99 research outputs found
Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving: data from a prospective study in a French network
International audienceBACKGROUND: Lower respiratory tract infection is a common cause of consultation and antibiotic prescription in paediatric practice. The misuse of antibiotics is a major cause of the emergence of multidrug-resistant bacteria. The aim of this study was to evaluate the frequency, changes over time, and determinants of non-compliance with antibiotic prescription recommendations for children admitted in paediatric emergency department (PED) with community-acquired pneumonia (CAP).METHODS: We conducted a prospective two-period study using data from the French pneumonia network that included all children with CAP, aged one month to 15 years old, admitted to one of the ten participating paediatric emergency departments. In the first period, data from children included in all ten centres were analysed. In the second period, we analysed children in three centers for which we collected additional data. Two experts assessed compliance with the current French recommendations. Independent determinants of non-compliance were evaluated using a logistic regression model. The frequency of non-compliance was compared between the two periods for the same centres in univariate analysis, after adjustment for confounding factors.RESULTS: A total of 3034 children were included during the first period (from May 2009 to May 2011) and 293 in the second period (from January to July 2012). Median ages were 3.0 years [1.4-5] in the first period and 3.6 years in the second period. The main reasons for non-compliance were the improper use of broad-spectrum antibiotics or combinations of antibiotics. Factors that were independently associated with non-compliance with recommendations were younger age, presence of risk factors for pneumococcal infection, and hospitalization. We also observed significant differences in compliance between the treatment centres during the first period. The frequency of non-compliance significantly decreased from 48 to 18.8 % between 2009 and 2012. The association between period and non-compliance remained statistically significant after adjustment for confounding factors. Amoxicillin was prescribed as the sole therapy significantly more frequently in the second period (71 % vs. 54.2 %, pâ<â0.001).CONCLUSIONS: We observed a significant increase in the compliance with recommendations, with a reduction in the prescription of broad-spectrum antibiotics, efforts to improve antibiotic prescriptions must continue
Apoptotic HPV Positive Cancer Cells Exhibit Transforming Properties
Previous studies have shown that DNA can be transferred from dying engineered cells to neighboring cells through the phagocytosis of apoptotic bodies, which leads to cellular transformation. Here, we provide evidence of an uptake of apoptotic-derived cervical cancer cells by human mesenchymal cells. Interestingly, HeLa (HPV 18+) or Ca Ski (HPV16+) cells, harboring integrated high-risk HPV DNA but not C-33 A cells (HPV-), were able to transform the recipient cells. Human primary fibroblasts engulfed the apoptotic bodies effectively within 30 minutes after co-cultivation. This mechanism is active and involves the actin cytoskeleton. In situ hybridization of transformed fibroblasts revealed the presence of HPV DNA in the nucleus of a subset of phagocytosing cells. These cells expressed the HPV16/18 E6 gene, which contributes to the disruption of the p53/p21 pathway, and the cells exhibited a tumorigenic phenotype, including an increased proliferation rate, polyploidy and anchorage independence growth. Such horizontal transfer of viral oncogenes to surrounding cells that lack receptors for HPV could facilitate the persistence of the virus, the main risk factor for cervical cancer development. This process might contribute to HPV-associated disease progression in vivo
Compliance with the current recommendations for prescribing antibiotics for paediatric community-acquired pneumonia is improving: data from a prospective study in a French network
Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study
Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality
COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Background:
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms.
Methods:
International, prospective observational study of 60â109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms.
Results:
âTypicalâ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (â€â18 years: 69, 48, 23; 85%), older adults (â„â70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each Pâ<â0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country.
Interpretation:
This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men
Methods to assess the optimality of care : examples of time to diagnosis and serious bacterial infection in children
