The specific metabolome profiling of patients infected by SARS-COV-2 supports the key role of tryptophan-nicotinamide pathway and cytosine metabolism.

The biological mechanisms involved in SARS-CoV-2 infection are only partially understood. Thus we explored the plasma metabolome of patients infected with SARS-CoV-2 to search for diagnostic and/or prognostic biomarkers and to improve the knowledge of metabolic disturbance in this infection. We analyzed the plasma metabolome of 55 patients infected with SARS-CoV-2 and 45 controls by LC-HRMS at the time of viral diagnosis (D0). We first evaluated the ability to predict the diagnosis from the metabotype at D0 in an independent population. Next, we assessed the feasibility of predicting the disease evolution at the 7th and 15th day. Plasma metabolome allowed us to generate a discriminant multivariate model to predict the diagnosis of SARS-CoV-2 in an independent population (accuracy > 74%, sensitivity, specificity > 75%). We identified the role of the cytosine and tryptophan-nicotinamide pathways in this discrimination. However, metabolomic exploration modestly explained the disease evolution. Here, we present the first metabolomic study in SARS-CoV-2 patients which showed a high reliable prediction of early diagnosis. We have highlighted the role of the tryptophan-nicotinamide pathway clearly linked to inflammatory signals and microbiota, and the involvement of cytosine, previously described as a coordinator of cell metabolism in SARS-CoV-2. These findings could open new therapeutic perspectives as indirect targets.

Validation of a noninvasive tension-time index of inspiratory muscles.

The aim of this study was to validate a noninvasive tension-time index (TT) for all the inspiratory muscles estimated from the measurement of mouth occlusion pressure (P0.1), i.e., TT of inspiratory muscles (TTmus = PI/PImax x TI/TT, where PI is mean inspiratory pressure, PImax is maximal PI, TI is time of muscle contraction, and TT is total time of respiratory cycle) compared with TT of the diaphragm (TTdi = Pdi/Pdimax x TI/TT, where Pdi is mean transdiaphragmatic pressure and Pdimax is maximal Pdi). PI was estimated as PI = 5 P0.1 x TI. Eleven patients with chronic obstructive pulmonary disease and seven normal subjects were studied at rest in the sitting position. After 5 min of steady state, we measured breathing pattern, gastric and esophageal pressures, Pdi, mean inspiratory transpulmonary pressure swing, PImax, and Pdimax. By linear regression analysis, significant positive correlations were found between PI and mean inspiratory transpulmonary pressure swing, PI and Pdi, PImax and Pdimax, and PI/PImax and Pdi/Pdimax, with P < 0.001 for all subjects combined. These led to the highly significant correlation between TTmus and TTdi for all subjects combined (TTmus = 2.1 TTdi + 0.012; r = 0.97; P < 0.001) and for patients only (TTmus = 2.0 TTdi + 0.024; r = 0.97; P < 0.001). Therefore, patterns of breathing that lie near fatigue thresholds can be identified with TTmus or TTdi. In conclusion, noninvasive and clinically easily determined TTmus seems valid for situating patients of chronic obstructive pulmonary disease in reference to the inspiratory muscle fatigue.

[Value of the stool bacteriological test in Mycobacterium avium complex infections in AIDS]. / Intérêt de l'examen bactériologique des selles dans les infections à Mycobacterium complex avium au cours du SIDA.

Incidence of Mycobacterium avium complex (MAC) infection has increased in HIV infected patients. We report a retrospective study of 25 cases of MAC infection occurring in HIV patients. Stools examination was performed in 5 (31%) of the patients without digestive symptoms and in the 9 (100%) patients presenting with diarrhoea. The stools culture are positive in 79% of cases (11/14). In all the patients with diarrhoea, direct examination of the stools gave the diagnosis of MAC infection. All the patients had profound immunodepression with CD4+ cell count < 5/mm3. The mean survival time from mycobacteriosis diagnosis was 122 +/- 90 days despite antimycobacteriosis therapy.

