The dog mummy, the ticks and the louse fly: Archaeological report of severe ectoparasitosis in Ancient Egypt.

The authors report the first archaeological case of dog ectoparasitosis in Ancient Egypt. The study of a mummified young dog dated to the Roman period suggests a significant infestation by two blood sucking ectoparasites, respectively the brown dog tick Rhipicephalus sanguineus Latreille, 1806 (Acari: Ixodidae), the louse fly Hippobosca longipennis Fabricius, 1805 (Diptera: Hippoboscidae) as well as puparia of sarcosaprophagous flies (Diptera: Sarcophagidae and Calliphoridae), a potential source of myiasis. All of these species are known to be potential vectors of different pathogens which may be responsible for the premature death of the dog.

[Value of RHD fetal genotyping in the prevention of anti-D immunization]. / Intérêt du génotypage foetal RHD dans la prévention de l'immunisation anti-D.

Anti-D prophylaxis is currently applied in France after birth of an RhD positive infant, after interruption of pregnancy and after some antenatal immunizing events (amniocentesis...). However this program does not cover all the prenatal exposures to fetal RhD antigen, and maternal Rh immunization continues to occur. DNA RhD genotyping of the fetus is now reliably performed on amniotic fluid, and pre diagnostic studies on fetal DNA extracted from maternal plasma are promising. The widespread use of fetal RhD genotyping on maternal blood would allow the antenatal administration of Rh immunoglobuline in all Rh negative patients bearing an Rh positive fetus, insofar as it would preclude exposing the other Rh negative patients to the above plasma derived and rather expensive blood product.

Bacteriological validation of a new apparatus for disinfection of hospital waste at the point of disposal.

OBJECTIVES: To evaluate the ability of a new apparatus (Dipsys 25, Société SGN, Bagnols sur Cèze, France) to disinfect biomedical waste, including both potentially infectious agents and the normal saprophytic flora of the waste. METHODS: Disinfection was assessed using standard methods (reference strains were fixed on reference carriers according to the French AFNOR methods) and nonstandard assays. Assays in conditions of hospital use, evaluations of bacterial survival during storage, sporicidal effect, and spore survival during storage were performed in parallel. Finally, bactericidal effect in extreme conditions (association of high contamination and high bacterial protection conditions) was tested with normal fecal flora. Bacterial counts were performed after treatment by the apparatus and without treatment (controls). All tests were carried out in triplicate. RESULTS: In all treated carriers, a bacterial population decrease of at least 5 log10 was obtained. Assays performed in hospital-use conditions did not show any bacterial growth. Concerning the evaluation of sporicidal effect and spore revival during conservation, a minimum reduction of 5 log10 was observed in all assays performed, without survival. Finally, concerning assays in extreme conditions, the decrease of bacterial population was between 5 log10 and 10 log10 for vegetative anaerobes of normal fecal flora. CONCLUSION: Under our study conditions, the study apparatus reduced the tested microbial populations by a minimal factor of 5 log10. The main advantage of the apparatus is the opportunity to treat contaminated waste inside hospital wards, at the point of initial collection, without pulverization, by nonspecialized staff.

Comparison of costs linked to the preparation and administration of fluorouracil as a continuous infusion based on three techniques.

The approach in treatment in medical oncology and particularly in the management of solid tumours has to integrate--at least--two targets: the enhancement of therapeutic efficacy, and the respect of global budget assigned to health. Different teams are implicated in such an approach and especially physicians and pharmacists. We decided to conduct a comparative study of three techniques of administering drugs as a continuous infusion. We analysed time and materials required for the preparation in the centralized preparation unit, and for dispensing and nursing in the health units. The use of programmable pumps (CADD-1) leads to overall saving costs of 27 to 40% compared to administration by means of an infusion bag or a motor-drive syringe.

Centralized preparation of hazardous drugs. A choice between isolator and laminar airflow.

In 1987, the manager of the Saint-Joseph Hospital (Paris, France) requested a reorganization of cytotoxic drug preparation. Protection for staff who handle hazardous drugs was the main concern. The conclusions drawn from a first analysis emphasize the advantages of a centralized reconstitution unit against a decentralized system. Subsequently, a workload study and an economic study (investment, maintenance, supplies, staff costs, comparative balance sheet and a 5-year simulation) were carried out, but to choose between a laminar airflow in aseptic room and an isolator in a conventional room. The selected isolator is the first of the conception: the central half-suit uses as a server, and four sleeves located on one side allow two technicians to work in a sterile and closed area without sterile garments.

[The perinatal transmission of the hepatitis B virus in the Paris area]. / Transmission périnatale du virus de l'hépatite B dans la région de Paris.

