High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020.

BACKGROUND: Elderly people in nursing homes are particularly vulnerable to COVID-19 due to their age, the presence of comorbidities, and community living. On March 14, 2020, at the beginning of the first epidemic wave of COVID-19 in France, a cluster was reported in a nursing home in the Nouvelle-Aquitaine region. We monitored the outbreak as well as the infection prevention and control (IPC) measures implemented. METHODS: A confirmed case was defined as laboratory-confirmed COVID-19 in a resident or staff member present in the nursing home between March 7 and May 1, 2020; and a probable case as a person presenting an acute respiratory illness after contact with a confirmed case. Symptomatic inpatient residents and symptomatic staff members were systematically tested for SARS-CoV-2. In addition, two screening sessions were held on site. RESULTS: We identified 109 cases (98 confirmed, 11 probable). The attack rate was 66% among residents and 45% among staff. Half of all cases were identified during the screening sessions. One-quarter of cases had minor symptoms or were asymptomatic. The case fatality rate among residents was 29%. IPC measures were rapidly implemented such as the quarantine of residents, the reinforcement of staff personal protective equipment, and home quarantine of staff testing positive, which were supplemented in April by systematic controls at the entrance of the nursing home and the creation of additional staff break rooms. CONCLUSIONS: This outbreak confirmed the considerable health impact of SARS-CoV-2 transmission in a nursing home. In addition to the implementation of IPC measures, the early detection of cases through the screening of residents and staff is essential to identify asymptomatic and pre-symptomatic cases and limit the spread of the virus.

Analysing spectral changes over time to identify articulatory impairments in dysarthria.

Identifying characteristics of articulatory impairment in speech motor disorders is complicated due to the time-consuming nature of kinematic measures. The goal is to explore whether analysing the acoustic signal in terms of total squared changes of Mel-Frequency Cepstral Coefficients (TSC_MFCC) and its pattern over time provides sufficient spectral information to distinguish mild and moderate dysarthric French speakers with Amyotrophic Lateral Sclerosis (ALS) and Parkinson's Disease (PD) from each other and from healthy speakers. Participants produced the vowel-glide sequences /ajajaj/, /ujujuj/, and /wiwiwi/. From the time course of TSC_MFCCs, event-related and global measures were extracted to capture the degree of acoustic change and its variability. In addition, durational measures were obtained. For both mild and moderately impaired PD and ALS speakers, the degree of acoustic change and its variability, averaged over the complete contour, separated PD and ALS speakers from each other and from healthy speakers, especially when producing the sequences /ujujuj/ and /wiwiwi/. Durational measures separated the moderate ALS from healthy and moderate PD speakers. Using the approach on repetitive sequences targeting the lingual and labial articulators to characterize articulatory impairment in speech motor disorders is promising. Findings are discussed against prior findings of articulatory impairment in the populations studied.

Complete coding regions of the prototypes enterovirus B93 and C95: phylogenetic analyses of the P1 and P3 regions of EV-B and EV-C strains.

Complete coding regions were sequenced for two new enterovirus genomes: EV-B93 previously identified by VP1 sequencing, derived from a child with acute flaccid paralysis in the Democratic Republic of Congo; and EV-C95 from a French soldier with acute gastroenteritis in Djibouti. The EV-B93 P1 had more than 30% nucleotide divergence from other EV-B types, with highest similarity to E-15 and EV-B80. The P1 nucleotide sequence of EV-C95 was most similar, 71%, to CV-A21. Complete coding regions for the new enteroviruses were compared with those of 135 EV-B and 176 EV-C strains representing all types available in GenBank. When strains from the same outbreak or strains isolated during the same year in the same geographical region were excluded, 27 of the 58 EV-B, and 16 of the 23 EV-C types were represented by more than one sequence. However, for EV-B the P3 sequences formed three clades mainly according to origin or time of isolation, irrespective of type, while for EV-C the P3 sequences segregated mainly according to disease manifestation, with most strains causing paralysis, including polioviruses, forming one clade, and strains causing respiratory illness forming another. There was no intermixing of types between these two clades, apart from two EV-C96 strains. The EV-B P3 sequences had lower inter-clade and higher intra-clade variability as compared to the EV-C sequences, which may explain why inter-clade recombinations are more frequent in EV-B. Further analysis of more isolates may shed light on the role of recombinations in the evolution of EV-B in geographical context.

