The French Epidemic Intelligence System: comparing disease surveillance at the national and international level using data from the Program for Monitoring Emerging Diseases.

In a context of globalisation and climate change, the risk of emerging infectious diseases spreading around the world has significantly increased in the past decades. In response to this growing threat, an epidemic intelligence team has been set up within the framework of the French animal health epidemiological surveillance platform (ESA platform). The French Epidemic Intelligence System (FEIS) monitors animal health risks in Europe and beyond that threaten animal populations in France (emerging and exotic diseases not yet present). The FEIS expert network covers all 53 category 1 health hazards identified as priority diseases by the French authorities. From January 2016 to December 2017, the FEIS published 126 reports on animal health events related to infectious diseases, of which 76.2% were related to events in Europe. When comparing FEIS reports to posts from the Program for Monitoring Emerging Diseases (ProMED), an FEIS report was produced for 52.6% of ProMED themes (combinations of disease and country) posted in 2016-2017 on events in Europe. The remaining European ProMED themes did not meet the criterion for the production of an FEIS report because either the disease was already present in France, the risk of introduction into France was considered low or negligible, or the introduction of the pathogen would have low or negligible economic and societal impacts. The FEIS efficiently detected and reported on all health hazards identified by ProMED to alert health authorities and stakeholders when needed (according to the criterion). Compared with international epidemic intelligence systems such as ProMED, which provide general information, the FEIS adds another layer of filtering and interpretation to available information on animal health threats tailored to France's specific needs, in order to communicate only essential information to health authorities.

Dans un contexte caractérisé par la mondialisation et le changement climatique, le risque de propagation mondiale des maladies infectieuses émergentes s'est significativement accru en quelques décennies. Pour répondre à cette menace croissante, une équipe de veille épidémique a été mise en place dans le cadre de la Plateforme française d'épidémiosurveillance en santé animale (Plateforme ESA). Le système de Veille sanitaire internationale (VSI) surveille les risques sanitaires en santé animale présents en Europe, voire au-delà, dès lors qu'ils représentent une menace pour les populations animales sur le territoire français (maladies émergentes et maladies exotiques jamais introduites en France). Le réseau d'experts de la VSI couvre les 53 risques sanitaires de catégorie 1 définis par les autorités françaises comme maladies prioritaires. De janvier 2016 à décembre 2017, 126 rapports de la VSI ont été publiés sur des événements de santé animale liés à des maladies infectieuses, dont 76,2 % concernaient des événements survenus en Europe. La comparaison entre les rapports émanant de la VSI et ceux du Programme de suivi des maladies émergentes (ProMED) fait apparaître que 52,6 % des thématiques publiées en 2016-2017 par ProMED (associant une maladie et un pays) relatives à des événements survenus en Europe avaient également fait l'objet d'un rapport par la VSI. Les thématiques restantes sur ProMED correspondant à des événements européens ne répondaient pas aux critères de la VSI, soit parce qu'il s'agissait d'une maladie déjà présente en France, soit parce que le risque d'introduction de l'agent pathogène en France était considéré comme faible ou négligeable, soit enfin parce que l'impact économique et sociétal d'une telle introduction, si elle survenait, aurait été faible ou négligeable. La VSI a détecté (en fonction de ses critères) l'ensemble des risques sanitaires identifiés par ProMED et les a notifiés avec efficacité aux autorités et acteurs en charge de la santé, chaque fois que nécessaire. Par rapport aux systèmes de veille sanitaire internationaux tels que ProMED qui fournissent des informations générales, la VSI, qui est spécifiquement adaptée aux besoins français, ajoute une strate supplémentaire de filtrage et d'interprétation des données disponibles sur les menaces de santé animale, afin de ne transmettre aux autorités sanitaires que les informations qui leur sont essentielles.

