Posterior reversible encephalopathy syndrome revealing acute intermittent porphyria

Lettre à l’éditeur (in Revue Neurologique, volume 172, numéro 6-7, pp.402-403). http://www.em-consulte.com/en/article/106640

Occurrence of palytoxins in marine organisms from different trophic levels of the French Mediterranean coast harvested in 2009

International audienceFour sites located in Nice and Villefranche-sur-Mer, on the French Mediterranean coast, were monitored during the summer of 2009 for the presence of epiphytic and planktonic Ostreopsis cf. ovata, and that of palytoxin (PITX) and 2 of its analogues (ovatoxin-a (OVTX-a) and ostreocin-D (OST-D)) in different marine organisms. Several of the 15 species that were sampled between June and September 2009 were found to be contaminated with OVTX-a as the major toxin (90% of the toxin profile) and PITX; this included fish, echinoderms, gastropods, crustaceans and cephalopods. The contamination levels varied geographically and between species, with the herbivorous species generally having higher toxin levels than carnivorous ones. The determination of the toxin distribution between the digestive tube (DT) and the remaining tissue (RT) or roe in the case of the sea urchin Paracentrotus lividus showed that the toxins were sequestered in the DT. The highest toxin level ever recorded over the course of the study was of 392.2 mu g for the sum of OVTX-a and PITX per kg of DT of the flathead mullet Mugil cephalus. No quantifiable levels of toxins were found in the roe of the sea urchins or in the RT of the other marine products. However, in several cases, the toxin level in the whole flesh of the analysed organisms was above 30 mu g OVTX-a + PITX/kg, when knowing that the European food safety authority's opinion is that an adult should not ingest more than 30 mu g PITX + OST-D per kg of shellfish meat to avoid putting the consumer's health at risk. This was observed for the following four species: the sea urchin P. lividus, the red-mouthed rock shell Stramonita haemastoma, the warty crab Eriphia verrucosa and the flathead mullet M. cephalus. The collection of such data is of great importance to refine and complete the risk assessment of PITX and its analogues and has to be encouraged in order to provide reliable information for setting up a regulatory level that would protect the consumers of edible marine organisms (C) 2013 Elsevier B.V. All rights reserved

Median Nerve Entrapment after Supracondylar Humeral Fracture in a Young Child

Median nerve entrapment after supracondylar humeral fracture in children is rare. We report a case of Gartland type III supracondylar humeral fracture complicated by an entrapment of the median nerve following closed reduction and percutaneous pinning in a 5-year-old child. The diagnosis of entrapment was made 14 months post injury following progressive motor and sensory palsy. Resection and end-to-end suture were performed, leading to complete sensory and motor recovery eight months later. This nerve complication is often unnoticed and should be suspected systematically before and after reduction of all displaced supracondylar humeral fracture in children. The indication of resection-suture or nerve graft depends on the entrapment and the delay of the palsy

Telemedicine for the acute management of stroke in Burgundy, France: an evaluation of effectiveness and safety

International audienceBackground:In the context of the development of telemedicine in France to address low thrombolysis rates and limited stroke infrastructures, a star-shaped telestroke network was implemented in Burgundy (1.6 million inhabitants). We evaluated the safety and effectiveness of this network for thrombolysis in acute ischemic stroke patients.Methods:One hundred and thirty-two consecutive patients who received intravenous thrombolysis during a telemedicine procedure (2012–2014) and 222 consecutive patients who were treated at the stroke center of Dijon University Hospital, France (2011–2012) were included. Main outcomes were the modified Rankin scale (mRS) score and case fatality at 3 months. Comparisons between groups were made using multivariable ordinal logistic regression and logistic regression analyses, respectively.Results:Baseline characteristics of telethrombolysis patients were similar to those of patients undergoing thrombolysis locally except for a higher frequency of previous cancer and pre-morbid handicap, and a trend towards greater severity at admission in the former. The distribution of mRS scores at 3 months was similar between groups, as were case-fatality rates (18.9% in the telethrombolysis group versus 16.5%, P = 0.56). In multivariable models, telethrombolysis did not independently influence functional outcomes at 3 months (odds ratio for a shift towards a worse outcome on the mRS, 1.11; 95% confidence interval, 0.74–1.66, P = 0.62) or death (odds ratio, 0.86; 95% confidence interval, 0.44–1.69, P = 0.66).Conclusion:The implementation of a regional telemedicine network for the management of acute ischemic stroke appeared to be effective and safe. Thanks to this network, the proportion of patients who benefit from thrombolysis will increase. Further research is needed to evaluate economic benefits

Clinical features of pain in amyotrophic lateral sclerosis: A clinical challenge

International audiencePain in amyotrophic lateral sclerosis (ALS) is paradoxical in this disease of the upper and lower motor neurons. As such, it remains an underestimated and neglected clinical problem because it is poorly identified by physicians, its mechanisms are numerous and its treatments are generally not effective. Pain may be primary in the form of cramps, spasticity and neuropathy, or secondary as nociceptive pain, and may arise before the first motor symptoms. It may also lead to depression and, in all cases, affect patients' daily activities and quality of life. Given the high frequency of pain in ALS, the use of analgesic or sedative drugs is necessary and should reduce the course of the disease. Nevertheless, it is important to understand the pathophysiological mechanisms of pain in ALS, and to train physicians how to detect ALS pain early on and provide dedicated treatments. In France, the implementation of ALS centers is a positive response to the public-health problem resulting from this disorder

Monitoring biosecurity in poultry production: an overview of databases reporting compliance with biosecurity practices from 7 European countries

Compliance with required on-farm biosecurity practices reduces the risk of contamination and spread of zoonotic and economically important diseases. With repeating avian influenza epidemics in the poultry industry, the need to monitor and improve the overall level of biosecurity is increasing. In practice, biosecurity compliance is assessed by various actors (e.g., academic, private and public institutions), and the results of such assessments may be recorded and gathered in databases which are seldom shared or thoroughly analyzed. This study aimed to provide an inventory of databases related to the assessment of biosecurity in poultry farms in seven major poultry-producing European countries to highlight challenges and opportunities associated with biosecurity data collection, sharing, and use. The institutions in charge of these databases were contacted and interviewed using a structured questionnaire to gather information on the main characteristics of the databases and the context of their implementation. A total of 20 databases were identified, covering the gamut of poultry species and production types. Most databases were linked to veterinary health authorities or academia, and to a lesser extent interbranch organizations. Depending on the institutions in charge, the databases serve various purposes, from providing advice to enforcing regulations. The quality of the biosecurity data collected is believed to be quite reliable, as biosecurity is mostly assessed by trained farm advisors or official veterinarians and during a farm visit. Some of the databases are difficult to analyze and/or do not offer information concerning which biosecurity measures are most or least respected. Moreover, some key biosecurity practices are sometimes absent from certain databases. Although the databases serve a variety of purposes and cover different production types, each with specific biosecurity features, their analysis should help to improve the surveillance of biosecurity in the poultry sector and provide evidence on the benefits of biosecurity