Evaluation of the efficacy and safety of pars plana vitrectomy with irido-zonulo-hyaloidotomy for malignant glaucoma.

PURPOSE: To assess the efficacy and safety of pars plana vitrectomy with irido-zonulo-hyaloidotomy (IZH) for fluid misdirection syndrome (FMS) in pseudophakic eyes. METHODS: This was a retrospective case series study of patients treated with pars plana vitrectomy with IZH for FMS between February 2017 and March 2020. Complete success was defined as central anterior chamber (AC) deepening with an intraocular pressure (IOP) of 21mmHg or less (on 2 consecutive visits at least 1 week apart) without topical or systemic glaucoma medications. Qualified success was defined as central AC deepening with an IOP of 21mmHg or less (on 2 consecutive visits at least 1 week apart) with topical or systemic glaucoma medications. RESULTS: Twelve eyes of 12 patients with a diagnosis of FMS were included. The mean age of the population was 73.6±15.4 years [39-90] with a majority of women (58.3%). Prior surgeries at the time of FMS diagnosis were trabeculectomy (4 eyes) and non-perforating deep sclerectomy (2 eyes). At presentation, mean IOP was 38.2±9.8mmHg, which decreased to 17.9±7.7mmHg (P<0.0001) at final follow-up (mean follow-up of 4.9±4.3 months). Complete success was achieved in 6 eyes (50%) and qualified success in 10 eyes (83%), with two eyes failing treatment. There was no statistical significant relationship between demographic data and clinical success (P > 0.05). CONCLUSION: Pars plana vitrectomy combined with IZH appears to be a safe and effective technique for the treatment of FMS in pseudophakic patients.

From the original SARS-CoV-2 strain to the Omicron variant: Predictors of COVID-19 in ambulatory symptomatic children.

OBJECTIVES: To determine the predictors of a positive SARS-CoV-2 test in a pediatric ambulatory setting. PATIENTS AND METHODS: We performed a cross-sectional prospective study (November 2020-February 2022) of 93 ambulatory settings in France. We included symptomatic children < 15 years old tested for SARS-CoV-2. For each period corresponding to the spread of the original strain and its variants (period 1: original strain; period 2: Alpha, period 3: Delta; period 4: Omicron), we used a multivariate analysis to estimate adjusted odds ratios (aORs) associated with COVID-19 among age, signs, symptoms or contact, and 95 % confidence intervals (95CIs). RESULTS: Of 5,336 children, 13.9 % (95CI 13.0-14.8) had a positive test. During the first three periods, the positivity rate ranged from 5.6 % (95CI 4.6-6.7) to 12.6 % (95CI 10.8-14.6). The main factors associated with a positive test were contact with an infected adult at home or outside the home (aOR 11.5 [95CI 4.9-26.9] to 38.9 [95CI 19.3-78.7]) or an infected household child (aOR 15.0 [95CI 4.8-47.1] to 28.4 [95CI 8.7-92.6]). By contrast, during period 4, aORs for these predictors were substantially lower (2.3 [95CI 1.1-4.5] to 5.5 [95CI 3.2-7.7]), but the positivity rate was 45.7 % (95CI 42.3-49.2). CONCLUSIONS: In pediatric ambulatory settings, before the Omicron period, the main predictor of a positive test was contact with an infected person. During the Omicron period, the odds of these predictors were substantially lower while the positivity rate was higher. An accurate diagnostic strategy should only rely on testing and not on age, signs, symptoms or contact.

[Abnormal retinal artery perfusion and optical coherence tomography angiography]. / Trouble de la perfusion artérielle rétinienne et tomographie en cohérence optique-angiographie.

INTRODUCTION: To analyze optical coherence tomography angiography (OCT-A) findings in patients with impaired retinal artery perfusion secondary to occlusion of the central retinal artery or its branches, cilioretinal artery occlusion or retinal vein occlusion (RVO). METHODS: In this retrospective observational study of patients with impaired retinal artery perfusion, we recorded the results of clinical examination and multimodal imaging, including fluorescein angiography, spectral-domain (SD)-OCT, and OCT-A (Optovue) of the central 10 degrees with measurement of vascular density. RESULTS: The files of 10 patients were analyzed (5 men, mean age: 63 years), including 3 retinal artery occlusions, 4 cilioretinal artery occlusions, isolated or combined with central retinal vein occlusion (CRVO), and 3 RVO with an arterial component. SD-OCT showed hyper-reflectivity of the inner nuclear layer consistent with paracentral acute middle maculopathy (PAMM) in the acute stage (8 eyes) resulting in retinal atrophy as early as the following month. OCT-A revealed capillary dropout in all patients with various degrees, the deep capillary plexus seemed to be more involved than the superficial plexus. A fern-like pattern was observed on en-face OCT in 4 eyes, outlining venular contours. Vascular density was significantly diminished (whole en-face density in the deep capillary plexus: 50.39 vs. 56.21 in the control group, P=0.001). On fluorescein angiography, reperfusion was observed in half of the eyes. CONCLUSION: OCT-A can be very useful in patients with a transitory arterial occlusion by revealing involvement of the superficial and deep capillary plexus. It may enable a retrospective diagnosis in the case of reperfusion.

