Genotyping of European Toxoplasma gondii strains by a new high-resolution next-generation sequencing-based method

PURPOSE

A new high-resolution next-generation sequencing (NGS)-based method was established to type closely related European type II Toxoplasma gondii strains.

METHODS

T. gondii field isolates were collected from different parts of Europe and assessed by whole genome sequencing (WGS). In comparison to ME49 (a type II reference strain), highly polymorphic regions (HPRs) were identified, showing a considerable number of single nucleotide polymorphisms (SNPs). After confirmation by Sanger sequencing, 18 HPRs were used to design a primer panel for multiplex PCR to establish a multilocus Ion AmpliSeq typing method. Toxoplasma gondii isolates and T. gondii present in clinical samples were typed with the new method. The sensitivity of the method was tested with serially diluted reference DNA samples.

RESULTS

Among type II specimens, the method could differentiate the same number of haplotypes as the reference standard, microsatellite (MS) typing. Passages of the same isolates and specimens originating from abortion outbreaks were identified as identical. In addition, seven different genotypes, two atypical and two recombinant specimens were clearly distinguished from each other by the method. Furthermore, almost all SNPs detected by the Ion AmpliSeq method corresponded to those expected based on WGS. By testing serially diluted DNA samples, the method exhibited a similar analytical sensitivity as MS typing.

CONCLUSION

The new method can distinguish different T. gondii genotypes and detect intra-genotype variability among European type II T. gondii strains. Furthermore, with WGS data additional target regions can be added to the method to potentially increase typing resolution.

A ring trial to harmonize Toxoplasma gondii microsatellite typing: comparative analysis of results and recommendations for optimization

A ring trial among five European laboratories was organized to reach consistency in microsatellite (MS) typing of the zoonotic parasite Toxoplasma gondii. Three sample sets were circulated and analyzed by each laboratory following a previously published method that is based on fragment length polymorphism of 15 MS markers. The first sample set compared typing results in general and focused on effects of DNA concentration; the second sample set focused on the polymorphic fingerprinting markers that can differentiate T. gondii strains within the same archetypal lineage; and the third set focused on non-archetypal genotypes. Methodological variations between laboratories, including the software programs used to determine MS fragment length, were collated using a questionnaire. Overall, lineage-level typing results reached a high level of agreement, especially in samples with the highest DNA concentrations. However, laboratory-specific differences were observed for particular markers. Major median differences in fragment length, of up to 6 base pairs, were related to the fluorophore used to label fragment-specific primers. In addition, primer pairs with identical sequences obtained from different suppliers resulted in fragments of differing length. Furthermore, differences in the way the sequencing profiles were assessed and interpreted may have led to deviating results in fragment length determination. Harmonization of MS typing, for example, by using the same fluorophores or by numerical adjustments applied to the fragment-lengths determined, could improve the uniformity of the results across laboratories. This is the first interlaboratory comparison, providing guidelines (added as a supplement) for the optimization of this technique.

Réponse sérologique après vaccination contre le coronavirus chez les patients atteints de rhumatisme inflammatoire chronique traités par DMARDs : une étude de cohorte et revue systématique avec méta-analyse

Introduction

La vaccination contre le coronavirus constitue l’une des pierres angulaires dans la gestion de la crise sanitaire liée au COVID-19. Alors que la vaccination confère une protection efficace chez les sujets immunocompétents, son immunogénicité dans la population atteinte de rhumatisme inflammatoire chronique (RIC) n’est pas clairement établie.

Patients et méthodes

Nous avons conduit une étude monocentrique rétrospective évaluant la réponse sérologique après deux doses de vaccination contre le coronavirus chez des patients adultes atteints de RIC et traités par traitements ciblés ou biologiques (n = 123). Les titres d’anticorps IgG dirigés contre la protéine spike du coronavirus (SARS-CoV-2) ont été mesurés après la seconde dose de vaccin. De plus, nous avons conduit une recherche systématique jusqu’au 31 septembre 2021 dans les bases de données PUBMED, preprint et littérature grise non encore publiée des études observationnelles des taux sérologiques après vaccination chez des patients atteints de RIC traités par médicaments ciblés ou biologiques (numéro d’enregistrement PROSPERO : CRD42021259410). Les études rapportant la taille d’échantillon, la date, le pays d’origine, le taux de séroconversion ont été incluses. Nous avons ensuite conduit une méta-analyse afin d’identifier des facteurs associés à la séroconversion.

Résultats

Sur nos 123 patients (âge médian 66 ans écart interquartile [EI] 57–75), 69,9 % ont séroconverti après 2 doses de vaccination. Les patients ayant eu une séroconversion étaient plus âgés que ceux qui n’en ont pas eu. Les patients traités par rituximab sont ceux qui ont le moins répondu à la vaccination. Nous avons identifié 20 études de séroprévalence en plus de notre cohorte, représentant un total de 4423 patients dans 11 pays. La méta-analyse a confirmé un impact négatif sur le taux de séroconversion du rituximab et dans une moindre mesure de l’abatacept, du léflunomide et du méthotrexate.