HBsAg was detected in 152 pregnant women among 6,605 (2.3%) screened in the prenatal clinics of four hospitals representative of the Paris metropolitan area. In 98% of cases, HBsAg positivity indicated chronic HBV carrier status. Among patients born out of continental France (47% of screened women, 79% of positive women) relative risk of chronic infection was 6 in Asians, 5.5 in Africans, and 4 in French women born in non-continental France. No significant difference in medical history was seen between HBsAg-positive and HBsAg-negative patients, in any of the birthplace groups. In women born out of continental France, number of children and crowding in the home were correlated with HBsAg-positivity; these correlations were not found in French women born in continental France. In non-African, non-Asian women, screening on the basis of medical, social and familial criteria (simulated in this study) would not be effective. Routine screening for HBsAg in pregnancy is advocated. The cost of the prevention of each case of perinatally acquired chronic HBV infection by routine screening followed by prophylactic treatment of a risk neonates was estimated at 180,000 French Francs (35,000 dollars). This approach is the only means of preventing the long-term life-threatening complications of chronic HBV infection in the 600 neonates born each year in France to HBsAg-positive mothers.

Immunogenicity and safety in newborns of a new recombinant hepatitis B vaccine containing the S and pre-S2 antigens.

A study to evaluate the safety and immunogenicity of a recombinant hepatitis B vaccine containing the S and pre-S2 antigens (GenHevac B Pasteur) was conducted in healthy newborn infants. All infants received 20 micrograms of vaccine within 24 h of birth and at 1 and 2 months with a booster injection at month 12. The vaccine was administered alone in 19 infants born to low risk mothers, i.e. surface antigen (HBsAg)-negative and antibody to the core antigen (Anti-HBc)-positive mothers. The vaccine was administered in combination with 100 IU hepatitis B immune globulin (HBIg) at birth and 1 month in 18 infants born to high risk mothers, i.e. HBsAg positive mothers. In the group not receiving HBIg, the anti-HBs seroconversion rate at the 10 mIU ml-1 threshold was 50% 1 month after the first injection. In both groups, the anti-HBs seroconversion rates were 100% 1 month after the third injection and greater than 85% 1 month after the second injection. After the booster injection greater than 90% of the infants had an anti-HBs titre greater than 1000 mIU ml-1 which will probably provide them with adequate protection for several years. The kinetics of the anti-pre-S2 response was similar to that of the anti-HBs response and 100% of infants in both groups had seroconverted 1 month after the second injection of the vaccine. The side effects were scarce, all mild and transient.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevention of perinatal hepatitis B virus transmission. Epidemiology and cost/efficacy ratio in the Paris region]. / Prévention de la transmission périnatale du virus de l'hépatite B. Epidémiologie et rapport coût/efficacité dans la région de Paris.

The HBs antigen (AgHBs) was detected in 152 out of 6605 (2.3 percent) pregnant women who attended four representative maternity clinics in the Paris region. In 98 percent of the cases this finding reflected chronic hepatitis B virus infection. Among women born outside France (47 percent of the women tested, 79 percent of the AgHBs positive women), the relative risk was 6 for Asiatics, 5.5 for Africans and 4 for French women born in overseas departments or territories. Whatever the women's geographical origin, studies of their medical history revealed no significant difference between AgHBs positivity and AgHBs negativity. Overcrowding and multiparity correlated globally with the presence of AgHBs, but this correlation was absent in French women born in France. In non-African and non-Asiatic women detection guided by medical and socio-familial criteria would not be efficacious. The authors recommend systematic detection of AgHBs in pregnant women and estimate at about 180,000 french francs the cost of prevention for each case evolving toward the vital complications of chronic hepatitis B virus infection, an outcome which in the long term may affect 600 individuals born each year and who had contracted the infection during the perinatal period.

[Perinatal transmission of the hepatitis B virus in Paris region]. / Transmission périnatale du virus de l'hépatite B dans la région de Paris.

HBsAg was detected in 152 pregnant women among 6,605 (2.3%) screened in the prenatal clinics of four hospitals representative of the Paris metropolitan area. In 98% of cases, HBsAg positivity indicated chronic HBV carrier status. Among patients born out of continental France (47% of screened women, 79% of positive women) relative risk of chronic infection was 6 in Asians, 5.5 in Africans, and 4 in French women born in non-continental France. No significant difference in medical history was seen between HBsAg-positive and HBsAg-negative patients, in any of the birthplace groups. In women born out of continental France, number of children and crowding of the home were correlated with HBsAg-positivity; these correlations were not found in French women born in continental France. In non-African, non-Asian women, screening on the basis of medical, social and familial criteria (simulated in this study) would not be effective. Routine screening for HBsAg in pregnancy is advocated. The cost of the prevention of each case of perinatally acquired chronic HBV infection by routine screening followed by prophylactic treatment of at risk neonates was estimated at 180,000 French Francs (35,000 dollars). This approach is the only means of preventing the long-term life-threatening complications of chronic HBV infection in the 600 neonates born each year in France to HBsAg-positive mothers.