[Impact of guidelines on ambulatory pediatric antibiotic prescriptions]. / Impact des recommandations sur la prescription en consultation de ville d'antibiotiques à l'enfant.

INTRODUCTION: The emergence of antibiotics resistance as a major public health threat has led, in France as in other countries, to the establishment of "antibiotics plans" based in part on practice guidelines. The objectives of this study were to determine the structure (number, causes, distribution of compounds) of antibiotic prescriptions by infectious diseases pediatricians (belonging to a pediatric infectious diseases research group), to check their compliance with guidelines and compare their prescriptions to other French pediatricians and general practitioners (GPs). PATIENTS AND METHODS: In a survey on acute otitis media (AOM), outpatient pediatricians reported prospectively from October 2013 to February 2014 all antibiotics prescribed and the reasons for these prescriptions. These results were compared with prescription data from a panel of other pediatricians and GPs in France (IMS Health panels). RESULTS: Between October 2013 and February 2014, 27 pediatricians from the Infectious Disease Pediatricians Group conducted 54,212 visits, 10.7 % of which resulted in antibiotic prescriptions, all diseases combined, compared to 12 % for other pediatricians and 21 % for GPs in the same period. AOM was the leading cause of prescriptions for infectious disease pediatricians and panel pediatricians, and GPs (respectively, 72.6 %, 33 %, and 25 %). Amoxicillin was the most frequently prescribed antibiotic (respectively, 71.7 %, 49.9 %, and 28.2 %). Cephalosporins were prescribed in 6.4 % of cases by infectious disease pediatricians versus 19 % for panel pediatricians and 19.9 % for GPs. CONCLUSION: The prescriptions of infectious disease pediatricians are in accordance with the French guidelines. The differences with the IMS data justify the need for continuous medical training and recommendations to promote these guidelines.

Update of (40)K and (226)Ra and (232)Th series γ-to-dose conversion factors for soil.

Over the last four decades, the dose conversion factors used to calculate external exposure to γ radiation from soil from (40)K and the (226)Ra and (232)Th chains have been 0.62, 0.042 and 0.46 (nGy/h per Bq/kg), respectively. This work updates these γ-to-dose conversion factors, taking into consideration the composition, depth and radius of the soil source, and importantly, updated branching ratios, with MCNPX simulations. The new conversion factors are 0.036, 0.357 and 0.482 (nGy/h per Bq/kg) for (40)K and the (226)Ra and (232)Th chains, respectively.

Transport of radioactive ion beams and related safety issues: the 132Sn+ case study.

The transport of intense radioactive ion beam currents requires a careful design in order to limit the beam losses, the contamination and thus the dose rates. Some investigations based on numerical models and calculations have been performed in the framework of the SPIRAL 2 project to evaluate the performance of a low energy beam transport line located between the isotope separation on line (ISOL) production cell and the experiment areas. The paper presents the results of the transverse phase-space analysis, the beam losses assessment, the resulting contamination, and radioactivity levels. They show that reasonable beam transmission, emittance growth, and dose rates can be achieved considering the current standards.

Simulation approach to coincidence summing in γ-ray spectrometry.

Some of the radionuclides used for efficiency calibration of a HPGe spectrometer are subject to coincidence-summing (CS) and account must be taken of the phenomenon to obtain quantitative results when counting samples to determine their activity. We have used MCNPX simulations, which do not take CS into account, to obtain γ-ray peak intensities that were compared to those observed experimentally. The loss or gain of a measured peak intensity relative to the simulated peak is attributed to CS. CS correction factors are compared with those of ETNA and GESPECOR. Application to a test sample prepared with known radionuclides gave values close to the published activities.

An unusual presentation of primary male genital tuberculosis.

Urogenital tuberculosis is a rare disease; however, it is the second most common location for tuberculosis after the lung. Currently, incidence of urogenital tuberculosis is increasing due to factors such as a higher prevalence of immunosuppression (especially that caused by human immunodeficiency virus infection) and drug abuse. Herein a new case of male genital primary tuberculosis is reported presenting as a scrotal tumor; the originality of this observation lies in its unusual pseudotumor form.

[Organizing pneumonia associated with primary biliary cirrhosis]. / Pneumonie organisée associée à une cirrhose biliaire primitive.

