How do the FIFA World Cup 2018 and the 2016 UEFA championships impact a pediatric emergency department?

INTRODUCTION: In France, soccer is the most popular sport, which today attracts a huge television audience with millions of spectators in the case of international competitions. During certain games with European top clubs, the attendance of adult emergencies is impacted. However, the impact of international soccer competitions on pediatric emergency department (PED) activity has not been evaluated. METHODS: We performed a retrospective analysis of attendance in the PED of a tertiary university hospital in Nancy (France) during the UEFA 2016 championship and the FIFA 2018 World Cup. Games were represented by 2.5-h blocks and the tournament period was compared with the same period in the previous year. RESULTS: Considering all games, we did not observe an impact of PED attendance. The admission rate was significantly lower during the final phase (11.1 patients per match vs. 13.9, P=0.037). We observed a decrease in consultations for trauma (4.9 vs. 6.7, P=0.006). The effects were higher during games involving the national French team, with a decrease in less severe admissions (P=0.034), attendance of older children (P=0.016), and the presence of the father as accompanying adult (P=0.002). During the two final matches, we observed a decrease of 14% in the total activity. CONCLUSION: We found significant differences in PED attendance during two international soccer tournaments. It would be interesting to study this effect in countries other than France or in countries with different sport habits.

Comparison of patient-led, fibromyalgia-orientated physical activity and a non-specific, standardised 6-month physical activity program on quality of life in individuals with fibromyalgia: a protocol for a randomised controlled trial.

BACKGROUND: Exercise has been shown to significantly improve pain and function in individuals with fibromyalgia. Research into the effectiveness of exercise is often based on standardised exercise programmes that are chosen by the investigating clinical research team. However, such programmes may not necessarily be appealing to the participating patients. Furthermore, in addition to being taught exercises, patients with chronic conditions like fibromyalgia also need to learn to manage their condition themselves and so be actively involved in their treatment. The primary aim of this study is to compare the effects of two, 6-month physical activity programs on quality of life in patients with fibromyalgia. One group followed a patient-led, fibromyalgia-orientated programme (experimental) whilst the control group followed a standard, general exercise programme. METHODS: This protocol is an open-label, two-centre, randomised, controlled superiority trial. Two treatment arms will be compared: an experimental group (patient-led, fibromyalgia-orientated exercise) and a control group (general exercise program). The control group will participate in the exercise programme currently provided in our centre, which involves general, group exercise for patients with various pathologies. The experimental group will be taught the principles of exercise specifically for fibromyalgia during a one-to-one coaching session. They will then be guided in the choice of one or several types of exercise that they enjoy. They will be instructed to perform the exercise according to the recommendations for exercise in fibromyalgia with regard to intensity, duration and frequency. The protocol will last for 6 months; participants will then be followed-up for a further 6 months. They will also be encouraged to continue exercising after the end of the protocol. Outcomes will be evaluated at baseline, 6 and 12 months. The primary outcome will be quality of life (Fibromyalgia Impact Questionnaire) and the secondary outcomes will include measures of pain (including a visual analogue scale and the neuropathic characteristics of the pain), depression (Hospital Anxiety and Depression Scale), kinesiophobia (Tampa scale of kinesiophobia) and adherence (Polar OH1 heart rate monitor). DISCUSSION: The results of this study will show if patient-led, fibromyalgia-orientated exercise is more effective than a general exercise programme on fibromyalgia-related outcomes, including quality of life, and on adherence to continued exercise. TRIAL REGISTRATION: ClinicalTrials.gov NCT03895086 . Registration no. 2018-A02881-54. Registered on 29 March 2019.

Knowledge assessment of sudden infant death syndrome risk factors in expectant mothers: A prospective monocentric descriptive study.