Conclusion

Le rituximab diminue la réponse sérologique à la vaccination contre le SARS-CoV-2 chez les patients atteints de RIC. Ce travail suggère également un impact négatif de l’abatacept, du méthotrexate ou du léflunomide particulièrement en cas d’association à un médicament biologique.

Vagues épidémiques de variants Beta, Delta et Omicron en milieu insulaire ultra-marin

Introduction

Dans cette région d'Outre-Mer, une surveillance génomique a été mise en place en janvier 2021 suite à l'émergence de variants du SARS-CoV-2. Elle se compose d'une surveillance génomique locale et des enquêtes Flash nationales. La surveillance génomique vise à cartographier la circulation de variants sur l'île, et s'inscrit dans le cadre du projet EMERGEN (Consortium pour la surveillance et la recherche sur les infections à pathogènes EMERgents via la GENomique microbienne). Elle permet également de détecter l'introduction et de suivre la diffusion de variants d'intérêt ayant un impact en termes de transmissibilité, de sévérité ou d'échappement immunitaire accrus.

Matériels et méthodes

Du 04 janvier 2021 au 30 janvier 2022, 11 341 génomes ont été séquencés et soumis à EMERGEN, soit 5,6 % des cas de COVID-19 sur la période. La sélection de prélèvements à séquencer était aléatoire pour l'enquête Flash (une certaine proportion des prélèvements sur une période définie) et pseudo-aléatoire pour la surveillance génomique locale qui cible des cas particuliers en fonction de caractéristiques épidémiologiques ou cliniques atypiques (ex : cas importés, cas graves).

Résultats

Au total, 110 lignages et sous-lignages du SARS-CoV-2 ont été identifiés, dont 68 sous-lignages du variant Delta (B.1.617.2). Pendant les six premières semaines de l'année 2021, la majorité des lignages détectés correspondait à des variants circulant activement en Europe (ex : B.1.160, B.1.177), illustrant l'impact des flux de voyageurs sur la dynamique de la COVID-19 sur l'île. Selon les données de la base de données GISAID (Global Initiative on Sharing All Influenza Data), le lignage B.1.622 semble être spécifique à l'île car aucun autre territoire n'a identifié de séquences de ce variant.

Trois variants d'intérêt ont été dominants pendant plusieurs semaines sur l'île et représentent à eux-seuls 95 % des séquences. Il s'agit du variant Beta (B.1.351 et B.1.351.2) prédominant de février à mi-juillet 2021 (29 % des séquences), le variant Delta (B.1.617.2 et sous-lignages AY) prédominant de mi-juillet à fin décembre 2021 (53 %) et le variant Omicron (B.1.529, BA.1 et BA.2) prédominant depuis fin décembre 2021 (13 %).

Ces trois variants ont influencé différemment la dynamique de l'épidémie et son impact sanitaire. Le taux d'incidence a atteint un plateau élevé de 100 et 150 cas pour 100 000 habitants en période de prédominance Beta, un pic de 397/100 000 hab en période de prédominance Delta et 5 431/100 000 hab en période de prédominance Omicron.

Conclusion

Cette étude permet de mieux comprendre les interactions entre les variants du SARS-CoV-2 et l'impact qu'ils peuvent avoir sur l'évolution de l'épidémie. Elle illustre aussi l'impact des flux de voyageurs sur la dynamique de la COVID-19 en milieu insulaire, et ouvre des perspectives de travaux en épidémiologie génomique pour mieux comprendre les mécanismes d'émergence d'un variant dominant et l'impact en termes de sévérité et d'échappement vaccinal de ces variants préoccupants plus transmissibles.

Aucun lien d'intérêt

Circulation des variants du SARS-CoV-2 en milieu insulaire ultra-marin

Introduction

Dans cette région d'Outre-Mer, les premiers cas de COVID-19 ont été détectés le 11 mars 2020 chez un groupe de personnes de retour de voyage. En réponse, une surveillance épidémiologique régionale basée sur le « contact-tracing » et l'identification de clusters a rapidement été mise en place. De mars à juillet 2020, les cas ont été importés ou autochtones sporadiques, puis la circulation virale s'est intensifiée sur l'île à partir d'août 2020 à la fin des vacances scolaires. En janvier 2021, une surveillance génomique locale a été mise en place suite à l'émergence de variants du SARS-CoV-2.

Matériels et méthodes

Du 04 janvier 2021 au 06 juin 2021, 1 528 génomes ont été séquencés, soit 8,3 % des cas de COVID-19 sur la période. La sélection de prélèvements à séquencer était pseudo-aléatoire, avec une sélection ciblée en fonction de caractéristiques épidémiologiques ou cliniques atypiques (ex : cas importés, cas graves). Les distributions de lignages génétiques dans l'Océan indien et dans certains pays d'Afrique ont été extraites de la base de données GISAID (Global Initiative on Sharing All Influenza Data).

