Epidemiological survey in a day care center following toddler sudden death due to human metapneumovirus infection.

We report the sudden death of a 33-month-old child owing to acute respiratory distress syndrome due to human metapneumovirus (hMPV) infection. Of 30 children attending the same day care centre, 26% and 59% had hMPV and multiple infections, respectively; three of six children with pneumonia had a diagnosis of hMPV. hMPV infection is common in childhood viral co-infections but it can cause sudden death.

[Photography in plastic surgery: practices, uses and legislation]. / Photographies en chirurgie plastique: pratiques, usages et législation.

INTRODUCTION: Photography in plastic surgery is omnipresent. Through its various uses, it may present both ethical and forensic risks. The objective of this study is to analyze the use of medical photography by the plastic surgeon, the perception of this use by the patient, and consequence of such use. METHOD: A questionnaire about the use of medical photography was assessed to 629 plastic surgeons. A questionnaire was given to patients, about their perception of the use of photography by their surgeon. RESULTS: One hundred and seventy-six surgeon's questionnaires and 93 patient's questionnaires were analyzed. For 97.7% of the responding surgeons, the proportion of patients refusing to be photographed was less then 1/20. The objective of the photography was especially medicolegal for 62.5% of the surgeons, especially for following the patient progress (87.5%), partially for the formation (72.1%), partially for scientific publications (57.8%) and not at all for the personal publicity (73.1%). Surgeons often share his photographs with others surgeons (71.1%), sometimes with others medical personnel (48.8%). The security and the access to photographs were determined to be correct for 67.6% of the surgeons and perfect for 23.3%. In total, 17.2% of the surgeons obtained a written consent, 41.4% obtained an oral consent, and 38.5% did not request patient consent. It was found that 48.3% of the surgeons and 40.2% of the patients think that the right to the photographic images belong to the patient. CONCLUSION: Medical photographs expose the plastic surgeon to medico-legal risks. He must know and follow the law in order to prevent eventual legal proceedings.

[Trusted person and living will: information and implementation defect]. / Personne de confiance et directives anticipées: défaut d'information et de mise en œuvre.

PURPOSE: The French law allows the persons of age to appoint a trusted person and to draft advance directives in case they are one day in a condition that prevents them from expressing their will regarding their health care. Our study objective was to assess patients' and relatives' knowledge and collecting their opinion regarding these means of expression of their will. METHODS: An anonymous survey by self-administered questionnaire was conducted in the admission offices of the University Hospital of Nancy in April 2011. The questions focused on trusted person and anticipated directives. RESULTS: We collected 367 answers, 61.8% of which were females. Average age of respondents was 48.7 years old (standard deviation: 15.6). Three fourths of respondents were informed of their possibility to appoint a trusted person and were able to establish the difference between a trusted person and a contact person. Respondents mainly chose their spouse (52%). They thought that the trusted person's opinion takes precedence over the family's or relatives' one (64.7%), given that this opinion is based on indications previously provided by the patient (74.8%). The majority of people surveyed were ignorant of the possibility to draft advance directives but were glad of it (57.5%). They would include herein their refusal of unreasonable obstinacy (75.8%), their wishes to withhold/withdraw of some treatments, to stop active treatments in case of high odds of chronic coma or vegetative state (52.8%) or their will to donate organ after death (50.6%). More than three fourths of the patients wished to include these informations on their health care card chip. CONCLUSION: Legal means of expression of the patient's wishes and are not systematically known by the population. The possibility to appoint a trusted person is much more known than that to draft advance directives. After the release in December 2012 of the Sicard report regarding the end of life in France, an important information campaign of the general public remains to be undertaken.

[West Nile virus infections in children]. / Infections à virus West Nile en pédiatrie.

West Nile Virus infection is an arbovirosis accidentally transmitted to humans from an aviary reservoir via an infected mosquito. Though a French surveillance network set up in 2001 reports low circulation in France, the virus is endemic in other territories. Approximately 80% of infected children remain asymptomatic, fever is seen in 20%, and very few develop a severe neurological disease in the patient's blood or spinal fluid. Treatment remains essentially symptomatic though new specific antiviral treatments and human immunization are currently being developed.

[Turicella otitidis infection: otitis media complicated by mastoiditis]. / Infections àTuricella otitidis: à propos d'un cas d'otite moyenne compliquée de mastoïdite.

