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National audience; INTRODUCTION: In a context of tension on the number of available kidney transplants compared to the number needed, the practices of refusal of transplants in the Rennes transplantation center were evaluated. MATERIALS AND METHODS: The donors completely refused by our team (no kidney accepted for any Rennes recipient) between January 1st 2012 and December 31st 2015 were identified from the national CRISTAL registry. The outcome of these refused transplants (possible transplantation in another center), the data of the recipients (from Rennes and other centers) and the data of the donors (refused and then finally accepted) were extracted. The outcome of recipients (from Rennes and other centers) was compared: graft survival (censored on death) and patient survival (not censored on cessation of function). The Kidney Donor Profile Index (KDPI) score was calculated and its usefulness studied. RESULTS: Among the 203 rejected donors, 172 (85 %) were accepted for transplantation in another center; 89% of these grafts were functional at one year. In univariate analysis, Rennes recipients transplanted after a refusal had a better graft survival (censored on death) than recipients transplanted in another center with the refused graft (p < 0.001). The main limitation of this analysis is the non-comparability of the groups. The KDPI score was significantly associated with graft survival (censored on death). Of the 151 Rennes patients who had a refusal, 3% were still on the waiting list at the end of the observation period, the others spent a median additional time on dialysis of 220 days (Q1-Q3 81-483). CONCLUSION: Rennes recipients transplanted after a first refusal seem to have a better graft survival (censored on death) than recipients from other centers transplanted with refused grafts. This is to be weighed against the additional time on dialysis and even the risk of non-transplantation. more...

After the huge decrease of measles thanks to vaccination, measles reappeared in 2008, with 604 cases reported at the Institut national de veille sanitaire (InVS), then 1,544 cases in 2009 and 2,605 cases up to 2010, June. At the same time, 86 viral strains were detected from saliva samples at the Centre national de référence de la rougeole et des Paramyxoviridae respiratoires (CNR) in 2008, 316 in 2009 and 946 up to August 2010. The reality of the outbreak was confirmed by the increase of the endemic cases: 0.0009% cases in 2008 and 0.004% in 2010, the diffusion to all parts of France, and the more specific attack of infants: 4% in 2008 and 9% in 2010, and of young adults: 17% in 2008 and 38% in 2010. Most of the cases (82%) occurred in non-vaccinated people. The number of hospitalised cases has increased as well, going from 18% in 2008 to 34% in 2010. The strain of this outbreak is a genotype D4. It appeared in 2008 then it spread in 2009 and 2010, representing 19, 75 and 99% of the strains, respectively. All the viruses in this genotype belonged to the Montreal-like cluster described in 1989: Montréal.CAN/89xD4. At the beginning of the outbreak some were closed to a variant which appeared in England in 2007 MVs/Enfield.GBR/14.07(D4), but most of them (95%) are nowidentical to a strain which caused a small focus of measles in the region Vendee at the last trimester 2008: MVs/Montaigu.FRA/43.08(D4). The salivary diagnosis of measles, which was introduced in France in 2005, in parallel to the obligation of reporting measles cases, has been proved very efficient: 75% of saliva are collected in the first four days, and viral RNA was detected in 536 (81%) out the 660 samples received at the CNR up to now in 2010; 136 (21%) saliva had IgM specific antibodies and 18% had neither RNA, nor IgM. more...

