Le diagnostic clinique des pneumopathies aigües communautaires de l'enfant en médecine générale

PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

Analyse de la pratique des médecins généralistes du sud de l'Oise concernant l'adressage à l'hôpital des enfants suspects d'infection respiratoire basse

Face à l encombrement des services de soins, et notamment des services d urgences pédiatriques, nous avons voulu savoir si l adressage des patients par les médecins généralistes pour infection respiratoire basse était justifié et s il y avait une différence de pratique entre différentes catégories de médecins généralistes. Pour cela, nous avons fait une étude rétrospective, descriptive, portant sur les dossiers des enfants et adolescents âgés de 0 à 18 ans, qui ont consulté aux urgences pédiatriques du centre hospitalier Laennec de Creil du 01/01/2009 au 31/12/2010, et qui ont été adressés par un médecin généraliste pour suspicion d infection respiratoire basse. L étude a inclus 214 patients adressés par 91 médecins. Il y avait 102 bronchiolites, 72 bronchites, 40 pneumonies. Les courriers des médecins généralistes étaient peu détaillés, et il n y avait pas de concordance entre les signes de gravité sur les courriers et les signes de gravité sur les examens des urgences sauf pour les patients adressés pour bronchiolite. Les enfants adressés avaient eu très peu d examens complémentaires en ambulatoire. Sur l ensemble des patients adressés, 50% n avaient aucun signe de gravité et seuls 40% avaient été hospitalisés. 25% des patients adressés n avaient aucun signe de gravité, n avaient pas été hospitalisés, mais avaient eu des examens complémentaires avant de quitter les urgences. Ces patients auraient pu avoir leurs examens en ambulatoire. 19% des patients adressés n avaient aucun signe de gravité, n avaient eu aucun examen complémentaire et n avaient pas été hospitalisés. Leur consultation aux urgences ne semble avoir aucune justification. L hospitalisation dépendait de la présence de signes de gravité, de l âge des enfants, de la pathologie, mais ne dépendait pas des différentes catégories de médecins étudiés. L adressage des patients par les médecins remplaçants étaient moins justifié que pour les autres catégories de médecin. Une meilleur formation des médecins généralistes et un meilleur accès aux examens complémentaires en ambulatoire permettraient de diminuer l adressage aux urgences des enfants sans signe de gravité.In front of the congestion of the departments of care, in particular the departments of pediatric emergencies, we wanted to know if the addressing of the patients by the general practitioners for low respiratory infection was justified and if there was a difference of practice between various categories of general practitioners. For that purpose, we made a retrospective, descriptive study, concerning the files cases of the children and the teenagers from 0 to 18 years old, who consulted in the pediatric emergencies of the Laennec hospital center of Creil from 01/01/2009 till 12/31/2010, and who were sent by a general practitioner for suspicion of low respiratory infection. The study included 214 patients sent by 91 doctors. There were 102 bronchiolitis, 72 bronchitis, 40 pneumonias. The letters of the general practitioners were little detailed, and there was no concordance between the signs of gravity on the letters and the signs of gravity on the examinations of emergencies except for the patients sent for bronchiolitis. The sent children had had very few complementary examinations in ambulatory. On all the sent patients, 50 % had no sign of gravity and only 40 % had been hospitalized. 25 % of the sent patients had no sign of gravity, had not been hospitalized, but had had complementary examinations before leaving emergencies. These patients would have been able to have their examinations in ambulatory. 19 % of the sent patients had no sign of gravity, had not had any complementary examinations and had not been hospitalized. Their consultation in emergencies seems to have no justification. The hospitalization depended on the presence of signs of gravity, the age of the children, the pathology, but did not depend on various categories of studied doctors. The addressing of the patients by the replacing doctors was less justified than for the other categories of doctor. A better training of the general practitioners and a better access to the complementary examinations in ambulatory would allow decreasing the addressing in the emergencies of the children without sign of gravity.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Impact de l'exposition à la fumée de tabac environnementale sur la mesure du monoxyde d'azote de l'air expire chez l'enfant asthmatique allergique

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Childhood Allergic Asthma Is Not a Single Phenotype

International audienc

Anthropogenic Carbon Nanotubes Found in the Airways of Parisian Children

Compelling evidence shows that fine particulate matters (PMs) from air pollution penetrate lower airways and are associated with adverse health effects even within concentrations below those recommended by the WHO. A paper reported a dose-dependent link between carbon content in alveolar macrophages (assessed only by optical microscopy) and the decline in lung function. However, to the best of our knowledge, PM had never been accurately characterized inside human lung cells and the most responsible components of the particulate mix are still unknown. On another hand carbon nanotubes (CNTs) from natural and anthropogenic sources might be an important component of PM in both indoor and outdoor air. We used high-resolution transmission electron microscopy and energy dispersive X-ray spectroscopy to characterize PM present in broncho-alveolar lavage-fluids (n = 64) and inside lung cells (n = 5 patients) of asthmatic children. We show that inhaled PM mostly consist of CNTs. These CNTs are present in all examined samples and they are similar to those we found in dusts and vehicle exhausts collected in Paris, as well as to those previously characterized in ambient air in the USA, in spider webs in India, and in ice core. These results strongly suggest that humans are routinely exposed to CNTs

Neutrophilic Steroid-Refractory Recurrent Wheeze and Eosinophilic Steroid-Refractory Asthma in Children

International audienceBackgroundLittle is known about inflammatory pathways of severe recurrent wheeze in preschool children and severe asthma in children.ObjectivesThe aim of the Severe Asthma Molecular Phenotype cohort was to characterize phenotypes of severe recurrent wheeze and severe asthma during childhood in terms of triggers (allergic or not), involved cells (eosinophil or neutrophil), and corticoid responsiveness.MethodsChildren with moderate-to-severe asthma and preschool children with moderate-to-severe recurrent wheeze were enrolled prospectively. They underwent standardized clinical and blood workup, and bronchoalveolar lavage (BAL) evaluation. Cluster analysis was applied to 350 children with 34 variables.ResultsThree clusters were identified: cluster 1, Neutrophilic steroid-refractory recurrent wheeze phenotype, with 138 children uncontrolled despite high-dose inhaled corticosteroids (ICS) (92%, P < .001), with more history of pneumonia (31%, P < .001), more gastroesophageal reflux disease (37%, P < .001), and the highest blood neutrophil count (mean 4.524 cells/mm3, P = .05); cluster 2, Severe recurrent wheeze with sensitization to a single aeroallergen (12%, P = .002), with 104 children controlled with high-dose ICS (63%, P < .001); cluster 3, Eosinophilic steroid-refractory asthma phenotype, with 108 children uncontrolled despite high-dose ICS (76%, P < .001) with more allergic rhinitis, atopic dermatitis, and food allergies (82%, 40%, 31%, P < .001, respectively). They also had a higher blood eosinophil count and a higher percentage of BAL eosinophil (506/mm3, 2.6%, P < .001 respectively).ConclusionsInflammation pathway of asthma and recurrent wheeze are related to eosinophil cells in older children and neutrophil cells in younger children. These results could improve personalized treatments