[Management of post-abortum infections]. / Prise en charge des infections du post-abortum.

In countries where induced abortions are legal and medically supervised, the frequency of post-abortion infections is low and maternal death is infrequent. Nevertheless, short and long term consequences of post-abortion infections must be addressed. Sexually transmitted pathogens are frequently in cause here. Risk factors include in particular young age (less than 24 years), low socioeconomic level, late pregnancy, nulliparity, and history of previous untreated pelvic inflammatory disease. Diagnosis is based on clinical criteria and an inflammatory syndrome occurring within 2 to 3 weeks after spontaneous or induced abortion. A pelvic ultrasound is recommended in order to ensure the uterus vacuity and to look for a possible pelvic abscess, and bacteriological samples must be performed. Management consists in a regimen combining two antibiotics intravenously, with the possible addition of intravenous heparin in case of pelvic thrombophlebitis. Antibiotics can be discontinued 48 h of a clinical improvement and further treatment by oral route brings no benefit. Intrauterine retention associated with post-abortion endometritis must be addressed either by medical or surgical method.

[Management of post-partum infections]. / Prise en charge des infections du post-partum.

Post-partum endometritis are frequent and account for the fifth cause of maternal death. This disease is preventable and effective treatments are available. Streptococcus agalactiae is the primary pathogen implicated. The clinical diagnosis is usually easy and involves pelvic pain, fever and abnormal lochia. Whenever antibiotic treatment provides no clinical improvement, or in case of doubt on the vacuity of the uterus, an ultrasound exam must be performed. Likewise, a CT scan or a MRI will be performed in case of persistent fever in search of a pelvic abscess requiring a drainage, or of a pelvic thrombophlebitis. Thromboplebitis requires heparin for the duration of antibiotic therapy, or oral anticoagulants for at least 3 months in case of pulmonary embolism or extension to the vena cava. The recommended antibiotic regimen combines clindamycin with gentamicin (once daily) intravenously. In case of contraindication or breastfeeding, other regimens may be prescribed. Adequate duration of treatment has not been evaluated and a switch to oral antibiotics after clinical improvement brings no benefit. Antibioprophylaxy (mostly cephalosporins) is recommended in cases of cesarean section (at skin incision), while it is debated in case of assisted delivery or of 3rd and 4th degree perineal tears.

HIV-1 replication in Langerhans and interstitial dendritic cells is inhibited by neutralizing and Fc-mediated inhibitory antibodies.

Langerhans cells (LCs) and interstitial dendritic cells (IDCs) may be among the first human immunodeficiency virus type 1 (HIV-1) targets after sexual transmission. We generated cells of these types by differentiation of purified CD34(+) cord blood cells. After in vitro infection with R5-tropic strains, we obtained similar percentages of infected cells for both dendritic cell (DC) subsets. Moreover, LC infection was not increased by blockage of langerin by antilangerin. These results indicate that, under our experimental conditions, there was no evidence of any preference of HIV replication in LCs versus IDCs. The inhibitory activity of HIV-1-specific IgAs and IgGs against HIV-1 replication in LCs and IDCs was analyzed. We found that neutralizing antibodies inhibit HIV-1 infection of both DC subsets. Interestingly, HIV-1 was inhibited more efficiently by the IgGs than the corresponding IgA, due to an Fcγ receptor-dependent mechanism. Moreover, nonneutralizing inhibitory IgGs were able to inhibit infection of both LCs and IDCs. These results underline the importance of HIV-1 inhibition by the binding of the Fc part of IgGs to Fcγ receptors and suggest that the induction of neutralizing and nonneutralizing inhibitory IgGs in addition to neutralizing IgAs at mucosal sites may contribute to protection against sexual transmission of HIV-1.

Selecting a set of housekeeping genes for quantitative real-time PCR in normal and tetraploid haemocytes of soft-shell clams, Mya arenaria.

