Teledentistry and management protocol in a pediatric dental department during the first COVID-19 lockdown.

BACKGROUND: During the first COVID-19 lockdown, from March 12 to May 15, 2020, private dental practices in France and in many other countries remained closed. Dental emergencies were therefore partly redirected to hospital dental departments. The aim of this article is to describe the modalities of remote management of emergencies during this period, by the pediatric dentistry department of Nancy University Hospital (France), via an oral telemedicine protocol. PATIENTS AND METHODS: All parents of children in difficulty were invited to contact the department by phone. Initial triage was managed by externs, interns, or dental practitioners following a management protocol specifically adapted to pediatric dentistry for this context. Depending on the situation (type of complaint, geographical location of the patients, possibility of travel, availability of digital equipment, etc.), an oral telemedicine solution was proposed using the Covotem® software (Maincare Society, Canejan, France) via the Pulsy platform (public interest grouping validated by the Grand Est Regional Agency for Health) and possibly using an intraoral photographic protocol suggested by the team. RESULTS: During this period, 176 patients used the pediatric dental department, 40 of whom were managed via oral telemedicine. Of these children, 57% (23/40) required an appointment in the department during the lockdown, 30% (12/40) did not require follow-up, and 13% (5/40) required a post-lockdown appointment. This teledentistry protocol resulted in a diagnosis in most cases (93%). CONCLUSION: Patient management through oral telemedicine appears to be an effective tool for planning and organizing oral healthcare. It should be more widely considered in dentistry in the current context of pressure in medical emergencies, significant medical needs, and medical desertification.

Antibiotic use and resistance: a nationwide questionnaire survey among French dentists.

The aim of this survey was to describe the attitudes and self-reported practices of French dentists towards antibiotic use and resistance and to compare practices with national guidelines. A nationwide cross-sectional internet-based survey was conducted among the 41,800 French dentists. The online questionnaire was distributed through professional networks from April 2017 to April 2018. Seven-hundred seventy-five dentists participated but only 455 questionnaires were complete enough to be included in the analyses. Amoxicillin was the most frequently prescribed antibiotic (65.8%, 1783/2711), followed by spiramycin + metronidazole fixed-dose combination (11.6%, 312/2711) and amoxicillin-clavulanic acid (10.3%, 279/2711). The main indications for use were abscess (349/423, 82.5%), cervicofacial cellulitis (74.2%, 314/423), and pericoronitis (58.6%, 239/408). Most dentists (90.5%, 381/421) considered that antibiotic resistance is of concern but only half of them (56.3%, 238/423) felt adequately informed about antibiotic use. Many dentists did not comply with the national guidelines: the majority of them declared inappropriate antibiotic prescriptions for 11/17 clinical situations. They did not prescribe antibiotics for 5/6 clinical situations requiring prophylaxis. They reported that the publication of clinical guidelines is the main factor influencing their prescriptions (71.0%, 299/421). They wished to receive regular updates of national guidelines in the form of practical sheets (93.0%, 172/185). French dentists should urgently be targeted by antibiotic stewardship initiatives.

Dramatic Increase in Incidence of Ulcerative Colitis and Crohn's Disease (1988-2011): A Population-Based Study of French Adolescents.

OBJECTIVES: Few data are available to describe the changes in incidence of pediatric-onset inflammatory bowel disease (IBD). The aim of this study was to describe changes in incidence and phenotypic presentation of pediatric-onset IBD in northern France during a 24-year period. METHODS: Pediatric-onset IBD (<17 years) was issued from a population-based IBD study in France between 1988 and 2011. Age groups and digestive location were defined according to the Paris classification. RESULTS: 1,350 incident cases were recorded (8.3% of all IBD) including 990 Crohn's disease (CD), 326 ulcerative colitis (UC) and 34 IBD unclassified (IBDU). Median age at diagnosis was similar in CD (14.4 years (Q1=11.8-Q3=16.0)) and UC (14.0 years (11.0-16.0)) and did not change over time. There were significantly more males with CD (females/males=0.82) than UC (females/males=1.25) (P=0.0042). Median time between onset of symptoms and IBD diagnosis was consistently 3 months (1-6). Mean incidence was 4.4/105 for IBD overall (3.2 for CD, 1.1 for UC and 0.1 for IBDU). From 1988-1990 to 2009-2011, a dramatic increase in incidences of both CD and UC were observed in adolescents (10-16 years): for CD from 4.2 to 9.5/105 (+126%; P<0.001) and for UC, from 1.6 to 4.1/105 (+156%; P<0.001). No modification in age or location at diagnosis was observed in either CD or UC. CONCLUSIONS: In this population-based study, CD and UC incidences increased dramatically in adolescents across a 24-year span, suggesting that one or more strong environmental factors may predispose this population to IBD.

