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Bréhon A, Bensefa-Colas L, D'Andrea C, Jeziorski E, Lehucher-Michel MP, Lequipe J, Marmion N, Mathelier-Fusade P, Mercier JC, Sebatigita G, Tannous J, Vigan M, Guillot B, Du-Thanh A, Soria A. Guidelines for cold urticaria management established by the Centre of Evidence of Dermatology and the Urticaria Group of the French Society of Dermatology. Br J Dermatol 2024; 190:445-447. [PMID: 38000904 DOI: 10.1093/bjd/ljad447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
This research letter provides guidelines for cold urticaria management established by the Centre of Evidence of Dermatology and the Urticaria Group of the French Society of Dermatology.
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Affiliation(s)
- Alice Bréhon
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
| | | | | | | | | | | | | | - Pascale Mathelier-Fusade
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
| | | | | | | | | | | | | | - Angèle Soria
- Sorbonne Université, Service de Dermatologie et d'Allergologie, APHP, Hopital Tenon, 75020 Paris [Department of Dermatology and Allergology, AP-HP, Tenon Hospital, 75020, Paris, France]
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2
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Foucaud P, Mercier JC. CFTR pharmacological modulators: A great advance in cystic fibrosis management. Arch Pediatr 2023; 30:1-9. [PMID: 36509624 DOI: 10.1016/j.arcped.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/16/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
Cystic fibrosis is a severe monogenic disease that affects around 7400 patients in France. More than 2100 mutations in the cystic fibrosis conductance transmembrane regulator (CFTR), the gene encoding for an epithelial ion channel that normally transports chloride and bicarbonate, lead to mucus dehydration and impaired bronchial clearance. Systematic neonatal screening in France since 2002 has enabled early diagnosis of cystic fibrosis. Although highly demanding, supportive treatments including daily chest physiotherapy, inhaled aerosol therapy, frequent antibiotic courses, nutritional and pancreatic extracts have improved the prognosis. Median age at death is now beyond 30 years. Ivacaftor was the first CFTR modulator found to both reduce sweat chloride concentration and improve pulmonary function in the rare CFTR gating mutations. Combinations of modulators such as lumacaftor + ivacaftor or tezacaftor + ivacaftor were found to improve pulmonary function both in patients homozygous for the F508del mutation characterized by the lack of CFTR protein and those heterozygous for F508del with minimal CFTR activity. The triple combination of ivacaftor + tezacaftor + elexacaftor was recently shown to significantly improve pulmonary function and quality of life, to normalize sweat chloride concentration, and to reduce the need for antibiotic therapy in patients with at least one F508del mutation (83% in France). These impressive data, however, need to be confirmed in the long term. Nevertheless, it is encouraging to hear treated patients testify about their markedly improved quality of life and to observe that the number of lung transplants for cystic fibrosis decreased dramatically in France after 2020, despite the COVID pandemic, with no increase in deaths without lung transplant.
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Affiliation(s)
- P Foucaud
- Vice-Président de l'Association Vaincre la Mucoviscidose, 181 Rue de Tolbiac, Paris 75013, France.
| | - J C Mercier
- Membre de la Commission de Transparence, Haute Autorité de Santé, 5 avenue du Stade de France, Saint Denis 93210, France
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3
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Stahli BE, Schindler M, Cammann VL, Szawan KA, Schweiger V, Niederseer D, Schonberger A, Schonberger M, Koleva I, Mercier JC, Petkova V, Wurdinger M, Ruschitzka F, Ghadri JR, Templin C. Cardiac troponin elevation and mortality in takotsubo syndrome: new insights from the International Takotsubo (InterTAK) registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Cardiac biomarker elevations are frequently observed in Takotsubo syndrome (TTS). The clinical relevance of cardiac troponin (cTn) elevations in TTS patients remains uncertain and threshold values indicating clinically relevant myocardial injury are unknown.
Purpose
This study sought to investigate the role of cTn elevations in mortality prediction of patients with TTS.
Methods
A total of 2,938 patients enrolled in the prospective International Takotsubo (InterTAK) Registry from January 2011 to February 2020 and with available data on baseline and peak cTn levels were included in the analysis. The threshold at which myocardial injury drives mortality was identified using restricted cubic spline analysis.
Results
Out of 2,938 patients, 222 (7.6%) patients died during 1-year follow-up. A more than 28.8-fold increase of cTn above the upper reference limit was identified as threshold for clinically relevant myocardial injury. Mortality at 1 year was significantly higher in patients with clinically relevant myocardial injury than in those without (Log Rank p<0.001, Figure 1). The presence of clinically relevant myocardial injury was significantly associated with an increased risk of mortality at 5 years (adjusted HR 1.58, 95% CI 1.18–2.12, p=0.002). Clinically relevant myocardial injury was related to 5-year mortality in patients with apical TTS (adjusted HR 1.57, 95% CI 1.21–2.03, p=0.001), with presence of physical stressors (adjusted HR 1.60, 95% CI 1.22–2.11, p=0.001), and with absence of emotional stressors (adjusted HR 1.49, 95% CI, 1.17–1.89, p=0.001).
Conclusions
This study for the first time determined a troponin threshold for the identification of TTS patients at excess risk of mortality. These findings advance risk stratification in TTS and assist in identifying patients in need for close monitoring and follow-up.
Funding Acknowledgement
Type of funding sources: Foundation.
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Affiliation(s)
- B E Stahli
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - M Schindler
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - V L Cammann
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - K A Szawan
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - V Schweiger
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - D Niederseer
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - A Schonberger
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - M Schonberger
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - I Koleva
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - J C Mercier
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - V Petkova
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - M Wurdinger
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - F Ruschitzka
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - J R Ghadri
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - C Templin
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
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Stahli B, Cammann VL, Schindler M, Schweiger V, Szawan KA, Niederseer D, Wurdinger M, Schonberger A, Schonberger M, Koleva I, Mercier JC, Petkova V, Ruschitzka F, Ghadri JR, Templin C. Body weight and mortality in takotsubo syndrome: insights from the International Takotsubo (InterTAK) registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
The obesity paradox has been described in different cardiovascular conditions. Data on the association between obesity and outcomes in patients with Takotsubo syndrome (TTS) are lacking.
Purpose
The aim of this study was to determine the relation of body weight to mortality in TTS patients.
Methods
Patients enrolled in the International Takotsubo (InterTAK) Registry from January 2011 to July 2021 and with available data on BMI were included in the analysis. Patients were stratified according to BMI (underweight, <18.5 kg/m2; normal weight, 18.5–24.9 kg/m2; overweight, 25.0–29.9 kg/m2; obese, 30.0–34.9 kg/m2; and very obese, ≥35.0 kg/m2). The primary endpoint was mortality at 1 year.
Results
Of the 2'707 patients, 222 (8.2%) were underweight, 1340 (49.5%) of normal weight, 759 (28.0%) overweight, 268 (9.9%) obese, and 118 (4.4%) very obese. Mortality at 1 year as a function of BMI with 95% confidence interval is given in Figure 1. Mortality at 1 year was 11.3%, 6.9%, 5.5%, 4.9%, and 9.3% in underweight, normal weight, overweight, obese, and very obese patients (p=0.02, Figure 2). Being overweight or obese was significantly associated with a lower mortality at 1 year (HR 0.70, 95% CI 0.51–0.96, p=0.03), and associations remained significant after multivariable adjustments (adjusted HR 0.67, 95% CI 0.46–0.97, p=0.03). Associations were observed when including patients without emotional stressors (adjusted HR 0.64, 95% CI 0.43–0.94, p=0.02), but not when including those with emotional stressors (adjusted HR 1.14, 95% CI 0.30–4.27, p=0.85).
Conclusion
A U-shaped mortality curve across BMI categories was observed in TTS patients, with lowest mortality rates in obese patients. These observations provide first evidence for the existence of the obesity paradox in TTS.
Funding Acknowledgement
Type of funding sources: Foundation.
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Affiliation(s)
- B Stahli
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - V L Cammann
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - M Schindler
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - V Schweiger
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - K A Szawan
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - D Niederseer
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - M Wurdinger
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - A Schonberger
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - M Schonberger
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - I Koleva
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - J C Mercier
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - V Petkova
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - F Ruschitzka
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - J R Ghadri
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
| | - C Templin
- Cardiology, Cardiovascular Center, University Hospital Zürich , Zurich , Switzerland
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Dinh A, Mercier JC, Jaulmes L, Artigou JY, Juillière Y, Yordanov Y, Jourdain P. Safe Discharge Home With Telemedicine of Patients Requiring Nasal Oxygen Therapy After COVID-19. Front Med (Lausanne) 2021; 8:703017. [PMID: 34805196 PMCID: PMC8595095 DOI: 10.3389/fmed.2021.703017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/11/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction: The COVID-19 pandemic created challenges to healthcare systems worldwide. To allow overwhelmed hospitals to focus on the most fragile and severely ill patients, new types of management had to be set up. During the pandemic, patients with COVID-19 from greater Paris area were monitored at home using a web-based remote system called COVIDOM™, using self-administered questionnaires, which triggered alerts to a regional control center. To ease hospital discharge and to prevent hospital from being overwhelmed, patients still requiring low-flow oxygen therapy discharged home were also included in this telemedicine solution. We aim to evaluate the safety of this original management. Methods: We conducted a retrospective multicenter cohort of patients discharged home from hospital after COVID-19 and still requiring nasal oxygen therapy, who were monitored by questionnaire and trained physicians using COVIDOM. During late follow-up, the status of the patients using a Euro-Qol (EQ-5D-5L) questionnaire, and the Medical Research Council (MRC) Dyspnea scale was collected. Results: From March 21st to June 21st 2020, 73 COVID-19 patients still receiving nasal oxygen at hospital discharge were included. Median [Inter-Quartile Range (IQR)] age was 62.0 [52.5–69.0] years, 64.4% were male. Altogether, risk factors were observed in 49/73 (67%) patients, mainly hypertension (35.6%), diabetes mellitus (15.1%) and active neoplasia (11.0%). Among the cohort, 26% of patients were previously managed in ICU. Oxygen therapy was required for a median [IQR] of 20 [16–31] days. No death or urgent unplanned hospitalization were observed during the COVIDOM telemonitoring. During the late follow-up evaluation (6 months after inclusion), the mean EQ-5D-5L questionnaire score was 7.0 ± 1.6, and the mean MRC dyspnea scale was 0.8 ± 1.0, indicating absence of dyspnea. Five patients have died from non-COVID causes. Conclusions: In this preliminary study, early discharge home of patients with severe COVID-19 disease who still required low-oxygen therapy seems to be safe.