De unos decenios a esta parte, en un contexto marcado por la mundialización y el cambio climático, ha aumentado sustancialmente el riesgo de propagación por todo el mundo de enfermedades infecciosas emergentes. Para responder a esta creciente amenaza se ha establecido, dentro del dispositivo francés de vigilancia epidemiológica zoosanitaria (plataforma ESA), un equipo de inteligencia epidemiológica. El Sistema Francés de Información Epidemiológica (épidémiologique) está dedicado a seguir de cerca los riesgos zoosanitarios que, desde Europa u otras partes del mundo, amenacen a las poblaciones animales de Francia (enfermedades emergentes y exóticas que aún no estén presentes en el país). La red de especialistas de la VSI cubre la totalidad de los 53 peligros sanitarios de categoría 1 que las autoridades francesas tienen definidos como enfermedades prioritarias. Entre enero de 2016 y diciembre de 2017, la VSI publicó 126 informes sobre episodios zoosanitarios relacionados con enfermedades infecciosas, de los que un 76,2% tenían que ver con episodios ocurridos en Europa. Al comparar los informes de la VSI con las notas publicadas por el Programa de Vigilancia de Enfermedades Emergentes (ProMED) se constató que ela VSI había elaborado un informe en relación con el 52,6% de los temas (combinación de enfermedades y países) tratados por el ProMED en sus notas de 2016 y 2017 sobre episodios ocurridos en suelo europeo. Los restantes temas europeos tratados por el ProMED no cumplían el criterio de que hubiera un informe de la VSI al respecto, ya fuera porque la enfermedad ya estaba presente en Francia, porque se consideró bajo o insignificante el riesgo de penetración en Francia o porque la llegada del patógeno tendría una repercusión escasa o insignificante en la economía o la sociedad. La VSI detectó y comunicó con eficacia todos los peligros sanitarios identificados por el ProMED para alertar a las autoridades sanitarias y demás interlocutores cada vez que fue necesario (con arreglo al criterio). En comparación con los sistemas internacionales de información epidemiológica, como el ProMED, que proporcionan información general, la VSI agrega un filtro y un nivel de interpretación suplementarios a la información disponible sobre amenazas zoosanitarias, adaptándola así a las necesidades específicas de Francia, con el fin de comunicar únicamente información esencial a las autoridades sanitarias.

Air pollution and humidity as triggering factors for stroke. Results of a 12-year analysis in the West Paris area.

BACKGROUND AND PURPOSE: Previous studies have suggested an association between stroke and meteorological factors, air pollution and acute respiratory infections as triggering factors. Often, these factors have been evaluated separately. We evaluated the association between all these environmental triggering factors and calls for suspected stroke in a suburb in west Paris from 2004 to 2015. METHODS: We used data from the emergency medical dispatching center of all calls for suspected stroke (SAMU 78), climatic parameters (MétéoFrance), pollution (AIRPARIF), and data from influenza epidemic surveillance networks (GROG and Sentinelles). The association between short-term exposure (1-day lag) to environmental triggering factors and stroke occurrence was analyzed using negative-binomial log linear regression model for counting time series. RESULTS: Between 2004 and 2015, a total of 11,037 calls for suspected stroke were recorded. In bivariate analysis, there were associations between calls for suspected stroke and temperature (mean, maximum and minimum), humidity and influenza epidemic. In multivariable analysis, only two variables were associated with calls for suspected stroke: humidity [3.93% excess relative risk (ERR) of stroke per 10% increase in humidity; 95% confidence interval (CI), 1.42 to 6.51; P<0.002] and pollution on the "Air Parif Atmo" scale (2.86% ERR of stroke per 1 unit increase; 95% CI, 1.01 to 4.75; P=0.002). CONCLUSIONS: This study suggests that short-term exposure to air pollution and a high level of humidity are associated with a significant excess relative risk of calls for suspected stroke.

Triangular nanoperforation and band engineering of InGaAs quantum wells: a lithographic route toward Dirac cones in III-V semiconductors.

The design of two-dimensional periodic structures at the nanoscale has renewed attention for band structure engineering. Here, we investigate the nanoperforation of InGaAs quantum wells epitaxially grown on InP substrates using high-resolution e-beam lithography and highly plasma based dry etching. We report on the fabrication of a honeycomb structure with an effective lattice constant down to 23 nm by realising triangular antidot lattice with an ultimate periodicity of 40 nm in a 10 nm thick InGaAs quantum well on a p-type InP. The quality of the honeycomb structures is discussed in detail, and calculations show the possibility to measure Dirac physics in these type of samples. Based on the statistical analysis of the fluctuations in pore size and periodicity, calculations of the band structure are performed to assess the robustness of the Dirac cones with respect to distortions of the honeycomb lattice.

Enhancement of Electrical Properties of Nanostructured Polysilicon Layers Through Hydrogen Passivation.