In France, approximately 500 deaths per year are related to sudden infant death syndrome (SIDS). After a 75% reduction of SIDS-related deaths in the 1990s, thanks to large prevention campaigns directing parents to put their infants to sleep on their back, the number of SIDS-related deaths remains stable. However, we estimate that 100-200 infant deaths per year in France could be prevented with better education on the risk factors for SIDS. In this prospective, descriptive monocentric study, we aimed to evaluate the level of expectant women's knowledge about SIDS. Questionnaires were distributed during a midwife consultation. A score on sleeping conditions, environmental and protective factors was determined with coefficients attributed according to their relevance to SIDS. Of 296 questionnaires distributed, 202 were completed and included in the analysis from March 1 to September 21, 2018. Scores were distributed from 2 to 46/50. The average score was 28.6/50. Information was principally obtained from media and not health professionals. When the information was delivered by a caregiver, in particular by a paediatrician, we observed better knowledge among these women. This study shows that it is important for health professionals to take the time to inform future mothers about the risk factors for SIDS, especially the least informed population groups such as young mothers and those from lower socioeconomic status, in order to reduce the number of avoidable infant deaths.

Epidemiological Data on Anaphylaxis in French Emergency Departments.

BACKGROUND: Although anaphylaxis has been considered a priority public health issue in the world allergy community, epidemiological data on morbidity and mortality remain suboptimal. We performed the first multicenter epidemiological study in French emergency departments (EDs). The study covered 7 EDs over a period of 1 year. The objectives were to identify areas that are amenable to change and to support ongoing national and international efforts for better diagnosis, management, and prevention of anaphylaxis. METHODS: Ours was a descriptive study based on data routinely reported to French institutional administrative databases from 7 French public health institutions in the Lorraine region between January and December 2015. Data were collected based on the anaphylaxisrelated codes of the International Classification of Diseases (ICD)-10, and cases were clinically validated as anaphylaxis. RESULTS: Of the 202 079 admissions to the EDs, 4817 had anaphylaxis-related codes; of these, 323 were clinically validated as anaphylaxis. Although 45.8% were severe, adrenaline was prescribed in only 32.4% of cases. Of the 323 cases, 57.9% were subsequently referred for an allergy work-up or evaluation (after or during hospitalization), and 17.3% were prescribed autoinjectable epinephrine. CONCLUSION: Our results highlight an urgent need for improved public health initiatives with respect to recognition and treatment of anaphylaxis. We flag key problems that should be managed in the coming years through implementation of national and international actions.

Epidemiological data on anaphylaxis in French emergency departments

BACKGROUND: Although anaphylaxis has been considered a priority public health issue in the world allergy community, epidemiological data on morbidity and mortality remain suboptimal. We performed the first multicenter epidemiological study in French emergency departments (EDs). The study covered 7 EDs over a period of 1 year. The objectives were to identify areas that are amenable to change and to support ongoing national and international efforts for better diagnosis, management, and prevention of anaphylaxis. METHODS: Ours was a descriptive study based on data routinely reported to French institutional administrative databases from 7 French public health institutions in the Lorraine region between January and December 2015. Data were collected based on the anaphylaxis-related codes of the International Classification of Diseases (ICD)-10, and cases were clinically validated as anaphylaxis. RESULTS: Of the 202 079 admissions to the EDs, 4817 had anaphylaxis-related codes; of these, 323 were clinically validated as anaphylaxis. Although 45.8% were severe, adrenaline was prescribed in only 32.4% of cases. Of the 323 cases, 57.9% were subsequently referred for an allergy work-up or evaluation (after or during hospitalization), and 17.3% were prescribed autoinjectable epinephrine. CONCLUSION: Our results highlight an urgent need for improved public health initiatives with respect to recognition and treatment of anaphylaxis. We flag key problems that should be managed in the coming years through implementation of national and international actions

