Infection néonatale bactérienne précoce : Quand mettre sous antibiotique et quelle antibiothérapie ? Early bacterial neonatal infection: When to indicate antibiotic treatment and what antibiotic therapy ?

Objective. Propose a relevant management strategy that can identify newborns with a bacterial infectious risk and those under clinical monitoring alone or in combination with parenteral antibiotic therapy.Methods. Retrospective study carried out between SA < 42, suspected of early bacterial infection and monitored in Maternity and in the Neonatology Unit of the Hospital Group Carnelle Portes of Oise [Val France]. The clinical-biological and bacteriological data, the therapeutic strategy and the evolution are analyzed. Results. Two hundred and forty newborns were eligible and divided into three groups: 120 asymptomatic newborns with antenatal criteria for bacterial infectious risk [G1NAS], 70 symptomatic newborns with antenatal criteria for bacterial infectious risk [G2NSCARIB] and 50 symptomatic newborns without antenatal criteria of bacterial infectious risk [G3NSSCARIB]. Inflammatory biology is limited tocolonized G1NAS newborns and symptomatic groups. The identified bacteria [Peripheral samples, gastric fluid, blood and cerebrospinal fluid] were mainly the Streptococcus of the group and the E Coli. Antibiotic therapy has been shown to be useful in asymptomatic newborns with inflammatory syndrome and bacteria identified on peripheral samples and gastric fluid, but  also in all symptomatic newborns. Conclusion. In a early bacterial infection, an interventionist attitude is required, but early antibiotic therapy is only useful in the situation of symptomatic newborns. On the otherhand, in the asymptomatic newborns, antibiotic therapy will be reserved for those carrying both an identified bacteria and an inflammatory syndrome. Contexte et objectif. L‟infection néonatale bactérienne précoce est greffée d‟une forte mortalité et morbidité conduisant à une antibiothérapie probabiliste sans délai souvent à posteriori inutile. L‟objectif du présent travail était de proposer une stratégie de prise en charge pertinente susceptible de bien identifier les nouveau-nés à risque infectieux bactérien et ceux relevant d‟une surveillance clinique seule ou associée à une antibiothérapie parentérale.    Méthodes. Etude documentaire menée entre janvier 2014 et janvier 2016 sur des nouveau-nés de 36≥SA<42, suspects d‟infection bactérienne précoce et suivis en Maternité et dans l‟unité de Néonatologie du Groupe Hospitalier Carnelle Portes de l‟Oise [Val D‟Oise, France]. Les données clinico-biologiques et bactériologiques, la stratégie thérapeutique et l‟évolution sont analysées.  Résultats. Deux cent quarante nouveau-nés [NNES] ont été éligibles et repartis en trois groupes : 120 NNES asymptomatiques avec critères anténatals de risque infectieux bactérien [G1NAS], 70 NNES symptomatiques avec critères anténatals de risque infectieux bactérien [G2NSCARIB] et 50 NNES symptomatiques sans critères anténatals de risque infectieux bactérien [G3NSSCARIB]. La biologie inflammatoire est limitée aux NNES du groupe G1NAS colonisés et aux groupes symptomatiques. Les germes identifiés [Prélèvements périphériques, liquide gastrique, sang et liquide céphalorachidien] ont été principalement le Streptocoque du groupe β et l‟E Coli. L‟antibiothérapie s‟est avérée utile chez les NNES asymptomatiques avec syndrome inflam-matoire et germes identifiés sur les prélèvements périphériques et liquide gastrique, mais aussi chez tous les NNES symptomatiques.                                                                    Conclusion. Chez un NNE âgé de ≥ 36SA et suspect d‟infection bactérienne précoce, une attitude interventionniste est de rigueur, mais l‟antibiothérapie sans délai n‟est utile que dans les situations des NNES symptomatiques. En revanche, chez les NNES asymptomatiques, l‟antibiothérapie sera réservée à ceux porteurs à la fois d‟un germe et d‟un syndrome inflammatoire

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

Werdnig-Hoffmann disease: report of the first case clinically identified and genetically confirmed in central Africa (Kinshasa-Congo).

Werdnig-Hoffmann Disease: Report of the first case clinically identified and genetically confirmed in Central Africa (Kinshasa-Congo): Type 1 spinal muscular atrophy (SMA1) or Werdnig-Hoffman disease is rarely described in black populations. We report on one black patient diagnosed in Kinshasa. This patient was referred to Paediatric consultation at the age of 5 months 1/2 with extreme hypotonia progressing since birth, severe muscular weakness in his trunk and proximal parts of the extremities, ASD type II, and repeated episodes of pulmonary infections. He died of severe respiratory failure at the age of 10 months. EMG analysis revealed motor neuron a defect without nerve conduction anomaly, suggesting the diagnosis of spinal muscular atrophy disease. The diagnosis of SMA1 was definitely confirmed by a quantitative PCR-based testing that demonstrated homozygous deletion of SMN1, the primary disease-causing gene for spinal muscular atrophy, while two normal SMN2 alleles were present. There was a history of similar clinical symptomatology in a patient's older brother, suggesting a familial involvement. To the best of our knowledge, this is the first documented Werdnig-Hoffman case ever reported from Central Africa people

Overdiagnosis of COPD in Subjects With Unobstructed Spirometry: A BOLD Analysis

Background There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. Methods A false positive diagnosis of COPD was considered when participants reported a doctor’s diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC Results Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of “chronic bronchitis” or “emphysema” (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. Conclusions False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.</p

Overdiagnosis of COPD in subjects with unobstructed spirometry: a BOLD analysis

Background There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. Methods A false positive diagnosis of COPD was considered when participants reported a doctor’s diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC &gt; LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC &lt; 0.7). Results Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of “chronic bronchitis” or “emphysema” (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. Conclusions False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.</p

Overdiagnosis of COPD in subjects with unobstructed spirometry

Background: There are several reports on the underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false-positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. Methods: A false-positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). Results: Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false-positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false-positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false-positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. Conclusions: False-positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.info:eu-repo/semantics/publishedVersio