Surveillance of avian influenza in the Caribbean through the Caribbean Animal Health Network: surveillance tools and epidemiologic studies.

The Caribbean region is considered to be at risk for avian influenza (AI) due to a large backyard poultry system, an important commercial poultry production system, the presence of migratory birds, and disparities in the surveillance systems. The Caribbean Animal Health Network (CaribVET) has developed tools to implement AI surveillance in the region with the goals to have 1) a regionally harmonized surveillance protocol and specific web pages for AI surveillance on www.caribvet.net, and 2) an active and passive surveillance for AI in domestic and wild birds. A diagnostic network for the Caribbean, including technology transfer and AI virus molecular diagnostic capability in Guadeloupe (real-time reverse transcription-polymerase chain reaction for the AI virus matrix gene), was developed. Between 2006 and 2009, 627 samples from four Caribbean countries were tested for three circumstances: importation purposes, following a clinical suspicion of AI, or through an active survey of wild birds (mainly waders) during the southward and northward migration periods in Guadeloupe. None of the samples tested were positive, suggesting a limited role of these species in the AI virus ecology in the Caribbean. Following low pathogenic H5N2 outbreaks in the Dominican Republic in 2007, a questionnaire was developed to collect data for a risk analysis of AI spread in the region through fighting cocks. The infection pathway of the Martinique commercial poultry sector by AI, through introduction of infected cocks, was designed, and recommendations were provided to the Caribbean Veterinary Services to improve cock movement control and biosecurity measures. The CaribVET and its organization allowed interaction between diagnostic and surveillance tools on the one hand and epidemiologic studies on the other, both of them developed in congruence with regional strategies. Together, these CaribVET activities contribute to strengthening surveillance of avian influenza virus (AIV) in the Caribbean region and may allow the development of research studies on both AI risk analysis and on AIV ecology.

[Perioperative perfusion in children: evaluation of a new perfusion solution]. / Perfusion périopératoire chez l'enfant: évaluation d'un soluté de perfusion.

A new intravenous solution (B66) containing 0.9% dextrose in water for infusion therapy in infants and children was assessed. Forty-one children, aged between 6 months and 11 years, scheduled for elective non haemorrhagic surgery, were randomly assigned to two groups: children in group I (n = 22) were given 1% dextrose in lactated Ringer's solution (RLG1), and those in group II (n = 19) the commercially available solution B66 (0.9% dextrose in lactated Ringer's solution). The fluids were administered throughout the study with volumetric infusion pumps (IVAC 541). The infusion rate was adapted to children's weight and age. Blood samples for blood glucose, sodium and protein concentration assessments were obtained at induction (T0), on arrival in the recovery room (T1), than 30 and 60 min later (T2 and T3). Preoperative blood glucose concentrations were within the normal range for all children except for two, who had asymptomatic hypoglycaemia (2.2 and 2.3 mmol.l-1). Postoperative blood glucose concentrations were higher in both groups. This increase was significantly greater in the RLG1 group than in the B66 group. The highest mean figures at T1 were 6.8 +/- 1.5 mmol.l-1 and 5.2 +/- 1.0 mmol.l-1 in the RLG1 and B66 groups respectively. Total protein levels decreased postoperatively significantly in both groups. Preoperative age-related differences in total protein concentrations were also observed postoperatively. Sodium concentrations remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Interaction between research and diagnosis and surveillance of avian influenza within the Caribbean animal health network (CaribVET).

The Caribbean region is considered to be at risk for avian influenza (AI) because of predominance of the backyard poultry system, important commercial poultry production, migratory birds and disparities in the surveillance systems. The Caribbean animal health network (CaribVET) has developed tools to implement AI surveillance in the region: (i) a regionally harmonized surveillance protocol, (ii) specific web pages for AI surveillance on http://www.caribvet.net, and (iii) a diagnostic network for the Caribbean including AI virus molecular diagnostic capability in Guadeloupe and technology transfer. Altogether 303 samples from four Caribbean countries were tested between June 2006 and March 2009 by real time PCR either for importation purposes or following clinical suspicion. Following AI H5N2 outbreaks in the Dominican Republic in 2007, a questionnaire was developed to collect data for risk analysis of AI spread in the region through fighting cocks. The infection pathway of Martinique commercial poultry sector by AI through introduction of infected cocks was designed and recommendations were provided to the Caribbean veterinary services to improve fighting cock movement controls and biosecurity measures. Altogether, these CaribVET activities contribute to strengthen surveillance of AI in the Caribbean region and may allow the development of research studies on AI risk analysis.

Diagnosis and anaesthesia management of haemophilia during the neonatal period.

We report here the case of a newborn infant admitted to our hospital for moderate gastro-intestinal bleeding. Despite abnormal value for aPTT, diagnosis of moderate haemophilia A was only made preoperatively when surgery was deemed necessary to treat pyloric stenosis. Clinical circumstances of the diagnosis and anaesthesia management of haemophilia during the neonatal period are discussed.

Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children.

Caudal anaesthesia is indicated for surgical procedures lasting less than 90 min. Fentanyl and clonidine are known to prolong postoperative caudal analgesia, but there are no data on their effect on duration of surgical analgesia. We evaluated if the addition of clonidine or fentanyl to local anaesthetics prolonged the duration of surgical analgesia after single shot caudal block in children in a randomized, double-blind study. We studied 64 children, aged 6-108 months, undergoing bilateral correction of vesicoureteral reflux which was expected to last more than 90 min. Patients were allocated to one of four groups: group O received 1 ml kg-1 of a mixture of 0.25% bupivacaine with epinephrine and 1% lidocaine in equal parts; group F received the same mixture of local anaesthetics in addition to fentanyl 1 microgram kg-1; group C received the same mixture of local anaesthetics in addition to clonidine 1.5 micrograms kg-1; and group C + F received the same mixture of local anaesthetics in addition to fentanyl 0.5 microgram kg-1 and clonidine 0.75 microgram kg-1. Single shot caudal block was sufficient in only 57% of children in group O compared with 93% in groups C and F and 86% in group C + F (P = 0.035). Global assessment of anaesthesia, defined as the time from caudal injection to the first administration of analgesic (either during or after surgery), was significantly longer in the three groups of children who received additives compared with local anaesthetics alone (P = 0.035), but there were no differences between the three additive groups. Vomiting was observed only in children who received fentanyl. Addition of clonidine or fentanyl to local anaesthetics prolonged the duration of surgical analgesia of caudal block, allowing single shot caudal anaesthesia to be recommended for surgery lasting 90-150 minutes. Clonidine had some advantages over fentanyl as it did not produce clinically significant side effects.

Stereoselective disposition of ibuprofen enantiomers in infants.

The pharmacokinetics of the enantiomers of ibuprofen were investigated after oral administration of a single 7.6 +/- 0.3 mg kg-1 dose of the racemate in 11 infants. Mean (+/- s.d.) half-lives were 1.6 +/- 0.5 h for S(+) and 1.5 +/- 0.5 h for R(-) and mean (+/- s.d.) AUC values were 31.5 +/- 14.3 mg l-1 h for S(+) and 36.6 +/- 13.8 mg l-1 h for R(-). Since plasma concentrations of the active S(+)-isomer were lower than those reported in adults, a higher dosage might be required in infants.