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Affiliation(s)
- Aurélien Dinh
- Infectious Disease Department, University Hospital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Garches, France
| | | | - Luc Jaulmes
- Centre de Pharmaco-épidémiologie (Cephepi), Pitié Salpêtrière Hospital, Paris, France
| | | | - Yves Juillière
- COVIDOM, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Youri Yordanov
- Emergency Department, University Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Patrick Jourdain
- Cardiology Department, University Hospital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, Le Kremlin-Bicêtre, France
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Mercier JC, Ouldali N, Basmaci R. [Multisystemic inflammatory syndrome in children (MIS-C) associated with Covid]. Rev Prat 2021; 71:1009-1015. [PMID: 35147323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Multisystemic inflammatory syndrome in children (mis-c) Asociated with covid Although children are less susceptible to sars-cov-2 and less symptomatic than adults with low mortality, clusters of Septic shock associated with elevated cardiac biomarkers and unusual vasoplegia have been recently described and Treated by inotropes, vasopressors, and fluid loading. Both clinical symptoms (i.e., high and persistent fever, gastrointestinal Disorders, skin rash, conjunctivitis and dry cracked lips) and biological signs (e.g., elevated crp/procalcitonin, high Levels of ferritinemia) resembled kawasaki disease. In most instances, intravenous immunoglobin therapy with glucosteroids Improved the cardiac function and led to full recovery within a few days. However, adjunctive biotherapy (e.g., Anti-il-1ra, anti-il-6 monoclonal antibodies) was sometimes necessary. Although almost all children fully recovered Within a few days, some of them developed late coronary artery dilation or aneurysm. Thus, a new "multisystem inflammatory Syndrome in children" (mis-c) associated with sars-cov-2 has been identified, and its pathophysiology better Understood.
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Affiliation(s)
| | - Naïm Ouldali
- CCA, membre du Pediatric-Biocovid Study Group, service de pédiatrie générale, hôpital Robert-Debré, Paris, France
| | - Romain Basmaci
- PU-PH, membre du Pediatric-Biocovid Study Group, service de pédiatrie générale, AP-HP, hôpital Louis-Mourier, Colombes ; Inserm UMR 1137 (IAME) ; université de Paris, France
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Mercier JC, Ouldali N, Melki I, Basmaci R, Levy M, Titomanlio L, Beyler C, Meinzer U. Severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children mimicking Kawasaki disease. Arch Cardiovasc Dis 2021; 114:426-433. [PMID: 34052147 PMCID: PMC8141693 DOI: 10.1016/j.acvd.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 02/08/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been characterized by high transmission rates and high mortality in adults with predisposing factors, including age > 70 years, obesity, diabetes, systemic hypertension and other underlying diseases. During the second week of viral pneumonia, acute respiratory distress syndrome can occur and carries high mortality. Unlike most common respiratory viruses, children seem to be less susceptible to SARS-CoV-2 infection, and generally develop mild disease with low mortality. However, clusters of severe shock associated with high levels of cardiac biomarkers and unusual vasoplegia requiring inotropes, vasopressors and volume loading have recently been described. Both the clinical symptoms (i.e. high and persistent fever, gastrointestinal disorders, skin rash, conjunctival injection and dry cracked lips) and the biological signs (e.g. elevated C-reactive protein/procalcitonin and high levels of ferritinaemia) mimicked Kawasaki disease. In most cases, intravenous immunoglobin therapy improved cardiac function and led to full recovery within a few days. Adjunctive steroid therapy and sometimes biotherapy (e.g. anti-interleukin 1Ra and anti-interleukin 6 monoclonal antibodies) were often necessary. Although almost all children fully recovered within a week, some of them later developed coronary artery dilation or aneurysm. Thus, a new “multisystem inflammatory syndrome in children” related to SARS-CoV-2 has recently been described. Similarities with Kawasaki disease and the physiopathology of this syndrome still need further exploration.
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Affiliation(s)
- Jean-Christophe Mercier
- Université de Paris, 75006 Paris, France; AP-HP et ARS Île de France, 93200 Saint-Denis, France.
| | - Naim Ouldali
- Service de Pédiatrie Générale, Hôpital Robert Debré, 75019 Paris, France
| | - Isabelle Melki
- Service de Pédiatrie Générale, Hôpital Robert Debré, 75019 Paris, France; Centre de Référence pour les Maladies Rhumatologiques Auto-Immunes et Systémiques (RAISE), Institut IMAGINE, 75015 Paris, France
| | - Romain Basmaci
- Service de Pédiatrie-Urgences, Hôpital Louis-Mourier, AP-HP, 92700 Colombes, France; Université de Paris, Inserm, Infection-Antimicrobials-Modelling-Evolution (IAME), UMR-1137, Université de Paris, Hôpital Bichat, 75018 Paris, France
| | - Michael Levy
- Service de Médecine Intensive-Réanimation Pédiatriques, Hôpital Robert-Debré, 75019 Paris, France
| | - Luigi Titomanlio
- Service des Urgences Pédiatriques, Hôpital Robert-Debré, 75019 Paris, France
| | - Constance Beyler
- Service de Cardiologie Pédiatrique, Hôpital Robert-Debré, 75019 Paris, France
| | - Ulrich Meinzer
- Service de Pédiatrie Générale, Hôpital Robert Debré, 75019 Paris, France; Centre de Recherche sur l'Inflammation, Inserm UMR-1149, 75018 Paris, France
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Mercier JC, Basmaci R, Gaschignard J, Titomanlio L. [Acute abdominal and lumbar pain in children]. Rev Prat 2020; 70:e309-e310. [PMID: 33739773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - Romain Basmaci
- Professeur des universités-praticien hospitalier, service de pédiatrie-urgences, hôpital Louis-Mourier, Colombes, France
| | - Jean Gaschignard
- Praticien hospitalo-universitaire, service de pédiatrie générale, hôpital Robert-Debré, Paris, France
| | - Luigi Titomanlio
- Professeur des universités-praticien hospitalier, service des urgences pédiatriques, hôpital Robert-Debré, Paris, France
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9
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Mercier JC, Basmaci R, Gaschignard J, Titomanlio L. [Acute abdominal and lumbar pain in children and adult]. Rev Prat 2020; 70:e299-e308. [PMID: 33739772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - Romain Basmaci
- Professeur des universités-praticien hospitalier, service de pédiatrie-urgences, hôpital Louis-Mourier, Colombes, France
| | - Jean Gaschignard
- Praticien hospitalo-universitaire, service de pédiatrie générale, hôpital Robert-Debré, Paris, France
| | - Luigi Titomanlio
- Professeur des universités-praticien hospitalier, service des urgences pédiatriques, hôpital Robert-Debré, Paris, France
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Greenough A, Decobert F, Field D, Hallman M, Hummler HD, Jonsson B, Sánchez Luna M, Van Overmeire B, Carnielli VP, Potenziano JL, Mercier JC. Inhaled nitric oxide (iNO) for preventing prematurity-related bronchopulmonary dysplasia (BPD): 7-year follow-up of the European Union Nitric Oxide (EUNO) trial. J Perinat Med 2020; 49:104-110. [PMID: 32892178 DOI: 10.1515/jpm-2020-0164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/08/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Most studies of inhaled nitric oxide (iNO) for prevention of bronchopulmonary dysplasia (BPD) in premature infants have focused on short-term mortality and morbidity. Our aim was to determine the long-term effects of iNO. METHODS A 7-year follow-up was undertaken of infants entered into a multicenter, double-blind, randomized, placebo-controlled trial of iNO for prevention of BPD in premature infants born between 24 and 28 weeks plus six days of gestation. At 7 years, survival and hospital admissions since the 2-year follow-up, home oxygen therapy in the past year, therapies used in the previous month and growth assessments were determined. Questionnaires were used to compare general health, well-being, and quality of life. RESULTS A total of 305 children were assessed. No deaths were reported. Rates of hospitalization for respiratory problems (6.6 vs. 10.5%, iNO and placebo group, respectively) and use of respiratory medications (6.6 vs. 9.2%) were similar. Two patients who received iNO and one who received placebo had received home oxygen therapy. There were no significant differences in any questionnaire-documented health outcomes. CONCLUSIONS iNO for prevention of BPD in very premature infants with respiratory distress did not result in long-term benefits or adverse long-term sequelae. In the light of current evidence, routine use of iNO cannot be recommended for prevention of BPD in preterm infants.
