Enteric fever among children: 50 cases in a French tertiary care centre.

Background: Enteric fever in France is primarily travel-associated. Characteristics of paediatric cases are scarce and information from field studies in endemic countries might not be generalizable to non-endemic countries. Methods: In this retrospective study, we reviewed all cases of typhoid and paratyphoid fever treated in a French paediatric tertiary care centre from 1993 through 2015. Results: Fifty cases of enteric fever due to Salmonella enterica serovar Typhi (n = 44) and Paratyphi (n = 6) were identified. Sixty-one percent of the children had travelled to Africa and 34 % to the Indian subcontinent. Among travel-associated cases, eighty-five percent were visiting friends and relatives (VFR). Ninety-six percent had high fever associated with gastrointestinal symptoms. Anaemia (66%), elevated CRP (80%), transaminitis (87%) and mild hyponatremia (50%) were the main biological findings. Blood cultures were positive in 90% of cases. Twelve strains (24%) were resistant at least to one antibiotic, and all of them had been isolated since 2003, increasing the resistance rate during this last period to 43% (12/28). Ceftriaxone was administered to 71 patients for a median duration of 6 days (IQR: 4‒8). The median time to apyrexia after onset of treatment was 4 days (IQR: 2‒5 days). Complications occurred in 9 children with 5 (10%) presenting neurologic disorders. All 50 patients recovered. Conclusion: In France, paediatric enteric fever is mainly a travel-associated disease and occurs in patients returning from a prolonged stay in an endemic area. Children VFR are at high risk and should be a priority target group for pre-travel preventive measures. The increase in antibiotic resistance reflects the situation in endemic countries and is a major concern

SYNTHESIS OF ALPHA-CYANO CARBONYL-COMPOUNDS BY FLASH VACUUM THERMOLYSIS OF (ALKYLAMINO)METHYLENE DERIVATIVES OF MELDRUMS ACID - EVIDENCE FOR FACILE 1,3-SHIFTS OF ALKYLAMINO AND ALKYLTHIO GROUPS IN IMIDOYLKETENE INTERMEDIATES

The syntheses and flash vacuum thermolyses of 5-[(alkylamino)methylene]-2,2-dimethyl-1,3-dioxane-4,6-diones (Meldrum's acid derivatives) 13a-i are described. Thermolysis of 13a as well as of ethyl 3-(tert-butylamino)acrylate (22) gives a tautomeric mixture of cyanoacetaldehyde (14) and 3-hydroxypropenenitrile (15). Thermolysis of 13b gives iminoacrolein 26 and not cyanoacetone (29). Thermolysis of 13c,d gives S-methyl cyanothioacetate (30), and 13f-h give cyanoacetamides 31 in high yields. 2-Cyanopent-4-enoic acid derivatives 32 are obtained from Meldrum's acids 13e,i. The results are discussed in terms of facile 1,3-shifts of methylthio and alkylamino groups in imidoylketenes, interconverting imidoylketenes and acylketene imines

Is the Kasai operation still indicated in children older than 3 months diagnosed with biliary atresia?

OBJECTIVES: The prognosis of hepatoportoenterostomy (the Kasai operation) for biliary atresia worsens when the age at surgery increases. This study examines whether the Kasai operation remains justified after 3 months of life. STUDY DESIGN: Records for all patients with biliary atresia living in France and born in the years 1986 to 1996 were reviewed, and patients were classified into 3 groups: group 1 (n = 30), no contraindication to the Kasai operation, but orientation to de novo transplantation; group 2 (n = 380), age at Kasai operation or =90 days. Survival with native liver, survival after liver transplantation, and overall survival (Kaplan-Meier method) were compared by using the log-rank test. RESULTS: Five-year (10-year) survival with native liver was 35% (30%) in group 2 and 25% (22%) in group 3 (P =.03). Five-year overall survival was 57%, 74%, and 55% in groups 1, 2, and 3, respectively (P =.003). Poor results in groups 1 and 3 were mainly due to increased pre-transplantation mortality, but survival after transplantation was not significantly different in the 3 groups. CONCLUSIONS: Performance of the Kasai operation after 3 months of age is justified in selected cases, because it may obviate liver transplantation. Preoperative evaluation should exclude patients with advanced liver disease for whom liver transplantation should not be delayed

2,5-Dithiacyclopentylideneketene and Ethenedithione, S=C=C=S, Generated by Flash Vacuum Pyrolysis

2,5-Dithiacyclopentylideneketene (4) is obtained by flash vacuum pyrolysis (FVP) of the Meldrum's acid derivative 1 and characterized by MS, IR, and NMR spectroscopy. 4 is stable in solution at -50-degrees-C. FVP of 4 as well as the isoxazolone derivatives 2 and 3 results in efficient cleavage into ethylene and ethenedithione, S=C=C=S, which is remarkably stable in the gas phase at high temperature, low pressure, and short contact times but extremely unstable in the condensed state or at higher pressures

Early compared with delayed inhaled nitric oxide in moderately hypoxaemic neonates with respiratory failure : a randomised controlled trial

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