[Thermal ablation: tolerance and efficacy in a population mostly composed of primary lung cancers]. / Thermo-ablation pulmonaire: tolérance et efficacité thérapeutique dans une population constituée majoritairement de tumeurs primitives pulmonaires.

PURPOSE: Radiofrequency thermal ablation (TA) of lung tumors currently is considered an alternative to surgical management for early primary lung cancers and non-surgical lung metastases. The purpose of this study was to determine the tolerability and efficacy of this treatment in 29 consecutive patients, most of which with primary lung cancers, managed in our center. MATERIALS AND METHODS: Twenty-nine patients with 32 lung tumors less than 35 mm in diameter underwent radiofrequency thermal ablation between May 2004 and July 2008. The CT examinations performed during and after the ablation were reviewed to determine lesion characteristics, complications, treatment, local recurrence rate and survival rate. RESULTS: Sixty-nine percent of our population consisted of primary lung cancer. The incidence of pneumothorax was 72% with 10% requiring drainage. The rate of complete response was 81%. The survival rate at 1 year was 79%. CONCLUSION: Radiofrequency thermal ablation of lung tumors is a minimally invasive technique with high rate of complete response. It can be considered in non-surgical patients with primary or metastatic lung tumors less than 35 mm in diameter.

Laryngeal Kaposi sarcoma: case report and literature review.

PROBLEM/OBJECTIVE: Kaposi sarcoma is the most frequently-occurring neoplasm in AIDS patients. Laryngeal localization is infrequent. We discuss the management options for laryngeal Kaposi sarcoma based on a literature review. CASE REPORT: A 42 year old, HIV-positive male receiving HAART therapy presented with mild hoarseness and sore throat. Fiberoptic laryngeal examination identified a small purple lesion in the right ventricular fold. He underwent biopsy under general anaesthesia. The lesion was histologically diagnosed as a Kaposi sarcoma. Systemic treatment was pursued, but 6 weeks later the patient developed severe dysphagia and acute airway obstruction when the lesion became glotto-supraglottic and obstruced the airway. Transoral tumour vaporization with a CO2 laser was performed in the emergency department. Post-operative chemotherapy was administered. Three months later, the patient was completely asymptomatic and the laryngeal examination was normal. CONCLUSION: Transoral CO2 laser vaporization combined with chemotherapy is a valid option for managing obstructive laryngeal Kaposi sarcoma.

Role of Mycoplasma pneumoniae in pediatric encephalitis.

A retrospective study investigating all the infectious encephalitis cases hospitalized at the pediatric intensive care unit of Edouard Herriot University Hospital in Lyon, France, was carried out in order to estimate the prevalence of Mycoplasma pneumoniae in acute childhood encephalitis. From January 2001 to December 2005, the cases of 29 children were selected and reviewed. M. pneumoniae related encephalitis was considered as probable in five cases (17%) on the basis of positive serological tests or positive polymerase chain reaction (PCR) tests in throat or nasopharyngeal swab while the PCR tests performed from the cerebrospinal fluid were negative. This study suggests that M. pneumoniae may be a major cause of infectious encephalitis in children as well as enteroviruses or Epstein-Barr virus detected in five and three cases, respectively.

[Stenting for superior vena cava obstruction associated with lung cancer: monocentric study]. / Mise en place précoce d'une endoprothèse dans les syndromes de la veine cave supérieure: étude monocentrique.

INTRODUCTION: Superior vena cava obstruction is an urgent complication of lung cancer. Superior vena cava stent insertion can be considered to provide rapid relief of the symptoms. METHODS: To estimate the efficiency and the complications of this procedure, we retrospectively analyzed 41 consecutive patients treated during the last 5 years by self-expanding nitinol stent insertion for superior vena cava obstruction due to lung cancer. It was combined with anticoagulation and corticosteroids. RESULTS: 41 patients benefited from this treatment (30 men and 11 women) with an average age of 59 years. Etiologies of the vena cava obstruction were: small cell carcinoma (11), adenocarcinoma (8), squamous cell carcinoma (9), large cell carcinoma (9) and others (4). All patients were symptomatic. The average period between the onset of symptoms and the vascular stenting was 14 days. Specific treatment was chemotherapy (18 patients), radiotherapy (1 patient), or both (14 patients), and no specific treatment for 6 patients. The procedure consisted of the insertion of 1 (73%) or 2 (27%) stents, with an average length and caliber of 7.5 cm and 14 mm respectively. No major complication was reported in short and long-term follow up. Symptomatic improvement was observed for all the patients within 48 hours. Median survival after the stenting was of 6.7 months. CONCLUSION: In our study, vascular stenting for malignant superior cava vena obstruction allows a rapid improvement of the symptoms with very few complications, suggesting a possible role as first line treatment for chemo or radio-resistant tumours.