The light absorption of polysilicon planar junctions can be improved using nanostructured top surfaces due to their enhanced light harvesting properties. Nevertheless, associated with the higher surface, the roughness caused by plasma etching and defects located at the grain boundary in polysilicon, the concentration of the recombination centers increases, leading to electrical performance deterioration. In this work, we demonstrate that wet oxidation combined with hydrogen passivation using SiN(x):H are the key technological processes to significantly decrease the surface recombination and improve the electrical properties of nanostructured n(+)-i-p junctions. Nanostructured surface is fabricated by nanosphere lithography in a low-cost and controllable approach. Furthermore, it has been demonstrated that the successive annealing of silicon nitride films has significant effect on the passivation quality, resulting in some improvements on the efficiency of the Si nanostructure-based solar cell device.

Narrowing the length distribution of Ge nanowires.

Synthesis of nanostructures of uniform size is fundamental because the size distribution directly affects their physical properties. We present experimental data demonstrating a narrowing effect on the length distribution of Ge nanowires synthesized by the Au-catalyzed molecular beam epitaxy on Si substrates. A theoretical model is developed that is capable of describing this puzzling behavior. It is demonstrated that the direction of the diffusion flux of sidewall adatoms is size dependent and has a major effect on the growth rate of differently sized nanowires. We also show that there exists a fundamental limitation on the maximum nanowire length that can be achieved by molecular beam epitaxy where the direction of the beam is close to the growth axis.

Pre-hospital treatment of STEMI patients. A scientific statement of the Working Group Acute Cardiac Care of the European Society of Cardiology.

In ST-elevation myocardial infarction (STEMI) the pre-hospital phase is the most critical, as the administration of the most appropriate treatment in a timely manner is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service are pivotal. The first steps are devoted to minimize the patient's delay in seeking care, rapidly dispatch a properly staffed and equipped ambulance to make the diagnosis on scene, deliver initial drug therapy and transport the patient to the most appropriate (not necessarily the closest) cardiac facility. Primary PCI is the treatment of choice, but thrombolysis followed by coronary angiography and possibly PCI is a valid alternative, according to patient's baseline risk, time from symptoms onset and primary PCI-related delay. Paramedics and nurses have an important role in pre-hospital STEMI care and their empowerment is essential to increase the effectiveness of the system. Strong cooperation between cardiologists and emergency medicine doctors is mandatory for optimal pre-hospital STEMI care. Scientific societies have an important role in guideline implementation as well as in developing quality indicators and performance measures; health care professionals must overcome existing barriers to optimal care together with political and administrative decision makers.

[Voluminous nodular splenomegaly in Gaucher disease: a case report]. / Volumineuse splénomégalie nodulaire au cours d'une maladie de Gaucher: à propos d'une observation.

Patients affected by type 1 Gaucher disease (an autosomal recessive inheritance lysosome storage disorder) develop nodular splenomegaly in 20 to 30% of cases where imiglucerase therapy proves ineffective. The lack of response to imiglucerase therapy on spleen nodules could be an indication of the existence or development of a malignant spleen. We report a 47-year-old man with Gaucher disease who presented with a voluminous splenic nodule, in whom therapy was delayed. Regular monitoring of patients is the most important factor to predict and therefore prevent morbidity.

[Vaccination against Rotavirus: an old challenge, an ongoing reality]. / Comment je préviens...le Rotavirus par la vaccination: motivations, enjeux et modalités.

Rotavirus are the leading cause of diarrhea and diarrhea related death among infants and young children. Every year rotavirus is associated with over half a million of deathss, mainly in developping countries. Development of a safe vaccine is nowaday the only way to control the disease. A life attenuated oral rotavirus vaccine will be commercialized in a few months in Belgium.

[Pre-hospital management of acute coronary syndromes with ST elevation in the Ile-de-France Region: the E-MUST registry]. / Prise en charge préhospitalière des syndromes coronaires aigus ST+ en île-de-France. Le registre E-MUST.

The E-MUST registry gathers patient data from the emergency ambulance service of the IIe-de-France for acute coronary syndromes with ST elevation seen within 24 hours from onset of symptoms. The parameters include the type of emergency phone call, details relative to the different phase of management, decisions of therapeutic strategy concerning pre-hospital thrombolysis or primary angioplasty and the different factors influencing these decisions. From January 2001 to June 2002, the mean delay from the onset of symptoms and the call-out of the emergency ambulance was 67.5 minutes for the 2584 patients studied. In this group, a pre-hospital decision for coronary revascularisation was taken in 84.3% of cases, pre-hospital thrombolyis started 33 minutes after arrival of the ambulance (32.7% of cases) and primary angioplasty carried out 81 minutes after that arrival (51.6% of cases). Decisions for revascularisation were less common in the elderly and those seen over 6 hours after the onset of symptoms. Pre-hospital management allows decisions concerning coronary reperfusion to be taken more often and earlier in patients with acute coronary syndromes.

