[Clinical and economic impact of an ambulatory cataract surgery center without anesthesia in an area with poor ophthalmologic coverage]. / Impact médico-économique d'un centre de chirurgie ambulatoire de la cataracte sans parcours anesthésique dans un territoire en tension.

INTRODUCTION: The Ambulatory Clinic for Cataract Surgery (CACC) is a public department of the Bourges Medical Center, with a fast-track protocol without perioperative anesthesia care launched in 2015. This study aimed to evaluate the benefits of the CACC in terms of access to cataract surgery. METHODS: This retrospective study included all patients undergoing cataract surgery between 2012 and 2018. Data were collected from the French PMSI database. In order to evaluate the impact of the CACC, the surgical activity and change in indicators of patient flow and usage, as well as clinical and economic factors were analyzed. RESULTS: Between 2012 and 2018, with the same number of ophthalmologists, surgical activity increased by 50.2% in the Cher (vs. a mean increase of 22.7% in France). The patient loss ratio decreased by 5.9 points, the attraction and self-sufficiency ratios increased by 2.3 and 8.6 points respectively. The standardized rate of healthcare utilization for cataract surgery increased by 4.3 points (from 11.6 to 15.9 surgeries per 1000 inhabitants). As a result, Cher became the second highest French Department in 2018 in terms of utilization rate despite its 96th place out of 109 Departments in terms of density of ophthalmologists. CONCLUSION: The ambulatory cataract surgery center without anesthesia for selected patients might represent a solution in medical deserts to improve access to cataract surgery without increasing costs.

[Epidemiology of ocular emergencies in a non-university hospital: Clinical characteristics and severity grading according to the Base Score]. / Épidémiologie des urgences ophtalmologiques dans un centre hospitalier non universitaire : spécificités cliniques et sévérité selon le Base Score.

OBJECTIVE: This study aimed to analyse the epidemiological characteristics of ophthalmological emergencies at the Bourges Medical Center (CHB) and to identify factors associated with severity according to the Base Score in a region of France considered a healthcare desert. METHODS: All consecutive charts of patients seen for an eye-related condition between January 1 and April 30, 2019 in the ocular emergency department of the CHB were studied retrospectively. Seven demographic and nine medical variables were collected, and ocular severity was defined according to the Base Score. Linear regressions were performed to identify the factors associated with higher severity. RESULTS: 1809 patients were included (mean age: 53.3±22.7 years, 51.4% women), of whom 1619 (89.5%) were self-referred. Ocular surface disease (12.5%) was the most frequent diagnosis. The severity of the eye-related condition was significantly associated with the following factors: male gender, distance from home to the emergency department, presentation soon after the onset of symptoms, and referral from a physician (ophthalmologist or not). The regression coefficient was greater than 1 only for the patient referral pattern. CONCLUSION: The current study highlights that when patients with ocular emergencies can self-refer to an ocular emergency department within a French healthcare desert, 9 patients out of 10 self-refer. Referral from a physician is the main factor associated with ocular severity; thus, these cases should be considered severe until proven otherwise.

[Survey of lymphatic filariasis on Ouvea Island in New Caledonia]. / Enquete sur la filariose lymphatique dans l'île d'Ouvéa en Nouvelle-Calédonie.

Several cases of Bancroftian filariasis were recently reported on Ouvea Island which is part of the archipelago of New Caledonia located in the south Pacific Ocean. Following these reports systematic screening was carried out in a group of 382 adult consultees at two medical dispensaries. Tests to detect microfilariae in the blood and antibodies in serum were performed at the Pasteur Institute in New Caledonia and the Malarde Institute in Papeete, French Polynesia, respectively. Of the two subjects with manifestations consistent with filariasis, one was seropositive but neither presented microfilariae. Overall 14 subjects (3.7 p. 100) presented microfilariae and 124 were seropositive (33.5 p. 100). The serologic index was significantly higher in men than in women (6.1 p. 100 vs 2.1 p. 100). Parasitic and serologic indexes were significantly higher (p < 0.001) in subjects living in the northern than southern part of the island. As in previous studies in New Caledonia, present data showed that Bancrofitian filariasis is asymptomatic on Ouvea Island. This finding contrasts with the symptomatic forms described on other islands in the south Pacific.

Outbreak of enterically-transmitted hepatitis due to hepatitis A and hepatitis E viruses.

BACKGROUND/AIMS: One hundred and eleven patients with acute hepatitis and 61 controls were investigated for hepatitis serological markers in order to determine the viral etiology of cases involved in a waterborne epidemic of hepatitis observed in 1993 in Djibouti, Republic of Djibouti (East Africa). These cases occurred both in indigenous Djiboutians, and in French soldiers and their families in Djibouti. A retrospective study of the viral etiology of acute hepatitis cases observed in French soldiers and relatives living in Djibouti during the 3-year period preceding the epidemic was also undertaken. METHODS: HAV, HBV and HCV infections were investigated using commercial ELISA tests. HEV infections were investigated by testing IgG and IgM-specific antibodies by means of three different ELISA tests using recombinant proteins or synthetic peptides. RESULTS: Hepatitis A was observed in 37 (33%) and hepatitis E in 43 (39%) of the 111 cases of acute hepatitis recorded during this epidemic. Hepatitis B represented only 6% of the indigenous cases and hepatitis C was not observed among the cases investigated. Anti-HEV IgG antibodies were also detected in 19% of the indigenous control group. CONCLUSION: These results suggest that both HAV and HEV were responsible for this waterborne epidemic of acute hepatitis. However, HAV and HEV infections were not equally distributed between French expatriates and Djibouti residents. Whereas HAV infections were mainly observed in French patients, HEV was almost exclusively found in indigenous patients. This study reports for the first time a waterborne outbreak of acute hepatitis simultaneously due to HAV and HEV.

