Etude prospective du profil épidémiologique, clinique et évolutif des infections à rhinovirus chez l'enfant hospitalisé, et comparaison avec le virus respiratoire syncytial

Une étude prospective comparative des infections à Rhinovirus (HRV) et Virus Respiratoire Syncytial (VRS) a été réalisée du 1er octobre 2010 au 31 mars 2012, chez les enfants hospitalisés au CHU de Clermont-Ferrand, afin d'évaluer leur profil épidémiologique, clinique et évolutif. Nous avons relevé 254 infections à HRV et 126 à VRS. Les données épidémiologiques retrouvent le caractère endémique des infections à HRV avec deux pics de circulation. Les atteintes rhinopharyngées et les crises d'asthme prédominent pour ces virus (p<0,01) alors qu'un tableau de bronchiolite est plus fréquent dans les infections à VRS (p<0,01) où l'on observe également un score de gravité et une durée d'hospitalisation plus élevés (p<0,05). L'étude des espèces d'HRV objective une gravité et une atteinte bronchique plus importantes pour l'espèce C (p=0,004). Dans un second temps, 111 familles de patients infectés par un HRV et 74 par un VRS, du 1er octobre 2010 au 7 mai 2011, ont été contactées, un an après l'infection, afin d'apprécier l'impact respiratoire des HRV par comparaison au VRS chez leurs enfants. Nous n'avons pas observé de différence significative entre les deux virus pour l'induction ou l'exacerbation d'un asthme à un an . Cependant, il est mis en évidence le rôle significatif des antécédents familiaux d'asthme (p=0,003) ou d'atopie (p=0,013) dans les exacerbations d'asthme liées au HRV et le rôle d'un terrain personnel atopique dans les inductions d'asthme liées aux HRV (p=0,032).La gravité de l'épisode initial influence aussi les inductions d'asthme ultérieur pour les deux virus étudiés (p<0,05). Enfin, bien que non significatifs, les résultats suggèrent un impact respiratoire plus marqué pour l'espèce C. Ce travail montre également l'intérêt d'un suivi pneumo pédiatrique pour les enfants à risque dans les suites d'une infection à HRV.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

LES INFECTIONS A MYCOPLASMA PNEUMONIAE CHEZ L'ENFANT HOSPITALISE (D.E.S.)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Flexible bronchoscopic cannulation of an isolated H-type tracheoesophageal fistula in a newborn.

International audienceCongenital isolated H-type tracheoesophageal fistula (H-TEF) is a rare malformation of the airways. Surgery should not be delayed once the diagnosis is established. Identification of the fistula during surgery is a prerequisite for a successful outcome. Intubation or cannulation of the H-TEF with a catheter can help the surgeon to identify the fistula. A rigid bronchoscope is generally used for cannulation of the fistula. Cannulation of an H-TEF in a newborn with a flexible bronchoscope has the merit of simplicity and safety. We report the insertion of a catheter in an isolated H-TEF in a newborn using a flexible bronchoscope and think that this method can be easily applied

RSV-hRV co-infection is a risk factor for recurrent bronchial obstruction and early sensitization 3 years after bronchiolitis

International audienc

Amantadine use in the French prospective NS-Park cohort

International audienceObjective: To assess amantadine use and associated factors in the patients with Parkinson's disease (PD).Background: Immediate-release amantadine is approved for the treatment of PD and is largely used in clinical practice to treat "levodopa-induced dyskinesia (LIDs). Its use varies according to countries and PD stages. The prospective NS-Park cohort collects features of PD patients followed by 26 French PD Expert Centres.Methods: Variables used for the analyses included demographics, motor and non-motor PD symptoms and motor complications [motor fluctuations (MFs), LIDs)], antiparkinsonian pharmacological classes and levodopa equivalent daily dose (LEDD). We evaluated: (i) prevalence of amantadine use and compared clinical features of amantadine users vs. non-users (cross-sectional analysis); (ii) factors associated with amantadine initiation (longitudinal analysis); (iii) amantadine effect on LIDs, MFs, apathy, impulse control disorders and freezing of gait (Fog) (longitudinal analysis).Results: Amantadine use prevalence was 12.6% (1,585/12,542, median dose = 200 mg). Amantadine users were significantly younger, with longer and more severe PD symptoms, greater LEDD and more frequent use of device-aided/surgical treatment. Factors independently associated with amantadine initiation were younger age, longer PD duration, more frequent LIDs, MFs and FoG, higher LEDD and better cognitive function. 9 of the 658 patients on amantadine had stopped it at the following visit, after 12-18 months (1.3%). New users of amantadine presented a higher improvement in LIDs and MF compared to amantadine never users.Conclusions: About 12% of PD patients within the French NS-Park cohort used amantadine, mostly those with younger age and more severe PD. Amantadine initiation was associated with a subsequent reduction in LIDs and MFs

