Bilan des signalements COVID-19 sur la plateforme e-SIN, France, 2020

Introduction

Le signalement des infections nosocomiales via l’outil e-SIN est depuis le début de l’épidémie utilisé par les équipes opérationnelles d’hygiène des établissements de santé pour signaler les cas nosocomiaux de Covid19.

Matériels et méthodes

La période d’étude est l’année 2020, du 01-01-2020 au 03-01-2021. L’analyse concerne plus précisément les cas groupés définis à partir de 3 cas survenus dans un délai entre 2 cas de 4 à 7 jours¹. Le caractère nosocomial² est caractérisé par les équipes opérationnelles d’hygiène qui signalent. Les signalements de Covid19 sont extraits de l’outil e-SIN puis analysés dans une base Microsoft® Excel (2016). ¹ Ministère des solidarités et de la santé. Gestion des cas groupés - clusters de COVID-19. (2020). ²Surveillance definitions for COVID-19. European Centre for Disease Prevention and Control.

Résultats

En 2020, 4,352 signalements (SIN) de Covid-19 nosocomiales ont été émis. Parmi ces SIN, 1845 cas groupés (CG) représentant 18 778 cas patients (60%), 12 574 cas soignants (40 %) et 10 cas visiteurs. La répartition par service des CG signalés est la suivante : 828 en médecine, 567 en SSR, 139 en chirurgie, 108 en SLD, 61 en secteur EHPAD, 42 en soins intensifs, 35 aux urgences, 13 en gynécologie-obstétrique, 3 en imagerie et 48 dans les services supports (laboratoire, cuisine, …). La part des professionnels dans les CG est variable selon les services: elle est proche de la moyenne dans les services de médecine (46 %) et de chirurgie (53 %), elle est plus faible dans les services de SSR (34 %), SLD (27 %) et secteur EHPAD (26 %) et plus élevée en Gynécologie-Obstétrique (63%), en Soins Intensifs (74 %), aux urgences (92 %) et en Imagerie (100 %). Les principales hypothèses formulées pour expliquer la transmission du virus sont: (1) la découverte fortuite d’un cas, (2) le non-respect strict des mesures barrières et (3) les pauses/transmissions entre professionnels sur leur lieu de travail. La première hypothèse est au premier plan dans les services de médecine (38 %) et de chirurgie (44 %), secteur EHPAD (46 %), SLD (41 %) et SSR (42 %). La 3^e hypothèse est au premier plan dans les services de gynécologie-obstétrique (62 %), imagerie (100 %) et urgences (43 %). En soins intensifs les 3 hypothèses sont au même niveau (environ 1/3). Le dépistage et le renforcement des mesures barrières sont de loin les 2 mesures correctives les plus décrites dans les 1,621 CG ayant renseigné des mesures correctives, tout type de service confondu.

Conclusion

La transmission nosocomiale de Covid-19 est une réalité à prendre en compte pour maîtriser la diffusion du virus. Elle prend des aspects différents selon les services. Les patients représentent la plus grande part des cas, souvent parce que le cas index n’est pas identifié à l’admission. Ce constat incite à renforcer les précautions standard, le dépistage et les mesures barrières spécifiques dès l’identification des cas. Une part importante des cas groupés implique des professionnels souvent contaminés lors des pauses ou transmission pendant lesquelles le strict respect des mesures barrières doit être maintenu.

Evaluation of the Efficacy of Dexamethasone-Eluting Electrode Array on the Post-Implant Cochlear Fibrotic Reaction by Three-Dimensional Immunofluorescence Analysis in Mongolian Gerbil Cochlea