[Djibouti, history of 2 epidemics of cholera: 1993-1994]. / Djibouti, histoire de deux épidémies de choléra: 1993-1994.

When two cholera epidemics broke out in Djibouti, respectively in 1993 and 1994, Bioforce was obliged to intervene. The first time, three goals were pursued: setting up a rehydration centre in a tent, organizing epidemiological surveillance and training local personnel in treatment and diagnosis techniques. The next year, the epidemic followed serious flooding. The epidemiological analysis showed that cholera had become endemic in the poor neighbourhoods of the town and that epidemic break-outs were favoured by contaminated surface water and disturbances in the distribution of drinking water. The epidemic of 1997, likewise following flooding, only confirmed this point of view.

[Epidemiologic aspects of 42 cases of human brucellosis in the Republic of Djibouti]. / Aspects épidémiologiques de 42 cas de brucellose humaine en République de Djibouti.

Brucellosis is an ubiquitous anthropozoonoses in the Republic of Djibouti, but it has only been studied in the City of Djibouti. This retrospective study of 42 cases of human brucellosis diagnosed between April 1993 and April 1995 was carried out at the Peltier Hospital in Djibouti to obtain epidemiological data concerning brucellosis in the Republic of Djibouti. Diagnosis was based on clinical symptoms and positive immunologic tests (Rose Bengal test > 100 UI and Wright serology > 1/80). The following information was obtained for each patient: nationality, ethnic origin, place of residence, age, sex, and risk factors for exposure to infected animals or products. There were 30 men and 12 women including 38 Djiboutis, 3 Somalis, and 1 Ethiopian. Ethnic origin was Afar in 32 cases, Somali in 6 cases, and undetermined in 4 cases. Mean age was 31.6 years. Of the 38 Djiboutis, 15 lived in the district of Djibouti, 17 in the district of Tadjourah, 3 in the district of Obock, and none in districts located in the Southern part of the country. In 18 cases brucellosis involved cattle raisers from the Northern part of the country. In five cases no risk factor could be identified. The incidence of brucellosis in the Republic of Djibouti appears to be comparable to that observed in other highly endemic countries. Further study is needed to determine the exact incidence in man and animals and ascertain the need and feasibility of preventive measures.

[Evaluation of rapid screening tests in the diagnosis of urinary infections]. / Evaluation des tests rapides de dépistage dans le diagnostic des infections urinaires.

Bacterial urine examination is the main bacterial examination used in microbiology laboratories. The comparative interest of urine aspect associated with rapid screening tests (catalase, leucocyte esterase, nitrite) and different urine examination methods (Gram stain of sediment, direct examination on Malassez cell and on centrifuged urine pellet) are evaluated for negative predictive value of urinary tract infection. In out-patient, the association urine aspect-leucocyte esterase has the best negative predictive value for urinary tract infection (99.4%). Either in outpatients or in hospitalized patients, the association Gram stain of sediment-leukocyturia evaluation has the best negative predictive value for urinary tract infection (100%). This data allows in our population to give back negative results without culture.

[Antibiotic sensitivity of 140 strains of Shigella isolated in Djibouti]. / Etude de la sensibilité aux antibiotiques de 140 souches de shigelles isolées à Djibouti.

Shigellae are the most frequently isolated invasive bacteria in Djibouti. 140 clinical strains collected during an eight months period have been studied for their in vitro susceptibility to antibiotics mainly used in treatment and prophylaxis by measure of MIC (agar dilution) for all antibiotics except for trimethoprim-sulfamethoxazole, trimethoprim and sulfamethoxazole (disk diffusion on lysed horse blood medium). Characterization of beta-lactamase is carried out for all strains resistant to amoxicillin and for all S. sonnei. The overall prevalence of resistance to amoxicillin is 41.7% (penicillinase TEM-1, OXA-1 and OXA-3 alone or associated) to tetracyclines 97.1% and to trimethoprim-sulfamethoxazole 51.4%. This prevalence is particularly high for amoxicillin with S. flexneri and for trimethoprim-sulfamethoxazole with S. sonnei. All strains of S. sonnei have a low level chromosomal cephalosporinase without phenotypic expression. Among 68 strains sensitive to trimethoprim-sulfamethoxazole, 39 are resistant to sulfamethoxazole alone. All strains are sensitive to nalidixic acid and fluoroquinolones. These data allows us to recommend fluoroquinolones for treatment and prophylaxis of shigellosis in Djibouti.

[Rapid diagnosis of malaria. The microwave furnace]. / Diagnostic rapide du paludisme. Le four à micro-ondes.

Thick blood is a well known method for malaria diagnosis, very faithful and sensitive, but it could not be used in emergency because it had to dry for many hours. Micro-wave over allows a quick drying (two minutes). Do it can now be used in emergency.