Résultats

Au total, 22 lignages du SARS-CoV-2 ont été identifiés et 71 % des observations étaient attribuées au variant Beta (B.1.351 et B.1.351.2). Ce variant a été détecté pour la première fois la première semaine de janvier 2021, dès le lancement des activités de séquençage. Pendant les six premières semaines de l'année 2021, la majorité des lignages détectés correspondait à des variants circulant activement en Europe (ex : B.1.160, B.1.177), illustrant l'impact des flux de voyageurs sur la dynamique de la COVID-19 sur l'île. Selon les données GISAID, le lignage B.1.622 serait spécifique à l'île car aucun autre territoire n'a identifié de séquences de ce variant.

Le variant Beta est devenu dominant à partir de mi-février 2021, malgré une circulation à bas-bruit du variant Alpha (B.1.1.7) qui était alors dominant en métropole. En plus de sa transmissibilité accrue, d'autres facteurs génétiques et épidémiologiques auraient pu expliquer la dominance du variant Beta, dont une fréquence d'introduction plus importante (flux de voyageurs) et les contextes locaux et régionaux. En effet, la proximité géographique et les mouvements de population avec d'autres îles de la région relient indirectement l'île au pays d'où serait originaire le variant Beta.

Deux sous-lignages du variant Beta ont été détectés. B.1.351.2 représentait trois fois plus de séquences que B.1.351. Les données disponibles dans GISAID suggèrent qu'il aurait été importé depuis son pays d'origine vers d'autres îles de l'Océan indien avant d'être introduit sur l'île, compte tenu des flux de voyageurs entre les régions concernées et l'importante épidémie liée variant Beta ayant eu lieu sur une île voisine de janvier à mi-mars 2021.

Conclusion

Cette étude permet de mieux comprendre les interactions entre les variants du SARS-CoV-2 sur l'île, qui représente un système fermé avec contrôle des entrées. L'étude illustre aussi l'impact des flux de voyageurs sur la dynamique de la COVID-19 en milieu insulaire, et ouvre des perspectives de travaux en épidémiologie génomique pour mieux comprendre les mécanismes d'émergence de variants dominants.

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The life history and feeding ecology of velvet shell, Velutina velutina (Gastropoda: Velutinidae), a specialist predator of ascidians

Velvet shell, Velutina velutina (Müller, 1776), is a specialist predator of ascidians, like other members of the gastropod family Velutinidae. Globally, invasive ascidians have become problematic, ecologically and economically, yet ecological knowledge of velutinids remains limited. This study outlines the life history and feeding ecology of V. velutina in eastern Canada based on laboratory work complemented by field observations. The life history of V. velutina is closely linked with ascidians, which serve as prey and protection for their egg capsules. Egg capsules were embedded within tunics of Aplidium glabrum (Verrill, 1871) and Ascidia callosa Stimpson, 1852, with a preference for the latter. Seasonal behavioural shifts were consistent annually and corresponded with seawater temperature cycles. Feeding dominated during the coldest months (January–May), growth occurred as water temperature increased to the annual maximum (June and July), transitioning to mating during the warmest period (July–August), and egg capsule deposition dominated as water temperature declined (November–January). Larvae hatched between January and July after 2–4 months of development. Velutina velutina preyed on all ascidian species presented during this study, including golden star tunicate, Botryllus schlosseri (Pallas, 1766), and vase tunicate, Ciona intestinalis (Linnaeus, 1767), two non-indigenous species, although solitary species were preferred.

[Seroprevalence of Toxoplasmosis among Pregnant Women in Benin: Meta-Analysis and Meta-Regression]

To assess the seroprevalence of toxoplasmosis among pregnant women in Benin, we conducted a meta-analysis using the PRISMA criteria. Al research published between 1990 and 2018 on toxoplasmosis among pregnant women Benin were eligible. A total of five databases were investigated, and the extracted data were subjected to a meta-analysis under R 3.1 using both random effect model and fixed effect model. The overall prevalence of toxoplasma-specific IgG among pregnant women was 47% (CI 95%: 40-53) and that of specific IgM was 2% (CI 95%: 1-3). The infection rate in urban areas (52%) was significantly higher than in rural areas (33%). The two main risk factors identified by the various eligible studies were the age of the pregnant women and the consumption of raw vegetables. We show that toxoplasmosis is endemic in pregnant women in Benin, implying that primary prevention measures must be put in place by the competent authorities to control this infection.

On the Weight of the Brain in the Insane, with reference to the Hemispheres, Lobes, Brain-Stem, and Cerebellum

These results are tabulated after weighing 400 brains as follows:—

Spread rate of lumpy skin disease in the Balkans, 2015-2016

After its introduction in Turkey in November 2013 and subsequent spread in this country, lumpy skin disease (LSD) was first reported in the western Turkey in May 2015. It was observed in cattle in Greece and reported to the World Organization for Animal Health (OIE) in August 2015. From May 2015 to August 2016, 1,092 outbreaks of lumpy skin disease were reported in cattle from western Turkey and eight Balkan countries: Greece, Bulgaria, The Former Yugoslav Republic of Macedonia, Serbia, Kosovo, and Albania. During this period, the median LSD spread rate was 7.3 km/week. The frequency of outbreaks was highly seasonal, with little or no transmission reported during the winter. Also, the skewed distribution of spread rates suggested two distinct underlying epidemiological processes, associating local and distant spread possibly related to vectors and cattle trade movements, respectively.

