Impact of COVID-19 pandemic on child abuse and neglect: A cross-sectional study in a French Child Advocacy Center

OBJECTIVE

This study aimed to describe the impact of the first COVID-19 lockdown in France on the activity of a Child Advocacy Center.

METHODS

This cross-sectional, observational study included all children involved in the activity of the CAC during the first lockdown, from March 16 to May 10, 2020 and the next 3 months and the corresponding periods in 2018 and 2019. Cases were considered severe when a hospitalization, social alert and/or judicial report to the prosecutor was decided.

RESULTS

Data for 1583 children were analyzed. During the lockdown, the global center activity decreased with 26.4 consultations per 100.000 children in 2018, 46 in 2019 and 20.7 in 2020 (p < 0.001). Judicial activity decreased (forensic examinations and child forensic interview recordings), whereas assessment consultations increased. Cases were more severe during the lockdown than in 2019 and 2018 (12.3, 9.4 and 6.04/100.000 children, respectively, p < 0.0001). The global activity of the center increased in the 3 months after the lockdown as compared with during the lockdown (38.2/100.000 versus 20.7/100.000, respectively, p < 0.001) but did not differ from activity in 2018 and 2019. Severe cases were more frequent in the 3 months after the lockdown than the previous years (13.7/100.000 in 2020, 9.62 in 2019 and 8.17 in 2018, p = 0.0002).

CONCLUSION

The CAC activity decreased during the lockdown in France but the increase in incidence of severe abuse cases during the lockdown and the next 3 months confirm the need for optimal screening, care and support of child abuse and neglect victims even in the context of health crisis.

Potential of tannin-rich plants, Leucaena leucocephala, Glyricidia sepium and Manihot esculenta, to reduce enteric methane emissions in sheep

An in vivo trial was conducted in sheep to investigate the effect of three tropical tannin-rich plants (TRP) on methane emission, intake and digestibility. The TRP used were leaves of Glyricidia sepium, Leucaena leucocephala and Manihot esculenta that contained, respectively, 39, 75 and 92 g condensed tannins/kg DM. Methane was determined with the sulphur hexafluoride tracer technique. Eight rumen-cannulated sheep of two breeds (four Texel, four Blackbelly) were used in two 4 × 4 Latin square designs. Four experimental diets were tested. They consisted in a tropical natural grassland hay based on Dichanthium spp. fed alone (C) or in association with G. sepium (G), L. leucocephala (L) or M. esculenta (M) given as pellets at 44% of the daily ration. Daily organic matter intake was higher in TRP diets (686, 984, 1054 and 1186 g/day for C, G, L and M respectively; p < 0.05) while apparent organic matter total tract digestibility was not affected (69.9%, 62.8%, 65.3% and 64.7% for C, G, L and M respectively; p > 0.05). Methane emission was 47.1, 44.9, 33.3 and 33.5 g/kg digestible organic matter intake for C, G, L and M, respectively, and was significantly lower (p < 0.05) for L and M than for G and C. Our results confirm the potential of some TRP to reduce methane production. The strong decrease in methane and the increase in intake with TRPs may be due to their presentation as pellets.

Selection for residual feed intake in growing pigs: effects on sow performance in a tropical climate