Rapid Improvement after Starting Elexacaftor–Tezacaftor–Ivacaftor in Patients with Cystic Fibrosis and Advanced Pulmonary Disease

International audienceRationale: Elexacaftor-tezacaftor-ivacaftor is a CFTR (cystic fibrosis [CF] transmembrane conductance regulator) modulator combination, developed for patients with CF with at least one Phe508del mutation. Objectives: To evaluate the effects of elexacaftor-tezacaftor- ivacaftor in patients with CF and advanced respiratory disease. Methods: A prospective observational study, including all patients aged ⩾12 years and with a percent-predicted FEV1 (ppFEV1) <40 who initiated elexacaftor-tezacaftor-ivacaftor from December 2019 to August 2020 in France was conducted. Clinical characteristics were collected at initiation and at 1 and 3 months. Safety and effectiveness were evaluated by September 2020. National-level transplantation and mortality figures for 2020 were obtained from the French CF and transplant centers and registries. Measurements and Main Results: Elexacaftor-tezacaftor- ivacaftor was initiated in 245 patients with a median (interquartile range) ppFEV1 = 29 (24-34). The mean (95% confidence interval) absolute increase in the ppFEV1 was +15.1 (+13.8 to +16.4; P < 0.0001), and the mean (95% confidence interval) in weight was +4.2 kg (+3.9 to +4.6; P < 0.0001). The number of patients requiring long-term oxygen, noninvasive ventilation, and/or enteral tube feeding decreased by 50%, 30%, and 50%, respectively (P < 0.01). Although 16 patients were on the transplant waiting list and 37 were undergoing transplantation evaluation at treatment initiation, only 2 received a transplant, and 1 died. By September 2020, only five patients were still on the transplantation path. Compared with the previous 2 years, a twofold decrease in the number of lung transplantations in patients with CF was observed in 2020, whereas the number of deaths without transplantation remained stable. Conclusions: In patients with advanced disease, elexacaftor-tezacaftor-ivacaftor is associated with rapid clinical improvement, often leading to the indication for lung transplantation being suspended

QUBIC-the Q & U bolometric interferometer for cosmology

QUBIC (Q and U bolometric interferometer for cosmology) is an international ground-based experiment dedicated to the measurement of the polarized fluctuations of the cosmic microwave background (CMB). It is based on bolometric interferometry, an original detection technique which combines the immunity to systematic effects of an interferometer with the sensitivity of low temperature incoherent detectors. QUBIC will be deployed in Argentina, at the Alto Chorrillos mountain site near San Antonio de los Cobres, in the Salta province. The QUBIC detection chain consists of 2048 NbSi transition edge sensors (TESs) cooled to 320 mK. The voltage-biased TESs are read out with time domain multiplexing based on superconducting quantum interference devices (SQUIDs) at 1 K and a novel SiGe application-specific integrated circuit (ASIC) at 60 K allowing an unprecedented multiplexing (MUX) factor equal to 128 to be reached. The current QUBIC version is based on a reduced number of detectors (1/4) in order to validate the detection technique. The QUBIC experiment is currently being validated in the lab in Salta (Argentina) before going to the site for observations. This paper presents the main results of the characterization phase with a focus on the detectors and readout system