Auto-antibodies to vascular endothelial cadherin in humans: association with autoimmune diseases.

To identify patients with autoimmune diseases who are at high risk of developing vascular cell dysfunction, early biomarkers must be identified. This study was designed to detect and characterize circulating autoantibodies to VE-cadherin (AAVEs) in patients with early-stage autoimmune diseases. An enzyme-linked immunosorbent assay (ELISA) was developed to capture autoantibodies, using a recombinant human VE-cadherin fragment covering the extracellular domains as a target antigen. AAVEs specificity for the target antigen was confirmed by western blotting. Basal AAVEs levels were determined for healthy donors (n=75). Sera from patients (n=100) with various autoimmune diseases, including rheumatoid arthritis (n=23), systemic lupus erythematosus (SLE, n=31), systemic sclerosis (n=30), and Behçet's disease (BD, n=16) were also tested. Levels of AAVEs were significantly higher in rheumatoid arthritis (P<0.0001), SLE (P<0.05), and BD (P<0.05) populations than in healthy subjects. Purified immunoglobulin G (IgG) from a BD patient with exceptionally high AAVEs levels recognized the EC1-4 fragment in western blots. Further characterization of the epitopes recognized by AAVEs showed that BD patients had antibodies specific for the EC3 and EC4 domains, whereas SLE patients preferentially recognized the EC1 fragment. This suggests that distinct epitopes of human VE-cadherin might be recognized in different immune diseases. Purified IgG from BD patients was found to induce endothelial cell retraction, redistribution of VE-cadherin, and cause the formation of numerous intercellular gaps. Altogether, these data demonstrate a potential pathogenic effect of AAVEs isolated from patients with dysimmune disease. This is the first description of AAVEs in humans. Because regions EC1 and EC3-4 have been shown to be involved in homophilic VE-cadherin interactions, AAVEs produced in the course of dysimmune diseases might be specific biomarkers for endothelial injury, which is part of the early pathogenicity of these diseases.

A national survey of endoscopic mucosal resection for superficial gastrointestinal neoplasia.

BACKGROUND AND STUDY AIM: Studies on endoscopic mucosal resection (EMR) are mostly based on data from centers with high expertise. We report the average EMR results in a national survey of consecutive patients in France. METHODS: A 1-year survey was carried out to record immediate outcome data of all EMRs performed, regardless of lesion size or gastrointestinal location. RESULTS: Overall, 1335 EMRs in 1210 patients were reported by 241 of the 736 gastroenterologists who performed such procedures (33 %). Resections were done for upper gastrointestinal lesions in 125 cases (41 esophageal, 43 gastric, and 41 duodenal lesions), in 45 % of cases using specific EMR techniques such as ligation, cap, or traction. The technique for resecting the 1210 lower gastrointestinal lesions mostly consisted of saline-assisted polypectomy or EMR, with specific techniques used in only 2.2 %. En bloc resection was less common with esophageal (46 %) or duodenal (54 %) neoplasms than in the lower gastrointestinal tract (73 %); size also had some influence (53 % > 1 cm vs. 92 % ≤ 1 cm). The overall complication rate was 5.2 %; the rate was lower for lesions 1 cm or smaller (0.6 % vs. 4.6 %). Fifty-four early and 17 delayed complications were recorded, in 12 % of upper gastrointestinal and 4.6 % of colonic lesions. Surgery became necessary in 1.6 % for upper and 2.9 % for lower gastrointestinal neoplasms. No association was seen between physician EMR caseload and either en bloc resection rate or complication rate. CONCLUSIONS: EMR in general, especially saline-assisted polypectomy in the colon, appears to be reasonably safe even when performed by nonexperts. EMR for larger or for upper gastrointestinal lesions should probably be limited to high-volume centers.

