[Vaccination before and during pregnancy]. / La vaccination de la femme avant la grossesse et pendant la grossesse.

Vaccination of pregnant women is designed to protect the mother and the fetus from preventable diseases through vaccination. Authorized vaccines contain inactivated viruses, otherwise (l ive virus), they cannot be made during pregnancy. Vaccines offered in all circumstances are those against influenza, at any point in pregnancy, and diphtheria-tetanus-pertussis, in the 3rd trimester. Hepatitis A and/or B, meningitis, pneumococcal, rabies, anthrax vaccines must be considered in post exposure. There is not enough data on vaccines against typhoid fever, Japanese encephalitis, cholera during the pregnancy. Vaccines to be done at distance of pregnancy are those against chickenpox, rubella, measles and mumps for unprotected women, as well as the vaccine against HPV, BCG, yellow fever and smallpox. In conclusion, only influenza vaccines and diphtheria-tetanus-pertussis showed a safe profile during pregnancy. Other vaccines should be considered in the event of exposure to risk of illness with the help of an infectious disease specialist.

La vaccination de la femme enceinte vise à protéger la mère et le foetus de maladies évitables par cette démarche. Les vaccins autorisés contiennent des virus inactivés, dans le cas contraire (virus vivants), ils sont contre indiqués pendant la grossesse. Les vaccins à proposer en toutes circonstances sont ceux de la grippe à n'importe quel moment de la grossesse et de la diphtérie-tétanos-coqueluche, au 3e trimestre. En cas d'exposition à risque, on peut envisager la vaccination contre l'hépatite A et/ou B, la méningite, le pneumocoque, la rage, l'anthrax. Les données sont insuffisantes concernant les vaccins de la fièvre typhoïde, de l'encéphalite japonaise et du choléra. Les vaccins proposés en dehors de la grossesse sont ceux de la varicelle, la rubéole, la rougeole et les oreillons pour les femmes non protégées, ainsi que le vaccin de l'HPV, la fièvre jaune et le BCG. En conclusion, seuls les vaccins antigrippaux et anti diphtérie-tétanos-coqueluche ont montré un profil d'innocuité sûr pendant la grossesse. Les autres vaccins doivent s'envisager en cas d'exposition à risque après avis d'un infectiologue.

[The alarming increase of incapacity for work]. / L'augmentation inquiétante de l'inaptitude au travail.

The alarming increase of incapacity for work The increase of incapacity for work in Belgium and in Europe is not a new phenomenon but only the transposition of an experience already lived on others continents (Canada--USA). The bio-psycho-social model proves to be, on the international level, as the more efficient view for the understanding of the mechanisms production of the disability and therefore of the incapacity for work. Following this approach, the chronic pain is the result of the dynamic interaction between physiological, psychological and social factors. It mentions also an existing link between the pain and the depression itself being a determining factor in the persistence of the incapacity for work. The bio-psycho-social model can only be conceived in the interdisciplinary approach, and will for sure allow to optimize the support and the use of medicines with a painkiller and depressive aim. The socio-economic impact created represents actually a real health problem.

[Falciparum malaria in French residents in Yaounde]. / Le paludisme a Plasmodium falciparum chez les Français résidants a Yaoundé.

In South Cameroon, malaria is a disquieting problem. It represented 2.6% of consultants and concerned each year 10% among French residents. We have included 310 cases of Falciparum malaria between January 1, 1990 and December 31, 1990. There were 207 adults and 103 children with a mean age of 26 years. The duration of the stay was over one year in 137 cases and lower than 1 year in 183 patients. The chemoprophylaxis was correct in 194 patients according to the dose and duration. Forty-nine patients followed a combination of chloroquine and proguanil. Malaria attack was observed in 272 patients. Among them, there were 95 children. A severe malaria occurred in 38 cases. Mean parasitemia was of 0.24% (range: 0.002-7.5%). Therapy regimen was quinine: 36 cases, halofantrine: 266 cases, amodiaquine: 7 cases and association MFP (Fansimef) in 12 patients. The study shows the importance of malaria in an endemic area among expatriates despite the observance of chemoprophylactics regimens including proguanil.

The effect of topical amphotericin B on inflammatory markers in patients with chronic rhinosinusitis: a multicenter randomized controlled study.

