Prognostic value of tumor mutational burden in patients with oral cavity squamous cell carcinoma treated with upfront surgery.

BACKGROUND: Oral cavity is the most prevalent site of head and neck squamous cell carcinomas (HNSCCs). Most often diagnosed at a locally advanced stage, treatment is multimodal with surgery as the cornerstone. The aim of this study was to explore the molecular landscape of a homogenous cohort of oral cavity squamous cell carcinomas (OCSCCs), and to assess the prognostic value of tumor mutational burden (TMB), along with classical molecular and clinical parameters. PATIENTS AND METHODS: One hundred and fifty-one consecutive patients with OCSCC treated with upfront surgery at the Institut Curie were analyzed. Sequencing of tumor DNA from frozen specimens was carried out using an in-house targeted next-generation sequencing panel (571 genes). The impact of molecular alterations and TMB on disease-free survival (DFS) and overall survival (OS) was evaluated in univariate and multivariate analyses. RESULTS: Pathological tumor stage, extranodal spread, vascular emboli, and perineural invasion were associated with both DFS and OS. TP53 was the most mutated gene (71%). Other frequent molecular alterations included the TERT promoter (50%), CDKN2A (25%), FAT1 (17%), PIK3CA (14%), and NOTCH1 (15%) genes. Transforming growth factor-ß pathway alterations (4%) were associated with poor OS (P = 0.01) and DFS (P = 0.02) in univariate and multivariate analyses. High TMB was associated with prolonged OS (P = 0.01 and P = 0.02, in the highest 10% and 20% TMB values, respectively), but not with DFS. Correlation of TMB with OS remained significant in multivariate analysis (P = 0.01 and P = 0.005 in the highest 10% and 20% TMB values, respectively). Pathological tumor stage combined with high TMB was associated with good prognosis. CONCLUSION: Our results suggest that a high TMB is associated with a favorable prognosis in patients with OCSCC treated with upfront surgery.

HPV ctDNA detection of high-risk HPV types during chemoradiotherapy for locally advanced cervical cancer.

BACKGROUND: Chemoradiotherapy (CRT) is the standard of care for patients diagnosed with locally advanced cervical cancer (LACC), a human papillomavirus (HPV)-related cancer that relapses in 30%-60% of patients. This study aimed to (i) design HPV droplet digital PCR (ddPCR) assays for blood detection (including rare genotypes) and (ii) monitor blood HPV circulating tumor DNA (HPV ctDNA) levels during CRT in patients with LACC. METHODS: We analyzed blood and tumor samples from 55 patients with HPV-positive LACC treated by CRT in a retrospective cohort (n = 41) and a prospective cohort (n = 14). HPV-ctDNA detection was carried out by genotype-specific ddPCR. RESULTS: HPV ctDNA was successfully detected in 69% of patients (n = 38/55) before CRT for LACC, including nine patients with a rare genotype. HPV-ctDNA level was correlated with HPV copy number in the tumor (r = 0.41, P < 0.001). HPV-ctDNA positivity for HPV18 (20%, n = 2/10) was significantly lower than for HPV16 (77%, n = 27/35) or other types (90%, n = 9/10, P = 0.002). HPV-ctDNA detection (positive versus negative) before CRT was associated with tumor stage (P = 0.037) and lymph node status (P = 0.02). Taking into account all samples from the end of CRT and during follow-up in the prospective cohort, positive HPV-ctDNA detection was associated with lower disease-free survival (DFS) (P = 0.048) and overall survival (OS) (P = 0.0013). CONCLUSION: This is one of the largest studies to report HPV-ctDNA detection before CRT and showed clearance of HPV ctDNA at the end of treatment in most patients. Residual HPV ctDNA at the end of CRT or during follow-up could help to identify patients more likely to experience subsequent relapse.

Combining immunotherapy with an epidrug in squamous cell carcinomas of different locations: rationale and design of the PEVO basket trial.

Squamous cell carcinomas (SCCs) are among the most frequent solid tumors in humans. SCCs, related or not to the human papillomavirus, share common molecular features. Immunotherapies, and specifically immune checkpoint inhibitors, have been shown to improve overall survival in multiple cancer types, including SCCs. However, only a minority of patients experience a durable response with immunotherapy. Epigenetic modulation plays a major role in escaping tumor immunosurveillance and confers resistance to immune checkpoint inhibitors. Preclinical evidence suggests that modulating the epigenome might improve the efficacy of immunotherapy. We herein review the preclinical and the clinical rationale for combining immunotherapy with an epidrug, and detail the design of PEVOsq, a basket clinical trial combining pembrolizumab with vorinostat, a histone deacetylase inhibitor, in patients with SCCs of different locations. Sequential blood and tumor sampling will be collected in order to identify predictive and pharmacodynamics biomarkers of efficacy of the combination. We also present how clinical and biological data will be managed with the aim to enable the development of a prospective integrative platform to allow secure and controlled access to the project data as well as further exploitations.