The transcripts involved in the molecular mechanisms of haemic neoplasia in relation to the haemocyte ploidy status of the soft-shell clam, Mya arenaria, have yet to be identified. For this purpose, real-time quantitative RT-PCR constitutes a sensitive and efficient technique, which can help determine the gene expression involved in haemocyte tetraploid status in clams affected by haemic neoplasia. One of the critical steps in comparing transcription profiles is the stability of selected housekeeping genes, as well as an accurate normalization. In this study, we selected five reference genes, S18, L37, EF1, EF2 and actin, generally used as single control genes. Their expression was analyzed by real-time quantitative RT-PCR at different levels of haemocyte ploidy status in order to select the most stable genes. Using the geNorm software, our results showed that L37, EF1 and S18 represent the most stable gene expressions related to various ploidy status ranging from 0 to 78% of tetraploid haemocytes in clams sampled in North River (Prince Edward Island, Canada). However, actin gene expression appeared to be highly regulated. Hence, using it as a housekeeping gene in tetraploid haemocytes can result in inaccurate data. To compare gene expression levels related to haemocyte ploidy status in Mya arenaria, using L37, EF1 and S18 as housekeeping genes for accurate normalization is therefore recommended.

Patterns of p53, p73 and mortalin gene expression associated with haemocyte polyploidy in the soft-shell clam, Mya arenaria.

The molecular mechanisms by which haemocytes of clams are transformed in the course of haemic neoplasia remain by far unknown. The aim of this study was to quantify the expression of p53/p73 and mortalin genes, in relation with the ploidy status of clam haemocytes and to correlate the p53 expression with mortalin expression. For this purpose, soft-shell clams, Mya arenaria, were collected from an endemic zone for neoplasia. The ploidy of haemocytes was assessed for each individual clam by flow cytometry using a propidium iodide protocol, while p53/p73 and mortalin gene expressions were quantified by real-time RT-PCR. Results show that haemocytes of some clams with a moderate percentage (15-50%) of tetraploid cells have a significantly high level of p53 and p73 in comparison with clams belonging to categories with low (<15%) or high levels (>50%) of tetraploid cells, where low levels of expression of these genes were observed. Furthermore, mortalin gene expression is strongly correlated (r(2)=0.68, p<0.01) with p53 gene expression level. This reinforces the hypothesis of a cytoplasmic p53 sequestration mechanism in clam haemic neoplasia. Further studies are needed to confirm these preliminary results and further unravel the molecular pathways involved in this process. Our results are believed to provide phenotypic foundation for such studies to be undertaken.

[Cases of pertussis among healthcare workers in a maternity ward: management of a health alert]. / Cas de coqueluche parmi le personnel d'un service de maternité: gestion d'une alerte sanitaire.

UNLABELLED: Pertussis is a highly contagious acute respiratory tract infection, with a poor prognosis in non-vaccinated new-borns. OBJECTIVES: The authors had for aim to investigate an epidemic of 5 pertussis cases among health care workers (HCW) in our maternity ward with potential exposure of new-borns and to evaluate HCW compliance and experience gain. METHODS: A retrospective study was made using a questionnaire with HCW on preventive measures taken (antibiotic prophylaxis with erythromycin and wearing a mask). RESULTS: Two hundred and thirty-eight patients were warned of a potential pertussis contamination. No nosocomial case was detected among patients or their new borns. Ten proved or probable cases were identified among 101 HCW having answered (N=101/210, 48%). Sixty percent of HCW people followed the antibiotic treatment and 85% wore a mask among whom 46% adequately. Non-compliance factors were mainly related to adverse effects (41%), delayed information (41%), and false vaccine protection (22%). Crisis communication was felt as unsatisfactory for 72% of HCW and recommendations not adapted for 39% of the staff. CONCLUSION: This survey points out the difficulty of managing a pertussis alert in a medical ward.

Techniques for delivery of arachidonic acid to Pacific oyster, Crassostrea gigas, spat.