Sodium Channel Trafficking

Voltage-gated sodium channels (VGSC) are critical determinants of cellular electrical activity through the control of initiation and propagation of action potential. To ensure this role, these proteins are not consistently delivered to the plasma membrane but undergo drastic quality controls throughout various adaptive processes such as biosynthesis, anterograde and retrograde trafficking, and membrane targeting. In pathological conditions, this quality control could lead to the retention of functional VGSC and is therefore the target of different pharmacological approaches. The present chapter gives an overview of the current understanding of the facets of VGSC life cycle in the context of both cardiac and neuronal cell types.

Patterns and Drivers of Egg Pigment Intensity and Colour Diversity in the Ocean: A Meta-Analysis of Phylum Echinodermata

Egg pigmentation is proposed to serve numerous ecological, physiological, and adaptive functions in egg-laying animals. Despite the predominance and taxonomic diversity of egg layers, syntheses reviewing the putative functions and drivers of egg pigmentation have been relatively narrow in scope, centring almost exclusively on birds. Nonvertebrate and aquatic species are essentially overlooked, yet many of them produce maternally provisioned eggs in strikingly varied colours, from pale yellow to bright red or green. We explore the ways in which these colour patterns correlate with behavioural, morphological, geographic and phylogenetic variables in extant classes of Echinodermata, a phylum that has close phylogenetic ties with chordates and representatives in nearly all marine environments. Results of multivariate analyses show that intensely pigmented eggs are characteristic of pelagic or external development whereas pale eggs are commonly brooded internally. Of the five egg colours catalogued, orange and yellow are the most common. Yellow eggs are a primitive character, associated with all types of development (predominant in internal brooders), whereas green eggs are always pelagic, occur in the most derived orders of each class and are restricted to the Indo-Pacific Ocean. Orange eggs are geographically ubiquitous and may represent a 'universal' egg pigment that functions well under a diversity of environmental conditions. Finally, green occurs chiefly in the classes Holothuroidea and Ophiuroidea, orange in Asteroidea, yellow in Echinoidea, and brown in Holothuroidea. By examining an unprecedented combination of egg colours/intensities and reproductive strategies, this phylum-wide study sheds new light on the role and drivers of egg pigmentation, drawing parallels with theories developed from the study of more derived vertebrate taxa. The primary use of pigments (of any colour) to protect externally developing eggs from oxidative damage and predation is supported by the comparatively pale colour of equally large, internally brooded eggs. Secondarily, geographic location drives the evolution of egg colour diversity, presumably through the selection of better-adapted, more costly pigments in response to ecological pressure.

[Prevalence of asthma consultations in general practice]

INTRODUCTION

Few data from primary care settings are available about asthma prevalence. The aim of this study was to evaluate the prevalence of asthma consultations in general practice, and to describe their characteristics.

METHODS

This was a multicenter, cross-sectional national study, conducted in general practice. Investigators were 54 interns from 27 medical schools. Between December 2011 and April 2012, they collected and entered variables specific to each consultation over a period of 20 days from a structured electronic health record using the International classification of primary care (ICPC-2) together with data about their trainer(s).

RESULTS

Data were recorded for 20,613 consultations with 45,582 consultation outcomes described. Asthma represented 348 (1.69%) of consultations. The presence of an asthma code was associated with fewer reasons for the consultation, but with more processes of care. Forty-two percent of other consultation results associated with asthma in the same consultation concerned chronic diseases.

CONCLUSION

Our findings suggest that asthma remains underdiagnosed in general practice in France. In order to address this problem, the development of validated diagnostic tools that can be used in general practice settings, and a better access to spirometry, may be directions to explore in future research.

Efficacy of communication skills training on colorectal cancer screening by GPs: a cluster randomised controlled trial

Colorectal cancer (CRC) mass screening has been implemented in France since 2008. Participation rates remain too low. The objective of this study was to test if the implementation of a training course focused on communication skills among general practitioners (GP) would increase the delivery of gaiac faecal occult blood test and CRC screening participation among the target population of each participating GP. A cluster randomised controlled trial was conducted with GP's practice as a cluster unit. GPs from practices in the control group were asked to continue their usual care. GPs of the intervention group received a 4-h educational training, built with previous qualitative data on CRC screening focusing on doctor-patient communication with a follow-up of 7 months for both groups. The primary outcome measure was the patients' participation rate in the target population for each GP. Seventeen GPs (16 practices) in intervention group and 28 GPs (19 practices) in control group participated. The patients' participation rate in the intervention group were 36.7% vs. 24.5% in the control group (P = 0.03). Doctor-patient communication should be developed and appear to be one of the possible targets of improvement patients adherence and participation rate in the target population for CRC mass screening.