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Affiliation(s)
| | | | - David Field
- University of Leicester Centre for Medicine, Leicester, UK
| | - Mikko Hallman
- University of Oulu and Oulu University Hospital, Oulu, Finland
| | | | - Baldvin Jonsson
- Karolinska University Hospital and Institute, Stockholm, Sweden
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Završnik J, Stiris T, Schrier L, Russell RR, Del Torso S, Valiulis A, Mercier JC, Illy K, Hadjipanayis A. Basic training requirements for health care professionals who care for children. Eur J Pediatr 2018; 177:1413-1417. [PMID: 29696474 DOI: 10.1007/s00431-018-3150-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/05/2018] [Accepted: 04/08/2018] [Indexed: 11/25/2022]
Abstract
UNLABELLED The European Academy of Paediatrics (EAP) is the paediatric section of the European Union of Medical Specialists (UEMS). The UEMS is responsible for the supervision and approval of training programmes in paediatrics and in its subspecialties. This implies also that EAP has the responsibility to address the training of all professionals working with children, to ensure that their paediatric competences and skills are adequate when dealing with children. The EAP has developed syllabi for paediatricians that provide standards of practice, and criteria for the assessment of competencies in trainees and training centres across Europe. The EAP recommends that all health care professionals working with children should have an officially approved training in child health in addition to formal qualifications in their own field. Moreover, the existing paediatric workforce must maintain their knowledge and skills with relevant continuous professional development and medical education in child health. CONCLUSION There is a need to reassess the training of all health care professionals caring for children, ensuring that it supports new models of integrated and multidisciplinary care and focuses on the needs of the child and the family. A standardised, competency-based minimum paediatric training programme/curriculum should be part in the specialty curriculums.
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Affiliation(s)
- Jernej Završnik
- Community Health Center "dr. Adolf Drolc" Maribor, Vošnjakova 2-4, 2000, Maribor, Slovenia
- European Academy of Paediatrics, Brussels, Belgium
| | - Tom Stiris
- European Academy of Paediatrics, Brussels, Belgium
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lenneke Schrier
- European Academy of Paediatrics, Brussels, Belgium
- Pediatric Department, Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert Ross Russell
- European Academy of Paediatrics, Brussels, Belgium
- Department of Paediatrics, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Stefano Del Torso
- European Academy of Paediatrics, Brussels, Belgium
- Pediatra di Famiglia, ULSS6 Euganea, Padua, Italy
| | - Arunas Valiulis
- European Academy of Paediatrics, Brussels, Belgium
- Vilnius University Clinic of Children's Diseases and Public Health Institute, Vilnius, Lithuania
| | - Jean-Christophe Mercier
- European Academy of Paediatrics, Brussels, Belgium
- Service de Pédiatrie-Urgences, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris & Université Paris Diderot, Paris, France
| | - Károly Illy
- European Academy of Paediatrics, Brussels, Belgium
- Pediatric Department, Ziekenhuis Rivierenland Tiel, Tiel, The Netherlands
| | - Adamos Hadjipanayis
- European Academy of Paediatrics, Brussels, Belgium.
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus.
- Medical School, European University of Cyprus, Nicosia, Cyprus.
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12
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Grossman Z, Hadjipanayis A, Stiris T, Del Torso S, Mercier JC, Valiulis A, Shamir R. Vitamin D in European children-statement from the European Academy of Paediatrics (EAP). Eur J Pediatr 2017; 176:829-831. [PMID: 28401345 DOI: 10.1007/s00431-017-2903-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 03/30/2017] [Indexed: 11/30/2022]
Abstract
Vitamin D is synthesized in human skin upon sun exposure and is also a nutrient. It regulates calcium and phosphate metabolism and is essential for the maintenance of bone health. Vitamin D supplementation during infancy, in order to prevent rickets, is universally accepted. Many human cell types carry vitamin D receptor, this being a drive for conducting studies on the possible association between vitamin D status and other diseases. Studies have affirmed that a considerable number of healthy European children may be vitamin D deficient, especially in high-risk groups (darker pigmented skin, living in areas with reduced sun exposure and other disorders). However, the definition of deficiency is unclear due to inter assay differences and due to a lack of consensus as to what is an "adequate" 25(OH)D level. Therefore, there is no justification for routine screening for vitamin D deficiency in healthy children. An evaluation of vitamin D status is justified in children belonging to high-risk groups. All infants up to 1 year of age should receive an oral supplementation of 400 IU/day of vitamin D. Beyond this age, seasonal variation of sunlight should be taken into account when considering a national policy of supplementation or fortification.
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Affiliation(s)
- Zachi Grossman
- Pediatric Clinic, Maccabi Health Services, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus. .,School of Medicine, European University of Cyprus, Nicosia, Cyprus.
| | - Tom Stiris
- Department of Neonatology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Jean-Christophe Mercier
- Service de Pédiatrie-Urgences, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris and Université Paris Diderot, Paris, France
| | - Arunas Valiulis
- Vilnius University Clinic of Children's Diseases and Public Health Institute, Vilnius, Lithuania
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Tel Aviv University, Tel Aviv, Israel
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13
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Affiliation(s)
- Jonas F. Ludvigsson
- Department Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
- Department of Pediatrics; Örebro University Hospital; Örebro University; Örebro Sweden
- Division of Epidemiology and Public Health; School of Medicine; University of Nottingham; Nottingham UK
- Department of Medicine; Columbia University College of Physicians and Surgeons; New York NY USA
| | - Adamos Hadjipanayis
- Department of Pediatrics; Larnaca General Hospital; Larnaca Cyprus
- Medical School; European University of Cyprus; Nicosia Cyprus
| | | | - Jean-Christophe Mercier
- Service de Pédiatrie-Urgences; Hôpital Louis Mourier; Assistance Publique-Hôpitaux de Paris and Université Paris Diderot; Paris France
| | - Arunas Valiulis
- Clinic of Children's Diseases and Public Health Institute; Vilnius University; Vilnius Lithuania
| | - Tom Stiris
- Department of Neonatology; Oslo University Hospital; Oslo Norway
- Faculty of Medicine; University of Oslo; Oslo Norway
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14
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Dornbusch HJ, Hadjipanayis A, Del Torso S, Mercier JC, Wyder C, Schrier L, Ross-Russell R, Stiris T, Ludvigsson JF. We strongly support childhood immunisation-statement from the European Academy of Paediatrics (EAP). Eur J Pediatr 2017; 176:679-680. [PMID: 28283786 DOI: 10.1007/s00431-017-2885-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 02/15/2017] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
Abstract
The eradication of smallpox and the elimination of several other infectious diseases from much of the world has provided convincing evidence that vaccines are among the most effective interventions for promoting health. The current scepticism about immunisation among members of the new US administration carries a risk of decreasing immunisation rates also in Europe. While only a small minority of the population are strongly anti-vaccine, their public activities have significantly influenced an uncertainty among the general population about both the safety of and the necessity for vaccination. Therefore, the EAP calls for greater publically available, scientifically supported information on vaccination, particularly targeted at health care providers, for the further development of electronically based immunisation information systems (IIS). We further call on all European countries to work together both in legislative and public health arenas in order to increase vaccination coverage among the paediatric population. In the interest of children and their parents, the EAP expresses its strong support for childhood immunisation and recommended vaccination schedules. We are prepared to work with governments and media and share the extensive evidence demonstrating the effectiveness and safety of vaccines.
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Affiliation(s)
- Hans Juergen Dornbusch
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Adamos Hadjipanayis
- Department of Paediatrics, Larnaca General Hospital, 6, 25th Martiou, 5380, Derynia, Cyprus. .,Medical School, European University of Cyprus, Nicosia, Cyprus.
| | | | - Jean-Christophe Mercier
- Service de Pédiatrie-Urgences, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris & Université Paris Diderot, Paris, France
| | - Corinne Wyder
- Paediatric Primary Care Center Kurwerk, Burgdorf, Switzerland
| | | | - Robert Ross-Russell
- Department of Paediatric Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tom Stiris
- Department of Neonatology, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
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15
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Laube M, Amann E, Uhlig U, Yang Y, Fuchs HW, Zemlin M, Mercier JC, Maier RF, Hummler HD, Uhlig S, Thome UH. Inflammatory Mediators in Tracheal Aspirates of Preterm Infants Participating in a Randomized Trial of Inhaled Nitric Oxide. PLoS One 2017; 12:e0169352. [PMID: 28046032 PMCID: PMC5207654 DOI: 10.1371/journal.pone.0169352] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ventilated preterm infants frequently develop bronchopulmonary dysplasia (BPD) which is associated with elevated inflammatory mediators in their tracheal aspirates (TA). In animal models of BPD, inhaled nitric oxide (iNO) has been shown to reduce lung inflammation, but data for human preterm infants is missing. METHODS Within a European multicenter trial of NO inhalation for preterm infants to prevent BPD (EUNO), TA was collected to determine the effects of iNO on pulmonary inflammation. TA was collected from 43 premature infants randomly assigned to receive either iNO or placebo gas (birth weight 530-1230 g, median 800 g, gestational age 24 to 28 2/7 weeks, median 26 weeks). Interleukin (IL)-1β, IL-6, IL-8, transforming growth factor (TGF)-β1, interferon γ-induced protein 10 (IP-10), macrophage inflammatory protein (MIP)-1α, acid sphingomyelinase (ASM), neuropeptide Y and leukotriene B4 were measured in serial TA samples from postnatal day 2 to 14. Furthermore, TA levels of nitrotyrosine and nitrite were determined under iNO therapy. RESULTS The TA levels of IP-10, IL-6, IL-8, MIP-1α, IL-1β, ASM and albumin increased with advancing postnatal age in critically ill preterm infants, whereas nitrotyrosine TA levels declined in both, iNO-treated and placebo-treated infants. The iNO treatment generally increased nitrite TA levels, whereas nitrotyrosine TA levels were not affected by iNO treatment. Furthermore, iNO treatment transiently reduced early inflammatory and fibrotic markers associated with BPD development including TGF-β1, IP-10 and IL-8, but induced a delayed increase of ASM TA levels. CONCLUSION Treatment with iNO may have played a role in reducing several inflammatory and fibrotic mediators in TA of preterm infants compared to placebo-treated infants. However, survival without BPD was not affected in the main EUNO trial. TRIAL REGISTRATION NCT00551642.