Cochlear implant is the method of choice for the rehabilitation of severe to profound sensorineural hearing loss. The study of the tissue response to cochlear implantation and the prevention of post-cochlear-implant damages are areas of interest in hearing protection research. The objective was to assess the efficacy of dexamethasone-eluting electrode array on endo canal fibrosis formation by three-dimensional immunofluorescence analysis in implanted Mongolian gerbil cochlea. Two trials were conducted after surgery using Mongolian gerbil implanted with dexamethasone-eluting or non-eluting intracochlear electrode arrays. The animals were then euthanised 10 weeks after implantation. The cochleae were prepared (electrode array in place) according to a 29-day protocol with immunofluorescent labelling and tissue clearing. The acquisition was carried out using light-sheet microscopy. Imaris software was then used for three-dimensional analysis of the cochleae and quantification of the fibrotic volume. The analysis of 12 cochleae showed a significantly different mean volume of fibrosis (2.16 × 10⁸ μm³ ± 0.15 in the dexamethasone eluting group versus 3.17 × 10⁸ μm³ ± 0.54 in the non-eluting group) (p = 0.004). The cochlear implant used as a corticosteroid delivery system appears to be an encouraging device for the protection of the inner ear against fibrosis induced by implantation. Three-dimensional analysis of the cochlea by light-sheet microscopy was suitable for studying post-implantation tissue damage.

Tolerance of salivary gland botulinum toxin A injection under local anesthesia for the treatment of sialorrhea in children: An observational study

OBJECTIVES

The main objective of this study was to assess tolerance of botulinum toxin A injection into the salivary glands under local anesthesia in a pediatric population. Secondary endpoints comprised efficacy and side-effects.

MATERIAL AND METHODS

A retrospective observational study included children treated between January 2013 and March 2020 for sialorrhea and/or pharyngeal salivary congestion. Children were identified from the botulinum toxin A injection database. The study included 162 injection sessions in 55 children. Injections were performed under local anesthesia with nitrous oxide, after clinical location of the site. Epidemiological and clinical data, injection tolerance on the FLACC scale, treatment response and complications were recorded.

RESULTS

For submandibular gland injections, pain was absent in 81 cases, mild in 64, moderate in 4 and intense in 1. In parotid gland injections, pain was absent in 45 cases, mild in 89, moderate in 17 and intense in 1. Injection tolerance was significantly poorer (P<0.005) in parotid than submandibular glands. Seventy-seven percent of the injections had a positive effect on sialorrhea. Fifteen patients presented transient adverse events: mainly dysphagia and paradoxical increase in sialorrhea.

CONCLUSION

Salivary gland botulinum toxin A injections in under local anesthesia were well-tolerated, safe and effective for children with sialorrhea and/or pharyngeal salivary congestion.

Interplay of disorder and antiferromagnetism in TlFe(1.6+δ)(Se(1-x)S(x))2 probed by neutron scattering

The effect of selenium substitution by sulphur on the structural and physical properties of antiferromagnetic TlFe1.6+δSe2 has been investigated via neutron, x-ray and electron diffraction, and transport measurements. The √5a×√5a×c super-cell related to the iron vacancy ordering found in the pure TlFe1.6Se2 selenide is also present in the S-doped TlFe1.6+δ(Se1-xSx)2 compounds. Neutron scattering experiments show the occurrence of the same long range magnetic ordering in the whole series i.e. the 'block checkerboard' antiferromagnetic structure. In particular, this is the first detailed study where the crystal structure and the √5a×√5a antiferromagnetic structure is characterized by neutron powder diffraction for the pure TlFe1.6+δS2 sulphide over a large temperature range. We demonstrate the strong correlation between occupancies of the crystallographic iron sites, the level of iron vacancy ordering and the occurrence of block antiferromagnetism in the sulphur series. Introducing S into the Se sites also increases the Fe content in TlFe1.6+δ(Se1-xSx)2 which in turn leads to the disappearance of the Fe vacancy ordering at x = 0.5 ± 0.15. However, by reducing the nominal Fe content, the same √5a×√5a×c vacancy ordering and antiferromagnetic order can be recovered also in the pure TlFe1.6+δS2 sulphide with a simultaneous reduction in the Néel temperature from 435 K in the selenide TlFe1.75Se2 to 330 K in the sulphide TlFe1.5S2. The magnetic moment remains high at low temperature throughout the full substitution range, which contributes to the absence of superconductivity in these compounds.