A fulminant colitis index greater or equal to 8 is not predictive of colectomy risk in infliximab-treated moderate-to-severe ulcerative colitis attacks.

INTRODUCTION: In severe attacks of ulcerative colitis (UC) treated with intravenous corticosteroids, a fulminant colitis index (FCI) greater or equal to 8 has been associated with a greater likelihood of colectomy (72 vs 16% with an FCI<8). This retrospective study aimed to assess the accuracy of such an association in infliximab-treated patients with moderate-to-severe bouts of UC. PATIENTS AND METHODS: The study was based on the medical files of 43 patients who had received at least one infusion of infliximab to treat moderate-to-severe UC (partial Mayo Clinic score). Remission and clinical response were also assessed using the partial Mayo score. The accuracy of an FCI greater or equal to 8 to predict the likelihood of colectomy was assessed by calculating the sensitivity, specificity, positive and negative predictive values, Yule's Q coefficient, Youden's index and statistical significance (Chi(2) test). RESULTS: After treatment with infliximab, 10 patients were in remission (23.3%), 21 (48.8%) had a clinical response, four (9.3%) had treatment failure (without, however, requiring colectomy) and eight (18.6%) had a colectomy. Calculation of the above-mentioned indicators revealed that an FCI greater or equal to 8 was not an indicator of the risk of colectomy in this patient population, and found that only an FCI greater or equal to 16 was statistically significant. However, low values for sensitivity, positive predictive value and Youden's index preclude the clinical application of this latter result. CONCLUSION: In patients treated with infliximab for moderate-to-severe UC attacks, the FCI is not a predictor of colectomy. In such patients, the factors predictive of a response to treatment or likelihood of colectomy, currently acknowledged with corticosteroid treatment, need to be further assessed for infliximab treatment.

[Acute respiratory distress syndrome as the presenting manifestation of an antisynthetase syndrome]. / Pneumopathie aiguë sévère révélatrice d'un syndrome des anticorps antisynthétases.

The antisynthetase syndrome is a subgroup of idiopathic inflammatory muscle diseases. Its characteristics are interstitial lung disease, myositis, polyarthritis, mechanic's hand like cutaneous involvement, and the presence of antisynthetase antibodies (anti-Jo1). The lung disease is the presenting feature in 50% of cases. We report a patient with an antisynthetase syndrome, revealed by an acute respiratory distress syndrome. This patient was already followed-up for a scleroderma and presented a probable overlap syndrome. The disease course was favourable with anti-CD20 therapy.

Respiratory chain defects in the mitochondria of cultured skin fibroblasts from three patients with lacticacidemia.

The cultured skin fibroblasts from three patients with lacticacidemia were found to have low rates of 1-[14C]pyruvate oxidation in the face of normal pyruvate dehydrogenase activity. After incubation with 1 mM glucose, these three cell strains also exhibited lactate/pyruvate ratios which were three times greater than those of controls. In two of the patients, both ATP and oxygen consumption in fibroblast mitochondrial preparations was deficient with NAD-linked substrates but normal with succinate and ascorbate/N'N'N'N' tetramethyl phenylene diamine. In the third patient, ATP synthesis in mitochondrial preparations was deficient with all substrates tested. Measurement of Rotenone-sensitive NADH-cytochrome c reductase in mitochondrial preparations from skin fibroblasts showed that two of the patients had 14 and 18%, respectively, of control activity. In the third patient, cytochrome oxidase activity was 15% of that in controls. We conclude that respiratory chain defects can be demonstrated in cultured skin fibroblasts with consistency using a number of different techniques.