The aim of the study was to evaluate the consequences of a divergent selection for residual feed intake (RFI) during growth in a temperate environment (TEMP) on sow performance in a tropical environment (TROP). Sows came from a selection experiment conducted at INRA in which 2 lines were selected for larger (RFI(+)) or smaller (RFI(─)) feed intake than predicted from performance. In the first analysis, a subsample of data obtained in TROP conditions (49 lactations) was compared to those obtained in TEMP on their sibs mated with the same boars (54 lactations). In the second analysis, data obtained in the TROP environment (82 lactations) were analyzed for testing the effect of season (warm vs. hot) and line on sow performance. Except for the lactation length, the interaction between line and climatic environment was not significant for the others traits (P > 0.05). The ADFI expressed per kilogram of litter BW gain tended to be higher in the RFI(+) line bred in the TROP environment (P = 0.080), together with piglet BW at weaning, which tended to be lower (P = 0.080). The ADFI was lower in TROP than in TEMP (4.56 vs. 5.86 kg/d; P = 0.003), with negative consequence on litter BW gain and maternal BW loss. The RFI(-) sows tended to eat less feed than RFI(+) sows during lactation (4.55 vs. 5.86 kg/d; P = 0.099). Litter BW at weaning was higher in the RFI(─) line. The RFI(─) sows ate significantly less feed to produce 1 kg of litter than the RFI(+) sows and tended to lose a larger amount of BW during lactation than the RFI(+) sows (2.40 vs. 3.02 kg/kg and -0.66 vs. -0.39 kg/d, respectively, P < 0.10). Whatever the line, ADFI was reduced by about 21% in the hot season (P < 0.05). Litter BW gain was depressed (P < 0.05) in the hot season (1.72 vs. 2.08 kg/d in the warm season; P = 0.023). Lactation maternal BW loss tended to increase in the hot season (1.10 vs. 0.71 kg/d in the warm season; P = 0.016), but back fat loss remained constant (P = 0.295). In the TROP environment, the amount of feed required to produce 1 kg of litter was not influenced by the line in the warm season (2.53 kg/kg on average; P = 0.99), but it tended to be lower in the RFI(─) line when compared to the RFI(+) line in the hot season (2.06 vs. 3.45 kg/kg; P = 0.050). This higher apparent efficiency in RFI(─) sows was mainly related to greater maternal body reserve mobilization (i.e., BW and back fat losses). In conclusion, selection for low RFI during growth in a TEMP environment did not impair sow and litter performance in tropical conditions.

[Gonococcal conjunctivitis complicated by perforating corneal abscess in an adult]

We present a case of bilateral purulent conjunctivitis complicated by ocular perforation of the right eye secondary to fulminant corneal melt in a 29-year-old man. He developed urethritis after a sexual contact with a prostitute 3 weeks previously. Microbiological analyses of conjunctival and urinary cultures were positive for Neisseria gonorrhoeae resistant to penicillins, tetracyclines, and fluoroquinolones. Progression was favorable with a 15-day course of high doses of parenterally administered antibiotics associating imipenem and fosfomycin. Keratoplasty was done after 3 months. This observation is a good example of the problems raised by gonococcal conjunctivitis in adults. Extremely rare in developed countries, it remains widely unrecognized by ophthalmologists. It is a sexually transmitted disease usually resulting from autoinoculation from an infected genital site. The risk of marginal purulent corneal melt, which can lead to fulminant perforation, warrants prompt microbiological analysis and early parenteral antibiotic treatment.

Mélanome annulaire révélé par un hyphéma spontané

INTRODUCTION

Ring melanoma is a rare form of uveal melanoma characterized by the circumferential involvement of the ciliary body. Unilateral chronic and refractory glaucoma is a classic circumstance of diagnosis.

OBSERVATION

We report a case of ring melanoma revealed by acute intraocular hypertonia secondary to spontaneous hyphema. Iris and iridocorneal angle were diffusely invaded by the tumor. The fundus was masked but B-scan ultrasonography revealed a voluminous ciliochoroidal tumor. The patient had been enucleated. Pathological examination confirmed the diagnosis of ring melanoma. The tumor involved angle structures. The patient died 1 year later because of metastasis.

DISCUSSION

Acute or chronic ocular hypertonia is a classic but rare circumstance of uveal melanoma diagnosis. Many mechanisms exist: neovascular glaucoma, secondary angle closure, involvement of angle structures, and trabecular obstruction by tumor cells or pigment. Acute intraocular hypertonia secondary to hyphema is more exceptional. Our observation highlights that apart from the classic situation of acute angle closure glaucoma, intraocular hypertonia requires meticulous fundus examination, if necessary using B-scan ultrasonography.

Currarino syndrome as an etiology of a neonatal Escherichia coli meningitis

We report the case of a 29-day-old baby girl in whom Escherichia coli meningitis led to the diagnosis of Currarino syndrome (CS) (OMIM 176450), an autosomal-dominant genetic disorder associated with sacral agenesis, anorectal malformation, presacral masses and spinal cord malformations. Her condition improved with antibiotics and early surgical treatment. A familial study identified other genetically related individuals with similar symptoms.