Les objectifs de cette thĂšse Ă©taient de produire des connaissances nouvelles sur les mĂ©thodologies dâĂ©valuation de lâoptimalitĂ© des soins avec lâexemple des dĂ©lais diagnostiques et des infections bactĂ©riennes sĂ©vĂšres de lâenfant (IBS). Nous avons mis en Ă©vidence, dans deux revues systĂ©matiques de la littĂ©rature, que les points mĂ©thodologiques potentiellement associĂ©s Ă des risques de biais et dâobstacles Ă la transportabilitĂ© des rĂ©sultats Ă©taient rarement rapportĂ©s dans les Ă©tudes primaires sur les dĂ©lais diagnostiques ou rarement Ă©valuĂ©s par les auteurs de mĂ©ta-analyses. Nous avons donc construit et validĂ© internationalement une reporting guideline pour aider les scientifiques Ă prendre en compte ces points mĂ©thodologiques critiques. Nous avons montrĂ© par une enquĂȘte confidentielle avec comitĂ© dâexperts en population que : (i) les prises en charge Ă©taient suboptimales pour 76% des enfants dĂ©cĂ©dĂ©s dâIBS, (ii) un retard au recours mĂ©dical, une sous-Ă©valuation de la gravitĂ© ou un retard Ă lâantibiothĂ©rapie Ă©taient retrouvĂ©s dans la prise en charge de respectivement 20%, 20% et 24% des enfants atteints dâIBS, (iii) les soins suboptimaux Ă©taient indĂ©pendamment et fortement associĂ©s au risque de dĂ©cĂšs et (iv) les soins suboptimaux Ă©taient plus frĂ©quents chez les enfants de moins dâun an ou lorsque quâils nâĂ©taient pas administrĂ©s par un mĂ©decin spĂ©cifiquement formĂ©. La minimisation des biais dans la sĂ©lection des participants et la mesure de lâoptimalitĂ© et la prise en compte de facteurs de confusion comme la sĂ©vĂ©ritĂ© intrinsĂšque de la maladie sont des Ă©lĂ©ments clefs de lâĂ©valuation de lâoptimalitĂ© des soins afin de produire des messages cliniques correctifs valides.The aim of this thesis was to product new knowledge about the methodology on how to assess the optimality of care with the examples of time to diagnosis and serious bacterial infection (SBI). In two systematic reviews, we found that the key methodological points potentially related to risks of bias or threats to transportability were rarely reported in the primary studies and rarely evaluated by authors of systematic reviews. Then, we developed and internationally validated a reporting guideline to help scientists to better take into consideration these critical methodological points. In a population-based confidential inquiry, we found that: (i) care was suboptimal in 76% of the initial management of children who died from SBI, (ii) delayed first medical contact, undervaluation of severity or delayed antibiotic administration were detected in the management of 20%, 20% and 24% of children admitted to intensive care for a SBI, respectively, (iii) the total number of suboptimal cares delivered during the management was independently associated with death, and (iv) suboptimal cares were more frequent in children younger than one year old and if the care was delivered by a non specialist physician. Minimizing the risks of bias both in the selection process of the study population and in the assessment of the optimality of care, and taking into account confounding factors such as the intrinsic severity of the disease are keys elements to ensure a reliable evaluation of optimality of care in order to produce effective corrective clinical messages
MĂ©thodologies dâĂ©valuation de lâoptimalitĂ© des soins : exemples des dĂ©lais diagnostiques et des infections bactĂ©riennes sĂ©vĂšres de lâenfant
The aim of this thesis was to product new knowledge about the methodology on how to assess the optimality of care with the examples of time to diagnosis and serious bacterial infection (SBI). In two systematic reviews, we found that the key methodological points potentially related to risks of bias or threats to transportability were rarely reported in the primary studies and rarely evaluated by authors of systematic reviews. Then, we developed and internationally validated a reporting guideline to help scientists to better take into consideration these critical methodological points. In a population-based confidential inquiry, we found that: (i) care was suboptimal in 76% of the initial management of children who died from SBI, (ii) delayed first medical contact, undervaluation of severity or delayed antibiotic administration were detected in the management of 20%, 20% and 24% of children admitted to intensive care for a SBI, respectively, (iii) the total number of suboptimal cares delivered during the management was independently associated with death, and (iv) suboptimal cares were more frequent in children younger than one year old and if the care was delivered by a non specialist physician. Minimizing the risks of bias both in the selection process of the study population and in the assessment of the optimality of care, and taking into account confounding factors such as the intrinsic severity of the disease are keys elements to ensure a reliable evaluation of optimality of care in order to produce effective corrective clinical messages.Les objectifs de cette thĂšse Ă©taient de produire des connaissances nouvelles sur les mĂ©thodologies dâĂ©valuation de lâoptimalitĂ© des soins avec lâexemple des dĂ©lais diagnostiques et des infections bactĂ©riennes sĂ©vĂšres de lâenfant (IBS). Nous avons mis en Ă©vidence, dans deux revues systĂ©matiques de la littĂ©rature, que les points mĂ©thodologiques potentiellement associĂ©s Ă des risques de biais et dâobstacles Ă la transportabilitĂ© des rĂ©sultats Ă©taient rarement rapportĂ©s dans les Ă©tudes primaires sur les dĂ©lais diagnostiques