Surveillance of vaccination coverage in 5-6- and 13-14-years-old schoolchildren in Geneva.

INTRODUCTION: Vaccination coverage rates have been key to evaluating childhood immunization programs. The objectives of this study were to assess the immunization coverage of children aged 5-6 years and 13-14 years during the 2017-2018 school year, and to identify sociodemographic factors associated with full immunization in these children. MATERIALS AND METHODS: A descriptive cross-sectional school-based study was carried out. The population under study was a sample of schoolchildren aged 5-6 years and 13-14 years attending the second and 10th grades of primary and middle schools, respectively, located in the canton of Geneva, Switzerland. The data extracted from the vaccination cards included dates of administration of all doses of diphtheria, tetanus, pertussis, polio (DTP), Haemophilus influenzae type B (Hib), measles, mumps, rubella (MMR) and hepatitis B (HBV). RESULTS: We collected 1994 records of second- and 10th-grade children. Results show that 52% of our samples were fully vaccinated for DTP, MMR, Hib, and HBV. For all the vaccines examined in this study, the rates of immunization were significantly better for the second-grade than for the 10th-grade children (P<0.0001). More Spanish children were inoculated than children of Swiss nationality: OR=1.90,95% CI (1.05-3.42). More children with parents who were workers were inoculated: OR=1.35 95% CI (1.04-1.75). CONCLUSIONS: This study suggests that full coverage in our sample was suboptimal. For children in the second grade, we observed high coverage rates for specific vaccines, yet the rates of MMR vaccination were lower than the level required for a herd immunity. Data collection using vaccination cards allows for regular surveillance of the vaccination coverage of school pupils and can be easily carried out in schools.

Syphilis, human immunodeficiency virus, herpes genital and hepatitis B in a women's prison in Cochabamba, Bolivia: prevalence and risk factors.

OBJECTIVE: To determine the prevalence and factors associated with syphilis, human immunodeficiency virus (HIV), hepatitis B (HBV) and herpes type 2 (HSV2) among women in the prison of San Sebastian in Cochabamba (Bolivia). MATERIAL AND METHODS: We carried out a cross-sectional study including a standardized questionnaire to assess socio-demographics characteristics and risk factors (sexual practices and exposure to blood); and serological tests for syphilis, HSV2, VIH, and HBV. We performed bivariate and multivariate analyses to test the associations between variables of interest and infections. RESULTS: A total of 219 out of 220 prisoners (99.5%) participated in the study. For syphilis, 12.8% of participants had both reactive tests (RPR+/TPPA+). The prevalence of HSV2 and VIH was 62.6% and 1.4%, respectively. Anti-HBc, indicating a resolved or chronic HBV, was positive in 11.9% of participants and 0.5% had active HBV (HBsAg positive). A low level of education was associated with syphilis, HSV2 and HBV. Having occasional sexual partners was associated with syphilis and HSV2. Being over 36 years old and having more than 3 children were associated with HBV. The number of sexual partners, history of prostitution and rape, having sexual intercourses in prison and detention time were not associated with any of these infections. DISCUSSION: The prevalence of syphilis, HIV, HSV2 and HBV was higher in this vulnerable female population than in the general population in Bolivia. Control measures in detention are needed to limit the spread of these infections both in prisons and in the community.

Comprehensive genomic profiling of head and neck squamous cell carcinoma reveals FGFR1 amplifications and tumour genomic alterations burden as prognostic biomarkers of survival.