[Retinal detachment caused by ocular perforation during periocular anesthesia: three case reports]

INTRODUCTION

Local anesthesia for eye surgery was first described in 1884; later Knapp popularized retrobulbar anesthesia. To reduce risks, peribulbar anesthesia appeared in the 1970s. Still used today, periocular anesthesia is not without complications, in particular the risk of ocular perforation.

PATIENTS AND METHODS

Three patients were referred to our department for diagnosis and treatment of an intravitreous hemorrhage following cataract surgery. We report the clinical features, treatment, and visual outcome for these three patients.

RESULTS

The most common presentation was vitreous hemorrhage: the three eyes were found to have associated retinal detachment on initial assessment. One patient presented severe vitreoretinal proliferation with two postoperative recurrences; the globe was finally enucleated. The two other patients presented attached retina after surgery but had achieved very poor visual recovery.

CONCLUSION

Inadvertent globe perforation during local ocular anesthesia is rare. Careful attention to risk factors, early recognition, and prompt referral for management are recommended to improve the visual prognosis. Surgical management must be adapted to the severity of the perforation (vitreous hemorrhage, retinal detachment, vitreoretinal proliferation). The problems treating these patients with severe, often recurrent, retinal detachment, with poor visual prognosis, in a tricky forensic context should be emphasized.

[Endophthalmitis after plana vitrectomy: incidence, microbiology, and visual outcome]

INTRODUCTION

The aim of this retrospective study was to analyze incidence, microorganisms, and final visual acuity after pars plana vitrectomy.

METHODS

Data on all patients with endophthalmitis after pars plana vitrectomy performed at Croix-Rousse Hospital, Lyon, France, between 1994 and 2004 were analyzed.

RESULTS

Among 1632 posterior vitrectomies done over an 11-year period, 14 cases of endophthalmitis occurred (0.86%). Half of the patients were diabetic with poor glycemic control. The most frequent microorganism was negative coagulase Staphylococcus. One case of Bacillus cereus was noted. On the whole, visual prognosis was poor: final visual acuity never exceeded 20/200 in the best cases. The final visual acuity depended on the initial pathology requiring vitrectomy. One eye was enucleated because of phthisis.

DISCUSSION

Historically, the incidence of endophthalmitis after vitrectomy is approximately 0.05%. It was higher in our series probably because of the high number of diabetic patients with poor glycemic control. Final visual acuity after pars plana vitrectomy in current series is low. Nevertheless it must be compared with the visual acuity before the vitrectomy because it depends greatly on the causal pathology which is very disabling.

CONCLUSION

Endophthalmitis after pars plana vitrectomy is a serious complication. Prophylaxis is still the best treatment.

[Panuveitis following intravesical bacille Calmette-Guerin therapy]

Uveitis occurring after bacille Calmette-Guerin (BCG) intravesical therapy for bladder carcinoma is rare: only nine cases have been described. In two previous reports, vitreous cultures proved Mycobacterium bovis presence. We describe the case of an 85-year-old woman who presented with bilateral panuveitis 2 months after the last BCG intravesical instillation, with no other systemic symptom. There was no evidence for any other etiology for this uveitis. She was given oral antibiotics that were effective against Mycobacterium species, oral steroids, and anti-inflammatory drops. Her ophthalmologic status dramatically improved. This case highlights that these patients may have a good visual outcome, as long as diagnosis and treatment are not delayed.

Survival after primary enucleation for choroidal melanoma: changes induced by the introduction of conservative therapies

BACKGROUND

Most uveal melanomas are currently treated by eye-preserving radiotherapies. However, for melanomas of the largest size or with initial complications, enucleation remains the reference treatment. Enucleation is called primary when it is proposed as the only local treatment option for a melanoma. There is very little literature on the use of primary enucleation after the introduction of conservative treatments. Our main goal was to evaluate the survival of melanoma patients treated by primary enucleation since the introduction of proton-beam therapy in France in 1991.

