Systemic lupus erythematosus-associated acute transverse myelitis: manifestations, treatments, outcomes, and prognostic factors in 20 patients.

BACKGROUND: Transverse myelitis is a rare complication of systemic lupus erythematosus (SLE). This retrospective multicentre study identifies the prognostic factors in a relatively large patient series. PATIENTS AND METHODS: Twenty patients fulfilled the SLE criteria of the ACR classification and the Transverse Myelitis Consortium Working Group. A severe neurological flare was defined as muscle strength grade <3/5 in more than half the muscle groups at the motor neurological level. Inability to run or another significant ambulation-unrelated disability was considered as 'unfavourable neurological outcome'. RESULTS: Myelitis was the first SLE symptom in 12 patients; in the eight others, it occurred 8.6 years (median delay) after SLE onset. Eleven patients presented severe neurological impairments. The treatment included corticosteroids in all patients associated with intravenous cyclophosphamide in 11 and/or hydroxychloroquine in 14. Unfavourable outcomes were observed in 53% of the patients at six months and in 28% at end of follow-up (median: 5.9 years). An initial severe neurological impairment and no cyclophosphamide use were associated with unfavourable neurological outcomes at six months and at end of follow-up, respectively. CONCLUSION: Transverse myelitis may reveal SLE or occur more than 10 years after SLE diagnosis. The initial severity of the neurological flare (with paraplegia) is the main prognostic marker. The study provides arguments for cyclophosphamide use.

Combined medico-surgical strategy for invasive sino-orbito-cerebral breakthrough fungal infection with Hormographiella aspergillata in an acute leukaemia patient.

Hormographiella aspergillata is a rare causative agent of invasive filamentous breakthrough infection, mostly arising after echinocandin exposure. We report a neutropenic patient who developed a severe sino-orbito-cerebral H. aspergillata infection while receiving empirical caspofungin, successfully controlled by an aggressive strategy associating surgical debridement and combined high-dose regimen of antifungal drugs.

Association between discordant immunological response to highly active anti-retroviral therapy, regulatory T cell percentage, immune cell activation and very low-level viraemia in HIV-infected patients.

The mechanisms sustaining the absence of complete immune recovery in HIV-infected patients upon long-term effective highly active anti-retroviral therapy (HAART) remain elusive. Immune activation, regulatory T cells (T(regs)) or very low-level viraemia (VLLV) have been alternatively suspected, but rarely investigated simultaneously. We performed a cross-sectional study in HIV-infected aviraemic subjects (mean duration of HAART: 12 years) to concomitantly assess parameters associated independently with inadequate immunological response. Patients were classified as complete immunological responders (cIR, n = 48) and inadequate immunological responders (iIR, n = 39), depending on the CD4(+) T cell count (> or < 500/mm(3)). Clinical and virological data (including very low-level viraemia) were collected. In parallel, immunophenotyping of CD4(+) lymphocytes, including T(reg) subsets, and CD8(+) T cells was performed. Percentages of activated CD4(+) T cells, T(regs), effector T(regs) and terminal effector T(regs) were found to be significantly elevated in iIR. Neither the percentage of activated CD8(+) T cells nor VLLV were found to be associated with iIR. In the multivariate analysis, nadir of CD4(+) T cell count and percentage of T(regs) were the only two parameters associated independently with iIR [odds ratio (OR) = 2·339, P = 0·001, and OR = 0·803, P = 0·041]. We present here the largest study investigating simultaneously the immune response to long-term HAART, activation of CD4(+) and CD8(+) T cells, T(reg) percentages and very low-level viraemia. Causative interactions between T(regs) and CD4(+) T cells should now be explored prospectively in a large patients cohort.

Determinants of COVID-19 vaccine hesitancy in French hospitals.

OBJECTIVES: COVID-19 vaccines have become the new hope for stemming the pandemic. We aimed to assess pre-launch vaccine acceptance among hospital workers in the Auvergne-Rhône-Alpes Administrative Region of France. METHODS: We performed a cross sectional study involving all hospital workers in 11 Auvergne-Rhône-Alpes hospitals in December 2020. Univariate and multivariate analyses were performed to identify factors associated with vaccine hesitancy. RESULTS: We analyzed completed questionnaires from 1,964 respondents (78% women, mean age 42 years, 21.5% physicians, 41% private care centers). A total of 1,048 (53%) hospital workers were in favor of COVID-19 vaccination. Vaccine hesitancy was associated with: female gender; young age; paramedical, technical, and administrative professions (i.e., all non-medical professions); no prior flu vaccination; and employment in the private medical care sector (p<0.05). Distrust of health authorities and pharmaceutical lobbying were the main obstacles to vaccination. Inversely, creating herd immunity and protecting patients and household members were the most frequently cited reasons in favor of vaccination. More than two-thirds of participants feared that the clinical and biological research was too rapid and worried about serious adverse effects. Most participants were interested in written information on the available vaccines, but the most vaccine-hesitant categories preferred oral information. Only 35% supported mandatory vaccination. CONCLUSIONS: Targeted written and oral information campaigns will be necessary to improve vaccination coverage among hospital workers who show a surprisingly high hesitancy rate. Imposing mandatory vaccination could be counterproductive.

Aspergillus necrotizing otitis externa with temporomandibulozygomatic involvement.