INTRODUCTION: Primary biliary cirrhosis is a hepatic auto-immune disease which is rarely associated with respiratory complications. CASE REPORT: A 40-year-old woman had a 5-year history of primary biliary cirrhosis. Two years previously, she had begun to experience a chronic cough and dyspnea. On clinical examination, the patient had fever, jaundice and basal pulmonary crackles. Chest X-ray showed bilateral slowly migrating and spreading airspace consolidation refractory to antibiotics. Microbiological investigations evidenced no abnormalities. Routine biological studies revealed an inflammatory syndrome, a mild neutrophilic hyperleukocytosis without hypereosinophilia and a mild hepatitis picture with cholestasis. Antineutrophil cytoplasmic antibody testing and anti-nuclear factor testing were negative. Fibreoptic bronchoscopy showed diffuse bronchial inflammation with no specific pathological pattern at bronchial biopsy. The bronchoalveolar lavage revealed a mixed cellular pattern. The chest computed tomography revealed peribronchial pulmonary consolidation with septal and pleural thickening, suggestive of an organizing pneumonia. The patient was treated with oral corticosteroids which resulted in a prompt clinical improvement and complete resolution of radiographic pulmonary abnormalities within two months. Treatment continued for six months and no relapse was noticed during the six months following the end of treatment. CONCLUSIONS: This case of organizing pneumonia highlights the importance of physicians considering this condition in women with primary biliary cirrhosis complaining of respiratory symptoms in the context of unresolved pneumonia.

[A rare form of rifampicin-induced skin toxicity: bullous pemphigoid]. / Une forme rare de toxidermie induite par la rifampicine: la pemphigoïde bulleuse.

INTRODUCTION: Rifampicin is an antituberculous drug causing minor cutaneous reactions. Rifampicin-induced bullous skin reactions are rare. CASE REPORT: We describe a 48-year-old man who was given rifampicin, streptomycin, isoniazid and pyrazinamide for pulmonary tuberculosis. Seventy-two hours later, he developed generalized pruritus, and an urticarial eruption developed 5 days later. He was admitted to hospital and the drugs were discontinued. He could remember no history of previous administration of antituberculous drugs and no other drugs had been taken recently. General physical examination yielded no relevant findings. On dermatological examination, Nikolsky's sign was negative. There were tiny symmetrical cutaneous vesicles overlying normal skin of all four limbs. These rapidly became confluent, forming large tense bullous lesions containing clear fluid, suggesting bullous pemphigoid. Blood tests showed a neutrophil leukocytosis and mild eosinophilia. Other biological tests were normal. Skin biopsy was refused by the patient. He was given intravenous antihistamine and dry bandages were applied to the forearms and legs. The antituberculous drugs were discontinued for two weeks and the lesions healed spontaneously. The drugs were then progressively reintroduced, streptomycin being excluded initially. A few hours after the first dose of rifampicin, a recurrence was noted and it was substituted by ethambutol. Subsequent introduction of streptomycin was uneventful. No recurrence occurred over 18 months follow up. CONCLUSION: The authors describe a rare case of rifampicin-induced skin toxicity and the related diagnostic and therapeutic difficulties.

Characterization of mutations in the iron-sulphur subunit of succinate dehydrogenase correlating with Boscalid resistance in Alternaria alternata from California pistachio.

Thirty-eight isolates of Alternaria alternata from pistachio orchards with a history of Pristine (pyraclostrobin + boscalid) applications and displaying high levels of resistance to boscalid fungicide (mean EC(50) values >500 microg/ml) were identified following mycelial growth tests. A cross-resistance study revealed that the same isolates were also resistant to carboxin, a known inhibitor of succinate dehydrogenase (Sdh). To determine the genetic basis of boscalid resistance in A. alternata the entire iron sulphur gene (AaSdhB) was isolated from a fungicide-sensitive isolate. The deduced amino-acid sequence showed high similarity with iron sulphur proteins (Ip) from other organisms. Comparison of AaSdhB full sequences from sensitive and resistant isolates revealed that a highly conserved histidine residue (codon CAC in sensitive isolates) was converted to either tyrosine (codon TAC, type I mutants) or arginine (codon CGC, type II mutants) at position 277. In other fungal species this residue is involved in carboxamide resistance. In this study, 10 and 5 mutants were of type I and type II respectively, while 23 other resistant isolates (type III mutants) had no mutation in the histidine codon. The point mutation detected in type I mutants was used to design a pair of allele-specific polymerase chain reaction (PCR) primers to facilitate rapid detection. A PCR-restriction fragment length polymorphism (RFLP) assay in which amplified gene fragments were digested with AciI was successfully employed for the diagnosis of type II mutants. The relevance of these modifications in A. alternata AaSdhB sequence in conferring boscalid resistance is discussed.

