Unusual presentation of acute annular urticaria: A case report

Acute urticarial lesions may display central clearing with ecchymotic or haemorrhagic hue, often misdiagnosed as erythema multiforme, serum-sickness-like reactions, or urticarial vasculitis. We report a case of acute annular urticaria with unusual presentation occurring in a 20-month-old child to emphasize the distinctive morphologic manifestations in a single disease. Clinicians who care for children should be able to differentiate acute urticaria from its clinical mimics. A directed history and physical examination can reliably orientate necessary diagnostic testing and allow for appropriate treatment

Bacteremic community-acquired infections due to Klebsiella pneumoniae: clinical and microbiological presentation in New Caledonia, 2008–2013

SummaryObjectivesTo provide data on severe bacteremic community-acquired infections due to Klebsiella pneumoniae in New Caledonia.MethodsAll patients admitted with bacteremic community-acquired infections due to K. pneumoniae at the only tertiary medical center in New Caledonia, from 2008 to 2013, were included retrospectively in this study. Clinical and microbiological characteristics were analyzed, as well as risk factors for mortality.ResultsThe characteristics of 119 patients were analyzed. The most common clinical presentation was urinary tract infection (40 cases, 33%), followed by pneumonia (28 cases, 23%), deep abscesses (15 cases, 13%), liver abscess (12 cases, 9%), meningitis in (five cases, 4%), and endophthalmitis (two cases, 1%). Multiple localizations were reported in 18 cases (15%) and isolated bacteremia was reported in 22 cases (18%). The overall mortality rate was 22% (26/119) and the mortality rate in the intensive care unit was 33% (14/42). Renal impairment, chronic liver disease, pneumonia, and isolated bacteremia were independent risk factors for mortality.ConclusionsK. pneumoniae is a dominant cause of severe community-acquired bacteremic infection in New Caledonia. Physicians should be aware of the poor prognosis of any patient with a bacteremic K. pneumoniae infection and should monitor patients presenting with risk factors closely

Malnutrition and Mortality Patterns among Internally Displaced and Non-Displaced Population Living in a Camp, a Village or a Town in Eastern Chad

BACKGROUND: Certain population groups have been rendered vulnerable in Chad because of displacement of more than 200,000 people over the last three years as a result of mass violence against civilians in the east of the country. The objective of the study was to assess mortality and nutritional patterns among displaced and non-displaced population living in camps, villages and a town in the Ouddaï and Salamat regions of Chad. METHODOLOGY: Between May and October 2007, two stage, 30-cluster household surveys were conducted among 43,900 internally displaced persons (IDPs) living in camps in Ouaddai region (n = 898 households), among 19,400 non-displaced persons (NDPs) living in 42 villages in Ouaddai region (n = 900 households) and among 17,000 NDPs living in a small town in Salamat region (n = 901 households). Data collection included anthropometric measurements, measles vaccination rates and retrospective mortality. Crude mortality rate (CMR), mortality rate among children younger than 5 years (U5MR), causes of death and the prevalence of wasting (weight-for-height z score <-2) among children aged 6 to 59 months were the main outcome measures. CONCLUSIONS: The CMR among the 4902 IDPs in Gozbeida camps, 4477 NDPs living in a village and 4073 NDPs living in a town surveyed was 1.8 (95% CI, 1.2-2.8), 0.3 (95% CI, 0.2-0.4), 0.3 (95% CI, 0.2-0.5) per 10,000 per day, respectively. The U5MR in a camp (n = 904), a village (n = 956) and a town (n = 901) was 4.1 (95% CI, 2.1-7.7), 0.5 (95% CI, 0.3-0.9) and 0.7 (95% CI, 0.4-1.4) per 10,000 per day, respectively. Diarrhoea was reported to be the main cause of death. Acute malnutrition rates (according to the WHO definition) among 904 IDP children, 956 NDPs children living in a village, 901 NDP children living in a town aged 6 to 59 months were 20.6% (95% CI, 17.9%-23.3%), 16.4% (95% CI, 14.0%-18.8%) and 10.1% (95% CI, 8.1%-12.2%) respectively. The study found a high mortality rate among IDPs and an elevated prevalence of wasting not only in IDP camps but also in villages located in the same region. The town-dweller population remains at risk of malnutrition. Appropriate contingency plans need to be made to ensure acceptable living standards for these populations

