Costs of dengue in three French territories of the Americas: an analysis of the hospital medical information system (PMSI) database.

BACKGROUND: Dengue is a major emerging public health concern in tropical and subtropical countries. Severe dengue can lead to hospitalisation and death. This study was performed to assess the economic burden of hospitalisations for dengue from 2007 to 2011 in three French territories of the Americas where dengue is endemic (French Guiana, Martinique and Guadeloupe). METHODS: Data on dengue-associated hospitalisations were extracted from the French national hospital administrative database, Programme de Médicalisation des Systèmes d'Information (PMSI). The numbers of stays and the corresponding number of hospitalised patients were determined using disease-specific ICD-10 codes. Associated hospital costs were estimated from the payer perspective, using French official tariffs. RESULTS: Overall, 4183 patients (mean age 32 years; 51 % male) were hospitalised for dengue, corresponding to 4574 hospital stays. In nearly all hospital stays (98 %; 4471), the illness was medically managed and the mean length of stay was 4.3 days. The mean cost per stay was €2522, corresponding to a total hospital cost of €11.5 million over the 5 years assessed. The majority of hospitalisations (80 % of patients) and associated costs (75 % of total hospital costs) were incurred during two epidemics. CONCLUSION: Severe dengue is associated with significant hospital costs that escalate during outbreaks.

Higher proportion of G2P[4] rotaviruses in vaccinated hospitalized cases compared with unvaccinated hospitalized cases, despite high vaccine effectiveness against heterotypic G2P[4] rotaviruses.

The overall vaccine effectiveness of the monovalent rotavirus vaccine in an observational, prospective, multicentre, hospital-based case-control study in Belgium (RotaBel) was 90%. However, rotavirus genotype and co-infecting pathogens are important parameters to take into account when assessing vaccine effectiveness. In this study we specifically investigated the effect of rotavirus genotypes and co-infecting pathogens on vaccine effectiveness of the monovalent vaccine. In addition, we also investigated the effect of co-infecting pathogens on disease severity. From February 2008 to June 2010 stool samples of rotavirus gastroenteritis cases of a random sample of 39 Belgian hospitals were collected and subsequently genotyped. Fisher's exact tests were performed to investigate the relationships between rotavirus genotype, co-infecting pathogens and disease severity. The vaccine effectiveness of a full series of the monovalent rotavirus vaccine against hospitalized rotavirus gastroenteritis caused by G1P[8] rotavirus strains was 95% (95% CI 77.5-98.7). Against G2P[4], the vaccine effectiveness was 85% (95% CI: 63.7-93.8). G4P[8]- and G3P[8]-specific vaccine effectiveness was 90% (95% CI 19.2-98.7) and 87% (95% CI -5.2 to 98.4), respectively. A post-hoc analysis showed that the genotype distribution was significantly related to the vaccination status (p <0.001), whereby G2P[4] strains were proportionally more prevalent in vaccinated cases than in unvaccinated cases. No statistical associations were found between co-infection status and vaccination status, Vesikari severity score or rotavirus genotype. The high vaccine effectiveness against the individual genotypes implies robust protection of the monovalent rotavirus vaccine against hospitalized rotavirus gastroenteritis caused by the major human rotavirus genotypes. The prevalence of G2P[4] requires continued monitoring.

Terminal deletion of chromosome 10q26: delineation of two clinical phenotypes.

We present genotype-phenotype correlations in two patients with distal 10q deletion. A patient with a small terminal deletion presented mild mental retardation and behavioral difficulties with hyperactivity, whereas the patient with a larger deletion, had multiple congenital anomalies and moderate mental retardation. Our observation confirms the previous suggestion that larger deletions of distal chromosome 10q are associated with a more severe clinical presentation, whereas hyperactive behavior may be a specific feature of small terminal deletions of chromosome 10q26.

Gastroenteric cyst.

The authors report a rare case of gastroenteric cyst in a 4-day-old baby with increasing cyanosis. CT and MRI demonstrated a posterior mediastinal cystic mass, which finally was characterised by pathology as a gastroenteric cyst.

Centromeric instability of chromosomes 1, 9, and 16 associated with combined immunodeficiency.

Instability of the centromeric regions of chromosomes 1, 9, and 16 in cultured lymphocytes of an 8-month-old girl with malabsorption and combined immunodeficiency is reported. Together with the two previous reports on this condition, the present report seems to confirm the specific association of combined immunodeficiency and centromeric instability of chromosomes 1, 9, and 16 with multibranching.

A malformed newborn with 9p and 4q trisomy.

A malformed male newborn with partial trisomy 9p (qter-9q13) and distal 4q trisomy (4qter-4q31), being the unbalanced product of a balanced reciprocal translocation in the mother karyotype: 46,XX,t(4;9)(q31;q13) is reported. Besides the typical craniofacial stigmata of pure 9q trisomy the child presented with poor neurological condition and failure to thrive.

[Isolation of free-living amoebae from the nasal mucosa of man. Potential risk (author's transl)]. / Isolement d'amibes libres à partir de la muqueuse nasale de l'homme. Risque éventuel.

From march 1976 until december 1978, we have analysed 1039 nasal swabs in order to discover the healthy free-living amoebae carriers. So, we have isolated 9 strains of which one Hartmannella vermiformis. From the 8 remaining Acanthamoebae, only one, ORL 561 (Acanthamoeba hatchetti) is as pathogenic for mice as the 2 other identical known strains and A. culbertsoni.