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Sire J.-M.,Center Hospitalier Intercommunal Of Poissy Saint Germain En Laye | Sire J.-M.,Institute Pasteur | Garin B.,Institute Pasteur | Chartier L.,Institute Pasteur Paris | And 6 more authors.
Paediatrics and International Child Health

Background: In sub-Saharan Africa, infectious diarrhoea is a major cause of childhood morbidity and mortality. A cross-sectional study was undertaken to document the pathogens potentially involved in community-acquired childhood diarrhoea in Dakar, the capital of Senegal. Methods: Between September 2007 and March 2008, 176 children aged 1 month to 5 years were recruited consecutively from a primary health care institution in an urban area. Clinical data were recorded and stool samples were collected. Bacterial pathogens were identified using conventional methods and/or PCR assays. Rotaviruses and adenoviruses were detected by a rapid immunochromatographic test. Intestinal parasites were diagnosed by microscopy. Results: Rotavirus was the most common enteric pathogen, detected in 27% of patients, followed by Shigella (12%), diarrhoeagenic Escherichia coli (8%), enteric adenovirus (8%), Salmonella (4%), Campylobacter jejuni (3%) and Plesiomonas shigelloides (2%). Mixed bacterial/viral infections were detected in 6% of cases. Parasites, mostly protozoa, were detected in 14% of children. Using ipaH PCR, 30% of samples were positive for Shigella/entero-invasive E. coli. Detection of rotavirus was more frequently associated with younger age groups (<24 months), whereas bacterial diarrhoea was isolated more often in children over 1 year of age. Detection of bacterial pathogens was significantly associated with malnutrition. Antibiotics were prescribed for 77% of children who attended for consultation. No pathogen was found in 36% of them, whereas a virus was detected without any other associated bacterial or parasitic pathogen in 23% of patients. Conclusion: In developing countries, there is a need to develop reliable, easy-to-use, inexpensive rapid diagnostic tests to guide the management of diarrhoea in infants and children and thereby prevent over-use of antimicrobial agents. © W. S. Maney & Son Ltd 2013. Source

Garbin O.,Hopitaux Universitaires Of Strasbourg | Verdon R.,University of Caen Lower Normandy | Fauconnier A.,Center Hospitalier Intercommunal Of Poissy Saint Germain En Laye
Journal de Gynecologie Obstetrique et Biologie de la Reproduction

The antibiotic treatment is indispensable for the treatment of the tubo-ovarian abscesses (TOA). It has to have a wide spectre and would be secondarily adapted in case of a sexually transmitted infection. The surgery remains indicated in first intention in case of vital threat (generalized peritonitis, toxic shock). In the not complicated TOA, the evacuation of abscesses (by draining under imaging or laparoscopy) with the antibiotic treatment gives better rates of cure than the antibiotic treatment alone. For the surgery, several entrys are possible. The laparoscopy allows a shorter hospitalization with fewer complications and a faster resolution of the fever than the laparotomy. The conservative surgery, realized by laparoscopy, has hight rates of successes with few complications. The radical surgery, by coelioscopy or by laparotomy, has high rates of complications. Transvaginal ultrasound guided aspiration is an alternative in the drainage by laparscopy with identical succes. It has been well evaluated. It has low morbidity and can be proposed in first intention in not complicated TOA. © 2012 Elsevier Masson SAS. All rights reserved. Source

Vinson-Bonnet B.,Center Hospitalier Intercommunal Of Poissy Saint Germain En Laye | Higuero T.,Clinique Beausoleil | Faucheron J.L.,Grenoble University Hospital Center | Senejoux A.,Center Hospitalier Prive Saint Gregoire | And 2 more authors.
International Journal of Colorectal Disease

