Probiotics: a new way to fight bacterial pulmonary infections?

Antibiotics, of which Fleming has identified the first representative, penicillin, in 1928, allowed dramatical improvement of the treatment of patients presenting with infectious diseases. However, once an antibiotic is used, resistance may develop more or less rapidly in some bacteria. It is thus necessary to develop therapeutic alternatives, such as the use of probiotics, defined by the World Health Organization (WHO) as "micro-organisms which, administered live and in adequate amounts, confer a benefit to the health of the host". The scope of these micro-organisms is broad, concerning many areas including that of infectious diseases, especially respiratory infections. We describe the rational use of probiotics in respiratory tract infections and detail the results of various clinical studies describing the use of probiotics in the management of respiratory infections such as nosocomial or community acquired pneumonia, or on specific grounds such as cystic fibrosis. The results are sometimes contradictory, but the therapeutic potential of probiotics seems promising. Implementing research to understand their mechanisms of action is critical to conduct therapeutic tests based on a specific rational for the strains to be used, the dose, as well as the chosen mode and rhythm of administration.

[On call emergency dental hospital service: creation and preliminary results]. / Astreinte odontologique au sein d'un CHU : mise en place et résultats préliminaires d'activité

BACKGROUND: In France, few hospitals are able to provide uninterrupted care for dental emergencies. To meet the legal and deontological requirements, since October 2007, the Brest University Hospital has set up a dental emergency unit with on call consultants. Prior to this set-up, the needs had been evaluated through surveys conducted in Brest hospital. This study deals with the results of these surveys, and reports the experience of this call emergency service after 1 year of operation. METHODS: The needs of the general population concerning emergency dental care were quantified in three units of Brest hospital (general, pediatric and ENT emergencies) for 6 months and the mobile emergency unit (Samu 29) for 1 year. The findings led to setting up an emergency dental unit during week-ends. The activities of this unit after 1 year of operation were evaluated retrospectively. Variables concerning attendance and activity level, patient parameters and out-of-hours emergency activity were studied. For this purpose, data from the medical record and from complementary "information sheets" completed by the clinicians were analyzed. RESULTS: The preliminary step of needs-quantification recorded an important demand for dental service in both emergencies units of Brest hospital and Samu 29. During the first year of operation, attendance level was on average 6.3 (+/-4.3) consultations per week-end. Peak activity levels were reached on saturday and sunday afternoons and also during the summer months. Male patients were more numerous than females and the mean age of the population was 32.6 years (+/-17.6). By decreasing order of frequency, the diseases encountered were mainly infectious, then trauma-related, inflammatory and others. Clinical interventions were mainly in endodontics, conservative dentistry and surgery. CONCLUSION: This on call emergency service meets the needs of the general population concerning emergency dental care when hospital dental departments and regular dental offices are closed. This is a public health issue.

Intrafamilial transmission of extended-spectrum-beta-lactamase-producing Escherichia coli and Salmonella enterica Babelsberg among the families of internationally adopted children.

OBJECTIVES: International adoption from developing countries has become an increasing phenomenon in recent years. Given the high prevalence of multidrug-resistant (MDR) bacteria in these countries, the adopted children represent a group at risk for both carriage and infection with MDR bacteria. The dynamics of intrafamilial transmission of MDR bacteria after adoption was studied in a prospective study from January 2002 to January 2005. METHODS: Stool samples, taken at the first visit to the outpatient adoption practice and subsequently every month, from the adopted children of an orphanage of Bamako (Mali) and from all the members of their adoptive families were screened for MDR bacteria and bacterial pathogens. Bacteria were characterized by standard biochemical methods, disc diffusion antibiograms, PFGE and plasmid analysis. beta-Lactamase genes were sought by PCR. RESULTS: Over the study period, 52 ESBL-producing Enterobacteriaceae (E-ESBL), with Escherichia coli (56%) being the most prevalent, were isolated from 24/25 adoptees at arrival in France. During follow-up, the transmission of ESBL-producing E. coli and Salmonella enterica Babelsberg between the adoptees and their adoptive family members has clearly been demonstrated for 5/22 families (23%). The mean duration of the carriage for the adopted children was 9 months (1-15 months). CTX-M-15 was the most prevalent resistance gene among the E-ESBLs (93%), while SHV-12 was found among the S. enterica Babelsberg studied. CONCLUSIONS: International travellers, transfer of patients and now adoption may contribute to the global emergence of MDR bacteria. Thus, in addition to the usual screening of adopted children for infectious diseases, additional screening for MDR bacteria should be recommended, at least for children coming from countries with a high prevalence of MDR bacteria.

[Mandibular fibrous dysplasia: a monostotic form]. / Dysplasie fibreuse mandibulaire : une forme monostotique.

INTRODUCTION: The onset of one or several diastema in adults with no link of etiology to tooth loss or to a periodontal problem can be the first evocative sign of an acromegaly or a benign or malignant tumoral process. OBSERVATION: A 40-year-old patient consulted for an implant to solve an esthetic problem caused by a diastema. The complementary exams revealed an osteolytic lesion marked by condensing areas. The biopsy proved the diagnosis of fibrous dysplasia. DISCUSSION: Etiologies of fibrous dysplasia are varied. They can be related to a congenital defect of osteo mesenchyma development or be the consequence of trauma, reaction to infection, or an endocrine or metabolic disorder.