METHODS

All melanoma patients undergoing primary enucleation in our department between 1991 and 2002 were included in this retrospective study. The 5-year melanoma-specific survival rate was calculated using the Kaplan-Meier method. The multivariate prognostic analysis was performed using the Cox proportional hazards model.

RESULTS

Forty patients, representing 8% of all patients with choroidal uveal melanoma diagnosed and followed up in our department during an 11-year period, were included in the study. No patient was lost to follow-up. The 5-year melanoma-specific survival rate was 31.45% (SE: 7.8) after primary enucleation. Significant prognosis factors in the multivariate analysis were: tumor thickness > 12 mm (p = 0.03), anterior margin of the tumor involving the iris (p = 0.018), and presence of epithelioid cells (p = 0.02).

CONCLUSIONS

The very low survival rate reported reflects the evolution of primary enucleation, which is currently indicated only for melanomas with the worst prognosis. The knowledge of current post-enucleation survival rates represents an essential achievement for both correct assessment of conservative therapies and patient counseling.

[Optic disc pit complicated by serous macular detachment: a case report]

INTRODUCTION

Optic disc pit is a rare congenital anomaly that, in 60% of cases, can be complicated by serous macular detachment.

CASE REPORT

We report the case of a 56-year-old patient who presented with serous macular detachment caused by optic disc pit and responsible for a deterioration of visual acuity. Intravitreal injection of 0.3 cc of C3F8 and peripapillary photocoagulation was unsuccessful. Vitrectomy, peripapillary photocoagulation, and intravitreal injection of C3F8 helped reduce the serous detachment and improved visual acuity.

CONCLUSION

Optic coherence tomography has become necessary in the management of this pathology whose mechanism is uncertain and treatment unconventional.

Influence of intraocular lens material on the development of acute endophthalmitis after cataract surgery?

PURPOSE

To investigate the causal relationship between acute postoperative endophthalmitis (POE) after cataract surgery and the biomaterial properties of the intraocular lens (IOLs) implanted.

METHODS

This retrospective cohort study included all patients who had undergone cataract surgery with IOL implantation at the Lyon Croix-Rousse University Hospital between 1st January 1994 and 31st December 2004. Details respecting the type of IOL implanted (material and manufacturer) were meticulously recorded. The number of patients presenting with POE within 6 weeks of cataract surgery was documented together with their medical characteristics. These data were then compared, and Fisher's exact test was used to establish the significance of any apparent associations.

RESULTS

Eight of the 5837 eyes manifested acute POE (0.14%). Seven of these were composed of polymethylmethacrylate (PMMA) and one of heparinized PMMA. Patients with PMMA IOLs carried a higher risk of developing POE than did those implanted with either heparinized PMMA (P=0.001), hydrophilic acrylic, or hydrophobic acrylic IOLs (P=0.002).

CONCLUSIONS

The incidence of acute POE after cataract surgery in our hospital is similar to that currently reported for other institutions in developed countries. Our results add further evidence that IOL material and type are factors contributing to the risk to develop an acute POE after cataract surgery, and that PMMA IOLs may be associated with an increased risk of POE.

Biopsie conjonctivale : une aide précieuse pour le diagnostic de sarcoïdose

PURPOSE

To highlight the advantages of conjunctival biopsy in order to confirm the diagnosis of sarcoidosis.

CASE REPORT

A 78-year-old woman presented with unilateral vitreitis. The examination of the conjunctive of right and left eyes revealed multiple, translucent, pale yellow nodules the size of millet grains located in the lower fornix. The diagnosis of sarcoidosis was suspected by an increased level of angiotensin-converting enzyme and bilateral hilar lymphadenopathies. A biopsy from conjunctival nodules showed noncaseating epithelioid and gigantocellular granulomas, confirming the diagnosis of sarcoidosis.

CONCLUSION

Although underused, conjunctival biopsy seems to be both a safe and effective tool in the diagnosis of sarcoidosis.

Neuropathie optique bilatérale révélant une infection par le virus de l’immunodéficience humaine

We report the case of a 57-year-old man who presented bilateral subacute and painless optic neuropathy after meningopolyradiculitis revealing a primary human immunodeficiency virus infection. Both antiretroviral and steroid treatments were ineffective. Clinical symptoms and evolutive pattern were consistent with a mechanism of microvascular ischaemia of the optic nerve head. Optic neuropathies related to HIV infection are rare compared to those resulting from opportunistic infections. There are several pathophysiological mechanisms involved.