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Affiliation(s)
- Mandy Laube
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents, Division of Neonatology, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Elena Amann
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Ulrike Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Yang Yang
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Hans W. Fuchs
- Department of Pediatrics, University Medical Center Freiburg, Freiburg, Germany
| | - Michael Zemlin
- Department of Pediatrics, University of Marburg, Marburg, Germany
- Department of Pediatrics, University of Saarland, Homburg, Germany
| | | | - Rolf F. Maier
- Department of Pediatrics, University of Marburg, Marburg, Germany
| | - Helmut D. Hummler
- Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Stefan Uhlig
- Institute of Pharmacology and Toxicology, RWTH Aachen University, Aachen, Germany
| | - Ulrich H. Thome
- Center for Pediatric Research Leipzig, Hospital for Children & Adolescents, Division of Neonatology, University of Leipzig, Leipzig, Germany
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16
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Mercier JC, Droz N, Bourgade C, Vizeneux A, Cotillon M, de Groc T. [Specificities of prescribing medicines for children]. Soins Pediatr Pueric 2016; 37:12-16. [PMID: 27177480 DOI: 10.1016/j.spp.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The vast majority of medicines have been developed for adults. Consequently, the prescribing of medicines for children must take into account their pharmacodynamic characteristics and must be calculated individually according to the degree of prematurity, the age, the weight or body area and the clinical condition. Medication errors are the most common type of medical errors, notably in children, due to dosage errors or prescribtion of inappropriate medicines. The best way to avoid them lies in the use of prescribing software, the involvement of pharmacists in care units, and proper communication between prescribing doctors, caregivers, pharmacists and families.
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Affiliation(s)
- Jean-Christophe Mercier
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France; Université Paris Diderot, 5 rue Thomas-Mann, 75013 Paris, France.
| | - Nina Droz
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
| | - Clara Bourgade
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
| | - Audrey Vizeneux
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
| | - Marie Cotillon
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
| | - Thibault de Groc
- Service de pédiatrie générale et urgences, hôpital Louis-Mourier, AP-HP, 178 rue des Renouillers, 92700 Colombes, France
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17
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Berthe-Aucejo A, Girard D, Lorrot M, Bellettre X, Faye A, Mercier JC, Brion F, Bourdon O, Prot-Labarthe S. Evaluation of frequency of paediatric oral liquid medication dosing errors by caregivers: amoxicillin and josamycin. Arch Dis Child 2016; 101:359-64. [PMID: 26729746 DOI: 10.1136/archdischild-2015-309426] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/01/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study reconstitution and preparation dosing errors of liquid oral medications given by caregivers to children. METHODS A prospective observational study was carried out in the departments of general paediatrics and emergency paediatrics at the Robert-Debré Children's University Hospital. An interview with caregivers involved (1) practical reconstitution and preparation of an oral liquid medication from a prescription drawn at random (amoxicillin (Clamoxyl, dosing spoon) or josamycin (Josacine, dose-weight pipette)) and (2) a questionnaire about their use. RESULTS One hundred caregivers were included. Clamoxyl and Josacine were incorrectly reconstituted in 46% (23/50) and 56% (28/50) of cases, respectively, with a risk of underdosing of Clamoxyl (16/23) and overdosing of Josacine (23/28). Dose preparation with the dosing spoon was incorrect in 56% of cases, and in 10% of cases with the dose-weight pipette. Female sex, native French speaker, and age were significantly associated with correct reconstitution. Male sex and medication were significantly associated with correct preparation. CONCLUSIONS This study highlights the high incidence of errors made by caregivers in reconstituting and preparing doses of these liquid oral medicines, which are associated with considerable risks of over- and underdosing. Factors associated with these errors have been identified which could help health professionals to optimise their strategy for educating families about the use of liquid oral medications and the need to check that they understand these instructions.
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Affiliation(s)
| | - D Girard
- Unité d'Epidémiologie Clinique, AP-HP Hôpital Robert-Debré, Paris, France Pediatric Pulmonology Research Group, University Children's Hospital, Basel, Switzerland
| | - M Lorrot
- Service de pédiatrie Générale, AP-HP Hôpital Robert-Debré, Paris, France Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - X Bellettre
- Service d'Accueil des Urgences Pédiatriques, AP-HP Hôpital Robert-Debré, Paris, France
| | - A Faye
- Service de pédiatrie Générale, AP-HP Hôpital Robert-Debré, Paris, France Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - J C Mercier
- Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France Service d'Accueil des Urgences Pédiatriques, AP-HP Hôpital Robert-Debré, Paris, France
| | - F Brion
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France Pharmacie clinique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire Educations et Pratiques de Santé, EA 3412, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - O Bourdon
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France Pharmacie clinique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire Educations et Pratiques de Santé, EA 3412, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - S Prot-Labarthe
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France INSERM, U1123, ECEVE, Paris, France
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18
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Hua-Huy T, Duong-Quy S, Pham H, Pansiot J, Mercier JC, Baud O, Dinh-Xuan AT. Inhaled nitric oxide decreases pulmonary endothelial nitric oxide synthase expression and activity in normal newborn rat lungs. ERJ Open Res 2016; 2:00060-2015. [PMID: 27730173 PMCID: PMC5005156 DOI: 10.1183/23120541.00060-2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/16/2015] [Indexed: 12/02/2022] Open
Abstract
Inhaled nitric oxide (iNO) is commonly used in the treatment of very ill pre-term newborns. Previous studies showed that exogenous NO could affect endothelial NO synthase (eNOS) activity and expression in vascular endothelial cell cultures or adult rat models, but this has never been fully described in newborn rat lungs. We therefore aimed to assess the effects of iNO on eNOS expression and activity in newborn rats. Rat pups, post-natal day (P) 0 to P7, and their dams were placed in a chamber containing NO at 5 ppm (iNO-5 ppm group) or 20 ppm (iNO-20 ppm group), or in room air (control group). Rat pups were sacrificed at P7 and P14 for evaluation of lung eNOS expression and activity. At P7, eNOS protein expression in total lung lysates, in bronchial and arterial sections, was significantly decreased in the iNO-20 ppm versus control group. At P14, eNOS expression was comparable among all three groups. The amounts of eNOS mRNA significantly differed at P7 between the iNO-20 ppm and control groups. NOS activity decreased in the iNO-20 ppm group at P7 and returned to normal levels at P14. There was an imbalance between superoxide dismutase and NOS activities in the iNO-20 ppm group at P7. Inhalation of NO at 20 ppm early after birth decreases eNOS gene transcription, protein expression and enzyme activity. This decrease might account for the rebound phenomenon observed in patients treated with iNO. Inhaled NO decreases endogenous NO synthesis and favours rebound pulmonary hypertension after inhaled NO withdrawalhttp://ow.ly/WNDq2
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Affiliation(s)
- Thông Hua-Huy
- Laboratoire de Physiologie respiratoire EA-2511, Université Paris Descartes, Service de Physiologie-Explorations fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Sy Duong-Quy
- Laboratoire de Physiologie respiratoire EA-2511, Université Paris Descartes, Service de Physiologie-Explorations fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Hoa Pham
- INSERM, UMR1141, Université Paris Diderot, Paris, France
| | - Julien Pansiot
- INSERM, UMR1141, Université Paris Diderot, Paris, France
| | - Jean-Christophe Mercier
- Service des Urgences Pédiatriques, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - Olivier Baud
- INSERM, UMR1141, Université Paris Diderot, Paris, France; Réanimation et pédiatrie néonatales, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - Anh Tuan Dinh-Xuan
- Laboratoire de Physiologie respiratoire EA-2511, Université Paris Descartes, Service de Physiologie-Explorations fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
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19
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Dornbusch HJ, Stiris T, Del Torso S, Ross-Russell R, Zavrsnik J, Wettergren B, Mercier JC, Valiulis A, Hadjipanayis A. Human papillomavirus vaccination crisis in Japan. J Paediatr Child Health 2015; 51:1146-7. [PMID: 26633608 DOI: 10.1111/jpc.13020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/30/2022]
Abstract
The European Academy of Paediatrics (EAP) is gravely concerned about the human papillomavirus (HPV) vaccination crisis in Japan and particularly about the negative position taken by governmental authorities. Given that the HPV vaccine is both safe and effective, there is no recognizable reason to date to withhold this lifesaving and cost effective public health measure from a population. Therefore, the EAP strongly encourages the Japanese health authorities to actively support HPV vaccination for the future health of their children and adolescents.
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Affiliation(s)
| | - Tom Stiris
- European Academy of Paediatrics, Brussels, Belgium
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20
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Affiliation(s)
- Tom Stiris
- European Academy of Paediatrics, Brussels, Belgium
| | | | | | - Shimon Barak
- European Academy of Paediatrics, Brussels, Belgium
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21
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Mercier JC, Bellettre X, Lejay É, Desmarest M, Titomanlio L. [Paediatric emergencies; example of the management of winter epidemics]. Rev Prat 2015; 65:47-50. [PMID: 25842428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Every year, epidemics of viral bronchiolitis and gastroenteritis occur with a significant increase in the number of visits (by a factor 1.8) and hospitalisations that can over-exceed bed capacity leading to transfer sick children to other hospitals. This kind of hospital 'crisis' is not limited to paediatrics, big cities or western nations. It is a worldwide worrying problem. Because our hospital sits in the Northern districts of Paris where a large community of m.ncants lives in poverty, our number of visits is high (mean 250 per day), and winter epidemics further jeopardise the difficult equilibrium achieved between quality management and waiting times. Thus, we have taken various initiatives in terms of organisation of the paediatric emergency department and other wards, including a "fast track" clinic, the opening of beds dedicated to winter epidemics, the institution of a "bed manager" in order to more easily find a bed, and a larger use of home hospitalisations. Furthermore, we created a specific committee which may decide on various indicators of tension whether it is necessary to cancel programmed hospitalisations or surgery.in order to resolve the emergency crisis. This kind of organisation can serve as a model for other hospitals facing winter epidemics crises.