ANTECEDENTES: La anafilaxia es un problema prioritario de salud pública en la comunidad mundial alergológica. Sin embargo, los datos epidemiológicos disponibles de morbilidad y mortalidad son mejorables. Presentamos el primer estudio epidemiológico multicéntrico, realizado en siete departamentos de urgencias franceses durante un año, que tuvo como objetivo identificar las cuestiones relevantes para lograr cambios en futuras estrategias, nacionales e internacionales, que deriven en un mejor diagnóstico, tratamiento y prevención de la anafilaxia. MÉTODOS: Se trata de un estudio descriptivo que utilizó la información proveniente de las bases de datos de siete instituciones francesas de salud pública, de la región de Lorena, desde enero hasta diciembre de 2015. Se buscaron nomenclatura y códigos relacionados con la anafilaxia, de la Clasificación Internacional de Enfermedades (CIE-10), y los pacientes fueron validados clínicamente como casos de anafilaxia. RESULTADOS: De los 202.079 ingresos en urgencias, 4.817 tenían códigos relacionados con la anafilaxia CIE-10, 323 de los cuales se validaron clínicamente con el diagnóstico de anafilaxia. Aunque el 45,8% presentó criterios de gravedad, la adrenalina se prescribió solo en el 32,4% de estos casos. En total, 323 casos, el 57,9%, se remitieron posteriormente para un estudio o evaluación alergológica (después o durante la hospitalización) y el 17,3% recibió una receta de adrenalina autoinyectable . CONCLUSIÓN: Según los resultados de este estudio, existe una necesidad urgente e imperiosa de mejorar los planes de salud pública respecto al reconocimiento y tratamiento de la anafilaxia. Los problemas clave detectados en este trabajo, señalan el camino de la toma de decisiones e implementación de acciones de mejora, nacionales e internacionales, para una mejor atención de los pacientes con anafilaxia

[Child sexual abuse: Description of a French population having consulted in a forensic medical service between 2011 and 2015]. / Agressions sexuelles sur mineurs : étude d'une population d'enfants ayant consulté dans une unité médico-judiciaire hospitalière entre 2011 et 2015.

BACKGROUND: When child sexual abuse (CSA) is suspected, the detection of anogenital anomalies is rare. In France, since 2011, most clinical examinations of children for whom CSA is suspected take place in the forensic medical service (FMS). OBJECTIVES: To describe a population of children examined for suspected CSA in the FMS of the Nancy Regional University Hospital Center. PATIENTS AND METHODS: Children under the age of 18 who consulted for suspected CSA in the Nancy FMS between 2011 and 2015 were included. Demographic data as well as data from questioning, the physical examination, any further examination, and the medical conclusions were collected. RESULTS: Three hundred and twenty-five girls and 79 boys were enrolled. The average age at the time the abuse was committed was 118.9 months. Two hundred sixty-nine (66.6%) children alleged fondling and 59 (14.6%) fellatio. Two hundred twelve victims (52.5%) described a penetration, 163 (76.9%) in the vagina and 73 (34.4%) in the anus. Significant bruises were found at the examination of 13 children, accounting for 2.5% of all victims. Thirty-four (11.7%) girls had lesions in the external genitalia and 28 (9.8%) lesions of the virginal membrane. One boy (1.3%) had a nonspecific lesion of the external genitalia. Six (8.2%) children alleging anal penetrations showed injury. The examiner concluded that clinical examinations were compatible with alleged facts for 253 (62.6%) victims. It was impossible to conclude for 116 (28.7%) children. CONCLUSION: In the case of suspected CSA, the clinical examination is frequently normal. This examination must be performed by physicians trained in child abuse, under appropriate conditions. It is important not to jump to conclusions about the reality of the alleged facts. A multidisciplinary approach, with the cooperation of the medical, social, and forensics sector is necessary.

[Motivations for a consultation before adoption: A multicenter study]. / Étude multicentrique sur les motivations d'une consultation avant adoption.