The present study tested two techniques for dietary supplementation of Crassostrea gigas spat with PUFA, such as arachidonic acid (AA). The first technique consisted of a preliminary enrichment and growth of an algal concentrate (T-ISO, Isochrysis sp.) with AA dissolved in an ethanol solution, the whole culture then being fed to the spat. This enrichment increased the AA weight percentage in T-ISO neutral and polar lipids from 0.6 to 22.4% and from 0.4 to 6.8%, respectively. The second delivery technique was direct addition separately of free AA dissolved in ethanol solution and algal concentrate (T-ISO + AA) to the spat-rearing tank. To test the efficiency of these delivery techniques, oyster spat were supplemented with AA-enriched T-ISO, T-ISO + AA, and T-ISO alone. The possible biological impacts of these dietary treatments were assessed by measuring growth, condition index, and TAG content of oyster spat. Dry weight and condition index of spat fed AA-enriched T-ISO decreased by 24 and 49%, respectively, after 26 d of feeding; basically, TAG content declined 88% after 34 d of conditioning. When AA was added directly to seawater, spat growth and condition index were comparable with those of oysters fed T-ISO alone. AA incorporation in oyster tissues was assessed by analysis of the FA compositions in both neutral and polar lipid fractions. After 34 d, AA content in neutral lipids reached 7 and 11.7% in the spat fed, respectively, AA-enriched T-ISO and T-ISO + AA, as compared with 1.1% in spat fed only T-ISO. AA incorporation was greater in polar lipids than in neutral lipids, reaching 7.8 and 12.5% in spat fed AA-enriched T-ISO and T-ISO + AA, respectively. A direct addition of PUFA along with the food supply represents an effective and promising means to supplement PUFA to oyster spat.

Molecular cloning and seasonal expression of oyster glycogen phosphorylase and glycogen synthase genes.

To investigate the control at the mRNA level of glycogen metabolism in the cupped oyster Crassostrea gigas, we report in the present paper the cloning and characterization of glycogen phosphorylase and synthase cDNAs (Cg-GPH and Cg-GYS, respectively, transcripts of main enzymes for glycogen use and storage), and their first expression profiles depending on oyster tissues and seasons. A strong expression of both genes was observed in the labial palps and the gonad in accordance with specific cells located in both tissues and ability to store glucose. Cg-GPH expression was also found mainly in muscle suggesting ability to use glycogen as readily available glucose to supply its activity. For seasonal examinations, expression of Cg-GYS and Cg-GPH genes appeared to be regulated according to variation in glycogen content. Relative levels of Cg-GYS transcripts appeared highest in October corresponding to glycogen storage and resting period. Relative levels of Cg-GPH transcripts were highest in May corresponding to mobilization of glycogen needed for germ cell maturation. Expression of both genes would likely be driven by the oyster's reproductive cycle, reflecting the central role of glycogen in energy storage and gametogenic development in C. gigas. Both genes are useful molecular markers in the regulation of glycogen metabolism and reproduction in C. gigas but enzymatic regulation of glycogen phosphorylase and synthase remains to be elucidated.

Strenuous working conditions and musculo-skeletal disorders among female hospital workers.

The relations between working conditions and various aspects of health among female hospital workers were studied in 26 departments of large hospitals in the Paris area in 1986; 90% of the workers of these departments filled in a questionnaire about their working conditions, sociodemographic characteristics and health in the previous 12 months and attended a medical examination. The study sample included 1505 women. The main cause of sick leave was musculoskeletal disorders and affected 16% of the women. Back pain was described by 47% of the women, and treatment for musculo-skeletal disorders by 28%. Three working conditions were considered to characterize the posture at work: standing more than six hours a day, bending over more than ten times per hour, and maintaining an uncomfortable posture. A cumulative posture index was constructed by adding for each worker the number of the working conditions to which she had been exposed. A cumulative lifting index was constructed in a similar way from the four following characteristics: lifting weights of more than 15 kg, lifting patients more than ten times a day, making beds normally or often, and pushing beds or trolleys more than ten minutes a day. A mixed index was then constructed associating the two previous ones. The relations between these indexes and musculoskeletal disorders (MSD) were studied after adjustment for potential confounders such as age, obesity, number of children, travel duration, sport practice, occupational level, number of years in the occupation, previous attack of back pain, and mental health (assessed by the score to the general health questionnaire). The logistic regressions of MSD indicators on the mixed index and other risk factors showed that MSD was about twice as frequent among women with a maximal load in posture and/or in lifting than among women with no more than one medium index (tiring posture or lifting). These facts support the necessity for improvement of the work load in hospitals.