Experimental characterization and Monte Carlo simulation of Si(Li) detector efficiency by radioactive sources and PIXE.

This work relates to the study and characterization of the response function of an X-ray spectrometry system. The intrinsic efficiency of a Si(Li) detector has been simulated with the Monte Carlo codes MCNP and GEANT4 in the photon energy range of 2.6-59.5keV. After finding it necessary to take a radiograph of the detector inside its cryostat to learn the correct dimensions, agreement within 10% between the simulations and experimental measurements with several point-like sources and PIXE results was obtained.

Creatinine clearance estimation after kidney transplantation: an analysis of three methods.

Surveillance of glomerular filtration rate (GFR) is essential for the management of kidney transplant recipients. We compared the performance of estimation equations with (99m)Technetium ((99m)Tc)-DTPA clearance (TcGFR) in 32 of our patients, using the Modification of Diet in Renal Diseases (MDRD), Nankivell (NK), and Cockcroft-Gault (CG) formulas. All patients were adequately hydrated before study. (99m)Tc-DTPA was injected intravenously (maximal dose = 37 MBq). A second syringe was prepared for an aliquot of the study ("standard"). Blood was sampled at 120 and 240 minutes in various sites. After centrifugation, 1.0 mL plasma was transferred into a counting vial. Both the samples and the "standard" were measured in a well counter. The mean time from transplantation to TcGFR was 47.9 months (range, 4-143 months). The mean serum creatinine level was 124 micromol/L (range, 70-371 micromol/L). The mean TcGFR was 58.6 mL/min/1.73 m(2) (range, 14-100 mL/min/1.73 m(2)). The MDRD equation showed a median difference of 1.4 mL/min/1.73 m(2) with 81.2% of estimated GFR within 20% of TcGFR. Median differences were 8.94 and 11.47 mL/min/1.73 m(2) for NK and CG formulas, respectively. The precision of the NK and CG was such that only 56.25% and 62.5% of estimations, respectively, fell within 20% of TcGFR. In this study, the MDRD equation demonstrated the best overall performance among the 3 tested methods. It should be sufficient for routine clinical practice in kidney transplantation.

[The pseudoalveolar form of sarcoïdosis: a diagnostic pitfall]. / La forme pseudo-alvéolaire de la sarcoïdose: un piège diagnostique à ne pas méconnaître.

BACKGROUND: Sarcoïdosis is a benign systemic granulomatosis whose aetiology remains unknown. Lung is the most frequently involved organ. The pseudoalveolar form of this disease is known to have an acute onset and is quite uncommon. Therefore, diagnosing such a rare variety of sarcoidosis is rather often challenging. OBSERVATIONS: In the present article, the authors report two cases of pseudoalveolar sarcoidosis. The patients, both young adults, showed no suggestive signs of sarcoidosis at first presentation. This resulted in a considerable delay to diagnosis and to the corticosteroid therapy. CONCLUSION: The authors emphasize the rarity of the pseudoalveolar form of sarcoidosis. They insist on its roentgenographic characteristics and demonstrate the functional benefits allowed by the precocious medical management. They also propose a current review of the literature.

[An unusual localization of a rare tumor: giant-cell tumor of the rib. Case report and review of the literature]. / Une localisation inhabituelle d'une pathologie rare: la tumeur costale à cellules géantes. A propos d'un cas avec revue de la littérature.

INTRODUCTION: Giant-cell tumors of bone are rare primary neoplasms commonly encountered in young adults. Women are slightly more affected than men. CASE REPORT: We report the case a 27 year old woman presenting with a twelve months history of painful and progressively growing thoracic mass in the right anterior chest wall. Physical examination found out a fixed thoracic mass in the right retro-mammary area measuring 8 x 6 centimeters. The overlying skin was normal. Chest roentgenogram demonstrated a large ill defined mass continuing the anterior arc of the fourth right rib. Computed tomography evidenced a well defined pathologic process originating from the fourth right rib without expansion of the surrounding soft tissue. Pulmonary functional tests were normal and other complementary investigations evidenced no abnormalities. Our patient first had a fine needle cytological biopsy that brought strong suspicion of Giant-cell tumor of the rib. She then underwent an "en bloc" resection of the tumor whose histopathologic analysis allowed a definitive diagnosis. The post-surgical follow up during 12 months showed no signs of tumor recurrence. CONCLUSION: Through this observation the authors emphasize not only the rarity of the giant-cell tumors of bone but also its unusual costal localization (few cases reported till date). They focus on the importance of precocious screening and treatment and underline the value of the follow up in order to detect timely any sign of local recurrence or sarcomatous transformation. Finally, they report a current review of the literature.