[Acute severe pain in emergencies. The key for efficient analgesia]. / Douleur aiguë intense en médecine d'urgence. Les clefs d'une analgésie efficace.

OBJECTIVE: To measure severe acute pain (SAP) frequency, to describe SAP management and to bring to view the conditions of analgesia success in emergency medicine. DESIGN: Multicentre prospective survey: 7 days in Emergency Departments (ED), 30 days in Mobile Intensive Care Units (MICU). Multivariate analysis to measure the independent effect on pain relief of factors identified by Chi squared test. SETTING: All of 6 ED and 8 MICU of a French region. PATIENTS: Over 15 years of age. MAIN OUTCOME MEASURES: Pain intensity was assessed with Visual Analog Scale (VAS) before and after ED or MICU management. SAP group (defined by initial VAS score > 40 mm) was analyzed for pain relief (defined by final VAS score < or = 40 mm). Influence on pain relief through pain aetiology, initial pain intensity, treatment delay and opioid use was analyzed. RESULTS: 1,082 fulfilled medical forms for 3,419 eligible patients. SAP frequency was estimated 36% (CI95 = 34-38%) in ED and 29% (CI95 = 25-33%) in MICU. SAP (n = 368) was often persistent: 45% (CI95 = 43-47%) after discharge from ED and 26% (CI95 = 22-30%) after MICU intervention. The prognostic factors of pain control success revealed by Chi squared test were: MICU (vs ED), treatment delay < or = 3 hours (vs > 3 hours), opioid use (vs non opioid use) and VAS pain level < or = 70 mm (vs > 70 mm). The last 3 factors were confirmed by multivariate analysis. Treatment delay, opioid use, and pain level were found to be determinants of efficient analgesia for SAP. CONCLUSION: Despite the high frequency of SAP in ED and MICU, pain control is not satisfying. Opioid use and early treatment are determinant in analgesia efficiency for SAP and should be therefore encouraged to improve pain relief in emergency medicine.

Tricho-hepato-enteric syndrome: further delineation of a distinct syndrome with neonatal hemochromatosis phenotype, intractable diarrhea, and hair anomalies.

We report on two sibs with syndromal congenital iron storage disease. Prenatal symptoms were IUGR, hydramnios, and placental hyperplasia. Clinical anomalies included hypertelorism and sparse, thin, curly hair (trichomalacia). Clinical course was marked by intractable diarrhoea, with normal histological and enzymological studies, cholestatic jaundice, hepatomegaly appearing after 30 days, and progressive liver failure, leading to death after a few months. The only metabolic anomaly was progressive hypermethioninemia. Pathologic examination of both children showed a similar pattern of multivisceral iron deposit compatible with a diagnosis of neonatal hemochromatosis: extensive liver fibrosis or cirrhosis with nodular regeneration, cholestasis, ductular proliferation, and hepatic, pituitary, thyroidal, adrenal, and pancreatic iron deposition. The unusual course for neonatal hemochromatosis in both sibs combined with concordant extrahepatic anomalies suggest that they could have a specific iron storage syndrome with possible autosomal recessive inheritance, probably similar to the sibship reported by Stanckler et al. [Arch Dis Child, 57:212-216, 1982].

Benefit of active compression-decompression cardiopulmonary resuscitation as a prehospital advanced cardiac life support. A randomized multicenter study.

BACKGROUND: We compared short-term prognosis of active compression-decompression (ACD) and standard (STD) cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests. METHODS AND RESULTS: We randomized advanced cardiac life support (ACLS) with ACD ACLS CPR on odd days and STD ACLS CPR on even days. We measured the rates of return of spontaneous circulation (ROSC), survival at 1 hour (H1), at 24 hours (H24), and at 1 month (D30): hospital discharge (HD); neurological outcome; and complications. Mean times from collapse to basic cardiac life support CPR was 9 minutes and from collapse to ACLS CPR was 21 minutes. Compared with the STD ACLS patients (n = 258), ACD ACLS patients (n = 254) had higher survival rates (ROSC, 44.9% versus 29.8%, P = .0004; H1, 36.6% versus 24.8%, P = .003; H24, 26% versus 13.6%, P = .002; HD without neurological impairment, 5.5% versus 1.9%, P = .03) and a trend for improvement in neurological outcome at D30 (Glasgow-Pittsburgh Outcome Categories = 1.6 +/- 0.8 versus 2.3 +/- 1.1. P = .09). Sternal dislodgements (2.9% versus 0.4%, P = .03) and hemoptysis (5.4% versus 1.3%, P = .01) were more frequent in the ACD ACLS group. CONCLUSIONS: Despite long time intervals, ACD significantly improved short-term survival rates in out-of-hospital cardiac arrests compared with STD CPR.