International audience; Introduction :En France, peu d’études se sont intéressées aux rôles des contre-indications temporaires (CIT) dans la disparité femme/homme de l’accès à la greffe. Notre objectif est de comparer les CIT entre les hommes et les femmes en distinguant les mises en CIT dès l’inscription et celles après avoir été actif sur la liste.Description/méthodes :Les données des insuffisants rénaux chroniques, âgés de 18 à 85 ans, ayant débuté la dialyse en 2017/2018 en France ont été extraites du registre REIN. Les raisons et durées de mise en CIT des patients inscrits sur la liste ont été comparées entre les femmes et les hommes.Résultats :Au total, 19 478 patients ont été inclus. Au 31/12/2020, 32,67 % étaient inscrits sur la liste d’attente. Parmi les inscrits, la moyenne d’âge est respectivement de 55 ans (±14 ans) et 57 ans (±14 ans) chez les femmes et les hommes. Au total, 21,3 % des femmes et 35,3 % des hommes présentaient au moins une maladie cardiovasculaire. 4611 patients étaient mis en CIT dès l’inscription (73 % des femmes et 72 % des hommes inscrits). Les femmes passent une durée médiane de 155 jours (IIQ : 65–223) en CIT versus 154 jours (IIQ : 70–330) chez les hommes. Le bilan pré-greffe incomplet est la cause principale (79 %) de ces CIT quel que soit le sexe.51 % des femmes et 52 % des hommes inscrits ont été mis en CIT ultérieurement. Les femmes et les hommes restent inactifs en médiane 79 jours par CIT. 8,3 % des CIT des femmes et 14,4 % des CIT des hommes sont de causes cardiovasculaires.Conclusion :Aucune différence n’a été observée sur le recours aux CIT ou sur leur durée entre les femmes et les hommes. Une fois inscrits, les CIT n’expliquent pas les disparités femmes/hommes dans l’accès à la greffe rénale en France. more...

International audience; IntroductionDifférentes cohortes et registres montrent que les patients avec une suppléance rénale sont majoritairement des hommes alors que les femmes sont prédominantes aux stades 3 et plus. Une des hypothèses testées dans cette étude est que l’orientation vers la suppléance ou le traitement conservateur serait différent selon le sexe et les comorbidités.Description/méthodesLe projet thérapeutique et les comorbidités des nouveaux insuffisants rénaux en stade 4 et stade 5 non suppléés en Bretagne entre 2019 et 2021 ont été obtenus à partir du registre Breizh IRC 5.RésultatsAu total, 1627 patients ont été inclus dont 1050 en stade 4 (421 femmes et 629 hommes) et 577 en stade 5 (219 femmes et 358 hommes). Parmi les patients du stade 5, les femmes sont plus âgées que les hommes (71,9 contre 69,9 ans), plus souvent dépendantes pour la marche (18 % contre 5 %) et seules à domicile (38 % contre 24 %). Dans les analyses univariées, la probabilité d’être orienté vers un traitement conservateur initialement et à la dernière consultation renseignée est plus grande chez les femmes par rapport aux hommes (OR respectivement OR = 2, IC95 % = 1,2–3,5 et OR = 2,1, IC95 % = 1,2–3,9). Parmi les patients du stade 4, la probabilité d’avoir un projet thérapeutique non fixé initialement et à la dernière consultation renseignée est plus élevée chez les femmes par rapport aux hommes (OR respectivement OR = 1,8, IC95 % = 1,3–2,4 et OR = 1,5, IC95 % = 1,1–2,1). Les analyses multivariées sont en cours.ConclusionLes premiers résultats en analyse univariée montrent que le sexe féminin est associé à une moindre orientation vers la suppléance au bénéfice du traitement conservateur. La richesse du registre Breizh IRC 5 et des modèles multivariés permettront l’analyse des choix thérapeutiques en tenant compte de toutes les caractéristiques disponibles des patients. more...

Iron deficiency is common and associated with worse outcomes in patients with non-dialysis chronic kidney disease. We performed a national, multicentre, observational and transversal study to assess the prevalence of iron deficiency as well as current iron deficiency screening practices in this population.A total of 25 nephrology centres in France participated in the study. All adult non-dialysis chronic kidney disease patients who met the inclusion (GFR15mL/min/1.73mA total of 1211 patients with non-dialysis chronic kidney disease were included in the analysis. The overall prevalence of iron deficiency was 47.1%. The rates of absolute iron deficiency and functional iron deficiency and anaemia were 13.4% and 17.1%, respectively. Among the 25 participating centres, 12 reported routine assessment of iron status in non-dialysis chronic kidney disease patients.In this observational study, a high prevalence of iron deficiency was observed among non-dialysis chronic kidney disease patients. Less than half of participating centres reported routine assessment of iron status. more...