[Prospective evaluation of modalities of ceftazidime prescription]. / Evaluation prospective des modalités de prescription de la ceftazidime.

Between November 1987 and October 1988, we have prospectively studied 101 hospital prescriptions of ceftazidime, a third generation cephalosporine, including all the health care departements of St Joseph hospital. A standard questionnaire was used to collect the date: dosage, length, and conditions of prescriptions. We observed that this antibiotic is correctly prescribed concerning dosage, length of prescription, and is adapted to bacteriological findings. The striking results were a high proportion of empirical prescriptions (48%) comparing to less than 10% 6 months before the beninning of this study. 75% of these empirical prescriptions being later on confirmed by bacteriological exams.

Collection of placental blood with a view to hemopoietic reconstitution.

Collection of placental blood in a sterile and closed system is a simple, safe and efficient procedure. One hundred and fifty eight units of fetal blood were collected by applying the same requirements of quality and safety as those defined for blood products in blood banks. No adverse effects were seen in mothers or their newborns.

[Prompt antibiotic prophylaxis in resection of the prostate and removal of the bladder catheter]. / Antibioprophylaxie ponctuelle lors de la résection de la prostate et de l'ablation de la sonde vésicale.

Several regimens of antibiotic prophylaxis have been used in transurethral prostatic resection. In this study 50 patients received 1 g of cefotaxime during resection and thereafter were divided at random into two groups: one group received another 1 g dose of cefotaxime when the bladder catheter was removed, while the other group was left untreated at that stage. The administration of cefotaxime during both prostatic resection and catheter removal resulted in a highly significant reduction of infection risk, duration of hospitalisation and cost of antibacterial treatment. The most important risk of sepsis seems to be related to an apparently innocuous procedure: removal of the bladder catheter with resumption of spontaneous micturition.

Two hundred intrauterine exchange transfusions in severe blood incompatibilities.

Two hundred intrauterine exchange transfusions were performed under local anesthesia in 107 cases of blood incompatibilities (60 fetuses with severe anemia and 47 with hydrops). Under sonographic guidance, depending on fetal and placental position, an optimal puncturing site was selected along the umbilical vein: placental insertion, fetal insertion, or fetal intraabdominal segment. Tests were immediately performed to confirm fetal origin of blood obtained and estimate hemoglobin level. Blood used for exchange transfusion was compatible with maternal blood and had a hematocrit value of 75%. Exchange transfusion was continued until a hemoglobin level of 16 gm/dl was reached. This procedure was first associated with intraperitoneal transfusions and was subsequently used independently once a month to maintain an adequate hemoglobin level. In 4 fetuses with hydrops, antenatal regression of this sign was observed in 33 cases (70.2%). Overall outcome of 107 fetuses after exchanges was 84 living neonates (78.5%), 15 deaths in utero, and eight neonatal deaths. The survival rate was 91.6% for fetuses without hydrops and 61.7% for those with hydrops. The advantage of exchange transfusion appears to be rapid and efficient correction of anemia with elimination of incompatible fetal red blood cells.

Paris cooperative study on HIV sero-positivity in pregnancy: preliminary results.

PIP: Researchers tested the sera of 10,277 pregnant women who visited 9 prenatal clinics in Paris, France or its environs between February 17, 1987 - August, 17, 1987. The women also completed a questionnaire about risk factors. Laboratory personnel tested for HIV using and ELISA technique, and referred positive sera for further screening to a virology laboratory in Tours. Researchers already knew that 43 cases were HIV positive, 26 of whom had an induced abortion and 17 chose to continue the pregnancy. 30 patients tested positive who did not know they carried HIV: 8 in the abortion group; 19 in the pregnancy group; 1 in the miscarriage group; and 1 in the ectopic pregnancy group. The overall HIV prevalence rate was 7.1/1000. The researchers further defined the prevalence rate by taking only into account the discovered HIV positive patients, since the others were already known and included in HIV statistics. In the induced abortion group, the prevalence rate was 6.42% and in the pregnancy group 2.18%. The leading mode of transmission for the 73 HIV positive women was intravenous (IV) drug use, followed by being from an endemic country. By comparing HIV testing results and the questionnaires of the discovered HIV positive women, researchers would have selected 93% of these women. On the other hand, 35.8% of all the patients responded positively to at least 1 item. This shows that it is difficult to develop an adequate questionnaire and select an appropriate sample size. The researchers hope to improve the specificity of the questionnaire, in order to reduce the number of patients to be screened for HIV.^ieng

[Prevalence of anti-HIV antibodies in immunoglobulins recipients]. / Prévalence des anticorps anti-HIV chez les receveurs d'immunoglobulines.