UNLABELLED: Turicella otitidis is a nonfermentative, Gram-positive bacillus, which is almost exclusively isolated from the ear. Few cases of infection caused by T. otitidis have been reported in the literature, but the pathogenic potential of this little-known bacterium remains controversial, particularly in acute and chronic otitis media. CLINICAL OBSERVATIONS: A retrospective study of T. otitidis isolated in the University Hospital of Montpellier in 2004 found T. otitidis in 13 patients. Among them, a 3-year-old girl had presented with acute and perforated otitis media and mastoiditis caused by T. otitidis, thereby confirming the pathogenic effect of this bacterium. CONCLUSION: T. otitidis is relatively frequently isolated from middle ear samples in healthy patients. However, T. otitidis has been implicated in serious cases of infection and should be considered an opportunistic pathogen. Its clinical significance can be difficult to establish and each case should be carefully interpreted. From a bacteriological point of view, T. otitidis should be precisely identified to obtain more information regarding its role in clinical pathology.

[Fusobacterium necrophorum meningitis: forgotten complication of a gingivitis]. / Méningite à Fusobacterium necrophorum: complication oubliée d'une gingivite.

UNLABELLED: By now Lemierre's syndrome is a seldom-described disease whose prognosis depends on the precocity of treatment. CASE PRESENTATION: We report the case of an 11-month-old child, with a fulminant Fusobacterium necrophorum meningitis, which derived from a gingival infection, with fatal outcome. CONCLUSION: This atypical case of Lemierre's syndrome (young age occurrence and localisation) underlines the potential severity of F. necrophorum sepsis.

[Paravertebral streptococcal myositis complicated by an epidural abscess in a 5-year-old girl]. / Myosite paravertébrale à Streptococcus pyogenes A beta hémolytique compliquée d'un abcès épidural chez une enfant.

CASE REPORT: A 5-year-old girl was hospitalised for fever, abdominal and lumbar pain, associated with general impairment state and a whitlow. One of the blood cultures and CSF grew A beta haemolytic Streptococcus, muscular echography and MRI showed paravertebral myositis, which was complicated by an epidural abscess. The outcome was good with medical treatment alone. DISCUSSION: Streptococcal myositis is a rare and severe skeletal muscle infection caused by A beta haemolytic Streptococcus. It is characterized by a muscle necrosis, without abscess formation. It has to be distinguished from pyomyositis, usually caused by Staphylococcus aureus, where a muscle abscess occurs, which must be treated by surgical drainage and antibiotics. Prognosis of this infection is poorer than other muscle infections such as pyomyositis, with a high mortality rate. The diagnosis is difficult and often delayed. Practitioners should keep in mind this diagnosis, even if symptoms are non specific, in front of an undetermined infectious syndrome associated with pain, and make an echography or nuclear magnetic resonance imaging to confirm the diagnosis.

[Pleural empyema in children: Montpellier's experience]. / Les pleurésies purulentes de l'enfant: expérience montpelliéraine.

OBJECTIVES AND METHOD: To assess the management of pleural empyema in pediatric from a medical and surgical experience and a review of the literature. STUDY: Fifty-eight cases were reviewed from January 98 to December 2003. 62.6% have already received antibiotherapy. Forty-three percent of cases were less than three years old. Initial cultures identified Streptococcus pneumoniae in 39%, Streptococcus pyogenes in 5.6%, Mycoplasma pneumoniae and Staphylococcus aureus in only one case and were negative in 47%. A primitive or second-line thoracoscopy were used for drainage in two-third of the cases and mainly 6.95 days after admission. Located pleural empyema and major collected volume were the main indications for thoracoscopy. Three cases have been converted into open thoracotomy. One death occurred in an immunocompromised child. All patients were well at last follow-up. DISCUSSION: The frequency of parapneumonic empyema has increased since ten years. Progress of echography and endoscopy changed their management. Antibiotics have to be effective against pneumococcal infection. Chest tube drainage is necessary to assure the lung reexpansion in case of fibropurulent collection. The difficulty is to optimise the time of video-assisted thoracoscopy (VAT) using predictive criteria as loculations and pneumatoceles. VAT allowed the aspiration of pleural fluid and removing of fibrinous loculations. Moreover VAT achieved optimal adhesiolysis and the irrigation or decortication of the pleural cavity. VAT minimized duration of stay, of chest tube drainage and the indications of thoracotomy.

[Epidemiology of Human Metapneumovirus in respiratory tract diseases of children: preliminary results]. / Epidémiologie du métapneumovirus humain dans les infections respiratoires de l'enfant: résultats préliminaires.

BACKGROUND: Human metapneumovirus (hmpv) is a newly identified agent responsible for respiratory tract infections in children, especially before one year of age. A prospective epidemiological study is underway to better define the spectrum of the disease in France. PATIENTS AND METHODS: From November 2003 to November 2004, rhinopharyngeal aspirates were obtained from all children under five years of age admitted to the hospital with upper or lower airway symptoms. Viral identification was made using gene amplification. RESULTS: Among 355 evaluable samples to date, 34 were positive for hmpv genome. Mean age of infected children was 6.4 months, 20.5% were prematurely born infants. The prognosis is usually good. CONCLUSION: Our preliminary results are consistent with the available literature data. Further studies are needed to better define the exact frequency and morbidity of this newly recognized infection, both in hospital and community settings.