Hb Poitiers [alpha 45(CE3)His-->Asp]: a new hemoglobin variant with a two-fold increase in oxygen affinity.

Hb Poitiers or alpha 45(CE3)His-->Asp was found in a 9-year-old French Caucasian boy. The structural modification concerns a heme contact and is responsible for an increased oxygen affinity and a faster than normal rate of autooxidation.

Bovine serum albumin immunization: a new risk of allergy during protocols for in vitro fertilization.

Three patients having undergone protocols for in vitro fertilization (IVF) showed an allergic reaction suggesting seric disease 6 to 10 days after follicle aspiration. The responsibility of bovine serum albumin, present in the follicle-rinsing fluid and in the medium used for embryo culture was suspected. An immunological study was carried out, using two groups for comparison. Group 1: 7 controls. Group 2: 11 women having undergone IVF protocols without incident. Anti-BSA antibodies were present in low quantities in one or two subclasses of IgG and IgA in Group 1, and in several subclasses at higher levels in nine of 11 subjects from Group 2. The IgG4 response predominated 7 times out of 9. The antibody content gradually fell after the IVF attempt. An immune response predominated in the IgG1 in two patients. Skin test for the two fluids and BSA were positive only in the three patients. These results show the frequency of immunization to BSA induced through the ovarian and peritoneal pathways. Seric disease corresponds to a rise in IgG1. The association of a IgE-dependent sensitization is suspected. The authors suggest the possibility of an interference of these immune processes with implantation and propose the elimination of heterologous proteins from fluids. They also suggest that LH-RH analogues facilitate immune responses.

[Defense and illustration of a health examination in adolescents as observed in the course of secondary education]. / Défense et illustration d'un examen de santé des adolescents jeunes en cycle d'observation de collège.

In France, children's health is carefully looked after by periodical examinations from birth to six years old. But the french children cannot have afterwards a systematic health examination during the course of their compulsory attendance at school, except those preparing a technical teaching. The author suggests that an examination during the first period of adolescence (between 11 and 15 years old) should be a vector of information very useful to subjects themselves and knowledge in Public Health not much documented at this stage. To assert this statement and draw useful conclusions, the Institut Regional pour la Santé de Tours, whose the author is the founder, and the departmental School Health Service have co-ordinated their actions for an examination on 56 classes in second forms (randomised among 321) of 1316 schoolchildren (662 boys-654 girls). This clinical, paraclinical and biological survey pointed out bad habits of nutrition, alcoholic drinks, smoking, excess of corpulence and blood pressure, visual and auditive trouble unknown or neglected, dental caries not treated, statics trouble and high hypercholesterolemia, as well. All these pathological elements are unknown and not taken over on the whole, at the present time. But these discoveries cannot really justify the systematic generalisation of an health examination, if, on the one hand, there is not an efficient follow-up that affects family physicians, pediatricians, local Health Educational Services, and, on the other hand, a short and mean-dated estimation. Such a completed and systematic examination could then be essential both from the individual benefit point of view and to the literature in Public Health (analytical and descriptive epidemiology). The author also refers to a similar study, as productive as the former, led one year before in the first form. Whatever the form--first or second ones--systematization of a good examination must fill the blank: it can be validly made by the coordinated actions of a dynamic School Health Service, a local partnership (bringing logistic, laboratory, data processing and physicians (general practitioners or pediatricians) for a medical and educational follow-up essential not only in the immediate future but with a view to a mean and long-dated prevention.

[Health status of adolescents in the 7th grade at schools in Indre-et-Loire]. / L'état de santé des adolescents des classes de 5e d'Indre-et-Loire.

A survey of 1,316 pupils in the 7th grade in private or public schools in the department of Indre et Loire was conducted in order to establish the health status and needs of adolescents aged 12-15 years. Nutritional behavior, alcohol and tobacco consumption, obesity, hypertension, audio-visual disturbances, and dental status were the essential points of this survey. This study demonstrates the necessity of frequent and systematic health care supervision of adolescents, in an effort to detect and prevent or treat disturbances which may have long term adverse effects. The absence of such a structure in our medico-social armament is underlined along with the potential consequences that such a deficiency may have on the future adult generation.

