Prévalence de la prise en charge ostéopathique chez les nourrissons de1,3et6mois

Objectif : l'objectif de cette étude est de déterminer le nombre d'enfant de 0 à 6 mois de la population vaudoise ayant eu recours à l'ostéopathie, de caractériser les motivations des parents à consulter un ostéopathe pour leur enfant, d'évaluer le niveau de satisfaction d'une telle prise en charge et d'établir un profil de parents type s'il en existe un. Méthode : La méthodologie utilisée dans cette recherche prospective s'est faite au moyen d'un questionnaire accessible aux parents des sujets d'étude en format papier ou en format numérique disponible en ligne sur internet. La distribution des questionnaires s'est faite par l'intermédiaire de pédiatres installés, de sages-femmes à domicile, de mamans de jour et s'est déroulée sur une période de 3 mois à la fin de l'année 2011. Résultats : 73.3% des sujets sondés disent avoir consulté au moins une fois un ostéopathe pour leur enfant. Dans une grande majorité des cas les causes du recours à l'ostéopathie sont, d'un point de vue strictement médical, des événements fréquents et relativement banaux dans les premiers mois de vie des enfants. Beaucoup de parents consultent un ostéopathe pour effectuer un contrôle « général » de leur enfant, souvent avant même le premier rendez-vous chez leur pédiatre. Ils sont en majorité satisfaits de la manipulation et envisagent de se rendre à nouveau chez ce praticien en cas de besoin ou pour un simple contrôle du développement de leur enfant. Il ressort de cette analyse trois profils de parents : les parents n'ayant pas recours à l'ostéopathe pour leur enfant, les parents ayant recours à cette thérapie occasionnellement et les parents y ayant recours fréquemment. Ces trois profils de parents se définissent uniquement sur l'usage ou non de l'ostéopathie pour l'enfant et de sa fréquence mais ils ne sont pas influencés par les ressources financières des parents et leur propre recours à l'ostéopathie. Conclusion : Cette étude a permis de constater que le nombre de parents ayant recours à l'ostéopathie pour leur nouveau-né est important, en effet 73,3% des sujets ont été manipulé par un ostéopathe au cours de leurs six premiers mois de vie. Le contrôle précoce du nourrisson chez un ostéopathe semble rassurer les parents sur la santé de leur enfant. L'ostéopathe s'impose ainsi comme un référent supplémentaire aux soins du nourrisson, au même titre que le pédiatre.

Dix erreurs a ne pas commettre lors de la prise en charge d'une prothèse articulaire infectée en orthopédie [Ten errors to avoid while dealing with infected total joint arthroplasties].

Infections after total joint arthroplasty are rare but come with severe consequences. Timely, adequate and standardized treatment beginning at the onset of symptoms will have a major impact on the handling of this dreaded complication. In absences of clear guidelines, errors are often committed, with occasionally severe consequences for the patient. In this article, the 10 most frequent errors starting with diagnostics till antibiotic and surgical treatment will be discussed.

Sinusite aiguë: prise en charge en médecine de premier recours [Acute sinusitis]

Les infections des voies aériennes supérieures sont parmi les motifs de consultation les plus fréquents en médecine de premier recours. Lorsque la localisation est principalement rhinosinusienne, la cause est en général virale. Nous passons en revue dans cet article les conditions permettant de suspecter une origine bactérienne avec comme question centrale les critères pour l'instauration d'un traitement antibiotique. La place des examens paracliniques dans la stratégie diagnostique est discutée et en particulier celle de la radiographie standard. Rhino-sinusitis is one of the most complaint in ambulatory clinic sitting and nasal obstruction. This diagnosis is however difficult and general practitioners might overdiagnose acute bacterial sinusitis. Most imaging is not useful in determining sinusitis. Acute sinusitis is very often a self-limiting disease. Antibiotics should be prescribed only after one week of symptoms' duration and in case of the presence of two additional criteria: pain and purulent nasal discharge with nasal obstruction

Full label space reduction in MPLS networks: asymmetric merged tunneling

Traffic Engineering objective is to optimize network resource utilization. Although several works have been published about minimizing network resource utilization in MPLS networks, few of them have been focused in LSR label space reduction. This letter studies Asymmetric Merged Tunneling (AMT) as a new method for reducing the label space in MPLS network. The proposed method may be regarded as a combination of label merging (proposed in the MPLS architecture) and asymmetric tunneling (proposed recently in our previous works). Finally, simulation results are performed by comparing AMT with both ancestors. They show a great improvement in the label space reduction factor

Label Space Reduction in MPLS Networks: How Much Can A Single Stacked Label Do?

