Éditeur(s) : HAL CCSD EDP Sciences
Résumé : The physiological ageing, the chronic conditions and the psycho-social environment are source of vulnerability to the old subject. These factors impact on the oral pathologies while the oral affections can deteriorate them on the contrary and lead the patient in the spiral of the decompensation. The clinical examination has to consist of a global approach of the eldely person, what confers it a specific character. Within the framework of this article, we propose a methodology of diagnostic survey bringing to light the necessity of interdisciplinary collaboration between the medical participants
Le vieillissement physiologique, les pathologies chroniques et l’environnement psychosocial sont source de vulnérabilité chez le sujet âgé. Ces facteurs impactent les pathologies bucco-dentaires alors que les affections orales peuvent à l’inverse les aggraver et conduire le patient dans la spirale de la décompensation. L’examen clinique doit consister en une approche globale de la personne âgée, ce qui lui confère son caractère spécifique. Dans le cadre de cet article, nous proposons une méthodologie d’enquête diagnostique mettant en évidence la nécessité de collaboration interdisciplinaire entre les intervenants médicaux
ISSN: 1760-611X

hal-01136939
https://hal.archives-ouvertes.fr/hal-01136939
DOI : 10.1 0 5 1 / a o s / 2 0 1 2 1 0 9

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
Background: Squamous cell carcinoma (SCC) is considered the most frequent skin cancer in black people. Its incidence is not known in the Afro-Caribbean population.Objective: To assess the incidence of SCC in Guadeloupe, the largest island of the Lesser Antilles (405 000 inhabitants, mostly black people of African and European descent). The second objective was to characterize clinical and histological patterns of SCC occurring in the Afro-Caribbean community.Methods: This retrospective study was conducted over an 11-year period (2000-2010). Data regarding 723 histological confirmed cases of SCC identified using the three Guadeloupean pathology laboratories computerized databases were retrieved from the records of 551 patients. Private practice dermatologists and general practitioners were contacted to obtain any missing data. Results: The annual age-adjusted incidence of SCC was 15 per 100.000 residents in Guadeloupe. In the Afro-Caribbean community, SCC had a greater size (i.e.: 2.8±2.8 cm versus 1.5±1.0 cm, p<0.001), was more often located on the anogenital area (i.e. :48/79-60.8% versus 14/320-4.4%, p<0.001) in association with an underlying dermatosis due to HPV infection (15/71- 21.1% versus 3/366, 0.8%, p<0.001) and led more frequently to metastasis (13/84-15.5% versus 10/366-2.7%, p<0.001) and/or fatal evolution (11/83-13.3% versus 7/365-1.9%, p<0.001). Conclusions: The results of this original study, which first estimated the incidence of SCC in West Indies, suggest that anogenital examination should be routinely performed in skin cancer screening of Afro-Caribbean people in order to detect the presence of SCC at an early stage.
ISSN: 0926-9959

inserm-01513116
http://www.hal.inserm.fr/inserm-01513116
http://www.hal.inserm.fr/inserm-01513116/document
http://www.hal.inserm.fr/inserm-01513116/file/2017%2C%20Cordel%20-%20Squamous%20cell%20carcinoma%20in%20the%20Afro-Caribbean%20community.pdf
http://www.hal.inserm.fr/inserm-01513116/file/CordeletalJ%20Eur%20Acad%20Dermatol%20Venereol2017.pdf

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND:In French Guiana, a French overseas territory in South America, 6 to 10 thousands undocumented persons work illegally in gold mining sites in the Amazonian forest. Precarious life conditions lead to poor health but few data exist on the health status of illegal gold miners in French Guiana. The objective of this article was to describe the sociodemographic and health status of this vulnerable population.METHOD:A prospective cross-sectional survey was conducted in 2015 on gold mine supply sites at the border between French Guiana and Suriname. Health status was assessed through medical examination, past medical history, haemoglobin concentration, and HIV and malaria testing. A questionnaire was used to collect data about the migration itinerary and life conditions on mining sites.RESULTS:Among the 421 adults included in the study, 93.8% (395/421) were Brazilian, mainly from Maranhão (55.7%, 220/395), the poorest Brazilian state. The sex ratio was 2.4. Overall, 48% of persons never went to school or beyond the primary level. The median time spent in gold mining was quite long (10 years), with a high turn-over. One third of the surveyed population (37.1%, 156/421) had high blood pressure, and only two had a medical follow-up. Most persons had experienced malaria (89.3%, 376/421). They declared frequent arboviroses and digestive disorders. Active leishmaniasis was observed in 8.3% of gold miners. Among women, 28.5% were anemic. Concerning HIV, 36.6% (154/421) of persons, mainly men, never got tested before and 6 were tested positive, which represented an HIV prevalence of 1.43% (95%CI =0.29-2.5).CONCLUSION:These findings support the hypothesis that mining in remote areas is linked to several specific illnesses. Theoretically, gold miners would be presumed to start their economical migration to French Guiana as a healthy group. However, their strenuous working and living conditions there lead to poor health caused by infectious and non infectious diseases. This description of their health status is precious for health policy planners in French Guiana given the importance of controlling communicable disease, and the severity and range of specific illnesses acquired by this neglected population.TRIAL REGISTRATION:Clinical trial registration PRS N° NCT02903706 . Retrospectively registered 09/13/2016.
ISSN: 1471-2458

inserm-01566314
http://www.hal.inserm.fr/inserm-01566314
http://www.hal.inserm.fr/inserm-01566314/document
http://www.hal.inserm.fr/inserm-01566314/file/2017%2C%20Douine%20-%20Illegal%20gold%20miners%20in%20French%20Guiana.pdf
DOI : 10.1016/S0140-6736(10)62169-1