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22
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Corcostegui SP, Azoun MB, Morin L, Mercier JC. [Borrelia-associated lymphocytoma cutis]. Rev Prat 2014; 64:310. [PMID: 24851357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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23
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Pham H, Vottier G, Pansiot J, Duong-Quy S, Bollen B, Dalous J, Gallego J, Mercier JC, Dinh-Xuan AT, Bonnin P, Charriaut-Marlangue C, Baud O. Inhaled NO prevents hyperoxia-induced white matter damage in neonatal rats. Exp Neurol 2013; 252:114-23. [PMID: 24322053 DOI: 10.1016/j.expneurol.2013.11.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/23/2013] [Accepted: 11/26/2013] [Indexed: 11/17/2022]
Abstract
White matter damage (WMD) and bronchopulmonary dysplasia (BPD) are the two main complications occurring in very preterm infants. Inhaled nitric oxide (iNO) has been proposed to promote alveolarization in the developing lung, and we have reported that iNO promotes myelination and induces neuroprotection in neonatal rats with excitotoxic brain damage. Our hypothesis is that, in addition to its pulmonary effects, iNO may be neuroprotective in rat pups exposed to hyperoxia. To test this hypothesis, we exposed rat pups to hyperoxia, and we assessed the impact of iNO on WMD and BPD. Rat pups were exposed to either hyperoxia (80% FiO2) or to normoxia for 8 days. Both groups received iNO (5 ppm) or air. We assessed the neurological and pulmonary effects of iNO in hyperoxia-injured rat pups using histological, molecular and behavioral approaches. iNO significantly attenuated the severity of hyperoxia-induced WMD induced in neonatal rats. Specifically, iNO decreased white matter inflammation, cell death, and enhanced the density of proliferating oligodendrocytes and oligodendroglial maturation. Furthermore, iNO triggered an early upregulation of P27kip1 and brain-derived growth factor (BDNF). Whereas hyperoxia disrupted early associative abilities, iNO treatment maintained learning scores to a level similar to that of control pups. In contrast to its marked neuroprotective effects, iNO induced only small and transient improvements of BPD. These findings suggest that iNO exposure at low doses is specifically neuroprotective in an animal model combining injuries of the developing lung and brain that mimicked BPD and WMD in preterm infants.
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Affiliation(s)
- Hoa Pham
- INSERM, UMR 676, 75019 Paris, France; Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; PremUP foundation, 75014 Paris, France
| | - Gaelle Vottier
- INSERM, UMR 676, 75019 Paris, France; Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; PremUP foundation, 75014 Paris, France
| | - Julien Pansiot
- INSERM, UMR 676, 75019 Paris, France; Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; PremUP foundation, 75014 Paris, France
| | - Sy Duong-Quy
- Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Hôpital Cochin, Service de Physiologie, 75014 Paris, France
| | - Bieke Bollen
- INSERM, UMR 676, 75019 Paris, France; Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; PremUP foundation, 75014 Paris, France; University of Leuven, Laboratory of Biological Psychology, Leuven, Belgium
| | - Jérémie Dalous
- INSERM, UMR 676, 75019 Paris, France; Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; PremUP foundation, 75014 Paris, France
| | - Jorge Gallego
- INSERM, UMR 676, 75019 Paris, France; Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; PremUP foundation, 75014 Paris, France
| | - Jean-Christophe Mercier
- Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Robert Debré, Pediatric emergency department, 75019 Paris, France
| | - Anh Tuan Dinh-Xuan
- Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Hôpital Cochin, Service de Physiologie, 75014 Paris, France
| | - Philippe Bonnin
- Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; INSERM, UMR 965, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Lariboisière, Physiologie Clinique-Explorations Fonctionnelles, 75010 Paris, France
| | - Christiane Charriaut-Marlangue
- INSERM, UMR 676, 75019 Paris, France; Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; PremUP foundation, 75014 Paris, France
| | - Olivier Baud
- INSERM, UMR 676, 75019 Paris, France; Université Paris Diderot, UFR de médecine Denis Diderot, Sorbonne Paris Cité, 75010 Paris, France; PremUP foundation, 75014 Paris, France; Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Hôpital Robert Debré, Neonatal intensive care unit, 75019 Paris, France.
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Angoulvant F, Rouault A, Prot-Labarthe S, Boizeau P, Skurnik D, Morin L, Mercier JC, Alberti C, Bourdon O. Randomized controlled trial of parent therapeutic education on antibiotics to improve parent satisfaction and attitudes in a pediatric emergency department. PLoS One 2013; 8:e75590. [PMID: 24086581 PMCID: PMC3784452 DOI: 10.1371/journal.pone.0075590] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate therapeutic education delivered in a pediatric emergency department to improve parents' satisfaction and attitudes about judicious antibiotic use. METHODS In an emergency department of a tertiary pediatric hospital, children aged 1 month to 6 years and discharged with an oral antibiotic prescription for an acute respiratory or urinary tract infection were randomized to a patient therapeutic education on antibiotic use (intervention group) or fever control (control group) delivered to the parents (in the presence of the children) by a pharmacist trained in therapeutic education. Education consisted in a 30-minute face-to-face session with four components: educational diagnosis, educational contract, education, and evaluation. The main outcome measure was parent satisfaction about information on antibiotics received at the hospital, as assessed by a telephone interview on day 14. The secondary outcome was attitudes about antibiotic use evaluated on day 14 and at month 6. RESULTS Of the 300 randomized children, 150 per arm, 259 were evaluated on day 14. Parent satisfaction with information on antibiotics was higher in the intervention group (125/129, 96.9%, versus 108/130, 83.0%; P=0.002, exact Fisher test). INTERVENTION Group parents had higher proportions of correct answers on day 14 to questions on attitudes about judicious antibiotic use than did control-group parents (P=0.017, Mann-Whitney U test). CONCLUSION Therapeutic education delivered by a clinical pharmacist in the pediatric emergency department holds promise for improving the use of antibiotics prescribed to pediatric outpatients. TRIAL REGISTRATION ClinicalTrials.gov NCT00948779 http://clinicaltrials.gov/show/NCT00948779.
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Affiliation(s)
- François Angoulvant
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Service d’Accueil des Urgences Pédiatriques, Paris, France
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Unité d’Épidémiologie Clinique INSERM CIE5, Paris, France
- * E-mail:
| | - Anne Rouault
- AP-HP, Hôpital Robert Debré, Faculté de Pharmacie, Université Paris Descartes, Département de Pharmacie, Paris, France
- Université Paris 13-Bobigny, Sorbonne Paris Cité. Laboratoire de Pédagogie de la Santé EA 3412, Paris, France
| | - Sonia Prot-Labarthe
- AP-HP, Hôpital Robert Debré, Faculté de Pharmacie, Université Paris Descartes, Département de Pharmacie, Paris, France
| | - Priscilla Boizeau
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Unité d’Épidémiologie Clinique INSERM CIE5, Paris, France
| | - David Skurnik
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Laurence Morin
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Service d’Accueil des Urgences Pédiatriques, Paris, France
| | - Jean-Christophe Mercier
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Service d’Accueil des Urgences Pédiatriques, Paris, France
| | - Corinne Alberti
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Unité d’Épidémiologie Clinique INSERM CIE5, Paris, France
| | - Olivier Bourdon
- AP-HP, Hôpital Robert Debré, Faculté de Pharmacie, Université Paris Descartes, Département de Pharmacie, Paris, France
- Université Paris 13-Bobigny, Sorbonne Paris Cité. Laboratoire de Pédagogie de la Santé EA 3412, Paris, France
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Durrmeyer X, Hummler H, Sanchez-Luna M, Carnielli VP, Field D, Greenough A, Van Overmeire B, Jonsson B, Hallman M, Mercier JC, Marlow N, Johnson S, Baldassarre J. Two-year outcomes of a randomized controlled trial of inhaled nitric oxide in premature infants. Pediatrics 2013; 132:e695-703. [PMID: 23940237 DOI: 10.1542/peds.2013-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The European Union Nitric Oxide trial was designed to assess the potential benefits of inhaled nitric oxide (iNO) compared with placebo in infants with respiratory failure. This follow-up study evaluated respiratory, neurodevelopmental, and other outcomes for infants entered into the European Union Nitric Oxide trial to age 2 years. METHODS In a multicenter, randomized, double-blind study, preterm infants born at <29 weeks' gestation with moderate respiratory failure were allocated to receive iNO (5 ppm) or placebo for 7 to 21 days. Subjects underwent assessments at 1 and 2 years corrected for prematurity. RESULTS At 36 weeks' postmenstrual age, 696 of 792 infants were alive; 4 in the iNO arm subsequently died before age 2 years compared with 7 in the control arm. We evaluated 95% of the survivors at 12 months and 90% at 2 years. In the iNO arm, 244 of 363 (67.2%) infants had survived without disability at age 2 years compared with 270 of 374 (72.2%) who received placebo (P = .094). Mean (SD) cognitive composite scores (Bayley Scales of Infant and Toddler Development, third edition) were 94 (13) in the iNO group and 95 (14) in the placebo group; in the iNO group, 19% scored <85 and 9.5% developed cerebral palsy compared with 13.3% and 9%, respectively. There were no significant differences in hospitalizations overall or due to respiratory illness in use of home oxygen therapy or respiratory medications, in growth, or in other health outcomes. CONCLUSIONS At 2 years of age, low-dose (5 ppm) iNO started early (<24 hours after birth) for a median of 20 days did not affect neurodevelopmental or other health outcomes.