BACKGROUND: We aimed at identifying deleterious genomic alterations from untreated head and neck squamous cell carcinoma (HNSCC) patients, and assessing their prognostic value. PATIENTS AND METHODS: We retrieved 122 HNSCC patients who underwent primary surgery. Targeted NGS was used to analyse a panel of 100 genes selected among the most frequently altered genes in HNSCC and potential therapeutic targets. We selected only deleterious (activating or inactivating) single nucleotide variations, and copy number variations for analysis. Univariate and multivariate analyses were performed to assess the prognostic value of altered genes. RESULTS: A median of 2 (range: 0-10) genomic alterations per sample was observed. Most frequently altered genes involved the cell cycle pathway (TP53 [60%], CCND1 [30%], CDKN2A [25%]), the PI3K/AKT/MTOR pathway (PIK3CA [12%]), tyrosine kinase receptors (EGFR [9%], FGFR1 [5%]) and cell differentiation (FAT1 [7%], NOTCH1 [4%]). TP53 mutations (p = 0.003), CCND1 amplifications (p = 0.04), CDKN2A alterations (p = 0.02) and FGFR1 amplifications (p = 0.003), correlated with shorter overall survival (OS). The number of genomic alterations was significantly higher in the HPV-negative population (p = 0.029) and correlated with a shorter OS (p < 0.0001). Only TP53 mutation and FGFR1 amplification status remained statistically significant in the multivariate analysis. CONCLUSION: These results suggest that genomic alterations involving the cell cycle (TP53, CCND1, CDKN2A), as well as FGFR1 amplifications and tumour genomic alterations burden are prognostic biomarkers and might be therapeutic targets for patients with HNSCC.

Sífilis, virus de la inmunodeficiencia humana, herpes tipo 2 y hepatitis B en una prisión de mujeres en Cochabamba, Bolivia: prevalencia y factores de riesgo / Syphilis, human immunodeficiency virus, herpes genital and hepatitis B in a women's prison in Cochabamba, Bolivia: prevalence and risk factors

Objetivo: Determinar la prevalencia y los factores asociados a la infección por sífilis, virus de la inmunodeficiencia humana (VIH), virus de hepatitis B (VHB) y virus herpes tipo 2 (HSV2) en las mujeres privadas de libertad (MPL) en la prisión de San Sebastián en Cochabamba (Bolivia). Material y método: Se realizó un estudio transversal. Mediante un cuestionario estandarizado se registraron las características sociodemográficas, las prácticas sexuales y la existencia de exposición a la sangre. Se realizaron pruebas serológicas para sífilis, HSV2, VIH y VHB. Para conocer la asociación entre las variables de interés y las enfermedades, se llevaron a cabo análisis bi y multivariantes. Resultados: Participaron 219 de 220 MPL (99,5%). La prevalencia de sífilis (RPR+/TPPA+), HSV2, VIH y VHB crónico (ABsAg+) fue de 12,8%, 62,6%, 1,4% y 0,5%, respectivamente. La sífilis y el HSV2 se asociaron con un bajo nivel de educación y con el hecho de tener parejas sexuales ocasionales. El VHB se asoció con un bajo nivel de educación, la edad y el hecho de tener más de tres hijos. Estas infecciones no se asociaron con el número de parejas sexuales, los antecedentes de prostitución o violación, las relaciones sexuales en prisión y la duración de la pena privativa de libertad. Discusión: La prevalencia de las enfermedades investigadas (sífilis, VIH, HSV2 y VHB) es más elevada en la población penitenciaria femenina que en la población general de Bolivia. Es necesario implementar medidas de control en la prisión para limitar la propagación de estas infecciones, tanto en prisiones como en la comunidad

Objective: To determine the prevalence and factors associated with syphilis, human immunodeficiency virus (HIV), hepatitis B (HBV) and herpes type 2 (HSV2) among women in the prison of San Sebastian in Cochabamba (Bolivia). Material and methods: We carried out a cross-sectional study including a standardized questionnaire to assess socio-demographics characteristics and risk factors (sexual practices and exposure to blood); and serological tests for syphilis, HSV2, VIH, and HBV. We performed bivariate and multivariate analyses to test the associations between variables of interest and infections. Results: A total of 219 out of 220 prisoners (99.5%) participated in the study. For syphilis, 12.8% of participants had both reactive tests (RPR+/TPPA+). The prevalence of HSV2 and VIH was 62.6% and 1.4%, respectively. Anti-HBc, indicating a resolved or chronic HBV, was positive in 11.9% of participants and 0.5% had active HBV (HBsAg positive). A low level of education was associated with syphilis, HSV2 and HBV. Having occasional sexual partners was associated with syphilis and HSV2. Being over 36 years old and having more than 3 children were associated with HBV. The number of sexual partners, history of prostitution and rape, having sexual intercourses in prison and detention time were not associated with any of these infections. Discussion: The prevalence of syphilis, HIV, HSV2 and HBV was higher in this vulnerable female population than in the general population in Bolivia. Control measures in detention are needed to limit the spread of these infections both in prisons and in the community

Students' Readiness and Perception of Interprofessional Learning in an Undergraduate Swiss Healthcare Student Context: A Cross Sectional Study.