INTRODUCTION: While the number of international adoptions in France is decreasing, adopted children are older and in poorer health than they used to be. This phenomenon has resulted in an increase in the demand for preadoption consultations over the past several years. This study analyses the reasons for these consultations. METHOD: Prospective multicenter study conducted from 1 January to 31 December 2013. RESULTS: Ten centers contributed to the study, i.e., 196 preadoption consultations. Seeking medical advice was the reason for 88% of the consultations, whether the advice was based on the study of an identified child's medical file (32%) or a country's healthcare characteristics, whether the country was identified (34%) or not (23%). In 6% of cases, the motive for preadoption consultations was social and familial, and in the last 5% it was to obtain general information about adoption and its procedures. In more than 40% of the cases, whether the child or the country identified, Russia is the subject of the consultation because of the complexity of the files and because of the dreaded but rarely mentioned fetal alcohol syndrome. CONCLUSION: The deterioration of adopted children's health is an additional worry for future adoption applicants. To provide them with the best information possible without making choices for them, specialists should have substantial experience in adoption before going into these preadoption consultations.

[Severe allergic reaction due to a rectal enema]. / Réaction allergique sévère suite à un lavement.

Allergic drug reactions must always be considered when prescribing treatment, even in frequent pediatric problems such as acute abdominal pain due to constipation. We describe an original case of anaphylactic shock due to the administration of hypertonic rectal enema in a child. A 9-year-old child admitted to the emergency department for an acute complaint of abdominal pain related to constipation received an administration of a hypertonic rectal enema to allow the passage of stools. Afterwards, the child presented a life-threatening episode, requiring emergency treatment with transfer to the pediatric intensive care unit, suggesting an anaphylactic shock. The absence of any other drug or food intake, the chronology of events, and favorable outcome after treatment led to the diagnosis of a probable allergy to methylparaben, sodium parahydroxybenzoate, present as the excipient in the rectal enema. Anaphylactic shock is a serious allergic reaction, setting in rapidly, which may lead to fatal outcome. Most reactions to parabens reported concern, almost exclusively, the cutaneous application of paraben-containing topical preparations. The present observation underscores the original and undescribed risk of an allergic general reaction following the rectal administration of parabens. The indications of any prescription must be carefully observed and potential drug contraindications, considering the patient's history of allergy, should be sought.

Fetal karyotyping after 28 weeks of gestation for late ultrasound findings in a low risk population.

OBJECTIVE: To analyze the indications and the results of invasive testing for fetal karyotyping for ultrasound abnormality in the third trimester of pregnancy, when first- and second-trimester screening tests were negative. METHODS: Retrospective study of 171 consecutive pregnancies that underwent invasive testing after 28 weeks of gestation in 2 institutions between January 1999 and December 2001. Forty-one patients did not have any form of screening for fetal aneuploidy beforehand. One hundred and thirty of them had a normal first-trimester scan and a low risk of fetal aneuploidy by nuchal translucency and/or maternal serum screening and were included in the statistical analysis. RESULTS: Mean maternal age, gestational age at diagnosis and at invasive testing were 30.5 years; 29.3 weeks and 32.5 weeks respectively. Amniocentesis and fetal blood sampling were performed in 97 and 33 cases respectively. The most frequent indications for invasive testing in the third trimester were major fetal malformations (51%) and intrauterine growth restriction (19%) detected on routine second- or third-trimester ultrasound examination. Ultrasound markers of aneuploidy and polyhydramnios accounted for 17 and 11% of the indications respectively. Fetal karyotype was normal in 121/130 cases. A gene mutation was found in one case. The karyotype was abnormal in nine cases, including seven cases of aneuploidy (one Turner syndrome, three trisomy 18, and three trisomy 21) and two cases of structural chromosomal abnormalities (46,XX, del 4 p16.1 and 46,XX, dup1). One hundred cases resulted in the delivery of a normal baby. Thirty cases led to termination of pregnancy or intrauterine death due to major fetal malformations (N = 25), abnormal karyotype in six of these, and severe IUGR (N = 5) with normal karyotype. Fetal US markers of aneuploidy and isolated polyhydramnios were associated with a favorable outcome in all cases.A significant increase in the risk of chromosomal anomaly was seen when two or more anomalies were found, rising from 2% with one anomaly to 21% when two or more anomalies were present. CONCLUSION: In low risk patients, fetal karyotyping in the third trimester may be justified when the diagnosis of fetal malformation is made in the third trimester of pregnancy. Two or more anomalies increase the risk of fetal aneuploidy even with a negative-screening test in the first and second trimester of pregnancy.