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Affiliation(s)
- Xavier Durrmeyer
- Department of Neonatology, CRC, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
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Romanello S, Spiri D, Marcuzzi E, Zanin A, Boizeau P, Riviere S, Vizeneux A, Moretti R, Carbajal R, Mercier JC, Wood C, Zuccotti GV, Crichiutti G, Alberti C, Titomanlio L. Association between childhood migraine and history of infantile colic. JAMA 2013; 309:1607-12. [PMID: 23592105 DOI: 10.1001/jama.2013.747] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Infantile colic is a common cause of inconsolable crying during the first months of life and has been thought to be a pain syndrome. Migraine is a common cause of headache pain in childhood. Whether there is an association between these 2 types of pain in unknown. OBJECTIVE To investigate a possible association between infantile colic and migraines in childhood. DESIGN, SETTING, AND PARTICIPANTS A case-control study of 208 consecutive children aged 6 to 18 years presenting to the emergency department and diagnosed as having migraines in 3 European tertiary care hospitals between April 2012 and June 2012. The control group was composed of 471 children in the same age range who visited the emergency department of each participating center for minor trauma during the same period. A structured questionnaire identified personal history of infantile colic for case and control participants, confirmed by health booklets. A second study of 120 children diagnosed with tension-type headaches was done to test the specificity of the association. MAIN OUTCOMES AND MEASURES Difference in the prevalence of infantile colic between children with and without a diagnosis of migraine. RESULTS Children with migraine were more likely to have experienced infantile colic than those without migraine (72.6% vs 26.5%; odds ratio [OR], 6.61 [95% CI, 4.38-10.00]; P < .001), either migraine without aura (n = 142; 73.9% vs 26.5%; OR, 7.01 [95% CI, 4.43-11.09]; P < .001), or migraine with aura (n = 66; 69.7% vs 26.5%; OR, 5.73 [95% CI, 3.07-10.73]; P < .001). This association was not found for children with tension-type headache (35% vs 26.5%; OR, 1.46 [95% CI, 0.92-2.32]; P = .10). CONCLUSION AND RELEVANCE The presence of migraine in children and adolescents aged 6 to 18 years was associated with a history of infantile colic. Additional longitudinal studies are required.
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Affiliation(s)
- Silvia Romanello
- Department of Pediatric Emergency Care, APHP-Hospital Robert Debré, Paris, France
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Balossini V, Zanin A, Alberti C, Freund Y, Decobert M, Tarantino A, La Rocca M, Lacroix L, Spiri D, Lejay E, Armoogum P, Wood C, Gervaix A, Zuccotti GV, Perilongo G, Bona G, Mercier JC, Titomanlio L. Triage of children with headache at the ED: a guideline implementation study. Am J Emerg Med 2013; 31:670-5. [DOI: 10.1016/j.ajem.2012.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/21/2012] [Accepted: 11/23/2012] [Indexed: 12/01/2022] Open
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Mercier JC, Grosclaude F, Martin P. La caséine κ et la famille multigénique des trois caseïnes "sensibles au calcium" : Polymorphisme, biosynthèse et évolution. ACTA ACUST UNITED AC 2013. [DOI: 10.4267/10608/4354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Levéziel H, Méténier L, Mahé MF, Choplain J, Furet JP, Pabœuf G, Mercier JC, Grosclaude F. Identification of the two common alleles of the bovine κ-casein locus by the RFLP technique, using the enzyme Hind III. ACTA ACUST UNITED AC 2012; 20:247-54. [PMID: 22879322 DOI: 10.1186/1297-9686-20-2-247] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Pham H, Vottier G, Pansiot J, Dalous J, Gallego J, Gressens P, Duong-Quy S, Dinh-Xuan AT, Mercier JC, Biran V, Charriaut-Marlangue C, Baud O. Inhaled NO Protects Cerebral White Matter in Neonatal Rats with Combined Brain and Lung Injury. Am J Respir Crit Care Med 2012; 185:897-9. [DOI: 10.1164/ajrccm.185.8.897] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Naudin J, Blondé R, Alberti C, Angoulvant F, De Lauzanne A, Armoogum P, Pull L, Lorrot M, Imbert P, Dauger S, Mercier JC, Faye A. Aetiology and epidemiology of fever in children presenting to the emergency department of a French paediatric tertiary care centre after international travel. Arch Dis Child 2012; 97:107-11. [PMID: 22241918 DOI: 10.1136/archdischild-2011-300175] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE As few data are available on the causes of fever in children returning from international travel, the authors studied children presenting to a French tertiary care centre with fever. METHODS Children presenting to the emergency department of the Robert Debré Paediatric Hospital, Paris, France between July and December 2007 with fever that occurred within 3 months of a stay abroad were included in this retrospective study. RESULTS The children (n=538) had most commonly visited North Africa (NA) (n=214), sub-Saharan Africa (SSA) (n=185) and Europe (n=67). Their median age was 2.8 years (IQR 1.4-5.8). The median time between their return to France and the onset of fever was 5 days (IQR 0-18). Cosmopolitan infections represented 85% of the established diagnoses (97.8% and 63.9% in the children returning from NA and SSA, respectively). Fever of unknown origin accounted for 19.3% of cases. Malaria was the leading tropical infection. Excluding malaria, diarrhoeal diseases were more frequent in the children returning from NA (38.5%) than in those returning from SSA (24.5%). Malaria was associated with stays in endemic countries that exceeded 30 days (OR 3.13, 95% CI 1.02 to 9.59). CONCLUSION Cosmopolitan infections are the leading cause of fever in French children returning from tropical and subtropical areas. However, all febrile children who have returned from an endemic area should be tested for malaria.
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Affiliation(s)
- Jérôme Naudin
- Assistance Publique des Hôpitaux de Paris, Service de Réanimation Pédiatrique, Hôpital Robert Debré, Paris, France
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Askie LM, Ballard RA, Cutter GR, Dani C, Elbourne D, Field D, Hascoet JM, Hibbs AM, Kinsella JP, Mercier JC, Rich W, Schreiber MD, Wongsiridej P(S, Subhedar NV, Van Meurs KP, Voysey M, Barrington K, Ehrenkranz RA, Finer NN. Inhaled nitric oxide in preterm infants: an individual-patient data meta-analysis of randomized trials. Pediatrics 2011; 128:729-39. [PMID: 21930540 PMCID: PMC3387905 DOI: 10.1542/peds.2010-2725] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Inhaled nitric oxide (iNO) is an effective therapy for pulmonary hypertension and hypoxic respiratory failure in term infants. Fourteen randomized controlled trials (n = 3430 infants) have been conducted on preterm infants at risk for chronic lung disease (CLD). The study results seem contradictory. DESIGN/METHODS Individual-patient data meta-analysis included randomized controlled trials of preterm infants (<37 weeks' gestation). Outcomes were adjusted for trial differences and correlation between siblings. RESULTS Data from 3298 infants in 12 trials (96%) were analyzed. There was no statistically significant effect of iNO on death or CLD (59% vs 61%: relative risk [RR]: 0.96 [95% confidence interval (CI): 0.92-1.01]; P = .11) or severe neurologic events on imaging (25% vs 23%: RR: 1.12 [95% CI: 0.98-1.28]; P = .09). There were no statistically significant differences in iNO effect according to any of the patient-level characteristics tested. In trials that used a starting iNO dose of >5 vs ≤ 5 ppm there was evidence of improved outcome (interaction P = .02); however, these differences were not observed at other levels of exposure to iNO. This result was driven primarily by 1 trial, which also differed according to overall dose, duration, timing, and indication for treatment; a significant reduction in death or CLD (RR: 0.85 [95% CI: 0.74-0.98]) was found. CONCLUSIONS Routine use of iNO for treatment of respiratory failure in preterm infants cannot be recommended. The use of a higher starting dose might be associated with improved outcome, but because there were differences in the designs of these trials, it requires further examination.
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Affiliation(s)
- Lisa M. Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Roberta A. Ballard
- Department of Pediatrics, University of California at San Francisco, School of Medicine, San Francisco, California
| | - Gary R. Cutter
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carlo Dani
- Section of Neonatology, Department of Surgical and Medical Critical Care, Careggi University Hospital of Florence, Florence, Italy
| | - Diana Elbourne
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Field
- Department of Health Science, University of Leicester, Leicester, United Kingdom
| | | | - Anna Maria Hibbs
- Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - John P. Kinsella
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado
| | - Jean-Christophe Mercier
- Department of Pediatric Emergency Medicine, Hôpital Robert Debré, Université Paris-7 Denis Diderot, Paris, France
| | - Wade Rich
- Division of Neonatology, University of California, San Diego, California
| | | | - Pimol (Srisuparp) Wongsiridej
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nim V. Subhedar
- Neonatal Unit, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Krisa P. Van Meurs
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Salter Packard Children's Hospital, Palo Alto, California
| | - Merryn Voysey
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Keith Barrington
- Division of Neonatology, Centre Hospitalier Universitaire Ste-Justine, Montreal, Quebec, Canada; and
| | - Richard A. Ehrenkranz
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Neil N. Finer
- Division of Neonatology, University of California, San Diego, California
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Angoulvant F, Bellettre X, Houhou N, Dexpert JB, Morin L, Siriez JY, Soole F, de Lauzanne A, Cohen R, Brun-Vezinet F, Alberti C, Mercier JC. Sensitivity and specificity of a rapid influenza diagnostic test in children and clinical utility during influenza A (H1N1) 2009 outbreak. Emerg Med J 2010; 28:924-6. [PMID: 20943835 DOI: 10.1136/emj.2010.098533] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The influenza A (H1N1) 2009 outbreak caused death and a disruption of public health services. Rapid influenza diagnostic tests (RIDT) could be helpful to ease the triage of patients and prevent an overload of emergency and laboratory facilities. OBJECTIVES To compare the sensitivity and specificity of the Clearview Exact Influenza A&B test and real-time reverse transcription(RT)-PCR to detect influenza A (H1N1) 2009 in a paediatric emergency department of a paediatric teaching hospital in Paris, France. METHODS 76 children with an influenza-like illness and either severe symptoms or an underlying medical condition were prospectively recruited between July 2009 and October 2009. RIDT and RT-PCR were simultaneously performed and compared. RESULTS Among 39 influenza A (H1N1) 2009 RT-PCR-positive children (median age 5 years), 23 Clearview Exact Influenza A&B tests were positive. Sensitivity was 59% (95% CI 42.2 to 74) and specificity was 94.6% (95% CI 80.5 to 99.1). CONCLUSIONS This study shows a sensitivity of RIDT of 59%, in agreement with other prospective studies, which could be useful in clinical practice for diagnosis influenza A (H1N1) 2009 in children. In outbreaks of a high prevalence, such as the 2009 outbreak, this test can help to prevent an overload of public health services.