Dual infections by influenza A/H3N2 and B viruses and by influenza A/H3N2 and A/H1N1 viruses during winter 2007, Corsica Island, France.

BACKGROUND: The investigation of dual influenza infection human cases is of major interest specifically for the control of new emerging influenza strains. OBJECTIVES: Using RT-PCR assays, we retrospectively assessed the prevalence of dual influenza virus infections that occurred in patients during the 2006-2007 winter season in Corsica Island (France). STUDY DESIGN: One hundred and thirty-four nasal swabbing samples taken from patients suffering from influenza-like illness between February and March 2007 were analysed using a rapid influenza antigen detection test, cell culture and RT-PCR assays. RESULTS AND CONCLUSION: Influenza viruses were detected in 93 (69.4%) of 134 patients with influenza-like illness using the combination of classical and molecular assays. Dual respiratory infections by influenza viruses were detected in 3 (3.2%) of the 93 influenza positive patients, including two cases of infection by influenza A/H3N2 and B viruses and one case of dual infection by influenza A/H3N2 and A/H1N1 viruses. In the present report, human co-infection cases by two influenza viruses appeared as a rare event in symptomatic patients. However, the virological and epidemiological mechanisms that determine the occurrence of dual influenza infections remain to be fully investigated in further prospective multicentric studies.

[Enterovirus-related pericarditis and mediastinitis after heart surgery: a case report]. / Péricardite et médiastinite à entérovirus après chirurgie cardiaque: description d'un cas.

We report a case of enterovirus related pericarditis associated to mediastinitis in a hospitalised 53-year-old male after heart surgery. Mediastinitis caused by enterovirus has not previously been described.

Congenital dacryocystocele: five clinical cases.

Congenital dacryocystocele (CDC) is recognised as a cause of nasal airway obstruction or respiratory distress in newborns. CDC is caused by the distal obstruction of the lachrymal duct and presents as a cystic formation in the inferior meatus. We discuss five cases of dacryocystocele, together with surgical management and outcome. Endoscopic endonasal marsupialisation and appropriate postoperative care resulted in definitive recovery for all patients. In newborns or infants with nasal obstruction, CDC should be considered in the differential diagnosis, and prompt endoscopic endonasal marsupialisation is mandatory.

[Enteroviruses receptors and cell entry]. / Récepteurs et voies d'entrée des entérovirus dans la cellule cible.

Human enteroviruses, which belong to the family of Picornaviridae, are common infectious viral agents transmitted by fecal-oral or airway routes. These positive RNA viruses possess a high genetic diversity and variability. They can evolve through genetic mutations or recombination mechanisms that are associated to the emergence of new potential epidemic serotypes. Human enteroviruses use different cellular receptors: receptors and co-receptors that are directly related to the tropism and the epidemiologic characteristics of some enterovirus serotypes. The receptors onto the cell-surface settle within a capsid depression, called canyon, initiating the process of viral uncoating. For some enteroviruses, a co-receptor molecule allows the crossing of cell topological barriers that is required to initiate the target cell infection. After the attachment phase, enteroviruses use the endocellar signaling pathways to support and optimize their entry into target-cells via endocytic pathways. The clathrin coated pits and the caveolae are both major ways of enterovirus entry in the cell even if "new" endocytic pathways regulated by enzymes of theADP ribosylation factors family and of the Rho family small GTPases have been recently described. The viral genetic diversity allows the human enteroviruses to simultaneously or alternatively use several distinct endocytic pathways in accordance to the infected cell lines, and allows a rapid and efficient adaptation to cellular microenvironments and to multiple immune selection pressures developed during the pathophysiological course of human infection. In conclusion, entry mechanisms used by human enteroviruses to infect target cells are various but they are closely dependent on the cellular functions that will be driven towards viral benefits. In the present time, the attachment and entry phases of the human enteroviruses into the target cell represent major viral events that may be targeted for the development of further new antiviral strategies.

[Characterisation of viral agents with potential to cause diarrhea in Djibouti]. / Caractérisation des virus agents potentiels des diarrhées chez l'adulte à Djibouti.