BACKGROUND: It has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of chronic rhinosinusitis (CRS). Based on this rationale, the use of topical antifungals (amphotericin B) has been advocated. Studies on its clinical effectiveness are, however, contradictory. OBJECTIVES: To examine the effect of nasal antifungal treatment on secreted mediators in samples of nasal lavage fluid from patients with CRS with or without nasal polyps (NP). METHODS: Part two of a prospective double-blind, placebo-controlled multicenter clinical trial investigating the effect of 13 weeks of treatment with amphotericin B or placebo on the levels of pro-inflammatory cytokines, chemokines and growth factors (i.e., IL-1beta, IL-1RA, IL-2, IL-2R, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p40/p70 subunits), IL-13, IL-15, IL-17, TNF-alpha, IFN-alpha, IFN-gamma, G-CSF, GM-CSF, MIP-1alpha, MIP-1beta, IP-10, MIG, eotaxin, RANTES, MCP-1, MCP-2, MCP-3, VEGF, EGF, FGF-basic, HGF, Gro-alpha) and albumin via a fluorescent enzyme immunoassay in nasal lavage specimens of CRS patients with or without NP. RESULTS: Topical amphotericin B had no significant effect on the level of any of the tested pro-inflammatory cytokines, chemokines, and growth factors in CRS nasal lavage samples. Treatment with placebo, however, increased the level of MIP-1alpha and MIP-1beta, which are mediators involved in wound healing. CONCLUSIONS: Topical amphotericin B has no significant effect on activation markers of nasal inflammatory cells in chronic rhinosinusitis with or without nasal polyps.

Amphotericin B nasal lavages: not a solution for patients with chronic rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is one of the most common chronic diseases. Recently, it has been suggested that an exaggerated immune response to fungi is crucial in the pathogenesis of the disease. On the basis of this hypothesis, intranasal treatment with amphotericin B should benefit patients with CRS. Data from 2 uncontrolled and 2 controlled trials are conflicting, however. OBJECTIVE: To clarify the role of intranasal antifungal drugs in the treatment of CRS, we conducted a large, double-blind, placebo-controlled, multicenter study comparing the effectiveness of amphotericin B nasal lavages with placebo. METHODS: A total of 116 randomly selected patients with CRS were instructed to instill 25 mL amphotericin B (100 microg/mL) or placebo to each nostril twice daily for 3 months. Primary outcomes included a reduction in total visual analog scale (VAS) score and nasal endoscopy score. Secondary outcome measures included peak nasal inspiratory flow, polyp score, quality of life (Short Form-36, Rhinosinusitis Outcome Measure-31), and individual VAS scores. RESULTS: Analysis was based on intention to treat and involved all patients randomly assigned. Mean VAS scores, Short Form-36 and Rhinosinusitis Outcome Measure-31 data, peak nasal inspiratory flow values, nasal endoscopy scores, and polyp scores were similar in both treatment groups at the time of randomization, and no significant differences were observed after 13 weeks of treatment. CONCLUSION: Amphotericin B nasal lavages in the described dosing and time schedule do not reduce clinical signs and symptoms in patients with CRS. CLINICAL IMPLICATIONS: Amphotericin B nasal lavages in the described dosing and time schedule are ineffective and therefore not advised in the treatment of patients with CRS.

[Stability of P. Falciparum resistance to chloroquine between 1987 and 1989 in Mounana, Gabon]. / Stabilité de la résistance de P. falciparum à la chloroquine entre 1987 et 1989 à Mounana, Gabon.

Between 1987 and 1989 the trend in the chloroquine resistance of Plasmodium falciparum in the mining town of Mounana in south-eastern Gabon was studied in vivo and in vitro in 58 and 158 subjects, respectively, aged from 1 to 15 years. The tests used were a simplified variant of the standard WHO 7-day test for the in vivo study and the isotopic semi-microtest of chemosensitivity for the in vitro study. The health situation in 1989 showed no change from the 1987 situation, but an increase in febrile symptoms suggestive of malaria was observed in 1989. This observation may be linked to a decrease in the distribution of chloroquine since 1987, accompanied by the use of other antimalarials following the appearance of chloroquine-resistant strains. While the parasitological efficacy in vivo remained the same in 1989, there was a decrease in the proportion of strains resistant to chloroquine in vitro compared to 1987; likewise, the therapeutic efficacy as estimated from temperature readings was better in 1989 than in 1987: the modification of the prophylactic strategy since 1986 and the drop in chloroquine consumption since 1987 could be responsible for a stabilization of chloroquine resistance at Mounana. The authors consider it appropriate in this region to continue treating malaria in children with chloroquine (in a dosage of 25 mg/kg) and to use a second-line treatment in the event of the recurrence of malaria symptoms within the next two weeks.