Most network operators have considered reducing LSR label spaces (number of labels used) as a way of simplifying management of underlaying virtual private networks (VPNs) and therefore reducing operational expenditure (OPEX). The IETF outlined the label merging feature in MPLS-allowing the configuration of multipoint-to-point connections (MP2P)-as a means of reducing label space in LSRs. We found two main drawbacks in this label space reduction a)it should be separately applied to a set of LSPs with the same egress LSR-which decreases the options for better reductions, and b)LSRs close to the edge of the network experience a greater label space reduction than those close to the core. The later implies that MP2P connections reduce the number of labels asymmetrically

Incontinence urinaire chez la femme: prise en charge en médecine de premier recours [Urinary incontinence in women: management in primary care]

Urinary incontinence in women is a largely under-evaluated problem that affects nearly one out of two adult women. Even thouh its physiopathology is complex and its etiologies are multiple (and often intricate), urodynamic investigations are not considered necessary before starting a conservative therapy, which can be initiated by the primary care physician. Conservative management is based upon lifestyle modifications, specialized physiotherapy, and in certain cases medication. In the case of insufficient response after three months, the patient should be recommended to a specialist who can evaluate the need for a surgical procedure.

Diagnostic et prise en charge de la thrombocytopénie immune primaire

La thrombocytopénie immune primaire (ITP) est une affection auto-immune acquise avec diminution de la survie des plaquettes et perturbation de la production plaquettaire. Il n'existe aucun test clinique simple permettant de prouver la nature auto-immune de l'affection. Pour cette raison, il s'agit presque toujours d'un diagnostic par exclusion d'autres causes. Bien que les plaquettes soient souvent inférieures à 10 x 109/l lors de la présentation initiale, la tendance hémorragique est étonnamment modérée chez la majorité des patients. Le traitement initial fait toujours appel aux corticostéroïdes, combinés à des immunoglobulines intraveineuses et à des transfusions de plaquettes dans les formes compliquées avec hémorragies significatives. Chez l'enfant, la maladie est souvent induite par des infections virales et son évolution est bénigne et spontanément régressive dans la majorité des cas. Chez l'adulte, la maladie est plus souvent persistante ou chroniquement récidivante, et le taux de plaquettes se situe souvent à un taux suffisant pour prévenir des hémorragies spontanées. Seule une faible proportion de patients souffre d'une thrombocytopénie sévère prolongée accompagnée de saignements réguliers avec risque d'hémorragies potentiellement fatales. C'est probablement ce groupe de patients restreint qui tirera surtout profit des nouvelles options thérapeutiques telles que les agonistes du récepteur de la thrombopoïétine. A la lumière de ces nouvelles possibilités, un groupe d'hématologues suisses s'est réuni pour élaborer des directives concernant la prise en charge de l'ITP conformément aux besoins et aux habitudes de notre pays.

Fine-tuning the space, time, and host distribution of mycobacteria in wildlife.

BACKGROUND We describe the diversity of two kinds of mycobacteria isolates, environmental mycobacteria and Mycobacterium bovis collected from wild boar, fallow deer, red deer and cattle in Doñana National Park (DNP, Spain), analyzing their association with temporal, spatial and environmental factors. RESULTS High diversity of environmental mycobacteria species and M. bovis typing patterns (TPs) were found. When assessing the factors underlying the presence of the most common types of both environmental mycobacteria and M. bovis TPs in DNP, we evidenced (i) host species differences in the occurrence, (ii) spatial structuration and (iii) differences in the degree of spatial association of specific types between host species. Co-infection of a single host by two M. bovis TPs occurred in all three wild ungulate species. In wild boar and red deer, isolation of one group of mycobacteria occurred more frequently in individuals not infected by the other group. While only three TPs were detected in wildlife between 1998 and 2003, up to 8 different ones were found during 2006-2007. The opposite was observed in cattle. Belonging to an M. bovis-infected social group was a significant risk factor for mycobacterial infection in red deer and wild boar, but not for fallow deer. M. bovis TPs were usually found closer to water marshland than MOTT. CONCLUSIONS The diversity of mycobacteria described herein is indicative of multiple introduction events and a complex multi-host and multi-pathogen epidemiology in DNP. Significant changes in the mycobacterial isolate community may have taken place, even in a short time period (1998 to 2007). Aspects of host social organization should be taken into account in wildlife epidemiology. Wildlife in DNP is frequently exposed to different species of non-tuberculous, environmental mycobacteria, which could interact with the immune response to pathogenic mycobacteria, although the effects are unknown. This research highlights the suitability of molecular typing for surveys at small spatial and temporal scales.

Niche dynamics in space and time.

Niche conservatism, the tendency of a species niche to remain unchanged over time, is often assumed when discussing, explaining or predicting biogeographical patterns. Unfortunately, there has been no basis for predicting niche dynamics over relevant timescales, from tens to a few hundreds of years. The recent application of species distribution models (SDMs) and phylogenetic methods to analysis of niche characteristics has provided insight to niche dynamics. Niche shifts and conservatism have both occurred within the last 100 years, with recent speciation events, and deep within clades of species. There is increasing evidence that coordinated application of these methods can help to identify species which likely fulfill one key assumption in the predictive application of SDMs: an unchanging niche. This will improve confidence in SDM-based predictions of the impacts of climate change and species invasions on species distributions and biodiversity.