End-tidal carbon dioxide during cardiopulmonary resuscitation in humans presenting mostly with asystole: a predictor of outcome.

OBJECTIVE: To determine whether continuous semiquantitative assessment of end-tidal CO2 could provide a highly sensitive predictor of return of spontaneous circulation during cardiopulmonary resuscitation (CPR). DESIGN: Prospective, clinical study. SETTING: Prehospital CPR. PATIENTS: One hundred twenty patients, during nontraumatic cardiac arrest. INTERVENTIONS: End-tidal CO2 values were measured continuously after tracheal intubation, and were categorized as the initial value, and as minimal and maximal values during the first 20 mins. MEASUREMENTS AND MAIN RESULTS: Presenting rhythm was asystole in 22 of the first 24 patients. Return of spontaneous circulation occurred in eight patients. Initial, minimal, and maximal end-tidal CO2 values were significantly (p < .01) higher in these patients than in the patients without return of spontaneous circulation. Cutoff values providing a 100% sensitivity and the highest specificity in predicting return of spontaneous circulation were found to be 10 torr for initial and maximal end-tidal CO2 values, and 2 torr for the minimal end-tidal CO2 value. The number of patients required to reject (with a risk error of <.05) the hypothesis of an actual sensitivity of < or = 90% for an observed sensitivity of 100% was found to be 95. In the second part of the study, this hypothesis was prospectively tested for initial and maximal end-tidal CO2 values in the subsequent 96 patients. Presenting cardiac rhythm was asystole in 87 patients. Return of spontaneous circulation was obtained in 30 patients. The cutoff value of 10 torr for maximal end-tidal CO2 during the first 20 mins after tracheal intubation provided an observed sensitivity of 100% in predicting return of spontaneous circulation with a specificity of 67%. This result allows rejection of the hypothesis of an actual sensitivity of < or = 90% (p = .042). By contrast, the observed sensitivity of initial end-tidal CO2 was only 87%. CONCLUSIONS: End-tidal CO2 represents a valuable tool for monitoring patients presenting with asystole during prehospital CPR. Fluctuations in end-tidal CO2 during CPR and the utility of end-tidal CO2 in detecting return of spontaneous circulation justify its continuous measurement. In addition, a high sensitivity (>90%) in predicting return of spontaneous circulation is prospectively demonstrated using the maximal end-tidal CO2 during the first 20 mins after tracheal intubation, with a cutoff value of 10 torr. Such a prognostic indicator could be used for a more rational approach to prolonged CPR.

Effect of epinephrine on end-tidal carbon dioxide pressure during prehospital cardiopulmonary resuscitation.

This prospective study was designed to quantify the effect of epinephrine on end-tidal PCO2 (PetCO2) during prehospital cardiopulmonary resuscitation (CPR) in humans. It included 20 patients (age range, 26 to 90 years) who presented in ventricular asystole on arrival of the prehospital medical team. Protocol began 5 minutes after tracheal intubation and during chest compressions. Mechanical ventilation was applied at constant rate and tidal volume. PetCO2 was measured before and 3 minutes after peripheral intravenous (IV) injection of 2 mg epinephrine. No other resuscitative drugs were administered during the study period. Mean PetCO2 decreased from 16.7 +/- 9.3 mm Hg before epinephrine to 12.6 +/- 7.1 mm Hg after epinephrine. The mean change in PetCO2 was 4.15 +/- 3.5 mm Hg (P < .0001). Four patients exhibited return of spontaneous circulation (ROSC). The decrease in PetCO2 was similar between the patients who exhibited ROSC and those who did not. There was a significant relationship between the epinephrine-induced change in PetCO2 and the PetCO2 value before epinephrine injection (r = .760; P < .0001). This study demonstrates a variable decrease in PetCO2 after IV epinephrine injection during CPR. Isolated PetCO2 readings may be misleading in assessing CPR efficacy or predicting outcome, and continuous measurement is recommended.