l'urémique. Etude chez 20 malades hémodialysés.

The glucose tolerance and serum lipids pattern were studied in 20 hemodialyzed patients after 8 and 12 hours of fasting. They all were non-obese uremics under 40 years of age. The test was conducted according to the nutritional conditions of the protocol of de Gennes. Fasting hyperglycemia and an abnormal glucose tolerance test were observed in 75% of the patients. The basal serum insulin levels were increased in 80% of the cases. 40% of the population studied exhibited significant hypertriglyceridemia after 12 hours and 65% after only 8 hours of fasting. Thus, this protocol was useful for detecting abnormalities in the metabolism of triglycerides in hemodialized patients with few baseline disturbances. The normal levels of serum tryglycerides at 12 hours could be explained by 1) the relatively young age of the population studied and 2) dialysis with glucose free solutions.

Pharmacokinetics of atenolol in patients with terminal renal failure and influence of haemodialysis.

1 The pharmacokinetics of atenolol, after 200 mg orally, were studied in 18 patients with terminal renal insufficiency (creatinine clearance less than 5 ml/min), of whom twelve were being treated by chronic dialysis. 2 The peak plasma level, 1.59 +/- 0.43 mg/l, was reached in 4.7 +/- 2.1 h. 3 Without dialysis treatment, the apparent plasma half-life of atenolol was greatly increased (73.4 +/- 28.8 /). During dialysis, it dropped to 7.5 +/- 3.7 h but returned to 51.2 +/- 17.3 h after dialysis. The plasma atenolol plot was a rising slope for a few hours after the end of dialysis. 4 Renal clearance of atenolol was very low (4.6 +/- 1.5 ml/min). 5 Plasma clearance during dialysis was 42.6 +/- 21.3 ml/min for a mean blood flow-rate of 236 +/- 25 ml/min through a cuprophane membrane dialyser. 6 These results suggest that dosage should be modified for these patients.

[Microangiopathy of the diabetic type, without carbohydrate intolerance (author's transl)]. / Microangiopathie de type diabétique sans intolérance aux hydrates de carbone.

Pathophysiology of diabetic microangiopathy is unclear, but hyperglycemia is admitted as an important factor. In three patients having microangiopathy with lesions very similar to those of diabetes (one nodular glomerulosclerosis, two retinopathies), glucose tolerance was found normal. Such cases, already reported, but rather rare, raise the question of the validity of tests currently used in the diagnosis of diabetes, of the importance of hyperglycemia compared to others factors (specially genetic) in the occurrence of microangiopathy, and of the specificity of these lesions.

[The abnormalities of carbohydrate and lipid metabolism in uremia. A study in 20 hemodialyzed patients (author's transl)]. / Les anomalies du métabolisme des glucides et des lipides chez l'urémique. Etude chez vingt malades hémodialysés.

The glucose tolerance and serum lipids pattern were studied in 20 hemodialyzed patients after 8 and 12 hours of fasting. They all were non-obese uremics under 40 years of age. The test was conducted according to the nutritional conditions of the protocol of de Gennes. Fasting hyperglycemia and an abnormal glucose tolerance test were observed in 75% of the patients. The basal serum insulin levels were increased in 80% of the cases. 40% of the population studied exhibited significant hypertriglyceridemia after 12 hours and 65% after only 8 hours of fasting. Thus, this protocol was useful for detecting abnormalities in the metabolism of triglycerides in hemodialyzed patients with few baseline disturbances. The normal levels of serum triglycerides at 12 hours could be explained by 1) the relatively young age of the population studied and 2) dialysis with glucose free solutions.

[Pseudocoarctation caused by a calcified intra-aortic mass]. / Pseudo-coarctation due à une masse intra-aortique calcifiée.

Weak or absent lower limb pulses and a thoracic systolic murmur in a fifty-seven-year-old woman with hypertension suggested coarctation. Thoracic X-Ray showed a narrowing of the thoracic aorta over 10 cm due to an intraluminal calcified aortic mass. The remaining aorta and its branches were normal. Histologic examination of the operative specimen found atherosclerotic lesions with thrombosis. This very unusual condition seems to represent an individual entity of which a few cases have been reported in the literature.

Hepatitis A among health workers in Paris hospitals. Occupational Health Physicians of Paris Hospital (AP-HP).

To design a vaccination strategy against hepatitis A among hospital employees, we carried out a serological survey of hepatitis A virus (HAV) infection in 10 university hospitals in the Paris area. Subjects under 60 years of age were consecutively enrolled by occupational health services and tested for IgG to HAV by ELISA. Of the 1,516 subjects recruited, 926 were health workers (HW), 322 clerks, and 268 cooks or kitchen employees. Among HW and clerks the HAV seroprevalence was 53.8% (95% CI: 44.0-65.6), increasing with age and being higher among employees of African or Caribbean origin than those from Europe (83.6% vs 45.6%, P < .001). Age correlated closely with the duration of hospital work, so only age was taken into account for further analysis. The HAV seroprevalences among HW and clerks originating from Europe were close (46.8% vs 42.6%) and remained so after adjustment for age. HAV seroprevalences in HW caring for adults and those caring for children were also similar (45.2% vs 40.1%). Seroprevalence was higher in assistant nurses than in nurses (51.3% vs. 39.8%, P < .02). Among cooks and kitchen employees, 53.4% were HAV-seropositive. This study shows that hospital employees need not routinely be vaccinated against HAV; the decision should be taken by the occupational physician according to the type of work, but should be routine for cooks and kitchen employees. The need for prevaccinal screening for anti-HAV should be assessed in the light of employees' geographical origin and age.

Hepatitis A among health workers in Paris hospitals. Occupational Health Physicians of Paris Hospital (AP-HP)

To design a vaccination strategy against hepatitis A among hospital employees, we carried out a serological survey against hepatitis A virus (HAV) infection in 10 university hospitals in the Paris area. Subjects under 60 years of age were consecutively enrolled by occupational health services and tested for IgG to HAV by ELISA. Of the 1,516 subjects recruited, 926 were health workers (HW), 322 clerks, and 268 cooks or kitchen employees. Among HW and clerks the HAV seroprevalence was 53.8 percent (95 percent CI: 44.0-65.6), increasing with age and being higher among Europe (83.6 percent vs 45.6 percent, P < .001). Age correlated closely with the duration of hospital work, so only age was taken into account for further analysis. The HAV seroprevalences among HW and clerks originating from Europe were close (48.8 percent vs 42.6 percent) and remained so after adjustment for age. HAV seroprevalences in HW caring for adults and those caring for children were also similar (45.2 percent vs 40.1 percent). Seroprevalence was higher in assistant nurses than in nurses (51.3 percent vs 39.8 percent, P < .02). Among cooks and kitchen employees, 53.4 percent were HAV-seropositive. This study shows that hospital employees need not routinely be vaccinated against HAV; the decision should be taken by the occupational physician according to the type of work, but should be routine for cooks and kitchen employees. The need for prevaccinal screening for anti-HAV should be assessed in the light of employees' geographical origin and age.(Au)