[Congenital ocular toxoplasmosis--ocular manifestations and prognosis after early diagnosis of infection]

BACKGROUND

Congenital toxoplasmosis (CT) is the most frequently encountered congenital infection. The aim of the present review is to report about the long-term outcome of functional and morphological manifestations after an early confirmation of the diagnosis.

PATIENTS AND METHODS

We report on a cohort of patients with serologically confirmed CT, born between 1988 and 2001, who were followed up prospectively at a single centre (Institute of Parasitology, Hôpital de la Croix Rousse, University of Lyon). All patients underwent regular ophthalmological, parasitological and paediatric controls on a half-yearly or annual basis. Ocular manifestations were documented and visual acuity was assessed as far as was possible.

RESULTS

1,506 seroconversions were diagnosed during pregnancy, and 327 of the live-born offspring were seropositive for CT. At the end of the study period, ocular manifestations occurred in 79 of the children (24 %), and in 7 cases (9 %) they were discovered during the first month of life. In 72 of the patients (91 %), the ocular manifestations developed between 1 and 151 months (median follow-up time: 6.3 +/- 3.7 years; range: 0.5 - 14 years) under medical treatment for the first year of life. At the end of the study period, information regarding visual acuity was available for 66 patients. In 55 of these (83 %), visual acuity was normal in both eyes, and in 11 (17 %), it was reduced below 0.5. In 1 child, both eyes were functionally affected, one severely.

CONCLUSION

CT may not become manifest ocularly until after a decade, which underlines the necessity for long-term ophthalmological monitoring of the infected individuals. In our patients, the prognostic outcome after therapy for the first year of life was better than that reported in the literature. This favourable outcome may serve as a basis for patient counselling.

Chirurgie de l’œdème maculaire chez le patient diabétique : étude prospective de 7 cas suivis en tomographie par cohérence optique

INTRODUCTION

A prospective study was performed in seven eyes of seven consecutive patients who had vitrectomy for diffuse diabetic macular edema (DME) with ILM premacular delamination as part of this treatment.

PATIENTS AND METHODS

All patients had retinopathy and DME. Only one patient had previous grid photocoagulation. In all eyes, there was no ophthalmoscopic evidence of traction from the posterior hyaloid membrane or proliferative tissue, but all patients had no posterior vitreous separation. A clinical examination and optical coherence tomography (OCT) were performed in preoperative and postoperative surgery (1 and 6 months). Pars plana vitrectomy with separation of the posterior hyaloid was performed in seven cases.

RESULTS

Only three patients had vitreomacular traction observed on OCT. Statistical analysis revealed a significant decrease in retinal thickness 6 months after surgery. Best corrected visual acuity improved in four patients.

CONCLUSION

Vitreous surgery can improve the visual prognosis of some eyes with DME with or without posterior vitreous separation, whether combined or not with vitreomacular traction observed on OCT.

Prognostic factors for the long-term development of ocular lesions in 327 children with congenital toxoplasmosis

The aim of this study was to identify the high-risk factors associated with the development of ocular lesions in a large cohort of children with congenital toxoplasmosis (CT), irrespective of their gestational age at the time of maternal infection. Children were managed according to a standardized protocol and monitored for up to 14 years at the Croix-Rousse Hospital, Lyon, France. Cox model and a flexible regression, spline-based method were used for the analysis. During a median follow-up time of 6 years, 79 of the 327 children (24%) had at least one retinochoroidal lesion. No bilateral impairment of visual acuity was observed. The risk of a child developing ocular disease was higher not only when mothers were infected early during pregnancy, which was expected, but also when CT was diagnosed prior to or at the time of birth, when non-ocular manifestations were present at baseline and when birth was premature.