PURPOSE: The objective of this study was to assess attitudes toward interprofessional education (IPE) among undergraduate health students in Switzerland after 2 weeks of IPE training during the first year of their bachelor's curriculum. METHODS: A cross-sectional study using a convenience sample of first-year undergraduate healthcare students assessed using the RIPLS scale. RESULTS: A total of 140 students participated in this study. Physiotherapist students achieved the highest mean scores for the total RIPLS. However, the total mean score for RIPLS for nurse students was statistically lower (p<0.001) in comparison to the other departments. CONCLUSIONS: The findings are inspiring in that students demonstrated positive attitudes, perceptions, and attributes toward IPE activities. This study contributes to the development of innovative IPE activities.

A comparison of the spatial dependence of body mass index among adults and children in a Swiss general population.

BACKGROUND: Body mass index (BMI) may cluster in space among adults and be spatially dependent. Whether BMI clusters among children and how age-specific BMI clusters are related remains unknown. We aimed to identify and compare the spatial dependence of BMI in adults and children in a Swiss general population, taking into account the area's income level. METHODS: Geo-referenced data from the Bus Santé study (adults, n=6663) and Geneva School Health Service (children, n=3601) were used. We implemented global (Moran's I) and local (local indicators of spatial association (LISA)) indices of spatial autocorrelation to investigate the spatial dependence of BMI in adults (35-74 years) and children (6-7 years). Weight and height were measured using standardized procedures. Five spatial autocorrelation classes (LISA clusters) were defined including the high-high BMI class (high BMI participant's BMI value correlated with high BMI-neighbors' mean BMI values). The spatial distributions of clusters were compared between adults and children with and without adjustment for area's income level. RESULTS: In both adults and children, BMI was clearly not distributed at random across the State of Geneva. Both adults' and children's BMIs were associated with the mean BMI of their neighborhood. We found that the clusters of higher BMI in adults and children are located in close, yet different, areas of the state. Significant clusters of high versus low BMIs were clearly identified in both adults and children. Area's income level was associated with children's BMI clusters. CONCLUSIONS: BMI clusters show a specific spatial dependence in adults and children from the general population. Using a fine-scale spatial analytic approach, we identified life course-specific clusters that could guide tailored interventions.

[Factors associated with HPV immunization for 13-14-year-old girls in the Geneva district, Switzerland]. / Facteurs associés à la vaccination HPV chez les jeunes filles de 13 à 14ans dans le canton de Genève, Suisse.

BACKGROUND: School vaccination programs against human papilloma virus (HPV) have been implemented in most Western countries. Only a few studies have investigated socio-economic factors related to school-based vaccination. METHOD: A cross-sectional study was conducted using the vaccination cards of 1158 randomized girls aged 13 to 14 years enrolled in the public schools of the canton of Geneva. Several other socio-economic variables (nationality, socio-professional category and marital status of the parents) were collected. RESULTS: Immunization coverage for three doses of HPV vaccine was 56%. After having controlled the covariates, Portuguese adolescents (adjusted OR [95% CI]: 4.18 [1.76-9.92]), adolescents whose mothers were workers (adjusted OR [95% CI]: 1.91 [1.38-2.65]) or married (adjusted OR [95% CI]: 1.44 [1.06-1.98]) showed significantly higher immunization rates than Swiss adolescents or those whose mothers' socio-professional category was senior manager or executive. CONCLUSION: This study shows that the HPV vaccine coverage is not yet optimal in Geneva and varies significantly according to the socio-economic status, thus better promotion of HPV vaccination for certain target groups must be implemented.

[Non traumatic lesions of the foot, calluses and nails: socioeconomic impact of an unexplored issue]. / Lésions non traumatiques du pied, cors et ongles: impact socio-écono- mique d'un problème méconnu.

Up to 20% of the general population, especially women and old people, suffer from non traumatic lesions of the foot. These lesions have repercussions on a person's health and wellbeing. Nevertheless, the clinical examination of the foot rarely forms part of routine medical consultations. Using questionnaires and individual interviews, this pilot study investigated the foot problems of 96 patients attending a podiatrist's practice, as well as the level of communication between the patients and their doctor. 85% of the participants said they never talked about calluses and nails with their doctor. The results were confirmed by fifteen individual interviews. Clinicians have an important role to play in the early detection of these lesions, allowing an efficient management of this issue.