Ovine serum biomarkers of early and late phase scrapie

<p>Abstract</p> <p>Background</p> <p>Transmissible spongiform encephalopathies are fatal neurodegenerative disease occurring in animals and humans for which no <it>ante-mortem </it>diagnostic test in biological fluids is available. In such pathologies, detection of the pathological form of the prion protein (i.e., the causative factor) in blood is difficult and therefore identification of new biomarkers implicated in the pathway of prion infection is relevant.</p> <p>Methods</p> <p>In this study we used the SELDI-TOF MS technology to analyze a large number of serum samples from control sheep and animals with early phase or late phase scrapie. A few potential low molecular weight biomarkers were selected by statistical methods and, after a training analysis, a protein signature pattern, which discriminates between early phase scrapie samples and control sera was identified.</p> <p>Results</p> <p>The combination of early phase biomarkers showed a sensitivity of 87% and specificity of 90% for all studied sheep in the early stage of the disease. One of these potential biomarkers was identified and validated in a SELDI-TOF MS kinetic study of sera from Syrian hamsters infected by scrapie, by western blot analysis and ELISA quantitation.</p> <p>Conclusions</p> <p>Differential protein expression profiling allows establishing a TSE diagnostic in scrapie sheep, in the early phase of the disease. Some proteic differences observed in scrapie sheep exist in infected hamsters. Further studies are being performed to identify all the discriminant biomarkers of interest and to test our potential markers in a new cohort of animals.</p

Investigating pupillometry to detect preoperative anxiety: a pilot study

Guidelines from the European Society of Anesthesia (ESA) insist on the importance of preoperative anxiety management. However, its assessment currently relies on questionnaires that are long to submit and sometimes difficult to interpret. Exploring the balance between sympathetic and parasympathetic neural systems through the use of pupillometry is a promising path to identify anxiety and thus provides an objective and reproducible assessment tool. A single-center prospective observational study was conducted in a population of ambulatory ophthalmological surgery patients. Preoperative anxiety was assessed using the Surgical Fear Questionnaire (SFQ). Measurements were taken using an Algiscan® (IDMed) type pupillometer before, during, and after insertion of the peripheral IV catheter. A statistical correlation test was carried out between the different evaluations of anxiety and the coefficient of variation of the pupillary diameter (VCPD). A total of 71 patients were included in the study between July 2020 and February 2021, with a median SFQ score of 23 [IQR 11-34]. No significant statistical correlation was found between the baseline pupillary diameter, or VCPD, and preoperative anxiety levels. Similarly, the pupillometric variables did not differ significantly when adjusting for the level of anxiety during and after painful stimulation due to canulation. More studies are necessary to explore the potential correlation between preoperative anxiety and pupillometry

Vocal markers of pre-operative anxiety: a pilot study

International audienceIntroduction Recent European guidelines in anaesthesia recommend systematic pre-operative anxiety management to prevent its negative peri-operative impact, 1 including impaired memorization of important instructions, and higher incidence of post-operative acute and chronic pain. Usual self-administered questionnaires or scales to assess anxiety in the preoperative setting are time-consuming and rely on the patients' willingness to comply with instructions. 2 Physiological signals such as patients' voice may provide useful information for objective, reliable, and accurate anxiety assessment before surgery. Because of the extensive parasympathetic innervation to the larynx, pharynx, face, and head, stress modifies vocal parameters. 3-4 The effects of acute anxiety on voice are poorly explored in the preoperative context. Our objective was to describe characteristics of patient's vocal parameters related to declared anxiety level in a day-care ophthalmic surgical unit performing cataract surgery

Prevalence, risk factors, and impact on outcome of cytomegalovirus replication in serum of Cambodian HIV-infected patients (2004-2007)