Purpose: The aims of this study are to review the advantages and drawbacks of the ambulatory management of patients scheduled for haemorrhoidal surgery and to highlight the reasons for unplanned hospital admission and suggest preventive strategies. Methods: We conducted a systematic review of the literature from January 1999 to January 2013 using MEDLINE and EMBASE databases. Manuscripts were specifically analysed for failure and side effects of haemorrhoidal surgery in ambulatory settings. Results: Fifty relevant studies (6082 patients) were retrieved from the literature review. The rate of ambulatory management failure ranged between 0 and 61 %. The main reasons for failure were urinary retention, postoperative haemorrhage and unsatisfactory pain control. Spinal anaesthesia was associated with the highest rates of urinary retention. Doppler-guided haemorrhoidal artery ligation has less frequent side effects susceptible to impair ambulatory management than haemorrhoidectomy and stapled haemorrhoidopexy. However, the fact that haemorrhoidopexy is less painful than haemorrhoidectomy may allow ambulatory management. Conclusion: Day-case haemorrhoidal surgery can be performed whatever the surgical procedure. Postoperative pain deserves special prevention measures after haemorrhoidectomy, especially by using perineal block or infiltrations. Urinary retention is a common issue that can be responsible for failure; it requires a preventive strategy including short duration spinal anaesthesia. Doppler-guided haemorrhoidal artery ligation is easy to perform in outpatients but deserves more complete evaluation in this setting. © 2014, Springer-Verlag Berlin Heidelberg. Source

Crosnier H.,Center Hospitalier Intercommunal Of Poissy Saint Germain En Laye | Tubiana-Rufi N.,Service dendocrinologie et de diabetologie pediatrique
Archives de Pediatrie

There is an increase in the incidence of type 1 diabetes (T1D) in children younger than 5 years of age and continuous subcutaneous insulin infusion (CSII) appears to be an increasingly popular therapeutic option in France. A retrospective self-evaluation questionnaire was distributed to parents of young children with T1D treated by CSII (42 children, age 4.8±1.0 years, 2.3±0.5 years at the onset of TD1, mean± SD). It focused on the quality of diabetes management in daycare centers or with nannies and at school. Parental satisfaction related to the management of their children was overall good (84% for all the parents, 70.5% for the parents of children at nursery-school, from 3 to 6 years. However 93% of the parents experienced and overcame serious difficulties: exclusion of the children on account of DT1 (school trips, daycare centers after school), use of the pump for lunch and snacks, realization of glycemic controls, participation in school trips, survey during school meals. In spite of these difficulties these young children had a normal and safe time at school. The management of the young children with DT1, treated by CSII, in alternate care centers and at school need to be improved; the experience was positive when daycare workers and teachers agreed to be instructed. © 2013 Elsevier Masson SAS. Source

Huchon C.,Center Hospitalier Intercommunal Of Poissy Saint Germain En Laye | Huchon C.,French Institute of Health and Medical Research | Huchon C.,University of Paris Descartes | Staraci S.,Center Hospitalier Intercommunal Of Poissy Saint Germain En Laye | And 3 more authors.
Human Reproduction

Background: Adnexal torsion (AT) is difficult to diagnose and requires immediate surgery. The aim of this study was to develop a simple score for assisting in the pre-operative diagnosis of AT in women with acute pelvic pain. Methods: Using data from a retrospective cohort of 142 patients with acute pelvic pain, we developed a score based on multiple logistic regression after a jackknife procedure. We validated the score in a prospective cohort of 35 women with acute pelvic pain. Results:Five criteria were independently associated with AT confirmed by surgery: unilateral lumbar or abdominal pain [adjusted odds ratio (aOR), 4.1; 95 confidence interval (95 CI), 1.2-14.0]; pain duration <8 h at first presentation (aOR, 8.0; 95 CI, 1.7-37.5), vomiting (aOR, 7.9; 95 CI, 2.3-27.0), absence of leucorrhoea and metrorrhagia (aOR, 12.6; 95 CI, 2.3-67.6) and ovarian cyst larger than 5 cm by ultrasonography (aOR, 10.6; 95 CI, 2.9-38.8). The torsion score was based on these five criteria. Low-risk and high-risk groups were derived from values of the score [probability of AT, 3.7 (95 CI, 0-7.8) and 69 (95 CI, 53-84), respectively]. Application of these criteria to the prospective cohort confirmed the diagnostic accuracy of the score [probability of AT, 0 (95 CI, 0-16) and 75 (95 CI, 26-100) in the low-risk and high-risk groups, respectively]. Conclusions: This easy-to-calculate score may prove useful for diagnosing AT in patients with acute pelvic pain seen at general or gynaecology emergency departments. © 2010 The Author. Source

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