LE DEFICIT IMMUNITAIRE COMMUN VARIABLE

Common variable immunodeficiency represent the most frequent hereditary disease of the immune system in adults, but it remains a rare and heterogeneous disease. It's manifested clinically by recurrent bacterial infections and benign lymphoproliferative disorders. Diagnosis is confirmed essentially by hypogammaglobulinemia after eliminating it's main differential diagnosis: Sarcoidosis. Prognosis has improved significantly by antibiotics, immunoglobulin therapy and immunosuppressive agents.Les déficits immunitaires primitifs, représentent un large éventail de maladies héréditaires du système immunitaire, très hétérogènes et souvent méconnus par les cliniciens. Chez l'adulte, le déficit immunitaire commun variable en constitue l'entité la plus fréquente. C'est une défaillance primitive du système immunitaire, dont la physiopathologie reste mal élucidée. Le DICV se manifeste cliniquement par des infections bactériennes à répétition, des manifestations auto-immunes, lympho-prolifératives et biologiquement par une hypogammaglobulinémie qui représente le signe biologique cardinal de la maladie. Son principal diagnostic différentiel est la sarcoïdose. Le pronostic s'est nettement amélioré ces dernières années grâce à une prise en charge précoce, codifiée, axée sur trois volets: la substitution en immunoglobulines, l'antibiothérapie curative et le traitement immunosuppresseur

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Le contrôle d'accès généralisé sur les autoroutes de l'ile de France : études en simulation et sur site réel

International audienceCe papier est focalisé sur la description des résultats de l'évaluation de l'impact de la régulation d'accès généralisée sur la partie Est du réseau autoroutier de l'Ile de France (IDF) en simulation et sur site réel en utilisant la stratégie locale ALINEA (Asservissement Linéaire d'entrée sur Autoroute) et coordonnée OASIS. Le site étudié comprend les autoroutes A86, A3, A4, A6BY dans les deux sens de circulation. La première étape a consisté à une étude en simulation et la seconde étape a été consacrée à l'évaluation sur site réel. Les résultats en simulation et sur site réel indiquent une nette amélioration des conditions du trafic en utilisant la stratégie de régulation ALINEA