BACKGROUND: In developing countries, the study of cytomegalovirus (CMV) coinfection in HIV-infected patients remains neglected. Quantitative CMV polymerase chain reaction (PCR) is the gold standard diagnostic tool for analyzing serum CMV replication and for predicting CMV disease. We estimated the prevalence of replicating CMV in sera of newly diagnosed HIV-infected Cambodian patients and examined its impact on mortality. METHODS: This cohort study was based on 2 highly active antiretroviral therapy treatment programs in Cambodia between 2004 and 2007. Quantitative CMV PCR was performed on baseline serum samples of 377 HIV-infected patients. RESULTS: The prevalence of serum CMV DNA was 55.2% (150 of 272) in patients with CD4 count <100/mm. In multivariate analysis, hemoglobin <9 g/dL, CD4 count <100/mm, and Karnofsky index <50 were independently associated with positive serum CMV DNA at baseline. During a 3-year follow-up period, CMV viral load >or=3.1 log10 copies per milliliter was significantly associated with death independently of CD4 count, other opportunistic infections, and highly active antiretroviral therapy. CONCLUSIONS: As in industrialized countries, serum CMV replication is highly prevalent among HIV-infected Cambodian patients and is associated with increased mortality. This underscores the importance of diagnostic CMV infection by PCR in sera of HIV-infected patients with CD4 count <100/mm and treating this opportunistic infection to reduce its associated mortality

Epidémiologie de la leptospirose en Nouvelle Calédonie et à Futuna : formes pédiatriques, reinfections symptomatiques and incidence de la réaction de Jarisch-Herxheimer

Leptospirosis is an endemo-epidemic zoonotic disease associated with potentially fatal renal, cardiovascular or pulmonary failure. Several aspects of the disease are poorly explored, including infections in children, Jarisch-Herxheimer reactions (JHR) and symptomatic re-infections. The objectives of the studies were the following: to describe disease spectrum and outcome differences in children and adolescents admitted for leptospirosis in a large at-risk population; to quantify frequency of and risk factors for JHR in leptospirosis management; and to assess incidence and characteristics of reinfection by leptospirosis in the Pacific region. Using a retrospective data collection, clinical and laboratory data were obtained on hospitalized confirmed cases in New Caledonia and in Futuna. A case-control study was designed to identify risk factors using a logistic regression model. There are four principal findings from this series of studies with direct implications for clinical practice in those settings. First, leptospirosis in New Caledonia is responsible for a limited number of admissions among children due to milder symptomatic clinical presentation. Second, although generally assumed to be a rare event, the true prevalence of JHR in leptospirosis is unknown in most part of the world. The awareness of this event is probably insufficient considering the significantly high proportion of JHR observed in Futuna. Third, recurrent episodes of symptomatic leptospirosis appear to be non-severe. Finally, specific immunity resulting from a previous episode of leptospirosis with the serovar Copenhageni did not protect against subsequent infection against the same serovar. Future research based those results may provide insights into the still challenging pathogenesis of this complex infectious disease.La leptospirose, spirochetose tropicale négligée, est considérée comme la zoonose la plus répandue dans le monde. Selon l’Organisation Mondiale de la Santé, les formes sévères représentent 5 à 15% des infections humaines et le taux de létalité peut varier entre 5% et 30%. En Océanie et particulièrement en Nouvelle-Calédonie et à Futuna, la leptospirose est une préocupation majeure de santé publique: son incidence annuelle moyenne est de 45 pour 100 000 habitants et peut atteindre 150 pour 100 000 habitants pendant les saisons pluvieuses. Malgré les progrès considérables accomplis pour comprendre la physiopathologie de la maladie, plusieurs aspects de la leptospirose encore négligés méritent d’être exploré: les infections symptomatiques pédiatriques, la réaction de Jarisch-Herxheimer (JH) pourtant bien étudiée dans les autres spirochetoses, et les reinfections nécessitant une hospitalisation. Questions posées et objectifs: La pratique clinique suggère que les enfants hospitalisés pour leptosirose sont moins sévèrement atteints que les adultes. Les raisons susceptibles d’expiquer cette différence de présentation sont peu claires. L’obejctif de l’étude 1 était de décrire l’épidemiologie et le profil clinico-biologique des formes pédiatriques de leptospirose nécessitant une hospitalisation en Nouvelle Calédonie et d’identifier des différences en fonction des classes d’âge. La réalité de la réaction de Jarisch-Herxheimer – bien connue dans les autres spirochetoses – reste un sujet controversé dans la leptospirose. Afin d’effectuer une mise au point sur le sujet, une revue systématique de la littérature préalable à été réalisée (Etude 2) avant de préciser la prévalence, la sévérité, et les facteurs de risque des réactions de Jarisch-Herxheimer au cours des épisodes de leptospirose humaine traitée par antibiotiques en Nouvelle Calédonie et à Futuna (Etude 3)