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.

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.

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.

[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.

[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.

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

[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.

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.