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Affiliation(s)
- F Angoulvant
- AP-HP, Hôpital Robert Debré, Pôle de Pèdiatrie Aiguë et Mèdecine Interne, Serviced’Accueil des Urgences Pèdiatriques, Universitè Diderot-Paris 7, Paris, France.
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Pernet J, Billiaux A, Auvin S, Rakatovao D, Morin L, Presedo A, Mercier JC, Titomanlio L. Early onset toe-walking in toddlers: a cause for concern? J Pediatr 2010; 157:496-8. [PMID: 20727441 DOI: 10.1016/j.jpeds.2010.04.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 02/26/2010] [Accepted: 04/28/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Julie Pernet
- Department of Pediatric Emergency Care, APHP-University Hospital R. Debré, Paris, France
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Mercier JC, Hummler H, Durrmeyer X, Sanchez-Luna M, Carnielli V, Field D, Greenough A, Van Overmeire B, Jonsson B, Hallman M, Baldassarre J. Inhaled nitric oxide for prevention of bronchopulmonary dysplasia in premature babies (EUNO): a randomised controlled trial. Lancet 2010; 376:346-54. [PMID: 20655106 DOI: 10.1016/s0140-6736(10)60664-2] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND In animal models, inhaled nitric oxide improved gas exchange and lung structural development, but its use in premature infants at risk of developing bronchopulmonary dysplasia remains controversial. We therefore tested the hypothesis that inhaled nitric oxide at a low concentration, started early and maintained for an extended period in babies with mild respiratory failure, might reduce the incidence of bronchopulmonary dysplasia. METHODS 800 preterm infants with a gestational age at birth of between 24 weeks and 28 weeks plus 6 days (inclusive), weighing at least 500 g, requiring surfactant or continuous positive airway pressure for respiratory distress syndrome within 24 h of birth were randomly assigned in a one-to-one ratio to inhaled nitric oxide (5 parts per million) or placebo gas (nitrogen gas) for a minimum of 7 days and a maximum of 21 days in a double-blind study done at 36 centres in nine countries in the European Union. Care providers and investigators were masked to the computer-generated treatment assignment. The primary outcome was survival without development of bronchopulmonary dysplasia at postmenstrual age 36 weeks. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00551642. FINDINGS 399 infants were assigned to inhaled nitric oxide, and 401 to placebo. 395 and 400, respectively, were analysed. Treatment with inhaled nitric oxide and placebo did not result in significant differences in survival of infants without development of bronchopulmonary dysplasia (258 [65%] of 395 vs 262 [66%] of 400, respectively; relative risk 1.05, 95% CI 0.78-1.43); in survival at 36 weeks' postmenstrual age (343 [86%) of 399 vs 359 [90%] of 401, respectively; 0.74, 0.48-1.15); and in development of bronchopulmonary dysplasia (81 [24%] of 339 vs 96 [27%] of 358, respectively; 0.83, 0.58-1.17). INTERPRETATION Early use of low-dose inhaled nitric oxide in very premature babies did not improve survival without bronchopulmonary dysplasia or brain injury, suggesting that such a preventive treatment strategy is unsuccessful. FUNDING INO Therapeutics.
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Affiliation(s)
- Jean-Christophe Mercier
- Assistance Publique-Hôpitaux de Paris, Université Paris-7 Denis Diderot, Hôpital Robert Debré, Paris, France.
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Pansiot J, Loron G, Olivier P, Fontaine R, Charriaut-Marlangue C, Mercier JC, Gressens P, Baud O. Neuroprotective effect of inhaled nitric oxide on excitotoxic-induced brain damage in neonatal rat. PLoS One 2010; 5:e10916. [PMID: 20532231 PMCID: PMC2879374 DOI: 10.1371/journal.pone.0010916] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 05/07/2010] [Indexed: 11/18/2022] Open
Abstract
Background Inhaled nitric oxide (iNO) is one of the most promising therapies used in neonates. However, little information is known about its impact on the developing brain submitted to excitotoxic challenge. Methodology/Principal Findings We investigated here the effect of iNO in a neonatal model of excitotoxic brain lesions. Rat pups and their dams were placed in a chamber containing 20 ppm NO during the first week of life. At postnatal day (P)5, rat pups were submitted to intracranial injection of glutamate agonists. At P10, rat pups exposed to iNO exhibited a significant decrease of lesion size in both the white matter and cortical plate compared to controls. Microglia activation and astrogliosis were found significantly decreased in NO-exposed animals. This neuroprotective effect was associated with a significant decrease of several glutamate receptor subunits expression at P5. iNO was associated with an early (P1) downregulation of pCREB/pAkt expression and induced an increase in pAkt protein concentration in response to excitotoxic challenge (P7). Conclusion This study is the first describe and investigate the neuroprotective effect of iNO in neonatal excitotoxic-induced brain damage. This effect may be mediated through CREB pathway and subsequent modulation of glutamate receptor subunits expression.
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Affiliation(s)
- Julien Pansiot
- INSERM, Hôpital Robert Debré, Paris, France
- INSERM, UMR 676, Hôpital Robert Debré, Paris, France
| | - Gauthier Loron
- INSERM, Hôpital Robert Debré, Paris, France
- INSERM, UMR 676, Hôpital Robert Debré, Paris, France
| | - Paul Olivier
- INSERM, Hôpital Robert Debré, Paris, France
- INSERM, UMR 676, Hôpital Robert Debré, Paris, France
| | - Romain Fontaine
- INSERM UMR 711, Université Pierre et Marie Curie, Faculté de Médecine, Hôpital de la Salpêtrière, Paris, France
| | | | | | - Pierre Gressens
- INSERM, UMR 676, Hôpital Robert Debré, Paris, France
- APHP, Neonatal Intensive Care Unit, Hôpital Robert Debré, Paris, France
| | - Olivier Baud
- INSERM, Hôpital Robert Debré, Paris, France
- INSERM, UMR 676, Hôpital Robert Debré, Paris, France
- APHP, Neonatal Intensive Care Unit, Hôpital Robert Debré, Paris, France
- PremUP Foundation, Paris, France
- * E-mail:
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Askie LM, Ballard RA, Cutter G, Dani C, Elbourne D, Field D, Hascoet JM, Hibbs AM, Kinsella JP, Mercier JC, Rich W, Schreiber MD, Srisuparp P, Subhedar NV, Van Meurs KP, Voysey M, Barrington K, Ehrenkranz RA, Finer N. Inhaled nitric oxide in preterm infants: a systematic review and individual patient data meta-analysis. BMC Pediatr 2010; 10:15. [PMID: 20331899 PMCID: PMC2860486 DOI: 10.1186/1471-2431-10-15] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 03/23/2010] [Indexed: 11/23/2022] Open
Abstract
Background Preterm infants requiring assisted ventilation are at significant risk of both pulmonary and cerebral injury. Inhaled Nitric Oxide, an effective therapy for pulmonary hypertension and hypoxic respiratory failure in the full term infant, has also been studied in preterm infants. The most recent Cochrane review of preterm infants includes 11 studies and 3,370 participants. The results show a statistically significant reduction in the combined outcome of death or chronic lung disease (CLD) in two studies with routine use of iNO in intubated preterm infants. However, uncertainty remains as a larger study (Kinsella 2006) showed no significant benefit for iNO for this combined outcome. Also, trials that included very ill infants do not demonstrate significant benefit. One trial of iNO treatment at a later postnatal age reported a decrease in the incidence of CLD. The aim of this individual patient meta-analysis is to confirm or refute these potentially conflicting results and to determine the extent to which patient or treatment characteristics may explain the results and/or may predict benefit from inhaled Nitric Oxide in preterm infants. Methods/Design The Meta-Analysis of Preterm Patients on inhaled Nitric Oxide (MAPPiNO) Collaboration will perform an individual patient data meta-analysis to answer these important clinical questions. Studies will be included if preterm infants receiving assisted ventilation are randomized to receive inhaled Nitric Oxide or to a control group. The individual patient data provided by the Collaborators will be analyzed on an intention-to-treat basis where possible. Binary outcomes will be analyzed using log-binomial regression models and continuous outcomes will be analyzed using linear fixed effects models. Adjustments for trial differences will be made by including the trial variable in the model specification. Discussion Thirteen (13) trials, with a total of 3567 infants are eligible for inclusion in the MAPPiNO systematic review. To date 11 trials (n = 3298, 92% of available patients) have agreed to participate. Funding was successfully granted from Ikaria Inc as an unrestricted grant. A collaborative group was formed in 2006 with data collection commencing in 2007. It is anticipated that data analysis will commence in late 2009 with results being publicly available in 2010.