Analyse des épisodes de bactériémies chez les patients nécessitant une prise en charge aux soins intensifs

Introduction : Bacteremia are among the leading forms of severe infections requiring ICU management, and have been reported to be associated with important morbidity and mortality. Bloodstream infection (BSI) can be classified as hospital-acquired (HA), healthcare-associated (HCA) and community-acquired (CA). Each type has its own characteristics and outcome. Methods : We analyzed all consecutive episodes of bacteremia occurring in patients hospitalized in our mixed 32-bed ICU over a 12 month period (01.10.2009-30.09.2010). HA BSI were prospectively included in a multicenter study (EUROBACT). We adapted the case report form to analyze retrospectively all other cases of BSI. Chi-square tests were used for the categorical variables and ANOVA tests for the continuous variables. Results : Bacteremia occurred in 103 patients (120 bacteria) for an incidence-density of 49.3 episodes/1000 admissions. Among HA episodes, about one quarter of episodes was related to vascular accesses, including two thirds acquired outside of the ICU. Concerning HCA BSI, two-thirds originated from the urinary tract. In contrast, a respiratory origin was found in one third of CA episodes. Multiresistant microorganisms were more frequent in HA and HCA BSI. The overall mortality was 32%, as compared to 7.9% and 13.6% for the overall ICU and hospital mortality of other ICU patients over the same period, respectively. In a multivariate model, age (1.06 [1.02-1.11]), septic shock (3.11 [1.16-8.33]) and renal remplacement (7.81 [1.50, 14.93]) were significantly associated with a fatal outcome. Conclusion : Two-thirds of bacteremia documented among ICU patients were nosocomial and in contrast to those community-acquired, Gram-negatives represented the majority of them. However, CA bacteremia were associated with a higher rate of septic shock and death. The microbiological characteristics of HCA episodes were more similar to those HA, that is why it is important to individualize this category in order to adapt the antibiotics.

Granular layer in the periplasmic space of gram-positive bacteria and fine structures of Enterococcus gallinarum and Streptococcus gordonii septa revealed by cryo-electron microscopy of vitreous sections.

High-resolution structural information on optimally preserved bacterial cells can be obtained with cryo-electron microscopy of vitreous sections. With the help of this technique, the existence of a periplasmic space between the plasma membrane and the thick peptidoglycan layer of the gram-positive bacteria Bacillus subtilis and Staphylococcus aureus was recently shown. This raises questions about the mode of polymerization of peptidoglycan. In the present study, we report the structure of the cell envelope of three gram-positive bacteria (B. subtilis, Streptococcus gordonii, and Enterococcus gallinarum). In the three cases, a previously undescribed granular layer adjacent to the plasma membrane is found in the periplasmic space. In order to better understand how nascent peptidoglycan is incorporated into the mature peptidoglycan, we investigated cellular regions known to represent the sites of cell wall production. Each of these sites possesses a specific structure. We propose a hypothetic model of peptidoglycan polymerization that accommodates these differences: peptidoglycan precursors could be exported from the cytoplasm to the periplasmic space, where they could diffuse until they would interact with the interface between the granular layer and the thick peptidoglycan layer. They could then polymerize with mature peptidoglycan. We report cytoplasmic structures at the E. gallinarum septum that could be interpreted as cytoskeletal elements driving cell division (FtsZ ring). Although immunoelectron microscopy and fluorescence microscopy studies have demonstrated the septal and cytoplasmic localization of FtsZ, direct visualization of in situ FtsZ filaments has not been obtained in any electron microscopy study of fixed and dehydrated bacteria.

A comparative evaluation of endemic and non-endemic region of visceral leishmaniasis (Kala-azar) in India with ground survey and space technology

In visceral leishmaniasis, phlebotomine vectors are targets for control measures. Understanding the ecosystem of the vectors is a prerequisite for creating these control measures. This study endeavours to delineate the suitable locations of Phlebotomus argentipes with relation to environmental characteristics between endemic and non-endemic districts in India. A cross-sectional survey was conducted on 25 villages in each district. Environmental data were obtained through remote sensing images and vector density was measured using a CDC light trap. Simple linear regression analysis was used to measure the association between climatic parameters and vector density. Using factor analysis, the relationship between land cover classes and P. argentipes density among the villages in both districts was investigated. The results of the regression analysis indicated that indoor temperature and relative humidity are the best predictors for P. argentipes distribution. Factor analysis confirmed breeding preferences for P. argentipes by landscape element. Minimum Normalised Difference Vegetation Index, marshy land and orchard/settlement produced high loading in an endemic region, whereas water bodies and dense forest were preferred in non-endemic sites. Soil properties between the two districts were studied and indicated that soil pH and moisture content is higher in endemic sites compared to non-endemic sites. The present study should be utilised to make critical decisions for vector surveillance and controlling Kala-azar disease vectors.