Coronaviruses are a large group of viruses and infect a lot of species of mammals and birds. Five coronaviruses currently infect humans: HCoVs 229E and OC43, identified in 1960's, SARS-CoV identified in March 2003 during the SARS epidemic, and the HCoVs NL63 and HKU1, identified in 2004 and 2005. The genome of the coronaviruses is a linear, nonsegmented, positive-sense single-stranded RNA molecule of approximately 30 kb. The evolution of these viruses occurs through some features: the flexibility of the genome including a high number of potentially non-essential genes, the demonstrated ability of the coronaviruses to establish persistent infections, the quasi-species structure of the viral population, the ability to undergo RNA mutations, deletions and recombinations at a high frequency. Two epidemiologic pictures of human coronavirus infections have to be distinguished: as suggested by a few epidemiologic studies, the classical coronaviruses, including HCoVs 229E, OC43, and NL63 are distributed worldwide and would circulate during seasonal outbreaks. In contrast, the SARS-CoV is responsible of the first new emerging infectious disease of this millennium, infecting more than 8,000 people and killing nearly 800 during a period of six months beginning at the end of 2002. Human coronaviruses may be also involved in enteric and neurologic diseases. The detection of coronaviruses is difficult and mainly based on molecular assays (RT-PCR). Despite research activities on the development of vaccines and antiviral agents, there is no established specific therapy to date. more...

Acute Respiratory Infections (ARI) need be better understood and more effectively treated, especially insofar as they are of pivotal importance in public health, particularly during a crisis such as the SARS-CoV2 pandemic. The prospective, multicentric cohort study of viral codetections in respiratory samples study known as ECOVIR was conducted in Normandy, France during two winters (2018-2019, 2019-2020). The objective of the project was to create a biobank of respiratory tract samples from patients consulting their general practitioner (GP) for ARI symptoms. ECOVIR involved 36 GP investigators (GPI), from 8 health care centers throughout Normandy. Six hundred and eighty-five patients with ARI symptoms were included; naso-pharyngeal samples were taken by the GPIs and subsequently analyzed in virology laboratories for the purposes of viral codetection. The median of inclusions was 16 patients for each of the 31 actively participating GPIs over the two winters (CI25-75% [4.75; 27]). By D7, 92% of the patients contacted had responded to our call for participation, enabling us to obtain clinical, environmental and socio-demographic data. Through this study, we created an original functional network, thereby establishing a viable link between research and primary care, which is generally underrepresented in research protocols, even though it constitutes the cornerstone of the French health care system, especially during this prolonged period of sanitary crisis. more...

Hundred viruses can be isolated in patients suffering from respiratory virus infections and hospitalised in intensive care unit (ICU): influenza virus, respiratory syncytial virus, para-influenza virus, adenovirus, coronavirus, rhinovirus, enterovirus, human metapneumovirus, bocavirus… Nasal or tracheobronchial specimens, which contain many epithelial cells will be used to isolate these common viruses. In immunocompromised patients a bronchoalveolar lavage has to be added to these specimens in order to detect cytomegalovirus and some adenovirus. The immunofluorescence or immunoenzymatic assays, which detect viral antigens in the infected cells are the easiest and fastest diagnostic methods, theoretically. As with other techniques, specimen quality is a major determinant of their performance. Unfortunately, the sensitivity of the antigen detection assays is low in respiratory infections in adults. Then the virus recovery by cell culture, which is usually more sensitive than the antigen detection assays, can be helpful. Many studies have reported more respiratory virus detections using nucleic acid testing such as PCR. They detect viruses, which are missed by conventional methods and increase the detection of common respiratory virus. Multiplex PCR assays have been developed, and these can simultaneously detect several viruses directly in clinical specimens. Nucleic acid testing can subtype viruses using subtype-specific primers, and analyse strain variation through genetic. It can be used also to quantify the viral load in clinical specimens. More recently real-time RT-PCR assays have been developed to get more rapidly the results of the nucleic acids assays. Specimen quality, timing and transportation conditions may be less critical for nucleic acid testing than for culture or antigen detection, as viable virus and intact infected cells need not to be preserved. Moreover, viral nucleic acids are detectable for several days longer into the clinical course than is cultivable virus, potentially allowing a diagnosis to be made in late-presenting patients. However, in a clinical virology laboratory, where the speed, low cost, and high sensitivity of the methods are required, the sequential use of antigen detection tests and multiplex PCR could be the best choice, particularly in the clinical setting of respiratory virus infections in adults hospitalised in ICU. In the future, the development of real-time multiplex PCR is likely to be top-priority. more...