[Screening for craniomandibular dysfunction. Epidemiological survey concerning 891 healthy subjects]. / Dépistage des dysfonctionnements cranio-mandibulaires. Enquête épidémiologique portant sur 891 sujets sains.

The authors study the frequency of the TMJ disorders on healthy subjects. 891 subjects have been examined: 11.7% of the male population had at least two of the classic TMJ disorders signs, for 16.6% of the female group. The authors have realized a simple questionnaire for the detection of the TMJ disorders, which is applicable within an health care center.

[Cefotaxime in the treatment of purulent meningitis in children (author's transl)]. / Le céfotaxime dans le traitement des méningites purulentes de l'enfant.

Five meningitis due to Haemophilus influenzae and 6 meningitis due to Enterobacteria were treated with cefotaxime. The antibiotic was administered at a dose of 150 to 200 mg/kg/day in four 1 hour infusions. The pathogens were eradicated in all patients. Cefotaxime activity was efficient either against resistant pathogens (Haemophilus, Enterobacter) or against organism susceptible to ampicillin. Because cefotaxime is active at low concentration and has a good diffusion in the CSF, it provides a particularly effective treatment in Gram-negative meningitis in children. The initial use of cefotaxime should result in rapid eradication of the pathogen, with consequent improvement in the prognosis.

[Dyskeratosis congenita Zinsser-Cole-Engman form. Report of two affected brothers (author's transl)]. / Dyskératose congénitale de Zinsser-Cole-Engman Chez deus frères.

Cutaneous pigmentation, lingual leukoplasia and dystrophic changes of nails are present in the two cases. The other clinical manifestations are dental alterations, epiphora, loss of dermal ridges of the pulp with hyperhidrosis, atrophic skin of the dorsum of the hands. Dysphagia and bone marrow hypoplasia are present in one case. The proband (case 1) has normal values for the following: hemoglobin electrophoresis, pyruvate kinase, marrow and blood chromosome analysis. Biopsy of pigmented skin showed an atrophic epidermis with orthokeratotic-hyperkeratosis; in the higher dermis there were several melanophores. Multiple layers of vasal lamina are seen under electron microscopy. The parents and the two daughters are free of clinical or hematologic manifestations. The mother and her two affected sons have A1-BW 27 HLA haplotype. X-linked transmission is discussed.

[Eradication of Candida from a premature infant unit]. / L'éradication des Candida dans un service de prématurés.

To eradicate Candida from a neonatal unit the authors used increasingly strigent protocols of prophylaxis and treatment. Finally all carriers were identified and treated with nystatin. A strict routine for washing hands was introduced. As a result of these measures the cross infection rate within the hospital was very low (3%). The eradication was maintained by constant surveillance (weekly oral and rectal swabs) because of regular reintroduction of Candida by babies who had been infected before transfer to the unit. The other conclusions were that post natal infection is usually due to cross infection and rarely from mother. The gut and perianal skin are important reservoirs of infection. Erythema of the buttocks almost disappeared after the eradication of Candida. Guteal erythema commonly preceded of manifestations of Leiner's disease.

[The pediatrician and school difficulties]. / Le pédiatre et les difficultés scolaires.

Difficulties at school are amongst the most frequent encountered in paediatric practice but paediatricians are infrequently consulted by those who are responsible for the children from day to day. As a result decisions are often contrary to the elementary principles of physiology. Unfortunately the chronological age is still the important criteria for determining school progress. Thus the age for learning to read is fixed arbitrarily at 6 years. Small children have specific difficulties even though they are normal intellectually. Overall the rhythm of life of the child is not considered by the exacting scholastic requirements. Finally the school forgets the need of the sick child too easily and demands a major effort of adaptation without making any allowances itself.