INTRODUCTION: Aspergillus necrotizing otitis externa (NOE) is a rare disease, often associated with delayed diagnosis, the management of which is poorly defined. SUMMARY: The authors report a case of Aspergillus flavus necrotizing otitis externa with temporomandibular arthritis and temporozygomatic osteomyelitis with Staphylococcal coinfection in a diabetic patient. The diagnosis and discontinuation of treatment were guided by PET-CT scan. A favourable course without sequelae was observed after repeated surgical curettage and 3 months of antifungal therapy. DISCUSSION: Aspergillus flavus is the agent most commonly incriminated in NOE. Indirect diagnostic tests (serology) may be negative. The diagnosis is based on imaging-guided surgical biopsy with histological examination and standard and fungal microbiological culture. Treatment requires a combination of surgery and antifungal therapy. The duration of antifungal therapy is poorly defined and discontinuation of therapy can be guided by PET-CT scan.

A case study of personal exposure to nitrogen dioxide using a new high sensitive diffusive sampler.

Personal NO(2) exposure measurements were achieved during two campaigns in a large northern France city. These campaigns were following an innovating approach based on sequential exposure measurements by diffusive samplers distinguishing four categories of microenvironments ("home", "other indoor places", "transport" and "outdoors"). The objective of these campaigns was to obtain NO(2) personal exposure data in different microenvironments and to examine the determinants of personal exposure to this pollutant. Each campaign comprised two 24-h sampling periods: one during a working day and the second during the weekend. The average total NO(2) personal exposure ranged from 17 microg m(-3) for the summer weekend samplings to 38 microg m(-3) for the winter weekday samplings. The highest levels were found in transports and outdoors, the intermediate ones in other indoor places and the lowest in homes. Despite their weak levels, indoor environments contributed for more than 78% to total NO(2) personal exposure because of more time spent in these living places. A Multiple Correspondence Analysis (MCA) highlighted the determinants of NO(2) personal exposure in the "home" and "transport" microenvironments. This led to a classification of NO(2) personal exposure levels according to different means of transport: from the lowest to the highest exposure levels, train, tramway or underground, bicycle, car or motorcycle. In homes, the rise of NO(2) personal exposures is mainly due to the use of gas stoves and gas heating and the absence of automatic airing system. A classification of NO(2) personal exposure levels was set up according to the characteristics of homes. An analysis of correlations between the home NO(2) personal exposures and outdoor concentrations measured by fixed ambient air monitoring stations showed weak relations suggesting that the data of these stations are poor predictors of NO(2) personal exposures in homes.

Evolution of the incidence of hepatitis B virus infection and immunization rates in a large French cohort born between 1960 and 1994.

In France, several successive changes in anti-hepatitis B virus (HBV) vaccination policies occurred since 1982. We estimated the incidence and prevalence of HBV infection according to years of birth 1960 to 1994 in a large sentinel cohort to evaluate the epidemiology of HBV during vaccination policy changes. A retrospective cohort study included data from all HIV, HBV and hepatitis C virus (HCV) screening facilities in Grand Lyon. From 2005 to 2010, all 57113 individuals with complete HBV serologic status were enrolled. Survival analyses modeled separately various ages in each birth cohort. The proportion of immunized individuals increased in birth cohorts 1978 to 1984 (up to 58.3% (95% confidence interval (CI), 43.3-68.2 at age 15). In post-1985 birth cohorts, this proportion decreased to 19.5% (95% CI, 15.5-24) in birth cohort 1987 at age 15. Probability of past or current HBV infection increased constantly in birth cohorts 1960 to 1967, up to 12% (95% CI, 10.4-14) at age 30, then decreased gradually in birth cohorts 1968 to 1991, down to 0.9% (95% CI, 0.7-1.2) at age 17.5. In post-1991 cohorts, the probability of HBV infection increased again, up to 2.5% (95% CI, 1.7-3.6) at age 17.5. HBV incidence fluctuated between 5 and 8 per 1000 person-years in pre-1986 birth cohorts, decreased to 2.1 (95% CI, 1.5-2.7) in birth cohorts 1986 to 1991 but rebounded to 5 (95% CI, 3.5-7.1) in post-1991 birth cohorts. HBV incidence was remarkably high in young adults with noticeable variations concomitantly to vaccination policy changes. A dramatic decline in immunization rate was temporally associated with a sharp rebound of infection after withdrawal of systematic adolescent vaccination in 1998.

Performances and application of a passive sampling method for the simultaneous determination of nitrogen dioxide and sulfur dioxide in ambient air.

The performances and applicability of a diffusion tube sampler for the simultaneous measurements of NO2 and SO2 in ambient air were evaluated. SO2 and NO2 are collected by the passive sampler using triethanolamine as trapping agent and are determined as sulphate and nitrite with ion chromatography. The detection limit (2.3 microg m(-3) of NO2 and 4.2 microg m(-3) of SO2 for two weeks sampling) is adequate for the determination of concentrations in urban and industrial areas. Precision of the method as RSD is in mean 5% for NO2 and 12% for SO2 at the concentration levels in urban areas. Calibration of the method was performed in the field conditions by comparison between the responses of sampler and the concentrations measured by the continuous monitors. High degree of linearity (correlation coefficients > 0.8) is found between the passive sampler tube and the continuous monitor data for both NO2 and SO2. To reduce the wind velocity influence on passive sampling of diffusion tubes, a protective shelter was tested in this study. The overall uncertainty of one measure for the optimised method is estimated at 5 microg m(-3) for NO2 and 6 microg m(-3) for SO2. Suitability of this passive sampling method for air pollution monitoring in urban areas was demonstrated by the results shown in this paper on a campaign carried out in the French agglomeration.