Résumé Les adénovirus sont une cause commune d’atteinte respiratoire ; bien que dépendant du sérotype, ils peuvent également être la cause d’atteintes extrarespiratoires. Le diagnostic positif peut en être difficile. Les résultats cliniques chez 116 enfants hospitalisés en raison d’une infection adénovirale ont été repris rétrospectivement. Chez 71 enfants, le diagnostic virologique a été obtenu par immunofluorescence directe sur les aspirations nasales, 71 par culture virale de ces mêmes prélèvements. Le tableau clinique de l’infection adénovirale est caractérisé par une fièvre élevée (moyenne 39°1C) et prolongée (durée moyenne 4,3 jours). L’atteinte des voies aériennes supérieures (rhinopharyngite, angine, otite) et des voies aériennes inférieures (bronchite, bronchiolite, pneumopathie) sont les plus fréquentes. Douze enfants ont présenté des convulsions hyperpyrétiques, 6 avaient une méningite lymphocytaire. Les examens complémentaires ont objectivé des valeurs allant de la normalité à celles évocatrices d’infection bactérienne. Cinquante-neuf enfants furent adressés pour fièvre résistante à une antibiothérapie. Les symptômes de l’atteinte respiratoire dues aux infections adénovirales s’étendent de la rhinite à la pneumopathie et la bronchiolite. Les adénovirus peuvent entraîner des séquelles graves même chez l’enfant sain. Les recherches sur les mécanismes moléculaires de l’infection virale sur les voies aériennes amèneront d’importantes voies de réflexion sur la nature des processus inflammatoires participant à l’asthme et à la bronchite chronique obstructive. La plupart des infections sont modérées et ne nécessitent qu’un traitement symptomatique. Il n’existe pas actuellement de traitement antiviral efficace pour les infections adénovirales graves. Le diagnostic virologique rapide par l’étude des sécrétions nasopharyngées est d’une grande utilité clinique. more...

Résumé Les premières données épidémiologiques sur virus et asthme ont été obtenues dans les années 1970–1980 par l'isolement viral et la sérologie. Chez l'enfant, une infection virale est identifiable dans 24 à 31,9 % des cas, et dans 13,3 % des cas chez l'adulte. Les trois virus les plus fréquents sont les rhinovirus (RV), le virus respiratoire syncytial (VRS), et les virus parainfluenza (PIV), détectés dans 8,8, 6,4 et 6 % des cas. Par son pouvoir amplificateur, l'utilisation de l'outil PCR accroît la fréquence de détection virale, et semble particulièrement approprié dans l'asthme où la charge virale peut être réduite. Dans une étude sur les bronchiolites, nous avons montré que les VRS, PIV3, AdV et RV sont identifiés dans respectivement 39,3, 4,3, 1,4 et 3,9 % des cas par IF ou culture, et dans 62,4, 8,3, 10,8 et 12,6 % des cas par PCR. Deux enquêtes épidémiologiques récentes utilisent le diagnostic moléculaire dans les crises d'asthme. Chez 61 adultes, 27 (44 %) infections sont identifiées: 16 RV, 4 CV OC43, 3 VPI, 1 VRS, 1 VI, 1 Chlamydia psitacci. Chez l'enfant, une infection virale est détectée dans 226 cas (77 %): 84 RV, 38 CV, 21 VI, 21 VPI, 12 VRS. Nous avons réalisé une courte enquête rétrospective sur l'année 1997, en biologie moléculaire, sur 39 aspirations nasales d'enfants consultant pour asthme ou bronchite sifflante. La recherche des virus respiratoires par les techniques conventionnelles identifie 8 (20,5 %) infections virales: 3 à RV, 3 à VRS, 1 à VIB et 1 à VPI2. Après extraction des acides nucléiques, des techniques de PCR-hybridations ont été appliquées à ces échantillons pour détecter des séquences de VRS, AdV, RV, CV 229E, CV OC43, CP et MP. Vingt-six aspirations (54 %) sont positives par les seules techniques de biologie moléculaire: 11 VRS, 12RV, 2 enterovirus, 1 CV OC43. Au total, 34 (82 %) infections virales sont détectées chez ces enfants, et dans 6 cas une infection mixte VRS-RV est notée. Par rapport aux études de la littérature, on retrouve la prédominance des infections à RV, plus d'infections à VRS, probablement liée à l'utilisation ici de l'outil PCR, et une plus faible incidence des infections à CV. more...

