Sudden deaths in adult-worn baby carriers: 19 cases.

Soft infant carriers such as slings have become extremely popular in the west and are usually considered safe. We report 19 cases of sudden unexpected death in infancy (SUDI) linked to infant carrier. Most patients were healthy full-term babies less than 3 months of age, and suffocation was the most frequent cause of death. CONCLUSION: Infant carriers represent an underestimated cause of death by suffocation in neonates. WHAT IS KNOWN: • Sudden unexpected deaths in infancy linked to infant carrier have been only sparsely reported. WHAT IS NEW: • We report a series of 19 cases strongly suggesting age of less than 3 months as a risk factor and suffocation as the mechanism of death.

First two autochthonous dengue virus infections in metropolitan France, September 2010.

In September 2010, two cases of autochthonous dengue fever were diagnosed in metropolitan France for the first time. The cases occurring in Nice, southeast France, where Aedes albopictus is established, are evidence of dengue virus circulation in this area. This local transmission of dengue calls for further enhanced surveillance, active case finding and vector control measures to reduce the spread of the virus and the risk of an epidemic.

A case of autochthonous Plasmodium vivax malaria, Corsica, August 2006.

A case of Plasmodium vivax malaria was diagnosed in Corsica in summer 2006. This is the first case of autochthonous transmission of malaria to be reported in Corsica since 1972. Corsica is a well-known malaria endemic region characterised, for several years now by an anophelism situation without malaria disease, due to the presence of An. labranchiae and An. saccharovi able to transmit P. vivax. The occurring sequence of malaria signs in an imported case on 9 July and in an autochthonous case on 5 August, both in Porto, implies a transmission by local Anopheles. This suspicion is reinforced by the results of entomological investigations. However, from June to September 2006, no other P. vivax malaria case and no other autochthonous case were detected in Corsica. Therefore, it seems that no permanent malaria transmission occurs in this island. Mosquito eradication actions and anti-vectorial measures have been reinforced as well as individual prevention measures against imported diseases while travelling in tropical countries. Obviously, detection of one exceptional autochthonous transmission of one malaria case in Corsica does not justify proposing malaria protection to tourists.

[Genital infections in women, in community practice. Comparison of two studies, 1987 and 2002]. / Les infections génitales chez la femme en pratique de ville Enquêtes Aforcopi-BIO. Comparaison des résultats 1987 et 2002.

One thousand eight hundred and thirty-six clinical and biological cervico-vaginal flora samples from genital infections in women observed in community practice in 1987 were compared to 368 samples collected in 2001. The diagnosis of sexually transmitted infection (STI) was rarely made. Nonetheless, examining these samples made it possible either to prescribe a specific treatment for a confirmed infection (chlamydia, trichonomiasis, candidiasis, gonococci, vaginosis), or to modify a long-term treatment that was often ineffective and sometimes badly tolerated. Not all vulvar itching, associated or not with pelvic pain, is caused by mycosis. Treatment based on a syndromic approach was often ineffective, because clinical symptoms, whether isolated or associated, even when they were suggestive of an etiology, presented only a minor positive predictive value (the PPV for the association ichting + pelvic pain was only 10% for chlamydia, but 45% for candidiasis). The diagnosis of vaginosis, suggested for the past 10 years as an improvement in the diagnosis of vulvo-vaginitis, was made in only 13% of the cases. The only significant difference in our two studies was a lower number of cases of gonococci, chlamydiae, and ureaplasms in 2001, the settings having remained identical, except for a lower number of patients in 2001.

Outbreak of typhoid fever on the French Riviera.

A case-control study was conducted to establish the source of a community outbreak of typhoid fever in Utelle, France, a village located in the Alpes-Maritimes district of the French Riviera. Thirteen confirmed cases of typhoid fever and 41 confirmed community controls were included in the study. Cases and controls did not differ regarding ingestion of water. Multivariate logistic regression analysis identified consumption of pork meats during a village festival as the only statistically significant risk factor for typhoid fever after adjusting for age and sex (odds ratio, 76.0; 95% confidence interval, 3.5-1660). Assessment of food-handling procedures at the inn where the food had been prepared showed that the refrigeration and cooking facilities were inadequate to maintain a proper sanitary environment during the preparation of a meal for 350 people. Although the exact cause of the epidemic could not be confirmed, food contaminated by a chronic typhi carrier is the most plausible hypothesis.

[Knowledge, opinions and attitudes of physicians regarding air pollution in the Bouches-du-Rhône]. / Connaissances, opinions et attitudes des médecins face à la pollution atmosphérique dans les Bouches-du-Rhône.

