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Duron S.,Center Depidemiologie Et Of Sante Publique Des Armees | Mayet A.,Center Depidemiologie Et Of Sante Publique Des Armees | Lienhard F.,Center Depidemiologie Et Of Sante Publique Des Armees | Haus-Cheymol R.,Center Depidemiologie Et Of Sante Publique Des Armees | And 12 more authors.
Swiss Medical Weekly | Year: 2013

QUESTION UNDER STUDY: Influenza is a viral infection caused by a pathogen with considerable ability for genetic mutation, which is responsible for seasonal outbreaks as well as pandemics. This article presents the results of epidemiological and virological monitoring of four successive influenza outbreaks in the French armed forces, for the period 2008 to 2012. METHODS: The main events monitored were acute respiratory infection (ARI). Weekly incidence rates were calculated by relating cases to the number of servicepersons monitored. RESULTS: In continental France, the incidence rates for ARI and for medical consultation attributable to influenza were highest during the pandemic and decreased to reach their lowest values in 2010-2011 and 2011-2012. In terms of virological results, the 2008-2009 outbreak was mainly due to the A(H3N2) virus, while the 2009-2010 pandemic and the following season saw the emergence of the A(H1N1) pdm09 strain. The last season 2011-2012 was characterised by a predominant circulation of A(H3N2) viruses. CONCLUSIONS: Despite some limitations, the MISS represents a good source of information about influenza in young people. Virological results are compatible with those reported by most other influenza surveillance networks, but could be improved by a better knowledge of the other respiratory viruses in circulation in the military community.

King L.A.,Institute of Veille Sanitaire | Nogareda F.,Institute of Veille Sanitaire | Nogareda F.,U.S. Center for Disease Control and Prevention | Weill F.-X.,Institute Pasteur Paris | And 24 more authors.
Clinical Infectious Diseases | Year: 2012

Background.On 22 June 2011, 8 patients with hemolytic uremic syndrome (HUS) or bloody diarrhea were reported in France. All 8 were attendees of a community center event on 8 June near Bordeaux. Three Escherichia coli cases were confirmed by isolation of Shiga toxin-producing E. coli O104:H4 stx2 aggR producing a cefotaximase (CTX-M) β-lactamase (STEC O104:H4); the same rare serotype caused the outbreak in Germany in May-July 2011. An investigation was initiated to describe the outbreak, identify the vehicle for infection, and guide control measures.Methods.We conducted a retrospective cohort study among all adults attending the event, including food handlers. A standardized questionnaire was administered to participants. A case was an attendee who developed HUS or diarrhea between 8 and 24 June. Cases were confirmed by isolation of STEC O104:H4 or O104 serology. Relative risks (RRs) and 95% confidence intervals (CIs) by exposure were calculated using a Poisson regression model.Results.Twenty-four cases were identified (14% attack rate). Of these, 18 (75%) were women, 22 (92%) were adults, 7 (29%) developed HUS, 5 (21%) developed bloody diarrhea, and 12 (50%) developed diarrhea. Ten (42%) cases were confirmed. Fenugreek was the only sprout type with an independent association to illness (RR, 5.1; 95% CI, 2.3-11.1) in multivariable analysis.Conclusions.This investigation identified a point-source STEC O104:H4 outbreak associated with consumption of fenugreek sprouts. Comparison of results from French and German STEC O104:H4 outbreak investigations enabled identification of a common food vehicle, fenugreek sprouts, and resulted in implementation of Europe-wide control measures in July 2011. © 2012 The Author.

Thomas G.,Service de Sante des Armees | Montean R.,HOpital dinstruction des armees Robert Picque
Information Psychiatrique | Year: 2010

The question of temporality is ancient in psychopathology. Subjective time is a highly individual construction which intimately touches the individual during psychiatric disorders. Concept of alexithymia initially developed in the psychosomatic field contains peculiar modalities as regards its relationship with the world. In this article, we offer to explore the features of habitual relationships in the world of alexithymics from the point of view of temporality and to represent what in our sense can be subject to mobilization during relaxation psychotherapy monitoring.

Objective: To determine whether, after knee ligamentoplasty by hamstring graft, servicemen recovered military aptitude and specific sports activity within 7 months postoperatively. Method: Results in a cohort of 20 patients were assessed by the isokinetic excentric IJ (30°/s)/concentric Q ratio (240°/s), COFRAS score and a questionnaire on resumption of sports activity. Results: The difference in ratio as compared to the healthy side did not exceed 15% in 85% of patients, and the COFRAS score was 28.1/30. Results were independent of age, gender, surgical technique and individual surgeon. Discussion: Recovery of open and closed kinetic chain stability enabled recovery of military aptitude. However, 75% of patients, reported apprehension as preventing or limiting return to previous personal sports activity. Level of evidence: Level 2. © 2013 Elsevier Masson SAS. All rights reserved.

Delmas Y.,University of Bordeaux 1 | Vendrely B.,University of Bordeaux 1 | Clouzeau B.,University of Bordeaux 1 | Bachir H.,University of Bordeaux 1 | And 16 more authors.
Nephrology Dialysis Transplantation | Year: 2014

BackgroundAn outbreak of haemolytic uraemic syndrome (HUS) due to Shiga toxin-secreting Escherichia coli (STEC) O104:H4 from contaminated fenugreek sprouts occurred in June 2011 near Bordeaux, France. In the context of this outbreak, all patients were treated with the monoclonal anti-C5 antibody, eculizumab.MethodsThe diagnosis of HUS was made based on haemolytic anaemia, low platelet count and acute kidney injury. Data were obtained from initial gastrointestinal symptoms to the end of follow-up 10 weeks after the start of eculizumab.ResultsAmong 24 cases of STEC gastroenteritis, HUS developed in nine patients (eight adults and one child), 6 (median; range 3-12) days after digestive symptoms begun. The median (range) highest or lowest biological values were platelet count 26 (range 14-93) G/L; haemoglobin 6.6 (range 5-10.7) g/dL; LDH 1520 (range 510-2568) IU/L; creatinine 152 (range 48-797) μmol/L. All patients had extra-renal complications (liver 9, pancreas 5, brain 3 and heart 3). Two patients were dialysed, and one was ventilated. After failure of plasma exchange to increase platelets in the first three patients, eculizumab was administered in all nine patients, 0-4 days after HUS diagnosis (median 1 day). One patient with very severe neurological HUS received immunoadsorption. Outcome was favourable in all patients, with rapid normalization of haemoglobin, platelets, LDH levels, renal function and neurological improvement. There were no deaths and no serious adverse events related to eculizumab.ConclusionsEarly treatment of O104:H4 STEC-HUS by eculizumab was associated with a rapid and efficient recovery. Controlled prospective evaluation of eculizumab in STEC-HUS is warranted. © 2013 © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA.

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