ou rarement Ă©valuĂ©s par les auteurs de mĂ©ta-analyses. Nous avons donc construit et validĂ© internationalement une reporting guideline pour aider les scientifiques Ă prendre en compte ces points mĂ©thodologiques critiques. Nous avons montrĂ© par une enquĂȘte confidentielle avec comitĂ© dâexperts en population que : (i) les prises en charge Ă©taient suboptimales pour 76% des enfants dĂ©cĂ©dĂ©s dâIBS, (ii) un retard au recours mĂ©dical, une sous-Ă©valuation de la gravitĂ© ou un retard Ă lâantibiothĂ©rapie Ă©taient retrouvĂ©s dans la prise en charge de respectivement 20%, 20% et 24% des enfants atteints dâIBS, (iii) les soins suboptimaux Ă©taient indĂ©pendamment et fortement associĂ©s au risque de dĂ©cĂšs et (iv) les soins suboptimaux Ă©taient plus frĂ©quents chez les enfants de moins dâun an ou lorsque quâils nâĂ©taient pas administrĂ©s par un mĂ©decin spĂ©cifiquement formĂ©. La minimisation des biais dans la sĂ©lection des participants et la mesure de lâoptimalitĂ© et la prise en compte de facteurs de confusion comme la sĂ©vĂ©ritĂ© intrinsĂšque de la maladie sont des Ă©lĂ©ments clefs de lâĂ©valuation de lâoptimalitĂ© des soins afin de produire des messages cliniques correctifs valides
Ăvaluation de la couverture vaccinale d'adolescents de 11 Ă 17 ans dans trois Ă©coles en milieu rural
Une enquĂȘte descriptive a Ă©tĂ© rĂ©alisĂ©e dans deux collĂšges et un lycĂ©e en milieu rural (VendĂ©e et Loire Atlantique) afin d'Ă©valuer la couverture vaccinale d'adolescents de 6Ăšme Ă la premiĂšre. Au total, 249 carnets de santĂ© ont pu ĂȘtre recueillis et Ă©tudiĂ©s, la majoritĂ© des adolescents Ă©taient des collĂ©giens (87%). L'Ă©tude trouve que 11,2% des adolescents sont Ă jour de tous leurs vaccins. La couverture vaccinale recommandĂ©e atteint les objectifs nationaux pour le DTP avant 13 ans (96%), et est sub optimale pour le ROR (92%). Des efforts sont Ă fournir pour le DTP aprĂšs 13 ans (85%), la coqueluche (82% avant 13 ans, 54% aprĂšs 13 ans), le mĂ©ningocoque 30%, l'hĂ©patite B (38% ont eu leur schĂ©ma complet), et HPV (30% ont eu leurs trois doses). Nous n'avons pas mis en Ă©vidence d'association significative entre anciennetĂ© de consultation et retard de vaccination, sauf pour le ROR. La frĂ©quence d'hospitalisation et la prĂ©sence de maladies chroniques n'influencent pas la couverture vaccinale, donc la multiplicitĂ© des interlocuteurs mĂ©dicaux n'amĂ©liore pas la couverture vaccinale. Des efforts de formation pour les mĂ©decins et pour la population gĂ©nĂ©rale seraient donc Ă fournir, et l'efficacitĂ© de la simplification du calendrier vaccinal en 2013 serait Ă rĂ©Ă©valuer dans les annĂ©es Ă venir.NANTES-BU MĂ©decine pharmacie (441092101) / SudocSudocFranceF
Méningites à pneumocoque chez des enfants de plus de 5 ans et prédispositions anatomiques
A partir de 9 cas cliniques d'enfants de plus de 5 ans ayant présenté une méningite à pneumocoque au CHU de Nantes durant les 10 derniÚres années, nous avons fait une mise au point sur les infections invasives à pneumocoque chez les grands enfants, en nous appuyant sur une revue de la littérature. Un facteur favorisant a été mis en évidence à chaque fois qu'il a été recherché (8 cas/9). Les méningites à pneumocoque, moins fréquentes chez les grands enfants mais tout aussi graves que chez les plus petits, doivent faire l'objet d'explorations diagnostiques et si besoin de mesures préventives. Nous proposons : i) un algorithme pour la réalisation d'un bilan systématique à la recherche de facteurs prédisposants tout d'abord anatomique (et notamment ORL), puis immunitaire et génétique, ii) une synthÚse des indications de la prophylaxie vaccinale.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF
Ăvaluation de la couverture vaccinale d'adolescents de 11 Ă 17 ans dans trois Ă©coles en milieu rural
Une enquĂȘte descriptive a Ă©tĂ© rĂ©alisĂ©e dans deux collĂšges et un lycĂ©e en milieu rural (VendĂ©e et Loire Atlantique) afin d'Ă©valuer la couverture vaccinale d'adolescents de 6Ăšme Ă la premiĂšre. Au total, 249 carnets de santĂ© ont pu ĂȘtre recueillis et Ă©tudiĂ©s, la majoritĂ© des adolescents Ă©taient des collĂ©giens (87%). L'Ă©tude trouve que 11,2% des adolescents sont Ă jour de tous leurs vaccins. La couverture vaccinale recommandĂ©e atteint les objectifs nationaux pour le DTP avant 13 ans (96%), et est sub optimale pour le ROR (92%). Des efforts sont Ă fournir pour le DTP aprĂšs 13 ans (85%), la coqueluche (82% avant 13 ans, 54% aprĂšs 13 ans), le mĂ©ningocoque 30%, l'hĂ©patite B (38% ont eu leur schĂ©ma complet), et HPV (30% ont eu leurs trois doses). Nous n'avons pas mis en Ă©vidence d'association significative entre anciennetĂ© de consultation et retard de vaccination, sauf pour le ROR. La frĂ©quence d'hospitalisation et la prĂ©sence de maladies chroniques n'influencent pas la couverture vaccinale, donc la multiplicitĂ© des interlocuteurs mĂ©dicaux n'amĂ©liore pas la couverture vaccinale. Des efforts de formation pour les mĂ©decins et pour la population gĂ©nĂ©rale seraient donc Ă fournir, et l'efficacitĂ© de la simplification du calendrier vaccinal en 2013 serait Ă rĂ©Ă©valuer dans les annĂ©es Ă venir.NANTES-BU MĂ©decine pharmacie (441092101) / SudocSudocFranceF
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