Concurrent outbreaks of dengue, chikungunya and Zika virus infections - an unprecedented epidemic wave of mosquito-borne viruses in the Pacific 2012-2014

Since January 2012, the Pacific Region has experienced 28 new documented outbreaks and circulation of dengue, chikungunya and Zika virus. These mosquito-borne disease epidemics seem to become more frequent and diverse, and it is likely that this is only the early stages of a wave that will continue for several years. Improved surveillance and response measures are needed to mitigate the already heavy burden on island health systems and limit further spread to other parts of the world.

Can we identify response markers to antihypertensive drugs? First results from the IDEAL Trial

Current antihypertensive strategies do not take into account that individual characteristics may influence the magnitude of blood pressure (BP) reduction. Guidelines promote trial-and-error approaches with many different drugs. We conducted the Identification of the Determinants of the Efficacy of Arterial blood pressure Lowering drugs (IDEAL) Trial to identify factors associated with BP responses to perindopril and indapamide. IDEAL was a cross-over, double-blind, placebo-controlled trial, involving four 4-week periods: indapamide, perindopril and two placebo. Eligible patients were untreated, hypertensive and aged 25-70 years. The main outcome was systolic BP (SBP) response to drugs. The 112 participants with good compliance had a mean age of 52. One in every three participants was a woman. In middle-aged women, the SBP reduction from drugs was -11.5 mm Hg (indapamide) and -8.3 mm Hg (perindopril). In men, the response was significantly smaller: -4.8 mm Hg (indapamide) and -4.3 (perindopril) (P for sex differences 0.001 and 0.015, respectively). SBP response to perindopril decreased by 2 mm Hg every 10 years of age in both sexes (P=0.01). The response to indapamide increased by 3 mm Hg every 10 years of age gradient in women (P=0.02). Age and sex were important determinants of BP response for antihypertensive drugs in the IDEAL population. This should be taken into account when choosing drugs a priori.

Molecular identification of Fasciola spp. (Digenea: Fasciolidae) in Egypt

A total of 134 Egyptian liver flukes were collected from different definitive hosts (cattle, sheep, and buffaloes) to identify them via the use of PCR-RFLP and sequence analysis of the first nuclear ribosomal internal transcribed spacer (ITS1). Specimens of F. hepatica from France, as well as F. gigantica from Cameroon were included in the study for comparison. PCR products of ITS1 were subjected for digestion by RsaI restriction enzyme and visualized on agarose gel. According to RFLP pattern, Egyptian flukes were allocated into two categories. The first was identical to that of French hepatica flukes to have a pattern of 360, 100, and 60 (bp) band size, whereas the second resembled to that of Cameroonian gigantica worms to have a profile of 360, 170, and 60 bp in size. Results of RFLP analysis were confirmed by sequence analysis of representative ITS1 amplicons. No hybrid forms were detected in the present study. Taken together, this study concluded that both species of Fasciola are present in Egypt, whereas the hybrid form may be not very common.

Binder phenotype in mothers affected with autoimmune disorders

OBJECTIVE

To report four foetal cases of the Binder phenotype associated with maternal autoimmune disorders.

PATIENTS AND METHODS

In three mothers with autoimmune diseases, 2D and 3D ultrasonographic measurements were made on four foetuses with the Binder profile, and were compared with postnatal phenotypes.

RESULTS

The Binder phenotype can be detected in early pregnancy (14.5 WG). All foetuses had verticalized nasal bones and midfacial hypoplasia. Punctuate calcifications were found in almost all the cases. No specific maternal auto-antibody has been associated with foetal Binder phenotype.

CONCLUSION

Since the Binder phenotype can be diagnosed at ultrasound examination during pregnancy, it is important to establish the underlying cause so as to assess the foetal prognosis. This study stresses the importance of systematic checks for maternal autoimmune disease in cases of prenatally diagnosed Binder phenotypes.

Human impact on genetic diversity of Toxoplasma gondii: example of the anthropized environment from French Guiana

In French Guiana, severe cases of toxoplasmosis in immunocompetent patients are associated with atypical strains of Toxoplasma gondii linked to a wild neotropical rainforest cycle and a higher genetic diversity than usually observed for T. gondii isolates from anthropized environment. This raises the question of the impact of anthropization of the natural environment, on genetic diversity and on the population structure of T. gondii. However, few data are available on strains circulating in the anthropized areas from French Guiana. Seropositive animals originating mainly from anthropized sub-urban areas and punctually from wild environment in French Guiana were analyzed for T. gondii isolation and genotyping. Thirty-three strains were obtained by bioassay in mice and compared with 18 previously reported isolates chiefly originating from the Amazon rainforest. The genotyping analysis performed with 15 microsatellite markers located on 12 different chromosomes revealed a lower genetic diversity in the anthropized environment. Results were analyzed in terms of population structure by clustering methods, Neighbor-joining trees reconstruction based on genetic distances, F(ST,) Mantel's tests and linkage disequilibrium. They clearly showed a genetic differentiation between strains associated to the anthropized environment and those associated to the wild, but with some inbreeding between them. The majority of strains from the anthropized environment were clustered into additional lineages of T. gondii that are common in the Caribbean. In conclusion the two environmental populations "wild" and "anthropized" were genetically well differentiated. The anthropization of the environment seems to be accompanied with a decreased diversity of T. gondii associated with a greater structure of the populations. We detected potential interpenetration and genetic exchanges between these two environmental populations. As a higher pathogenicity in human of "wild" genotypes has been described, the interpenetration of both environments leads to hybridization between strains that may be at risk for human health.