Access to kidney transplants for patients with end-stage chronic renal disease is a major challenge in France. Registration on the transplant waiting list is a mandatory step to be able to access this technique. The Haute Autorité de santé (HAS) updated, in 2015, the contraindications to access this list. In this context, we wanted to make an inventory of the reasons for non-registration on the renal transplant waiting list in patients on dialysis for at least a year, aged less than 80 years, in France. All patients included in the Epidemiology and Nephrology Information Register (REIN), who were supposed to have their annual monitoring point from August 1 to November 30, 2016 meeting the criteria, were included and a dedicated questionnaire was completed by their dialysis center. Thus, 3172 patients were analyzed: 2302 (73%) had a medical contraindication to transplant, most often (33%) vascular, 458 (14%) refused to be registered, with proportionately more women in this category, and finally in 412 patients (13%), there was no reason given in our questionnaire. However, for 65% of patients in the latter category, an assessment for registration had started. There were therefore, in our cohort, only 144 patients (4.5%) without explanation for the non-registration. This national study is the first to give a view of the reasons for non-registration on the renal transplant list in France. Unsurprisingly, medical contraindication is the primary reason in this population of chronic patients. The high refusal rate should be emphasized and analyzed more precisely, in particular with the patient's point of view. And finally, very few patients have no informed reason or current assessment. more...

The etiological diagnosis of bronchopulmonary infections cannot be assessed with clinical, radiological and epidemiological data alone. Viruses have been demonstrated to cause a large proportion of these infections, both in children and adults.The diagnosis of viral bronchopulmonary infections is based on the analysis of secretions, collected from the lower respiratory tract when possible, by techniques that detect either influenza and respiratory syncytial viruses, or a large panel of viruses that can be responsible for respiratory disease. The latter, called multiplex PCR assays, allow a syndromic approach to respiratory infection. Their high cost for the laboratory raises the question of their place in the management of patients in terms of antibiotic economy and isolation. In the absence of clear recommendations, the strategy and equipment are very unevenly distributed in France.Medico-economic analyses need to be performed in France to evaluate the place of these tests in the management of patients. The evaluation of the role of the different viruses often detected in co-infection, especially in children, also deserves the attention of virologists and clinicians.The availability of new diagnostic technologies, the recent emergence of SARS-CoV-2, together with the availability of new antiviral drugs are likely to impact future recommendations for the management of viral bronchopulmonary infections. more...