Due to limited laboratory facilities in the tropics, the exact role of enteric viruses in causing diarrhea among adults in the tropics is unknown. The purpose of this report is to describe a multicenter study undertaken in Djibouti to determine the prevalence of a large panel of enteric viruses using immunochromatography; antigenic detection by ELISA, RT-PCR cellular inoculation, sequence analysis; and indirect serology. Study samples were collected from 108 patients presenting acute and sporadic diarrhea. Although they are well known causes of diarrhea in children, rotavirus and adenovirus were identified in only 2 and 5% of adults respectively. In contrast human caliciviruses (HuCVs) and enterovirus were identified in 25 and 42% of adult cases respectively. Uncommon genotypes of HuCVs and recombinant forms (junction pol/l cap) as well as a significant number of sapovirus (30%) were identified. Further study is needed to clarify the role of enterovirus (echovirus) in the etiology of acute diarrhea in adults. No polivirus was identified. These new data from the Horn of Africa increase our knowledge about the epidemiology of acute infectious diarrhea that is a major public health problem and potential danger for travelers.

Low serum selenium concentrations in French patients with measles.

OBJECTIVE: Selenium deficiency adversely affects the clinical outcome of measles in the tropics. In developed countries, serum selenium level has never been investigated during acute measles. The aim of this study was to determine serum selenium concentrations in French patients with acute measles and to seek correlations with clinical and virological findings. PATIENTS AND METHODS: We studied serum selenium concentrations in 94 French patients with acute measles and in 99 healthy controls matched for age and sex. RESULTS: The mean of selenium concentration was significantly lower in the patients than in the controls (46.4±14.1µg/L versus 86.5±13.9µg/L, P<0.0001). In the patients, selenium concentrations were not associated with age, sex, vaccination status, clinical signs or specific antibody responses. Selenium levels did not differ significantly between patients with uncomplicated measles (45.8±14.2µg/L) and patients with complications (52.7±13.2µg/L) (P=0.15). CONCLUSION: Acute measles is associated with significant reduction of selenium level that did not seem to negatively affect the course of the disease suggesting compensating mechanisms in patients from developed countries against the disease.

Use of a molecular form technique for the penetration of supersaturated solutions of salicylic acid across silicone membranes and human skin in vitro.

Permeation enhancement of salicylic acid (SA) from supersaturated solutions formed using a 'molecular form' technique was investigated. In a conventional cosolvent technique, two solvents are used, one in which the drug is considerably more soluble than the other. Propylene glycol and water have been predominantly used as cosolvents to create supersaturation in skin permeation enhancement. In this paper, we report the use of buffer solutions with different pHs as media for producing different molecular forms. Supersaturated solutions were prepared using pH 8:pH 2 (80:20 v/v), which gave a nominal pH when mixed of around 5. Model silicone membranes and human skin were used. Hydroxypropyl methyl cellulose (HPMC) was employed to stabilise the supersaturated states. Stability data showed that while the SA supersaturated solutions without HPMC crystallised between 15 min and 46 h depending on the degree of supersaturation, the solutions with HPMC were stable for more than 2 months. The flux of SA increased with the degree of saturation for solutions prepared in a 80:20 buffer pH 8/buffer pH 2 mixture. Although the fluxes of SA with and without HPMC were similar both through silicone membrane and human skin, HPMC was found to be effective in increasing the stability of supersaturated solutions of SA.

[Speech therapy guidelines in patients with amyotrophic lateral sclerosis]. / Quelles sont les modalités de la prise en charge orthophonique des patients atteints de sclérose latérale amyotrophique?

Bulbar involvement is usual in patients with amyotrophic lateral sclerosis (ALS), leading to a progressive loss of speech, phonation and swallowing abilities. The goal of the speech therapy is to maintain, as long as possible, those abilities and to devise alternative communication strategies when oral communication is ineffective. This paper presents guidelines for speech therapy during disease progression.

Advances in the metabolic profiling of acidic compounds in children's urines achieved by comprehensive two-dimensional gas chromatography.