[Obstacles to effective treatment of depression. A general practitioners' postal survey in the north-west region of France]

CONTEXT AND AIM

Depression is a quite common condition, and its treatment is mainly provided by General Practitioner (GP). It is already known that detection and treatment requires significant improvement. The well known and high consumption of antidepressant drugs in France, the highest of all other European countries, requires specific studies. The causes of this situation are not clear and seem to be numerous: Patient's demands, social claims; lack of initial and continuous medical education, bad GP demographic trends, and lack of them in rural areas; pharmaceutical company pressure; and organisation of the health care system. GP are the main medical actors of the primary care system in France. The aim of this study was to survey GP perceptions on secondary care services, seek the views and barriers to the provision of good services, and ask them about perceptions and solutions they could suggest.

METHODS

A structured postal questionnaire was sent to all GP of the north-west region of France, asking physicians about obstacles perceived when taking care of depressive patients; factors influencing the use of services, specialised advice, treatments, access to psychiatrists and psychological care. Their psychiatric knowledge and demographic data were also assessed. Quantitative data were analysed using Epi-Info software, and qualitative data were transcribed and coded manually.

RESULTS

A total of 25% of the GP returned the questionnaire (n=2097 in 8709). The sample profile was the same as the studied population. Less than a third of the GP (28%) were aware of the clinical guidelines on depression, and less than a fifth (18%) had clinical experience of psychiatry during their studies. Lack of time was not the main obstacle assessed by the GP. Their complaints were about lack of mental health services, difficulty in accessing services, and about general liaison between primary and secondary health care services: they reported difficulties obtaining quick and good response from the specialist either for emergency or non emergency cases. Regarding secondary care, they mainly referred to the psychiatrist, rather than to the psychologist, probably because this second option is not reimbursed by the social security system. Not surprisingly, medication was cited as the most frequently used treatment, followed by psychotherapy and cognitive behavioral therapy (CBT), and almost never self help literature and self help groups. Trained GP considered they were much more comfortable coping with depressed patients, less frequently using secondary care providers, and easily alternative solutions rather than antidepressant drugs. This situation suggests the usefulness of medical education, and is attested by many qualitative answers.

DISCUSSION

It is not sure that the low rate of knowledge of the guidelines should be judged only as a lack of professionalism. According to the "French Society of Primary Care", clinical guidelines need updating, and it is known that those available could be useful only for half of the situations encountered in primary care. Operational propositions urgently need to be proposed. Recent questioning of the real interest of pharmaceutical options in the treatment of depression is another argument. Nor can we wait for a hypothetic rise in the demographic situation. The GP have several propositions to improve these problems, e.g. continuous medical education (CME) focusing on "patient centred therapy", dedicated hotline or circuit for depressed people, and an adapted sociomedical directory. They also feel that political awareness about lack of physicians is required, but say that improving quality of care does not rely only on improving demographics. They ask for funds for psychological care. When thinking about the circuit of care, the role of all care providers, and their communication, a global vision appears unavoidable, which would get rid of the divisions between out-patients and the hospital.

CONCLUSION

Despite an unavoidable questioning on the dysfunctions of the health care system, quality of care and probably pharmaceutical consumption for the depressed patient might be improved by simple tools, such as adapted CME for primary care physicians, and communication improvement between secondary and primary care systems.

Genetic characterization of Toxoplasma gondii from wild boar (Sus scrofa) in France

Toxoplasma gondii strains isolated from domestic animals and humans have been classified into three clonal lineages types I-III, with differences in terms of pathogenicity to mice. Much less is known on T. gondii genotypes in wild animals. In this report, genotypes of T. gondii isolated from wild boar (Sus scrofa) in France are described. During the hunting seasons 2002-2008, sera and tissues of individuals from two French regions, one continental and one insular, were tested for Toxoplasma infection. Antibodies to T. gondii were found in 26 (17.6%) of 148 wild boars using the modified agglutination test (MAT, positivity threshold: 1:24). Seroprevalence was 45.9% when considering a threshold of 1:6. Hearts of individuals with a positive agglutination (starting dilution 1:6) (n=60) were bioassayed in mice for isolation of viable T. gondii. In total, 21 isolates of T. gondii were obtained. Genotyping of the isolates using 3 PCR-restriction fragment length polymorphism markers (SAG1, SAG2 and GRA7) and 6 microsatellite loci analysis (TUB2, TgM-A, W35, B17, B18 and M33) revealed that all belonged to type II lineage. These results underline that wild boar may serve as an important reservoir for transmission of T. gondii, and that strains present in wildlife may not be different from strains from the domestic environment.