[Evolution of vaccine coverage from school year 2003-2004 to 2006-2007, for 5 to 6-year-old children in Geneva]. / Evolution de la couverture vaccinale de l'année scolaire 2003-2004 à 2007-2008 pour les enfants de cinq à six ans à Genève.

OBJECTIVE: The authors had for aim to study the evolution of vaccination coverage for diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella (MMR) and Haemophilus influenzae b (Hib) in 5 to 6-year-old children in Geneva, from school year 2003-2004 to 2006-2007. DESIGN: The data was collected from vaccination cards of 17,184 children attending public schools in the Geneva canton. RESULTS: The average vaccination coverage over the study period was 93.4% for diphtheria, 93.5% for tetanus, 92.5% for pertussis, and 92.4% for poliomyelitis. For MMR and Hib, the coverage was 80.6, 78.4, 79.1 and 81.2% respectively. Between 2003 and 2007, an increase of coverage was observed for all vaccines. It was especially observed for MMR and Hib vaccines, even though the coverage remained below 90%. CONCLUSION: In the Geneva canton, epidemiological surveillance of vaccination coverage of 5 to 6-year-old children can be achieved through systematic data analysis of children's vaccination cards. All commonly used vaccines reached the recommended coverage rates, except for MMR and Hib, even though their coverage had significantly increased.

[Need for health and human rights training: survey in six French-speaking African countries]. / Besoins de formation en santé et droits de l'homme: une enquête dans six pays d'Afrique Francophone.

The purpose of this study was to assess the need of healthcare and non-healthcare professionals for training in the field of health and human rights as a basis for developing relevant education programs. In 2007 a self-administered survey questionnaire was sent to 360 health professionals and human rights activists in Chad, the Democratic Republic of the Congo, the Republic of the Congo, Mali, Burkina-Faso, and Ivory Coast. The response rate was 67% (242/360). The most common training needs involved planning tools (87%), types of human rights violations in health systems (85%), risk factors for human rights violations (80%), and human rights monitoring tools (74%). The preferred training approaches were mixed and participative methods (60%) and practical applications as a means of validation (65%). There was a high degree of homogeneity between the needs expressed by the healthcare and non-healthcare professionals. The findings of this survey indicate that healthcare and non-healthcare professionals wish to obtain the knowledge and skills necessary to prevent and/or identify human rights issues in healthcare systems and to provide adequate responses. Training programs dealing with human rights in healthcare systems should reflect these needs.

[Individual plan for school integration of students living with a chronic disease: four years of experience]. / Projet d'accueil individualisé des élèves avec une maladie chronique à l'éecole: quatre ans d'expérience.

We developed the Individual plan for school integration (projet d'accueil individualisé, PAI) to promote quality of life and school and social integration of the increasing number of children living with a chronic disease. The PAI is utilized in every child with a chronic disease having an impact on his schooling, and defines the child's specific health needs, treatments and measures necessary at school. It clarifies the roles and responsibilities of partners involved. The number of PAl increases since its creation in 2004. Its prevalence is 1% for pre-school and primary, 0.6% for low secondary (12-14 years old) and 0.2% for post-mandatory schools. Its utility is acknowledged by families, schools and child's doctors. It reassures parents and teachers and develops a better knowledge of the children with chronic diseases at school.

Grid-enabling medical image analysis.

Grids have emerged as a promising technology to handle the data and compute intensive requirements of many application areas. Digital medical image processing is a promising application area for grids. Given the volume of data, the sensitivity of medical information, and the joint complexity of medical datasets and computations expected in clinical practice, the challenge is to fill the gap between the grid middleware and the requirements of clinical applications. The research project AGIR (Grid Analysis of Radiological Data) presented in this paper addresses this challenge through a combined approach: on one hand, leveraging the grid middleware through core grid medical services which target the requirements of medical data processing applications; on the other hand, grid-enabling a panel of applications ranging from algorithmic research to clinical applications.

Inhalation treatment: errors in application and difficulties in acceptance of the devices are frequent in wheezy infants and young children.

