New Insights in the Pathophysiology of Hospital- and Ventilator-Acquired Pneumonia: A Complex Interplay between Dysbiosis and Critical-Illness-Related Immunosuppression.

Both hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) have long been considered as diseases resulting from the invasion by pathogens of a previously sterile lung environment. Based on this historical understanding of their pathophysiology, our approaches for the prevention and treatment have significantly improved the outcomes of patients, but treatment failures remain frequent. Recent studies have suggested that the all-antimicrobial therapy-based treatment of pneumonia has reached a glass ceiling. The demonstration that the constant interactions between the respiratory microbiome and mucosal immunity are required to tune homeostasis in a state of symbiosis has changed our comprehension of pneumonia. We proposed that HAP and VAP should be considered as a state of dysbiosis, defined as the emergence of a dominant pathogen thriving at the same time from the catastrophic collapse of the fragile ecosystem of the lower respiratory tract and from the development of critical-illness-related immunosuppression. This multidimensional approach to the pathophysiology of HAP and VAP holds the potential to achieve future successes in research and critical care. Microbiome and mucosal immunity can indeed be manipulated and used as adjunctive therapies or targets to prevent or treat pneumonia.

[Retinopathy in premature infants. Present value of surveillance of premature and newborn infants at risk]. / Rétinopathie de la prématurité. Intérêt actuel de la surveillance des prématurés et nouveau-nés à risques.

Systematic ophthalmologic screening of infants in a Neonatal Intensive Care Unit is time consuming and sometimes difficult. In this retrospective study of 1200 infants examined in the neonatal unit of Toulouse Regional Hospital from January 88 through December 89, we tried to summarize our findings and assess the value of systematic screening. We found 118 infants with abnormal examination: 58 preterms had retinopathy of prematurity (ROP) (5.16%) with 36 stage I, 15 stage II, 7 stage III (2 stage III+ had cryotherapy), no stage IV. Risk factors are discussed. 40 preretinal hemorrhages, all found in the first week of life. Only 2 of them persisted beyond the 2nd month (0.2%) and we found vascular anomalies that were cryotreated. 20 had various diseases. Diseases requiring early treatment were found in a general context with obvious need of ophthalmologic examination. Our study shows that 4 infants: 2 ROP III+ and 2 retinal hemorrhages or 0.4% of all infants obtained an effective benefit from this systematic screening. We confirmed the value of this screening: all infants in the neonatal care unit have at least one ophthalmologic exam, before they leave the hospital. Preterm less than 1600 g or less than 2000 g with initial resuscitation are checked during first and second month. Preterm less than 1200 g or less than 1600 g who had more than one month of oxygen therapy are checked every month until the 6th month.

[Treatment of keratoconus using non-freezing epikeratoplasty]. / Traitement du kératocône par épikératoplastie plane non congelée.

Keratoconus may present a difficult therapeutic challenge when it becomes impossible to adapt Contact Lenses. Penetrating Keratoplasty is sometime difficult to perform and the result is often altered by important astigmatism. Other solutions have been tried with variable results. We treated 26 eyes with Keratoconus that were unadapted to CL bud didn't have central opacities, with Non Freeze Epikeratoplasty. 14 of them are analysed (more than 3 months after suture ablation). 13 increased visual acuity without correction. All of them increased best corrected VA. Medium astigmatism was 3 dioptries, always regular. No major complications were observed. The comparison with an equivalent group treated with Penetrating Keratoplasty showed that the results were equivalent. Epikeratoplasty can be a reasonable alternative in central or large KC without central opacities. It's extraocular and always reversible. The Non Freeze procedure is less aggressive for the graft tissue.