[Blindness after nitrous oxide anesthesia and internal gas tamponade]

The authors describe the case of a patient with bilateral retinal detachment. Immediately after surgery for the second eye under general anesthesia with nitrous oxide, the patient reported severe visual loss in the first eye successfully treated surgically 2 weeks before, with a residual gas bubble (C3F8) of 50%. In this case, nitrous oxide had rapidly entered the gas bubble and induced a transient expansion of the gas tamponade with a dramatic increase in intraocular pressure. The consequence was a central retinal artery occlusion, which resulted in irreparable ischemic retinal damage and blindness, explaining the severe and sudden visual loss. Nitrous oxide is regularly used but contraindicated if intraocular gas is present, due to its potential threat to visual function. We suggest that patients anesthetized with nitrous oxide carry a card or a bracelet detailing the risks of intraocular gas tamponades combined with nitrous oxide and with travel to high altitudes. This would inform not only patients but also medical personnel caring for these patients.

Characterisation of atovaquone resistance in Leishmania infantum promastigotes

Atovaquone, an antiparasitic agent, could possibly represent an alternative therapy after relapse following classical treatment for visceral leishmaniasis. Atovaquone-resistant strains were selected in vitro by stepwise drug pressure to study the mechanism of resistance in Leishmania. Characteristics of a promastigote strain resistant to 250 microg/ml of atovaquone were compared with those of the wild type (WT) strain. Resistant strains were shown to have a high level of resistance (45 times). They were stable in drug-free medium for 6 months, and showed no cross-resistance with other antileishmanial drugs. Rhodamine uptake and efflux were studied. They were not modified in the resistant strain, indicating the absence of P-glycoprotein overexpession. The effect of atovaquone on membrane lipidic composition was determined in both WT and atovaquone-resistant promastigotes. Analysis of lipid composition of the atovaquone-resistant strain showed that sterol biosynthesis was decreased in atovaquone-resistant parasites. Cholesterol was found to be the major membrane sterol as opposed to the WT strain. Cholesterol, due to its ordering effect, could decrease membrane fluidity and subsequently block the passage of atovaquone through the membrane. Increased membrane cholesterol content and altered drug membrane fluidity resulted from possible decrease of ergosterol biosynthesis by atovaquone, incorporation of cholesterol by promastigotes in the culture medium, solubilisation of atovaquone by cholesterol and co-passage of the two compounds or influence of dimethylsulfoxide. These results indicate that different cellular alterations may participate in the resistant phenotype, by altering drug membrane permeability.

Allogeneic hematopoietic stem cell transplantation in ovarian carcinoma: results of five patients

Allogeneic hematopoietic stem cell transplantation is often used to treat hematologic malignancies. The efficacy of this procedure is due to both myeloablative conditioning and graft-versus-leukemia (GVL). However, the disadvantages of allogeneic transplantation include graft-versus-host disease (GVHD), relapse from the original tumor, and patient susceptibility to opportunistic infections. Lately, allogeneic transplantation has been developed to treat solid tumors, with the expectation that graft-versus-tumor (GVT), like GVL, will have a significant anti-tumor effect. This effect has been demonstrated in renal carcinomas, and with less evidence in breast cancers. Five patients with malignant ovarian tumors resistant to chemotherapy underwent allogeneic transplantation, four from bone marrow, and one from peripheral blood stem cells. All donors were HLA-identical siblings. One patient received a myeloablative conditioning regimen, while the other four received a non-myeloablative regimen. Two patients received donor lymphocyte infusions (DLI). Four of the patients presented with acute or chronic GVHD associated with tumor regression of at least 50%. These tumor regressions were measured by CA-125 levels and CT scans. The fifth patient died of rapid progression just after transplantation. Of the four transplantation survivors, three received a non-myeloablative regimen which did not seem to reduce treatment effectiveness. While it did reduce toxicity, one of these patients died of GVHD after 127 days. DLI was administered to two patients. These infusions seemed to promote GVHD which was able to control disease progression for one patient and had no apparent effect on the other. Allograft of hematopoietic stem cells might be of interest in ovarian cancer. The results in one patient also suggest that DLI may be an effective immunotherapy, although doses and timing need to be determined. The number of cases presented is small, however, and clinical experience on a larger scale will be required to determine the real clinical efficacy of graft versus cancerous ovarian cells.