Seven hundred and forty subjects who, between 1980 and 1985, had received intravenous or intramuscular injections of immunoglobulins (Ig) prepared by Cohn fractionation of plasma pools from more than 2000 donors were investigated for anti-HIV antibodies. Anti-HIV antibodies were detected in only one subject, a female drug addict and therefore belonging to a group at high risk of AIDS. In contrast with the huge amounts of Ig received by the remaining 739 subjects (976 litres intravenously, 128 litres intramuscularly), this young woman had only received 10 ml of anti-HBs Ig intramuscularly. The wide scattering in both space and time of these recipients of Ig and the prevalence of anti-HIV antibodies among blood donors in France (0.7 per 1000 in 1985) suggest that all the batches studied (over 100) were contaminated by HIV. The absence in these subjects of seropositive reaction ascribable to the injections of Ig confirms that Cohn fractionation inactivates the virus, as demonstrated in vitro. It is concluded that recipients of Ig prepared from plasma pools not tested for the absence of anti-HIV antibodies should not be regarded as a group at risk of AIDS.

[Ante-partum administration of preventive treatment of Rh-D immunization in rhesus-negative women. Parallel evaluation of transplacental passage of fetal blood cells. Results of a multicenter study carried out in the Paris region]. / Application anté-partum du traitement préventif d'immunisation rhésus D chez les femmes rhésus négatif. Evaluation parallèle des passages transplacentaires d'hématies foetales. Résultats d'une étude multicentrique menée en région parisienne.

1,969 non immunized rhesus negative primiparous women were followed up in 23 maternity units in the geographical region of Paris. 1,882 could be retained to study antepartum protection and 1,884 to study transplacental passage of fetal blood cells. Two groups were defined according to whether they were born in even or uneven years, so that: 955 were the "control" group who delivered 590 rhesus D positive infants, and 927 were the "treated" group who delivered 599 rhesus D positive infants. The "control" group were used as controls at the 28th and 34th weeks of pregnancy, while the "treated" group received two injections of anti-D immunoglobulin given on the same dates after taking the necessary tests. Immunological testing at the time of the delivery and after the delivery showed that 7 women had become Rh D immunized in the "control" group whereas only one in the "treated" group. This difference, which is statistically significant, confirms the results of other authors about the efficiency of antepartum rhesus disease prevention. The incidence of immunisation during or immediately after the first pregnancy in women who had no previous story of blood transfusions or of terminations of pregnancy is 1.11%, which is a figure relatively low as compared with studies of series carried out in North America, but close to those carried out in other European centres. When primipara of all categories are lumped together the frequency rises to 1.5%. A study of the passage of fetal red blood cells into the maternal circulation shows that at the 29th week of pregnancy out of 1,884 cases there were 5.5% positive kleihauer tests, without a large volume of blood being detected and at the 34th week of pregnancy when 957 tests were carried out, 7% were positive with one of them being of a massive transfusion of blood from the fetus to the mother, which was life-threatening for the fetus. It may be that the incidence had been under-estimated and that the positive results in the two groups, control and treated, show that there is a statistically significant difference that demonstrates that antepartum treatment in the trial has eliminated a worthwhile percentage of positive kleihauer tests which arose from the transfusion of small quantities of blood.(ABSTRACT TRUNCATED AT 400 WORDS)

[Immunologic abortion and its treatment by immunotherapy]. / La maladie abortive immunologique et son traitement par immunothérapie.

Recurrent spontaneous abortions in most cases, can be explained by classical abnormalities; but for some cases without etiology and consequently without appropriate therapy until a few years ago, there is hope a successful treatment, thanks to recent advances. Contrary to what was suspected in the past, during pregnancy, the mother is immunologically competent against the paternal antigens of the fetus; this competence is necessary for her to respond to the trophoblast paternal antigen stimulations and develop her immune tolerance. If, because of insufficient stimulation, the woman does not succeed in producing this tolerance, it is now possible to help her by vaccination with paternal lymphocytes, before she becomes pregnant. Our results confirm these data: Again, we observe a greater frequency of HLA antigen sharing in couples with recurrent spontaneous abortions (RSAs), especially at the DR locus, Women with three or more RSAs, produce fewer antibodies against their husbands HLA antigens than regular normal fertile women (none out of the 50 cases studied), Anti-paternal antibodies the specificity of which cannot be determined at the moment, are shown by means of the microlymphocytotoxicity test at 37 degrees C carried out on the paternal B lymphocytes. They appear with the cure of the abortive illness after treatment by paternal lymphocyte injections. In the control women who did not receive any immunotherapy, those who developed anti-paternal antibodies spontaneously had a new normal pregnancy; 57.2 of those who did not produce any anti-paternal antibodies aborted once more.