Microsatellite markers in Triatoma pseudomaculata (Hemiptera, Reduviidae, Triatominae), Chagas' disease vector in Brazil

Six polymorphic microsatellite loci were isolated and characterized using a microsatellite-enriched genomic library from the Chagas' disease vector Triatoma pseudomaculata. This species is found in Brasil in Caatinga areas and predominantly in peridomestic habitats. All the microsatellites tested on a population of T. pseudomaculata sampled in the Bahia State, Brazil, were polymorphic (2-15 alleles). Markers amplification was also tested on six Triatoma species and some loci successfully amplified in the most phylogenetically related species, in particular Triatoma brasiliensis.

Anomalous roughening of viscous fluid fronts in spontaneous imbibition

We report experiments on spontaneous imbibition of a viscous fluid by a model porous medium in the absence of gravity. The average position of the interface satisfies Washburn's law. Scaling of the interface fluctuations suggests a dynamic exponent z approximately 3, indicative of global dynamics driven by capillary forces. The complete set of exponents clearly shows that interfaces are not self-affine, exhibiting distinct local and global scaling, both for time (beta = 0.64 +/- 0.02, beta(*) = 0.33 +/- 0.03) and space (alpha = 1.94 +/- 0.20, alpha(loc) = 0.94 +/- 0.10). These values are compatible with an intrinsic anomalous scaling scenario.

Consensus national sur la prise en charge des enfants dépistés avec une hyperphénylalaninémie

Phenylketonuria (PKU) is an inherited metabolic disease affecting about one birth out of 15 000. From 1978, a national systematic neonatal screening was set up in France with a regional organisation. French rational and guidelines have been established by the national PKU group with the collaboration of all the physicians responsible for the regional centres. These guidelines specify the minimal diagnosis procedures leading to an optimal treatment of all patients. A low-phenylalanine diet must be started as soon as possible in the neonatal period for all newborns whose phenylalanine levels are above 10 mg/dl. The dietary control must keep the phenylalanine plasma levels between 2 and 5 mg/dl until 10 years of age. After this age, several data argue for a progressive and controlled relaxation of the diet, keeping the phenylalanine level below 15 mg/dl until the end of the adolescence and below 20 to 25 mg/dl in adulthood. All PKU patients must be followed up for life, in order to screen those who may not bear the diet relaxation and in order to strictly prevent maternal PKU deleterious consequences.

Effect of enteral supplementation with glutamine on mesenteric blood flow in premature neonates

BACKGROUND AND AIMS

This study investigated the effects of enterally supplied glutamine on mesenteric blood flow in premature neonate.

METHODS

Twenty-five neonates, aged at least 14 days and free of acute illness participated in a prospective, randomised, double-blind study. All were fed with total enteral nutrition enriched with glutamine (0.7 g kg(-1)day(-1), group 1) or isonitrogenous control (group 2). Blood flow velocities in the superior mesenteric artery were analysed by pulsed Doppler US before and after 21 days of supplemented feeding. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and time-averaged mean velocity (TAV) were measured and resistance index (RI) and flow (Q) were calculated.

RESULTS

Both groups were well matched clinically at inclusion. At inclusion, the velocimetry parameters were (mean +/- SD) : PSV:114.9 +/- -38 cms(-1), EDV:17.5 +/- 7.5 cm x s(-1), TAV:44.8 +/- 18.2 cms(-1), RI : 0.8 +/- 0.1, Q : 2.4 +/- 1.2 mls(-1). Mesenteric blood flow parameters remained stable between day 0 and day 21 with same values in both groups.

CONCLUSIONS

Superior mesenteric blood flow remained stable in neonates after 14 days of life and did not appear to be influenced by enteral glutamine at that stage.

Neonatal screening and long-term follow-up of phenylketonuria: the French database

BACKGROUND

In France, neonatal screening of phenylketonuria (PKU) started in 1966. A national association was created in 1978 in order to organise the neonatal screening program and to control the efficacy of the screening and patients' follow-up.

AIMS

To evaluate the results of the French PKU screening program in terms of hyperphenylalaninaemia epidemiology, efficacy of the screening procedure, management and outcome of the patients.

STUDY DESIGN

The national database has been filled-up first with the answers to questionnaires that were sent each year by the PKU patients' physicians, and second with the results of an additional inquiry, which was set up in 1994 in order to investigate diagnosis, treatment, and school outcome of all French PKU patients.