Tunnel diode oscillator measurements of the upper critical magnetic field of FeTe(0.5)Se(0.5)

Temperature dependence of the upper critical magnetic field (Hc2) of single crystalline FeTe0.5Se0.5(Tc = 14.5 K) have been determined by tunnel diode oscillator-based measurements in magnetic fields of up to 55 T and temperatures down to 1.6 K. The Werthamer-Helfand-Hohenberg model accounts for the data for magnetic field applied both parallel (H ‖ ab) and perpendicular (H ‖ c) to the iron conducting plane, in line with a single band superconductivity. Whereas Pauli pair breaking is negligible for H ‖ c, Pauli contribution is evidenced for H ‖ ab with Maki parameter α = 1.4, corresponding to Pauli field HP = 79 T. As a result, the Hc2 anisotropy [Formula: see text] which is already rather small at Tc (γ = 1.6) further decreases as the temperature decreases and becomes smaller than 1 at liquid helium temperatures.

Dependence of the structural, transport and magnetic properties of Tl(1-y)Fe(2-z)(Se(1-x)S(x))2 with isovalent substitution of Se by S

The effect of selenium substitution by sulfur in the Tl(1-y)Fe(2-z)Se(2) antiferromagnet was studied by x-ray and electron diffraction, magnetization and transport measurements. Tl(0.8)Fe(1.5)(Se(1-x)S(x))(2) (nominal composition) solid solution was synthesized in the full x range (0 ≤ x(S) ≤ 1) using the sealed tube technique. No superconductivity was found down to 4.2 K in the series despite the fact that the optimal crystallographic parameters, determined by Rietveld refinements, are reached in the series (i.e. the Fe-(Se, S) interplane height and (Se, S)-Fe-(Se, S) angle for which the critical superconducting transition T(c) is usually maximal in pnictides). A quasi-full Tl site (y ~ 0.05) compared to significant alkaline deficiency (y = 0.2-0.3) in analogous A(1-y)Fe(2-z)Se(2) (A = K, Rb, Cs), and the resulting differences in iron valency, density of states and doping, are suggested as an explanation for this absence of superconductivity. Transmission electron microscopy confirmed the existence of an ordered iron vacancies network in the samples of the Tl(0.8)Fe(1.5)(Se(1-x)S(x))(2) series in the form of the tetragonal √5a × √5a × c superstructure (I4/m). The Néel temperature (T(N)) indicating the onset of antiferromagnetism order in this √5a × √5a × c supercell is found to decrease from 450 K in the selenide (x = 0) to 330 K in the sulfide (x = 1). Finally, we demonstrate a direct linear relationship between T(N) and the Fe-(Se, S) bond length (or Fe-(Se, S) height).

Disorder effects in pnictides: a tunneling spectroscopy study

We present the synthesis and the tunneling spectroscopy study of superconducting FeSe(0.5)Te(0.5) (T(c) = 14 K), SmFeAsO(0.85) (T(c) = 54 K) and SmFeAsO(0.9)F(0.1) (T(c) = 45 K). The samples were characterized by Rietveld refinement of x-ray diffraction patterns and transport as well as temperature-dependent magnetic measurements. Tunneling experiments on FeSe(0.5)Te(0.5) revealed a single superconducting gap ∼ 1 meV in BCS-like tunneling conductance spectra. In SmFeAsO(0.85) and SmFeAsO(0.9)F(0.1), however, more complex spectra were observed, characterized by two gap-like structures at ∼ 4 and ∼ 10 meV. These spectra are qualitatively understood assuming a two-band superconductor with a 's ±' order parameter. We show that, depending on the sign relation between the pairing amplitudes in the two bands, the interband quasiparticle scattering has a crucial effect on the shape of the tunneling spectra. On the other hand, single-gap spectra found in FeSe(0.5)Te(0.5) are more compatible with a disorder-induced 's '-wave gap, due to the Se-Te substitution.

[Association of disseminated lupus erythematosus and Crohn's disease]

INTRODUCTION

Association of Crohn's disease and systemic lupus erythematosus is infrequent. We report an observation of Crohn's disease that appeared in an 18-year-old woman followed-up for systemic lupus erythematosus for four years.

EXEGESIS

The patient had all the clinical, biological and histological criteria of Crohn's disease and systemic lupus erythematosus was diagnosed according to the American Rheumatism Association criteria. On the base of this observation, we discuss the digestive manifestation of systemic lupus erythematosus and extradigestive manifestations of Crohn's disease.

CONCLUSION

The immunological background of both diseases was proposed to explain the mechanism of this rare association.