Éditeur(s) : HAL CCSD Oxford University Press
Résumé : International audience
Chronic rhinosinusitis (CRS) rank second at chronic inflammatory diseases in industrialized countries and are an important public health concern. Diagnosis relies on a set of arguments including clinical signs, imaging, histopathologic and mycological analyses of sinus specimens, collected during nasal endoscopy. The sensitivity of fungal cultures is reported to be poor, even when direct examination is positive, thus the epidemiology of fungal chronic sinusitis is ill-known. This study evaluated the sensitivity of molecular diagnosis in 70 consecutive samples (61 patients with CRS) analysed at the University Hospital of Rennes during a 3-year period. DNA detection was performed using a conventional PCR method targeting the ITS1/ITS2 sequence and the resulting amplification products were sequenced. Fungal CRS was proven in 42 patients (69%), of which only 20 (48%) had a positive culture. 37/42 (88%) patients were diagnosed with a fungus ball, 3 with allergic fungal CRS and 2 with undetermined fungal CRS. PCR was positive in all 42 cases and direct sequencing allowed to identify fungi in all cases but one, and detected multiple infection in 3. Aspergillus fumigatus was present in 69% of patients; Cladosporium cladosporoides in 9.5%, Scedosporium sp., A. nidulans and A. flavus in 7% each. In 2/19 patients with negative direct examination, sequencing analysis revealed the presence of Capnobotryella sp. and C. cladosporoides, in clinical settings compatible with fungal sinusitis. In conclusion, ITS1/ITS2 PCR had a twice better sensitivity than culture, and combined sequencing provides accurate epidemiological data on fungal CRS.
ISSN: 1369-3786

hal-01383632
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632/file/Contribution%20of%20molecular%20tools%20for%20the%20diagnosis.pdf
DOI : 10.1093/mmy/myw041

Éditeur(s) : HAL CCSD American Society for Microbiology
Résumé : International audience
Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection in immunocompromised patients. Quantitative real-time PCR (qPCR) is more sensitive than microscopic examination for the detection of P. jirovecii but also detects colonized patients. Hence, its positive predictive value (PPV) needs evaluation. In this 4-year prospective observational study, all immunocompromised patients with acute respiratory symptoms who were investigated for PCP were included, totaling 659 patients (814 bronchoalveolar lavage fluid samples). Patients with negative microscopy but positive qPCR were classified through medical chart review as having retained PCP, possible PCP, or colonization, and their clinical outcomes were compared to those of patients with microscopically proven PCP. Overall, 119 patients were included for analysis, of whom 35, 41, and 43 were classified as having retained PCP, possible PCP, and colonization, respectively. The 35 patients with retained PCP had clinical findings similar to those with microscopically proven PCP but lower fungal loads (P extless 0.001) and were mainly non-HIV-infected patients (P extless 0.05). Although the mean amplification threshold was higher in colonized patients, it was not possible to determine a discriminant qPCR cutoff. The PPV of qPCR in patients with negative microscopy were 29.4% and 63.8% when considering retained PCP and retained plus possible PCP, respectively. Patients with possible PCP had a higher mortality rate than patients with retained PCP or colonization (63% versus 3% and 16%, respectively); patients who died had not received co-trimoxazole. In conclusion, qPCR is a useful tool to diagnose PCP in non-HIV patients, and treatment might be better targeted through a multicomponent algorithm including both clinical/radiological parameters and qPCR results.
ISSN: 0095-1137

hal-01063906
https://hal.archives-ouvertes.fr/hal-01063906
DOI : 10.1128/JCM.01480-14
PUBMED : 25009050

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
BACKGROUND: Dengue and malaria are two major public health concerns in tropical settings. Although the pathogeneses of these two arthropod-borne diseases differ, their clinical and biological presentations are unspecific. During dengue epidemics, several hundred patients with fever and diffuse pain are weekly admitted at the emergency room. It is difficult to discriminate them from patients presenting malaria attacks. Furthermore, it may be impossible to provide a parasitological microscopic examination for all patients. This study aimed to establish a diagnostic algorithm for communities where dengue fever and malaria occur at some frequency in adults. METHODOLOGY/PRINCIPAL FINDINGS: A sub-study using the control groups of a case-control study in French Guiana - originally designed to compare dengue and malaria co-infected cases to single infected cases - was performed between 2004 and 2010. In brief, 208 patients with malaria matched to 208 patients with dengue fever were compared in the present study. A predictive score of malaria versus dengue was established using .632 bootstrap procedures. Multivariate analysis showed that male gender, age, tachycardia, anemia, thrombocytopenia, and CRP>5 mg/l were independently associated with malaria. The predictive score using those variables had an AUC of 0.86 (95%CI: 0.82-0.89), and the CRP was the preponderant predictive factor. The sensitivity and specificity of CRP>5 mg/L to discriminate malaria from dengue were of 0.995 (95%CI: 0.991-1) and 0.35 (95%CI 0.32-0.39), respectively. CONCLUSIONS/SIGNIFICANCE: The clinical and biological score performed relatively well for discriminating cases of dengue versus malaria. Moreover, using only the CRP level turned to be a useful biomarker to discriminate feverish patients at low risk of malaria in an area where both infections exist. It would avoid more than 33% of unnecessary parasitological examinations with a very low risk of missing a malaria attack.
ISSN: 1935-2727

inserm-00872353
http://www.hal.inserm.fr/inserm-00872353
http://www.hal.inserm.fr/inserm-00872353/document
http://www.hal.inserm.fr/inserm-00872353/file/journal.pntd.0002420.pdf
DOI : 10.1371/journal.pntd.0002420