RESULTS

PKU was diagnosed in 81.6% of patients with hyperphenylalaninaemia (HPA), non-PKU HPA in 17.2% and cofactor deficiency in 1.1%. From 1980, incidence of PKU has been stable: 1 per 17,124 live births. Sensitivity of the screening procedure was 99.3%. Age at diet initiation regularly decreased to reach 14 days as a median in 1996. Until 1990, median age at diet discontinuation was 6 years of age. Later, strict diet was continued longer (at least, up to 8-10 years). PKU patients who entered to secondary school at normal age were characterised by an earlier age at diagnosis and at diet initiation and a later age at diet discontinuation, compared to those who entered 1 year or more behind normal age.

CONCLUSION

These data confirm the benefit of a nationwide organised screening program. They emphasise the importance of an early neonatal diagnosis and diet initiation in PKU patients and are consistent with the benefit of a longer period of strict diet in childhood.

Fetal and neonatal cerebral infarcts

Focal arterial infarction in the full-term newborn is an important cause of acquired cerebral lesions in the perinatal period. Clinical motor seizures, most often unifocal, are the nearly constant disclosing symptom confirmed by focal EEG abnormalities. A multifactorial physiopathology is usual, including genetic and perinatal environmental factors. In the past decade, various acquired or genetic thrombophilias have been discussed as risk factors. For several of the involved mechanisms, the excitotoxic cascade could represent a common final pathway leading to neuronal cell death. Early magnetic resonance imaging studies and EEG help to identify the newborns with strokes who are likely to develop hemiplegia and disabilities at school. Protection of the human fetal brain remains difficult, since the triggering factor initiating the excitotoxic cascade is rarely observed. Treatment of seizures is nevertheless necessary, because it seems that they accelerate anoxia-induced neuronal death in animal models of focal hypoxic ischemia.

Isolated mild fetal cerebral ventriculomegaly: a retrospective analysis of 26 cases

We retrospectively studied 26 fetuses with isolated mild cerebral ventriculomegaly diagnosed between 1992 and 1998 and defined by a lateral ventricular atrial diameter of 10-15 mm without any other cerebral anomaly. Our objectives were to determine maternal risk factors, to evaluate complementary investigations, to assess developmental prognosis and to propose possible management. During pregnancy 10/26 patients had regressive ventriculomegalies, ten remained borderline at birth and six were confirmed postnatally. No maternal risk factors were identified. Prenatal investigations were carried out in 69% of cases but in only a few cases supplied any information. Postnatal examinations revealed one case of Down syndrome and one of porencephaly. Four children were lost to follow-up. In the 22 other cases, four had developmental delay. Early and unexplained mild ventriculomegaly appears to have a good prognosis. If ventriculomegaly is persistent, prenatal management should be carried out to investigate chromosomal abnormalities, viral infection, and fetal cerebral parenchymal damage. A long postnatal clinical follow-up is required.

Settlement preferences and early migration of the tropical sea cucumber Holothuria scabra

Settlement and post-settlement processes of the sea cucumber Holothuria scabra Jaeger were studied in the laboratory. Independent and paired choice experiments revealed that several substrates could induce metamorphosis into pentactulae, but that specific substrates favoured settlement. Leaves of seagrass Thalassia hemprichii, with or without their natural bio-film, yielded the highest settlement rates (4.8-10.5%). T. hemprichii was preferred as a settlement substrate over sand, crushed coral, several other plant species and artificial seagrass leaves with or without a bio-film. Only settlement on the seagrass, Enhalus acoroides, was similar to that recorded for T. hemprichii. In the absence of a substrate, the larvae delayed settlement for nearly 96 h and survival was less than 0.5%. Sand and crushed coral, either alone or together, induced settlement from <1.5% of the available larvae. The pentactulae found on sand, coral and in bare containers were 10-35% smaller than those on T. hemprichii leaves. Soluble extracts from T. hemprichii and E. acoroides successfully induced metamorphosis and settlement on clean plastic surfaces. Newly settled juveniles remained on the seagrass leaves for 4-5 weeks before migrating to sand at around 6 mm in length. Prior to this, the juveniles spent 4-5 days moving on and off the leaves. Once on the sand, the juveniles became deposit-feeders, but did not show the typical burrowing behaviour of older specimens until they reached around 11 mm in length. The larvae of H. scabra appear to actively select seagrass leaves, possibly through chemical detection. We hypothesise that larvae settling on seagrass have an increased chance of growth and survival because they are provided with a suitable substrate on which to grow, and a bridge to sand substrates as they become deposit-feeders.

2-ethoxycarbonyl-2-methyl-3,4-dihydro-2H-pyrrole-1-oxide: evaluation of the spin trapping properties

The 2-ethoxycarbonyl-2-methyl-3,4-dihydro-2H-pyrrole-l-oxide (EMPO), an easily prepared pyrroline-N-oxide has been tested as a free radical scavenger. Spin adducts of superoxide, hydroxyl radical, and other free radicals were characterized in phosphate buffer at pH 7.0 and 5.6. At pH 7 in phosphate buffer, the EMPO/O(2)(-*) spin adduct was estimated to be about five times more persistent than its DMPO analogue. Furthermore, its decay does not produce the EMPO/HO&z.rad; adduct.