Revisiting first-trimester fetal biometry.

INTRODUCTION: Although advances in ultrasound have facilitated the diagnosis of fetal abnormalities in the first trimester, fetal biometry at this stage of pregnancy remains underused in prenatal diagnosis. We hypothesized that charts which directly correlate measurements to crown-rump length (CRL) could be more accurate than those based on gestational age (GA) derived from CRL measurement. The aim of this study was to construct CRL-based biometric charts. METHODS: Measurements of biparietal diameter (BPD), head circumference (HC) and abdominal circumference (AC) were prospectively collected from 939 normal singleton fetuses. Charts and predictive equations were constructed from data obtained from pregnancies in which the CRL was between 45 and 84 mm and for which the outcome was normal. RESULTS: Measurements of BPD, HC and AC from 880 fetuses who met the criteria were correlated with CRL and used to construct charts and predictive equations. The standard error of estimates using CRL was significantly lower than that using GA in all cases. DISCUSSION: First-trimester growth charts and predictive equations based on CRL instead of GA are more accurate. They might have a role in quality control of first-trimester ultrasound examination and may help in the diagnosis of fetal conditions that involve early growth abnormalities.

Measurement of the corpus callosum using magnetic resonance imaging: analyses of methods and techniques.

Since the first postmortem report of sex-related differences in the size of the human corpus callosum, a number of studies on sex differences have been published, but results conflicted. The aim of this review was not to assess the possible existence and magnitude of sex variations in the size of the corpus callosum but to analyze methodological differences in several studies using Magnetic Resonance Imaging to investigate the sexual dimorphism in the size of the corpus callosum. Methodological problems arise at several steps of the method: sampling, imagery techniques, and measurements. Moreover, the means of callosal areas obtained by the nine reported studies are significantly different. The hypothesis that methodoiogical differences could explain these differences is supported by statistical results. A common method for investigating sex-related differences in callosal morphology appears necessary to resolve the question of a real sexual dimorphism of the corpus callosum and its subregions.

Relationship between discrimination tasks of the cantab and the corpus callosum morphology in Alzheimer's disease.

The relationship between performances on a simple discrimination task of the Attentional Set Shifting of the Cambridge Neuropsychological Test Auto mated Battery (CANTAB) and morphometry of the corpus callosum is examined in patients with Alzheimer's disease. Analysis showed patients with probable Alzheimer's disease are heterogeneous for the relationship between performances in the attentional test of the CANTAB and the anterior callosal atrophies. Interest in these results for clinical diagnosis of this mental disease is discussed.

Magnetic resonance imaging and cerebral volumic evaluation: comparison of four post-processing techniques.

Four different MRI techniques of volumetric evaluation were applied in 10 healthy females and compared. The results have shown that not all techniques were interchangeable, but that the results of two groups of methods are not statistically different.

An unusual form of Stevens-Johnson syndrome with subcorneal pustules associated with Mycoplasma pneumoniae infection.

We report a 10-year-old girl in whom Stevens-Johnson syndrome (SJS) (with acute gingivostomatitis and conjunctivitis) was associated with a pustular eruption clinically and histologically similar to Sneddon-Wilkinson subcorneal pustulosis. This is a very rare form of SJS, the true incidence of which is probably underestimated.

Hemispheric asymmetry and corpus callosum morphometry: a magnetic resonance imaging study.