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Affiliation(s)
- Lisa M Askie
- NHMRC Clinical Trials Centre, University of Sydney, Australia.
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Mercier JC. [Obstructions in pediatric emergencies and demand for an increase of nurses]. Soins Pediatr Pueric 2010:16-17. [PMID: 20225589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Hummler HD, Hallman M, Jonsson B, Sanchez-Luna M, Carnielli V, Mercier JC. The EU Nitric Oxide Trial: Inhaled Nitric Oxide for the Prevention of Bronchopulmonary Dysplasia in Preterm Infants. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Callegaro S, Titomanlio L, Donegà S, Tagliaferro T, Andreola B, Gibertini GG, Park SY, Smail A, Mercier JC, Da Dalt L. Implementation of a febrile seizure guideline in two pediatric emergency departments. Pediatr Neurol 2009; 40:78-83. [PMID: 19135618 DOI: 10.1016/j.pediatrneurol.2008.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 08/01/2008] [Accepted: 09/05/2008] [Indexed: 11/28/2022]
Abstract
Despite the typically benign nature of febrile seizures, a large number of children with simple febrile seizures are overinvestigated and overtreated, according to the personal clinical experience of the treating doctors. The study objective was to analyze the effect of implementing an evidence-based medicine guideline on the management of febrile seizures in two European pediatric emergency departments. After introduction of a selected guideline, we analyzed the change in hospitalization rate and in the rate of execution of blood exams in children presenting with febrile seizures. Included in the study were 483 children. Clinical characteristics of seizures were similar both before and after implementation. Clinical management was modified after guideline introduction, because the hospitalization rate significantly decreased (respectively, from 57.3% to 20.5%, and from 16.9% to 3.2%), without any concomitant increase in readmission rate. Readmission cases were never due to severe bacterial infections. The proportion of patients who received blood examinations decreased significantly. We conclude that in both of the Emergency Departments studied, introduction of a guideline on febrile seizure positively modified clinical management. The availability of a guideline contributed to accelerating the process of improving welfare and positively influenced the quality of care.
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Affiliation(s)
- Silvia Callegaro
- Pediatric Emergency Department, Department of Pediatrics, University of Padova, Italy
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de Buys Roessingh AS, de Lagausie P, Ebrahimian T, Duong-Quy S, Schneider JC, Huang XL, Mercier JC, Aigrain Y, Boulanger C, Dinh-Xuan AT. Neuronal nitric oxide synthase does not contribute to the modulation of pulmonary vascular tone in fetal lambs with congenital diaphragmatic hernia (nNOS in CDH lambs). Pediatr Pulmonol 2008; 43:313-21. [PMID: 18306337 DOI: 10.1002/ppul.20796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM The aim of this study was to determine the presence of the neuronal nitric oxide synthase (nNOS) in near full-term lambs with congenital diaphragmatic hernia (CDH) and its role in the modulation of pulmonary vascular basal tone. METHODS We surgically created diaphragmatic hernia on the 85th day of gestation. On the 135th, catheters were used to measure pulmonary pressure and blood flow. We tested the effects of 7-nitroindazole (7-NINA), a specific nNOS antagonist and of N-nitro-L-arginine (L-NNA), a nonspecific nitric oxide synthase antagonist. In vitro, we tested the effects of the same drugs on isolated pulmonary vessels. The presence of nNOS protein in the lungs was detected by Western blot analysis. RESULTS Neither 7-NINA nor L-NNA modified pulmonary vascular basal tone in vivo. After L-NNA injection, acetylcholine (ACh) did not decrease significantly pulmonary vascular resistance (PVR). In vitro, L-NNA increased the cholinergic contractile-response elicited by electric field stimulation (EFS) of vascular rings from lambs with diaphragmatic hernia. CONCLUSION We conclude that nNOS protein is present in the lungs and pulmonary artery of near full-term lamb fetuses with diaphragmatic hernia, but that it does not contribute to the reduction of pulmonary vascular tone at birth.
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Affiliation(s)
- Anthony S de Buys Roessingh
- Faculté de Médecine, Université Paris Descartes, EA 2511, Assistance Publique Hôpitaux de Paris, Service de Physiologie-Explorations Fonctionnelles, Hôpital Cochin, Paris, France.
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Titomanlio L, Evrard P, Mercier JC. Pediatric strabismus. N Engl J Med 2007; 356:2750; author reply 2750-1. [PMID: 17600905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Titomanlio L, Verloes A, Mercier JC. Case 31-2006: a girl with severe obesity. N Engl J Med 2007; 356:194; author reply 195-6. [PMID: 17215542 DOI: 10.1056/nejmc063066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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de Buys Roessingh AS, de Lagausie P, Barbet JP, Mercier JC, Aigrain Y, Dinh-Xuan AT. Role of ATP-dependent potassium channels in pulmonary vascular tone of fetal lambs with congenital diaphragmatic hernia. Pediatr Res 2006; 60:537-42. [PMID: 16988185 DOI: 10.1203/01.pdr.0000242372.99285.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
High mortality in newborn babies with congenital diaphragmatic hernia (CDH) is principally due to persistent pulmonary hypertension. ATP-dependent potassium (K(ATP)) channels might modulate pulmonary vascular tone. We have assessed the effects of Pinacidil, a K(ATP) channel opener, and glibenclamide (GLI), a K(ATP) channel blocker, in near full-term lambs with and without CDH. In vivo, pulmonary hemodynamics were assessed by means of pressure and blood flow catheters. In vitro, we used isolated pulmonary vessels and immunohistochemistry to detect the presence of K(ATP) channels in pulmonary tissue. In vivo, pinacidil (2 mg) significantly reduced pulmonary vascular resistance (PVR) in both controls and CDH animals. GLI (30 mg) significantly increased pulmonary arterial pressure (PAP) and PVR in control animals only. In vitro, pinacidil (10 microM) relaxed, precontracted arteries from lambs with and without CDH. GLI (10(-5) microM) did not raise the basal tone of vessels. We conclude that activation of K(ATP) channels could be of interest to reduce pulmonary vascular tone in fetal lambs with CDH, a condition often associated with persistent pulmonary hypertension of the newborn.
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Affiliation(s)
- Anthony S de Buys Roessingh
- Department of Pediatric Surgery, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris-Université Paris 7, 75019 Paris, France.
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Devaskar SU, Mercier JC. Pediatric research--a look toward the future. Pediatr Res 2004; 55:179-80. [PMID: 14715918 DOI: 10.1203/01.pdr.0000113554.58853.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Macrae DJ, Field D, Mercier JC, Møller J, Stiris T, Biban P, Cornick P, Goldman A, Göthberg S, Gustafsson LE, Hammer J, Lönnqvist PA, Sanchez-Luna M, Sedin G, Subhedar N. Inhaled nitric oxide therapy in neonates and children: reaching a European consensus. Intensive Care Med 2004; 30:372-80. [PMID: 14722629 DOI: 10.1007/s00134-003-2122-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Accepted: 12/01/2003] [Indexed: 10/26/2022]
Abstract
Inhaled nitric oxide (iNO) was first used in neonatal practice in 1992 and has subsequently been used extensively in the management of neonates and children with cardiorespiratory failure. This paper assesses evidence for the use of iNO in this population as presented to a consensus meeting jointly organised by the European Society of Paediatric and Neonatal Intensive Care, the European Society of Paediatric Research and the European Society of Neonatology. Consensus Guidelines on the Use of iNO in Neonates and Children were produced following discussion of the evidence at the consensus meeting.
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Affiliation(s)
- Duncan J Macrae
- Royal Brompton Hospital, Sydney Street, SW3 6NP London, U.K.
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Schneider JC, El Kebir D, Chéreau C, Lanone S, Huang XL, De Buys Roessingh AS, Mercier JC, Dall'Ava-Santucci J, Dinh-Xuan AT. Involvement of Ca2+/calmodulin-dependent protein kinase II in endothelial NO production and endothelium-dependent relaxation. Am J Physiol Heart Circ Physiol 2003; 284:H2311-9. [PMID: 12560211 DOI: 10.1152/ajpheart.00932.2001] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Nitric oxide (NO) is synthesized from l-arginine by the Ca(2+)/calmodulin-sensitive endothelial NO synthase (NOS) isoform (eNOS). The present study assesses the role of Ca(2+)/calmodulin-dependent protein kinase II (CaMK II) in endothelium-dependent relaxation and NO synthesis. The effects of three CaMK II inhibitors were investigated in endothelium-intact aortic rings of normotensive rats. NO synthesis was assessed by a NO sensor and chemiluminescence in culture medium of cultured porcine aortic endothelial cells stimulated with the Ca(2+) ionophore A23187 and thapsigargin. Rat aortic endothelial NOS activity was measured by the conversion of l-[(3)H]arginine to l-[(3)H]citrulline. Three CaMK II inhibitors, polypeptide 281-302, KN-93, and lavendustin C, attenuated the endothelium-dependent relaxation of endothelium-intact rat aortic rings in response to acetylcholine, A23187, and thapsigargin. None of the CaMK II inhibitors affected the relaxation induced by NO donors. In a porcine aortic endothelial cell line, KN-93 decreased NO synthesis and caused a rightward shift of the concentration-response curves to A23187 and thapsigargin. In rat aortic endothelial cells, KN-93 significantly decreased bradykinin-induced eNOS activity. These results suggest that CaMK II was involved in NO synthesis as a result of Ca(2+)-dependent activation of eNOS.
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Affiliation(s)
- Jean-Christophe Schneider
- Service de Physiologie-Explorations Fonctionnelles, Centre Hospitalier Universitaire Cochin, Assistance Publique, Hôpitaux de Paris, Université Paris 5, France
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