The recent availability of small-volume spacers has facilitated the general use of inhaled treatment in infants. The purpose of this study was to evaluate any errors made by parents when using this new inhalation technique and the child's behavior during the inhalation. Ninety-four young children (61% boys) under 5 years of age were enrolled in the study. Inhalation treatment was recommended either by a general practitioner or by a pediatrician. Data concerning treatment regimens, the ability of parents to use the spacer and metered-dose inhalers (MDIs), and the acceptance of the devices, were collected by means of a demonstration and questionnaire. Unexpectedly, the doses, administration times, and duration of the treatments varied from one child to the next. No explanation or training in administering the treatment via the spacers was given to 12% and 47% of the parents, respectively. Fourteen per cent of parents did not shake the MDIs, 12% did not monitor the valves, and 22% allowed too short a time for inhalation. The lack of explanation increased the occurrence of errors in manipulation of the devices. The procedure was judged to be easy to follow by 78% of the parents, but the face mask was accepted with difficulty by 22% of the children. Repeated crying during administration of the treatment was observed in 38% of the patients, particularly the youngest. Crying influenced the acceptance of the face mask, reduced parental compliance, and made the use of the devices more difficult. Errors altering the efficiency of inhalation treatment in infants are frequent. Most of these errors could be avoided by spending more time to inform the parents about correct usage. Furthermore, repeated crying during inhalation is common in young children and this problem should to be taken into consideration in the evaluation of treatment.

[Severe cutaneous Streptococcus pyogenes infections in the child: results of a multicenter survey]. / Infections cutanées sévères à Streptococcus pyogenes chez l'enfant: résultats d'une enquête multicentrique.

UNLABELLED: To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein. PATIENTS AND METHOD: A retrospective (1990-2000) survey was carried out in pediatric hospital centers. RESULTS: Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30% of the cases, vancella lesions were associated; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey. CONCLUSIONS: Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.

[Lyme disease in Upper Normandy: report of a hospital survey]. / Maladie de Lyme chez l'enfant en Haute-Normandie: à propos d'une enquête hospitalière.

This study presents the results of a hospital survey on Lyme disease in children living in upper Normandy, a region that is quite densely wooded (with 18% forest areas and woods). The aim of this survey was to assess the prevalence of this disease in children from the Seine-Maritime and L'Eure, hospitalized in pediatric wards in the Seine-Maritime department, which includes Rouen, Dieppe, Fécamp, Elbeuf, and Le Havre. Fifteen cases of Lyme disease were diagnosed between September 1988 and June 1997. The children (6 girls and 9 boys) were aged between 5 and 14 years old. Only 7 subjects showed primary symptoms, while secondary symptoms were observed in 12 children. In the study population, a high prevalence (11 out of the 15 children) of neurological disorders was found. The following secondary symptoms were noted: 5 cases of erythema migrans, 2 cases of non-malignant cutaneous lymphocytoma, and 4 cases which in fact had previously displayed primary clinical signs (3 subjects with erythema migrans and 1 subject with non-malignant cutaneous lymphocytoma); 7 cases of uni- or bilateral facial paralysis, the most frequent neurological manifestation with or without lymphocytic meningitis; 1 case of central vestibular syndrome with a hyperalgesic meningoradicular reaction in the vicinity of the tick bite; 1 case of peripheral radicular involvement and intense pain in the left lower limb; 4 cases of ocular disorders (3 diplopias, 1 bilateral conjunctivitis complicated by kerato-uveitis, 1 bilateral complete cecitis). Only 10 child had rheumatological symptoms, i.e., Lyme arthritis of the right knee. Treatment consisted of amoxicillin (10 children) administered at a dosage of 50 to 100 mg/kg/d over a period ranging from 10 days to 1 month, or ceftriaxone (7 children) at a dosage of 50 to 100 mg/kg/d administered intravenously over a period ranging from 8 days to 3 weeks. Two of the children received combined antibiotic therapy, and 5 subjects had adjunct corticotherapy.

Positive rolandic sharp waves in the EEG of the premature newborn: a five year prospective study.

In a prospective study of 301 premature newborn infants, neonatal tracings were done to evaluate the use of the electroencephalogram (EEG) and positive rolandic sharp waves (PRSW) in the diagnosis and prognosis of periventricular leucomalacia. Each infant had ultrasonographic studies and standardised neurological examinations at 1 year of age or later. Two hundred and eighty infants were followed up at 1 year. This study demonstrated that the absence of PRSW was correlated with a favourable motor development (98.2%) and confirmed the great value of PRSW in the diagnosis and the prognosis of periventricular leucomalacia. PRSW were sensitive (98%) and specific (84%) markers of developmental motor disability and were a sensitive (96%) marker of severe spastic diplegia. A frequency above 2/minute was a specific (92%) sign of severe spastic diplegia. Social and language developmental abnormalities were not correlated with the neonatal EEG.