Resume Position du probleme La France est confrontee a une nouvelle resurgence de la rougeole. Depuis le mois de novembre 2017, le nombre de cas est en forte augmentation. La couverture vaccinale dans la population generale, tous les âges confondus, se situe en dessous du seuil requis pour esperer l’arret rapide de la circulation du virus. Concernant les professionnels de sante, le taux d’immunisation contre cette maladie est peu connu. Dans ce contexte, le service de sante au travail du CHU de Caen a effectue un etat des lieux de la connaissance de l’immunisation contre la rougeole des personnels de sante au sein des services a risques. Methodes L’etat des lieux concernant la connaissance de l’immunisation contre la rougeole a ete effectue au sein des services de pediatrie, d’imagerie, des urgences pediatriques et adultes du CHU de Caen, et de l’institut d’hematologie de Basse-Normandie (IHBN). L’analyse inclut tous les professionnels de sante presents au sein de ces services sur la periode de mars et avril 2018. Le recueil de donnees a ete effectue par consultation des dossiers medicaux des services de sante au travail, et en prenant en compte l’ensemble des reponses aux courriers envoyes aux personnels. Resultats Les donnees recueillies concernant l’etat d’immunisation contre la rougeole se rapportent a 1017 professionnels de sante. En se basant sur les criteres propres aux recommandations, 234 (50,6 %) sur les 462 professionnels nes avant 1980 et 437 (78,7 %) sur les 555 professionnels nes a compter de 1980 ont pu etre consideres comme immunises. Sur l’ensemble de l’echantillon, 115 (11,3 %) ont beneficie d’une serologie rougeole positive. Parmi ces 1017 professionnels, nous manquons d’information sur l’etat d’immunisation contre la rougeole pour 174 (17,1 %). Conclusion L’etat d’immunisation du personnel soignant reste insuffisant pour eviter la survenue de cas de rougeole et est egalement insuffisamment renseigne. Il est essentiel de disposer de la connaissance de l’etat d’immunisation de cette population, de proceder au rattrapage de la vaccination des personnels non immunises, au sein des services de sante au travail, afin de prevenir l’apparition de nouveaux cas de rougeole et de renforcer l’information concernant l’importance des precautions air, liees a la transmission aeroportee, en cas de contage rougeole. more...

Alcohol induced neurocognitive disorder: screening strategies and tools. Chronic and excessive alcohol consumption results in cognitive disorders partially reversible with abstinence. These heterogeneous cognitive impairments affect executive functions, episodic memory and social cognition. They may interfere with the motivational process to abandon excessive drinking behavior, impair patients' ability to benefit from treatment and increase the risk of relapse. Alcohol-related neuropsychological deficits should thus be evaluated and considered for personalized alcohol treatment. Several screening tools available in clinical settings enable clinicians to detect patients with cognitive impairments and to offer them appropriate and adjusted treatment.Repérage des troubles cognitifs liés à l’alcool. La consommation chronique et excessive d’alcool est fréquemment associée à des troubles cognitifs, en partie réversibles à l’arrêt de l’alcool. Variables d’un individu à l’autre, ils touchent principalement les fonctions exécutives et motrices, la mémoire épisodique, ainsi que la cognition sociale. Ces troubles peuvent freiner le processus motivationnel, amoindrir les capacités des patients à bénéficier des prises en charge et augmenter le risque de rechute. Plusieurs outils de dépistage rapide sont disponibles en pratique clinique. Ils permettent d’orienter les patients ayant une altération cognitive vers des prises en charge spécialisées pour la réalisation de bilans complémentaires. Le profil neuropsychologique des patients peut aussi éclairer les difficultés de prise en charge et permettre de personnaliser les soins addictologiques. more...

International audience

France is facing a new resurgence of measles. Since November 2017, the number of cases has been increasing sharply. Immunization coverage in the general population, all ages combined, is below the threshold required for a rapid decline of the virus propagation. Regarding health professionals, the rate of immunization against this disease is insufficiently documented. In this context, the Occupational Health Service of the University Hospital of Caen has carried out an inventory of health personnel knowledge of immunization against measles in the units the most exposed to risk.Knowledge of immunization against measles was studied in pediatric, imaging, and pediatric and adult emergencies departments of the University Hospital of Caen, and the Hematology Institute of Lower Normandy (IHBN). The analysis included all health professionals present within these units during the study period: March and April 2018. Data collection was carried out by consulting the medical files of the occupational health unit and considering the set of responses to postal inquiries sent to staff.Measured immunization status data refer to 1017 health professionals. Based on the criteria specific to the recommendations, 234 (50.6%) of the 462 professionals born before 1980 and 437 (78.7%) of the 555 professionals born in or after 1980 could be considered as immune. Of the total sample, 115 (11.3%) had positive measles serology. Among these 1017 professionals, information on the state of immunization against measles was lacking for 174 (17.1%).The state of immunization of the nursing staff remains insufficient to prevent the occurrence of measles cases and the staff is also insufficiently informed. It is essential to have knowledge of the immunization status of this population, to organize the vaccination of non-immunized personnel within the occupational health unit, to prevent the emergence of new cases of measles and to reinforce the information regarding the importance of precautions related to airborne transmission in case of measles. more...