OBJECTIVE: To evaluate knowledge, opinions and attitudes of physicians towards prevention of health consequences from air pollution, especially photo-chemical pollution. METHODS: A questionnaire was prepared by a multidisciplinary group from published literature on Health impact of air pollution and from local context. It was administered on line among a random sample of physicians practising in the County of the Bouches du Rhône (Marseille, South-eastern France). The sample consisted in pediatricians (1/2), general practitioners (GP; 1/14) and pneumologists. RESULTS: The answer rate was 79% (112/169 GP, 94/107 pediatricians, 82/91 pneumologists). Among the 288 physicians who answered the questionnaire, 44% declared they felt very concerned by air pollution, especially pediatricians. While 87% were knowledgeable about SO2 regulations, only 59% (48% among pediatricians) were knowledgeable about ozone regulations. While about all physicians knew the health effects of air pollution episodes on respiratory tract, only half knew that mortality rates can increase significantly during such episodes. Forty percent of physicians had never heard about air pollution episodes that occurred in their city, while air quality control networks had identified them. At last, only 15% of physicians had already given recommendations to patients during episodes of ozone pollution (above 180 micrograms/m3). CONCLUSION: That study shows the need for improving knowledge and attitudes of physicians about air pollution, especially photo-chemical air pollution. As physicians are concerned about the Health impact of air pollution, and patients are demanding about this issue, training and information programmes should be implemented rapidly. However, experimental interventions aimed at reducing the acute effects of air pollution episodes should be evaluated to show their efficiency, and to convince physicians with scientific arguments.

Gaseous air pollution and atopy.

BACKGROUND: Photochemical air pollutants are commonly thought to be implicated in the gradual increase in the prevalence of atopy. However, no epidemiological data are available. METHODS: To clarify this issue, we performed a cross-sectional epidemiological survey in 2604 primary school children, 10 and 11 years old, living in seven communities among which some have the highest photochemical exposure in France. The mean levels of the main gaseous air pollutants (SO2, NO2 and O3) were measured during a 2-month period in 1993. The protocol included a standardized questionnaire, skin prick tests to common aeroallergens and in the atopic children, collection of a sample of mattress dust to measure group 1 mite allergens. Atopy was only defined on the basis of the skin prick tests. RESULTS: Percentage of positive skin tests and the number of positive skin tests were similar in the different communities looked at. The distribution of dust samples with a group 1 allergen level greater than 2 microg/g dust, was also similar. Logistic regression analysis including potential confounding factors, as well as the mean level of air pollutants, did not demonstrate any association between atopy and mean SO2, NO2 and O3 levels. CONCLUSION: The increase in photochemical air pollutants is unlikely to be a major determinant for the recent increase in the prevalence of atopy.

The prevalence of reported asthma is independent of exposure in house dust mite-sensitized children.

In areas with low house dust mite (HDM) allergen exposure, both mite sensitization and asthma prevalence are low. In most other areas, HDM allergen exposure is higher than the threshold for sensitization. In this setting, is HDM allergen exposure a factor which is causally related to the development of asthma in HDM-sensitive individuals? To answer this question, the cumulative prevalence of asthma was evaluated in a group of 157 schoolchildren, aged 10 and 11 yrs, who were allergic to HDM allergen, and compared it with HDM allergen exposure and atopic status, using univariate and multivariate analysis. HDM allergen levels were measured in mattress dust using an enzyme-linked immunosorbent assay (ELISA) method. Of mattress dust samples, 94% had an HDM allergen level >2 microg x g dust(-1). Atopy was evaluated by means of skin prick tests using five common allergens. Among the predictive variables studied by means of univariate analysis, only the number of positive skin tests and male sex correlated with asthma prevalence, but not HDM allergen exposure. Logistic regression analysis also demonstrated that the number of positive skin tests correlated with asthma prevalence (odds ratio (OR)=1.38, p=0.05), whereas the OR for HDM allergen exposure was 1.0. This survey suggests that, in a geographical area with high HDM allergen exposure, asthma prevalence is not linked with HDM allergen levels.

Urban outbreak of Q fever, Briancon, France, March to June 1996.

Q fever is an ubiquitous zoonosis caused by the rickettsial organism Coxiella burnetii. Both sporadic cases and epidemics occur in areas where sheep and goats are bred. The main route of transmission is by inhalation of aerosols from the environment (soil

Diffusion of enoxacin into the cerebrospinal fluid in dogs with healthy meninges and with experimental meningitis.

After a 1 h intravenous injection of 12.5 and 25 mg/kg enoxacin in dogs with healthy meninges, the concentrations in cerebrospinal fluid observed between 90 and 240 min averaged 2.6 (1.8-3.3) mg/l and 6.5 (4.7-8.4) mg/l respectively. In dogs with meningitis, a dosage of 12.5 mg/kg yielded a mean concentration of 4.9 (3.1-6.4) mg/l. The concentrations obtained in dogs with healthy meninges greatly exceeded the MICs for meningococci and Haemophilus influenzae. In the infected dogs, the concentrations obtained exceeded the MICs of the most common causative agents of meningitis. In the dogs with healthy meninges the ratio CSF/plasma AUCs was 47% after 25 mg/kg and 33% after 12.5 mg/kg. In the infected dogs, the ratio was 67.3% after 12.5 mg/kg.