Previous post-mortem studies (Aboitiz, F., Scheibel, A.B., Fisher, R.S., Zaidel, E., 1992. Brain Res. 598, 154-161 and Aboitiz, F., Scheibel, A.B., Zaidel, E., 1992. Brain 115, 1521-1541) have shown an inverse association between asymmetry in perisylvian areas and the size of a specific segment, the isthmus, of the corpus callosum (CC) in males. The purpose of this work was to study in vivo the association between hemispheric asymmetry and the total size of the CC in 35 right-handed subjects (16 males, 19 females; mean age 24.9 +/- 3.9). An MRI scan was performed for each subject. The area of the right (RH) and left (LH) hemispheres were measured from images in the sagittal plane and the area of the CC from images in the mid-sagittal plane. The index of hemispheric asymmetry was absolute value((LH - RH)/[(LH + RH)/2]). There was a negative correlation between the absolute value of hemispheric asymmetry and the size of the CC in males (r = -0.55, P = 0.03) but not in females (r = -0.20, P = 0.42). These findings, like those of Aboitiz et al. (Aboitiz, F., Scheibel, A.B., Zaidel, E., 1992. Brain 115, 1521-1541), suggest a sex-dependent decrease in interhemispheric connectivity with increasing hemispheric asymmetry.

Magnetic resonance imaging of cerebral central sulci: a study of monozygotic twins.

The cerebral central sulci, seat of the sensorimotor cortex, vary anatomically in form, length and depth among individuals and present a left/right asymmetry. The purpose of this work was to measure central sulcus's lengths, at the surface and in-depth, in each hemisphere of monozygotic twins in order to evaluate the influence of environmental factors on the morphometry and asymmetry of this structure. A measurement technique on MR images of the brains using 3 D software was developed. Two operators applied this technique to measure central sulcus lengths at the surface of the brain and in-depth in each hemisphere. Besides the fact that the technique developed gave high Intraclass Correlation Coefficients (ICC) for the surface lengths (mean value 0.94), and slightly less high for the in-depth length (mean value 0.87), we found a weak (from 0.57 to 0.73 for raw data) but significant ICC between homologous sulci in pairs of twins. In addition, the ICC for asymmetry indices were not significant. Hence, if central sulcus morphometry is in part genetically influenced, these results show that nongenetic factors are nonetheless important in their development.

The effects of the amount and variability of practice on the learning of a multi-segmented motor task.

Since the Shea, J.B. and Morgan (1979) study, investigators have repeatedly shown that the learning of a set of movement patterns (as evaluated in a retention test) is enhanced when acquisition occurred under a random rather than a blocked schedule of practice. Supposedly, this is the case because a random schedule of practice necessitates more elaborate cognitive activities than a blocked schedule before each acquisition trial can be initiated. Our main objective was to determine whether the advantage for learning found for random practice increases as a function of the number of acquisition trials. During acquisition, the results indicated a general tendency for smaller movement reproduction errors under a blocked rather than a random schedule of practice. However, this effect disappeared with larger amount of acquisition trials. In retention, larger errors were observed when acquisition occurred under a blocked rather than a random schedule of practice. Finally, the disadvantage for learning observed for the blocked schedule of practice disappeared under a block-repeated condition in which each movement pattern was first practiced under a blocked schedule which was then repeated a second time. The results are discussed in terms of the so-called contextual interference effect and indicates some of its limitations.

[Ultrasonographic aspects of hemolytic uremic syndrome in children. Apropos of a series of 21 cases]. / Aspects échographiques du syndrome hémolytique et urémique chez l'enfant. A propos d'une série de 21 cas.

The sonographic expression of the hemolytic-uremic syndrome in children is a cortical hyper-echogenicity, which has a real prognostic value in comparison to the clinical criteria. In addition, renal ultrasonography with Doppler is useful to predict the evolution of the condition, and may help the clinician to define the therapeutic choices.