[Patient care pathway and securing immunoglobulin supplies in primary immunodeficiency: Results of a pilot study]. / Parcours de soins du patient et sécurisation des approvisionnements en immunoglobulines dans les déficits immunitaires primitifs : résultats d'une étude pilote.

OBJECTIVES: Securing the supply of immunoglobulins is essential in indications without therapeutic alternatives, such as primary immunodeficiencies (PIDs). The objective was to obtain an inventory of patients with PID, and to quantify their immunoglobulin needs. METHODS: The retrospective study was conducted using data from January to June 2018, in Bordeaux, Lyon and Paris (Saint-Louis). Patients with PID were included based on the pharmaceutical traceability of the 3 centres. The concordance between the patients included and the patients in the CEREDIH register was analysed. RESULTS: For the 361 patients included (sex ratio: M/F 0.8; mean age: 45±20years, mean weight: 62±19kg), 2082 dispensations were performed for a total volume of 57kg of immunoglobulins. Of the 108 specialty changes identified, 68% were due to supply tensions. In total, the analysis of CEREDIH data made it possible to identify 727 patients with PID and followed up once in the study centres, 161 of whom were recorded in the 2 data follow-ups (patients included and CEREDIH). CONCLUSIONS: A complete overview of immunoglobulin needs in PIDs is difficult to obtain. Supply tensions have been observed although PIDs are a priority indication. Measures must be proposed to ensure an adequate supply regardless of the location of patients in the territory.

Axial acoustic field along a solid-liquid fluidized bed under power ultrasound.

This work investigates the ultrasound propagation within a liquid-solid fluidized bed. The acoustic mapping of the reactor is achieved by means of a hydrophone. A spectral analysis is carried out on the measured signals to quantify the cavitation activity. The effects of several parameters on the spectral power distribution is appraised - including emitted ultrasound power, liquid superficial velocity and solid hold-up. Results show that increasing US power promotes a higher energy transfer from the driving frequency toward the broad-band noise - which is the signature of transient cavitation - and yields a stronger acoustic shielding. The presence of a flow opposite to the acoustic streaming may affect the sonoreactor behavior by sweeping the cavitation bubbles away from the ultrasonic horn. Finally the presence of millimeter sized particles significantly increases wave attenuation, presumably due to viscous losses on the one hand, and through the contribution of their surface defects to bubble nucleation on the other hand. Moreover, the influence of the solid hold-up appears to depend upon the particle material (glass or polyamide).

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.

Severe anaphylaxis to Propofol: first case of evidence of sensitization to soy oil.

The growing worldwide prevalence of food allergies is drawing attention to the risk of allergenic proteins found in intravenous medicinal products, particularly anaesthetics. Propofol induced anaphylaxis has been described. The presence of soybean oil and egg lecithins in the lipid emulsion highlights their suspected responsibility in certain cases. We report a case of anaphylaxis to propofol in an adult patient without food allergy to soy, but with a latent sensitization to soy. An IgE-dependent allergy to propofol was established by a basophil activation test. Here, we document for the first time the existence of specific IgEs to a 65kDa protein, found in soybean oil and soy flour. In the absence of data on the reactogenic threshold for allergenic food proteins injected intravenously, a risk appears to be established and leads us to recommend a systematic detection for proteins in the refined soybean oil used in the pharmaceutical industry for intravenous products.

[Pediatric anesthesia: little children, big problems]. / Anesthésie pédiatrique et hôpital de jour: les grands problèmes des petits enfants.

Infants and children are patients who are the most susceptible to benefit from a procedure in the ambulatory setting. However, some of these patients are at risk. They include infants, especially if premature, and children with sleep apnea syndrome or with current or recent upper respiratory infection. The present paper gives advices for an optimal anesthesic management of these young patients.

Temporal awareness: pivotal in performance?

This paper describes an experiment where operators have to deal with various parallel asynchronous processes. The authors were interested in the level of 'temporal awareness' developed by the operator. By temporal awareness, one means the ability of the operator to build a representation of the situation including the recent past and the near future. The hypothesis was that this ability is linked to other elements of performance. The authors also looked at the effects of an aid aimed at supporting the construction of temporal representation. The experiment showed that this support system was largely ineffective, but that the presence of temporal awareness proves to be a good indicator of performance, both in terms of errors committed and multiple-goal optimization.