[Salmonella infections in children: a retrospective study over a four-year period]. / Les infections à salmonelles chez l'enfant: étude retrospective sur quatre ans.

OBJECTIVES: Epidemiological state of salmonella infections in Languedoc-Roussillon (France) and discussion of therapeutic indications. MATERIAL AND METHOD: Retrospective study over a four-year period of paediatric salmonella infections requiring hospitalisation in Montpellier University Hospital. Analysis of clinical, bacteriological, laboratory and therapeutic data. RESULTS: One hundred and sixty nine cases of paediatric salmonella infections have been investigated. The clinical triad consisted of diarrhea, abdominal pain and fever. Six severe cases have been observed and seemed to have been independent of patient's background. Laboratory findings showed inconstantly hyperleucocytosis and increase in CRP levels. Stool analysis remained the reference laboratory test to detect salmonella. Two major strains of salmonella have been identified: Salmonella enterica subsp. enterica serovar Typhimurium and Enteriditis. Treatments have been essentially symptomatic but 20% of the children (n=34) required antibiotic therapy. A favourable outcome was observed in all the children. DISCUSSION: Incidence of salmonella infections is increasing in France, particularly in the Languedoc-Roussillon area. Diagnosis of mild forms is generally easy but certain patient background seems to expose to severe forms. Treatment of salmonella infections is mainly symptomatic, only severe or specific cases (young age, immunodepression...) requiring antibiotic treatment. The growing antibiotic use and the increasing of resistance are currently the main problems in the management of salmonella infections. Those infections remain a public health problem in Languedoc-Roussillon.

[Digitalis intoxication during the neonatal period: role of dehydration]. / Intoxication digitalique en période néonatale: rôle de la déshydratation.

BACKGROUND: Despite the great progress which has been made in the treatment of acute digitalis intoxication by digoxin-immune Fab, it still remains a severe complication of cardiotonic therapy. CASE REPORT: A neonate with ventricular septal defect and large left-to-right shunt was treated with digitalis and diuretics at the usual starting doses. An intensive phototherapy was also required because of a hyperbilirubinemia due to glucose-6-phosphate dehydrogenase deficiency. Toxic digoxin accumulation (plasma level 14 ng/mL) was diagnosed three days after the initiation of treatment by the presence of sinus bradycardia and bursts of ventricular fibrillation. Intravenous administration of digoxin-specific antibody Fab fragments (Digidot) was effective, with a rapid improvement of the digitalis poisoning. CONCLUSION: Because of the particularities concerning drug distribution, metabolism and elimination of drugs in the neonatal period, the digoxin therapeutic index is narrow. This case report suggests the involvement of phototherapy and diuretics, which might induce a significant decrease in extracellular water and drug distribution volumes, ultimately promoting the occurrence of an intoxication.

An assessment of the validity of a computer system for probabilistic record linkage of birth and infant death records in Canada. The Fetal and Infant Health Study Group.

Studies on the validity of probabilistic record linkage are sparse. We performed a probabilistic linkage to link the 1984-1994 birth records (obtained from the Canadian Birth Data Base) with 1984-1995 infant death records (from the Canadian Mortality Data Base) in Canada. We extracted the linked birth-death records for Nova Scotia and Alberta (from January 1990 to December 1991) obtained from Statistics Canada's vital registration data and compared them with corresponding records from provincial data (primarily hospital records). The results showed that over 99% of infant deaths (153/155) in the Nova Scotia provincial data were successfully located in the linked Statistics Canada file; the corresponding figure for Alberta neonatal deaths was also 99% (365/367). The distributions of gestational age and birth weight in matched cases demonstrated high agreement between the two data sources. We conclude that the computer system for probabilistic linkage developed by Statistics Canada using the available personal identifying variables in the Canadian Birth Data Base and the Canadian Mortality Data Base is valid.

Pharmacokinetic considerations in neonatal drug therapy.

The application of pharmacokinetics has contributed to improved drug treatment regimens for the neonatal population. Significant advances in neonatal drug therapy occurred once it became possible to measure serum concentrations for medications with a narrow therapeutic range or low margin of safety. The nurse who understands the neonate's pharmacokinetic profile will not only be aware of the therapeutic effects and signs of toxicity of a given drug; she will also be able to actively plan the preferred route of administration with the physician and pharmacist and accurately time medication administration and scheduled blood sampling.