Seroprevalence of anti-HEV IgG in children: very early exposure in young children in a hyperendemic region.

Background and objectives: Hepatitis E virus (HEV) can be considered an emerging zoonotic pathogen and is an important cause of acute viral hepatitis in high-income countries. Corsica has been identified as a hyperendemic region for HEV. We aimed to characterize the prevalence of IgG among children and estimate the annual force of infection of HEV. Methods: From April 2020 to June 2021, we collected 856 "residual sera" in 13 medical biology laboratories. Sera were tested using the Wantaï HEV IgG assay. Data were weighted according to the distribution by sex and age of the real Corsican population. Serocatalytic models were applied to assess the annual force of infection of HEV. Results: The weighted seroprevalence was 30.33% [27.15-34.0]. The seroprevalence was only associated with increasing age (7.25-40.52%; p < 0.001). The annual probability of infection was 5.4% for adults and children above 10-year-old and 2.2% for children under 10 yo. Conclusion: Our study demonstrates that in the hyperendemic island of Corsica, (i) exposure of the population to HEV is homogeneous at the spatial level with no difference between genders; (ii) HEV exposure occurs from birth, resulting in 7.4% seropositivity at the age of 4 years; and (iii) super exposure is observed after the age of 9 years. Accordingly, specific studies should be conducted to determine the breadth of the situation identified in our study. The role of the environment and its contamination by domestic or wild swine excreta should be investigated using a One Health approach.

Impact of the Second Epidemic Wave of SARS-CoV-2: Increased Exposure of Young People.

We aimed to use serological surveillance based on serial cross-sectional sampling of residual sera obtained from clinical laboratories to compare the differences in age and sex profiles of infected persons in the first and second waves of SARS-CoV-2 in Corsica, France. Residual sera were obtained, including samples from individuals of all ages collected for routine screening or clinical management by clinical laboratories. All the sera collected were tested for the presence of anti-SARS-CoV-2 IgG using a kit for semi-quantitative detection of IgG antibodies against the S1 domain of the viral spike protein (ELISA-S). Samples that were borderline and positive in ELISA-S were tested with an in-house virus neutralization test. During the second-wave period, we collected between 6 November, 2020 and 12 February, 2021, 4,505 sera from patients aged 0-101 years (60.4% women). The overall weighted seroprevalence of residual sera collected during the second-wave period [8.04% (7.87-9.61)] was significantly higher than the overall weighted seroprevalence estimated at the end of the first wave between 16 April and 15 June, 2020 [5.46% (4.37-7.00)] (p-value = 0.00025). Ninety-eight (30.1%) of the 326 samples tested in the VNT assay had a positive neutralization antibody titer. Estimated seroprevalence increased significantly for men [odds ratio (OR) OR = 1.80 (1.30-2.54); p-value = 0.00026] and for people under 30 years of age [OR = 2.17 (1.46-3.28); p-value = 0.000032]. This increase was observed in young adults aged 20-29 years among whom antibody frequencies were around four-fold higher than those observed at the end of the first wave. In conclusion, our seroprevalence estimates, including the proportion of the participants who had produced neutralizing antibodies, indicate that in February, 2021 the population of Corsica was still far from being protected against SARS-Cov-2 by "herd immunity."

[Parent counseling following an antenatal diagnosis of malformation or a diagnosis at birth. The pediatric surgeon's perspective]. / Point de vue du chirurgien pédiatre. Prise en charge des parents lors de la découverte d'une malformation avant ou après la naissance.

Since many years age for pregnancy in women is increasing with elderly parents whose possibility to get others child is improbable. Diagnosis of major congenital anomalies during a prenatal test or severe surgical complication in neonate period, sometimes on a premature newborn, will be a very difficult problem for parents to make the good choice. Relationship between parents and paediatric surgeon must be clear with good explanations but the own point of view of the surgeon must not interfere with parents choice when vital prognosis or severe aftereffects are expected. The review of literature show in many papers that age of parents do not have any influence on their choice to continue or not with treatment child's.

Seroprevalence of SARS-CoV-2 IgG Antibodies in Corsica (France), April and June 2020.

Our aim was to assess the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection after the lockdown in a sample of the Corsican population. Between 16 April and 15 June 2020, 2312 residual sera were collected from patients with a blood analysis conducted in one of the participating laboratories. Residual sera obtained from persons of all ages were tested for the presence of anti-SARS-CoV-2 Immunoglobulin G (IgG) using the EUROIMMUN enzyme immunoassay kit for semiquantitative detection of IgG antibodies against the S1 domain of viral spike protein (ELISA-S). Borderline and positive samples in ELISA-S were also tested with an in-house virus neutralization test (VNT). Prevalence values were adjusted for sex and age. A total of 1973 residual sera samples were included in the study. The overall seroprevalence based on ELISA-S was 5.27% (95% confidence interval (CI), 4.33-6.35) and 5.46% (4.51-6.57) after adjustment. Sex was not associated with IgG detection. However, significant differences were observed between age groups (p-value = 1 E-5). The highest values were observed among 10-19, 30-39, and 40-49 year-old age groups, ranging around 8-10%. The prevalence of neutralizing antibody titers ≥40 was 3% (2.28-3.84). In conclusion, the present study showed a low seroprevalence for COVID-19 in Corsica, a finding that is in accordance with values reported for other French regions in which the impact of the pandemic was low.