The main objective of this work was to evaluate a comprehensive two-dimensional gas chromatographic (GCxGC) coupled to quadrupole mass spectrometry (qMS) method in the field of biomarker candidates' discovery. To this purpose we developed a GCxGC-qMS method suitable for the separation of organic acids and other classes of compounds with silylable polar hydrogen such as sugars, amino-acids, and vitamins. As compared to those obtained by a widely used 1D-GC method, the urinary chromatographic profiles performed by the proposed 2D-GC method exhibit higher resolution and sensitivity, leading to the detection of up to 92 additional compounds in some urine samples including some well-known biomarkers. In order to validate the proposed method we focused on three metabolites of interest with various functional groups and polarities including CH3-malonic acid (MMA: biomarker of methylmalonic acidemia), 3-hydroxy-3-methyl-glutaric acid (3-OHMGA: biomarker of 3-hydroxy-3-methylglutaric acidemia), and phenylpiruvic acid (PhPA: marker of phenylketonuria). While these three metabolites can be considered as representative of organic acids classically determined by 1D-GC, they cannot be representative of new detected metabolites. Thus, we also focused on quinolic acid (QUIN), taken as an example of biomarker not detected at basal levels with the classical 1D GC-qMS method. In order to obtain sufficient recoveries for all tested compounds, we developed a sample preparation protocol including a step of urea removal followed by two extraction steps using two solvents of different polarity and selectivity. Recoveries with the proposed method reached more than 80% for all targeted compounds and the linearity was satisfactory up to 50µmol/L. The CVs of the within-run and within-laboratory precisions were less than 8% for all tested compounds. The limits of quantification (LOQs) were 0.6µmol/L for MMA, 0.4µmol/L for 3-OHMGA, 0.7µmol/L for PhPA, and 1µmol/L for QUIN. The LOQs of these metabolites obtained by a classical GC-MS method under the same chromatographic conditions were 5µmol/L for MMA, 4µmol/L for 3-OHMGA, 6µmol/L for PhPA while QUIN was below the limit of detection. As compared to 1D-GC, these results highlight the enhanced detectability of urine metabolites by the 2D-GC technique. Our results also show that for each new detected compound it is necessary to develop and validate an appropriate sample preparation procedure.

Quantitation of LH subunits released by rat anterior pituitary cells in primary culture.

Immunoreactive rLH, rLH alpha, rLH beta and rFSH in the cell extracts and medium of rat anterior pituitary cell cultures were measured after gel filtration on Sephadex G-100 Superfine. Cell extracts contained uncombined rLH alpha and rLH beta present as approximately 40% and 4%, respectively, of native rLH on a molar basis. Unstimulated cultures appeared to release a large excess of rLH alpha (approximately 2560% of rLH on a molar basis) as well as a minimum of uncombined rLH beta. Stimulation of cultures with physiological (LHRH) or non-physiological agents (A23187, elevated K+) increased the absolute but not the relative quantities of uncombined subunits released relative to those present intracellularly. Thus, rat anterior pituitary cell cultures appear to produce and release an excess of free alpha subunit as well as a minimum of uncombined rLH beta. However, one cannot be certain whether the uncombined rLH beta represents a pool of 'free' rLH beta or simply results from the dissociation of rLH.

Comparison of Franz cells and microdialysis for assessing salicylic acid penetration through human skin.

The purpose of the present study was to compare Franz cells (FC) and microdialysis (MD) for monitoring the skin absorption of salicylic acid (SA). The influence of pH on SA flux was also assessed by these two techniques. Excised abdominal human skin was used in the experiments. SA was dissolved in phosphate buffer solutions of pH 2, 5 and 7 (2 mg/ml). SA concentrations in the receptor FC solutions and in MD samples were assessed by high performance liquid chromatography (HPLC). The results demonstrate that the flux of SA decreased with increased pH. The profiles permeation determined by Franz cells and microdialysis were similar. However, whatever the pH, the SA flux was higher with microdialysis than with Franz cells. The results showed that SA percutaneous permeation conformed to the pH partition hypothesis. The flux of SA was different when it was determined by the two techniques. The collect of SA, by these two techniques is different. The results of the two techniques are compared and discussed.

[An analysis of treatment delays of thoracic cancers: a prospective study]. / Analyse des délais de prise en charge des cancers thoraciques: étude prospective.

INTRODUCTION: Lung cancer is the main cause of cancer death in France. The diagnosis is often late and the delay between the onset of symptoms and management is considered an aggravating factor. MATERIAL AND METHODS: Our prospective study collected the dates of the start of management of 139 consecutive patients receiving first line treatment for thoracic cancer in our hospital between November 2008 and May 2009. The aim of this study was to evaluate the delays in medical or surgical treatments in patients with thoracic cancer and to determine the cause of these delays. RESULTS: The median delay between the first abnormal chest X-ray and treatment was 9.6 weeks. The delays were significantly shorter in the late stages and in small cell cancer (P=0.001). There was a tendency for shorter delays in women and for longer delays in older patients. CONCLUSION: Evaluation of the delays in treatment, particularly in the early stages, is part of the quality control of management of these diseases.