[Inflammatory pseudotumour of the bladder in children: report of a new case and review of the literature]. / Pseudo tumeur inflammatoire de vessie chez l'enfant: a propos d'une nouvelle observation et revue de la littérature.

Bladder tumour is rare in children and usually corresponds to embryonic rhabdomyosarcoma. However one of the differential diagnoses is inflammatory pseudotumour of the bladder which is a benign lesion with a good prognosis. The authors report the case of a 3-year-old boy who presented with macroscopic haematuria related to a lesion of the anterior bladder wall. Histological examination of the partial cystectomy specimen demonstrated inflammatory pseudotumour of the bladder that was confirmed by a review examination. Thirteen cases have been reported in the literature over the last ten years and all had a favourable outcome after complete resection of the lesion. Thorough histological examination of the lesion is therefore important to guide treatment.

[Evaluation of the results of the Snodgrass procedure in hypospadias surgery]. / Evaluation des résultats du procédé de Snodgrass dans la chirurgie de l'hypospade.

OBJECTIVE: The Snodgrass urethroplasty, described in 1994 for the treatment of distal hypospadias, has very rapidly become a popular technique. However, incision of the urethral plate could be associated with a risk of stenosis of the neourethra. We present our preliminary results with this technique. MATERIALS AND METHODS: Fifty two patients (47 distal forms and 5 midshaft forms) were operated according to this technique. Twenty five of these patients were reviewed with a follow-up of 18 months, and uroflowmetry was performed in 20 of them. Only the records of the other 27 patients were reviewed. RESULTS: The meatus is apical and oval and the glans is conical. There is no residual chordee. Early in our experience, we observed 13% of fistulas and 4% of stenoses. Four patients presented uroflowmetry results below the curve of the 5th percentile, but were completely asymptomatic. CONCLUSIONS: The results of this technique are excellent. With experience, our complication rate has been markedly decreased by performing deeper incision of the urethral plate. The risk of stenosis is theoretical rather than practical.

In vitro smooth muscle contractility before and after relief of experimental obstruction in the rat: application to the surgical management of ileal dilatation.

PURPOSE: Bowel dilatation occurs proximal to an obstruction and predisposes to intestinal dysmotility. The present study sought to determine whether or not changes in smooth muscle contractility and the thickness of the proximal, dilated bowel wall can be reversed following relief of the obstruction. MATERIALS AND METHODS: Three groups of seven male Wistar rats were studied. In 8-week-old animals in a control group and a sham-operated group, a small segment of bowel (designated as R1 for controls and R2 for shams) was resected 5.0 cm from the cecum. In the third (operated) group, a narrow, isoperistaltic intestinal loop was created proximal to an end-to-end anastomosis of the ileum in 4-week-old animals. When these animals were 6 weeks old, the loop was re-anastomosed to the distal small bowel (after resection of the loop's distal portion, referred to as R3). Two weeks later, a small segment of bowel was resected proximal to the anastomosis (R4). We evaluated the thickness of the smooth muscle layers and the in vitro contractile responses of circular smooth muscle ileal strips (R1-R4) to electrical stimulation and pharmacological stimulation (with KCl, acetylcholine (ACh), substance P, N(G)-nitro-l-arginine methyl ester (L-NAME) and histamine). RESULTS: The amplitudes of contraction in response to electrical and Ach-mediated stimulation were higher for R3 than for R4 (P<0.001), R1 and R2 (both P<0.05). Compared with R1 and R2, the smooth muscle layer was three times as thick in R3 (P<0.001) and 2.5 times as thick in R4 (P<0.01). CONCLUSION: Our study provides evidence of the possible recovery of intestinal motility (in response to neurotransmitters involved in gut function) after the relief of an obstruction. If ileal motility can conceivably return to normal values, conservative surgical procedures in pediatric patients should be preferred (in order to leave a sufficient length of bowel and avoid short bowel syndrome).

Assessment of the efficiency of warming devices during neonatal surgery.

This study assessed the relative efficiency of different warming devices (surgical sheets covering the body and a tubegauze on the head, forced-air warming, warming mattress) commonly used to prevent body hypothermia during neonatal surgery. Dry heat losses were measured from a thermal manikin, which simulated a low-birth-weight neonate of 1,800 g. The manikin's surface temperatures (35.8 degrees C) corresponded to those of neonates nursed in closed incubators. Experiments were performed in a climatic chamber at an ambient temperature of 30 degrees C, as commonly found in operating theatres. The supine manikin was naked or covered with operative sheets with a 5x5 cm aperture over the abdomen. Its head could be covered by a tube-gauze. Additional warming was provided by conduction through a warming mattress (surface temperature, 39 degrees C) and/or by convection (Bair Hugger, forced-air temperature 38 degrees C). Covering the manikin with surgical sheets decreased the dry heat loss by 10.4 W. Additional forced-air warming was more efficient than the warming mattress to reduce the total dry heat loss (6.8 W vs 2.1 W). Heat losses were reduced by 7.9 W when combining the warming mattress and Bair Hugger. The heat loss from the head of the covered manikin was reduced from 4.5 W to 3.9 W when the head was covered with the tubegauze. Our data indicate that forced-air warming is more effective than conductive warming in preventing neonatal hypothermia during abdominal operations.