[Minors in a French custody center: Sociodemographic characteristics, global health and vulnerability factors]. / Mineurs en garde à vue: caractéristiques sociodémographiques, auto-évaluation de la santé et identification de facteurs de vulnérabilité.

Minor offenders are at risk for medico-psycho-social vulnerability, that impacts global health, schooling, professional future, and socio-familial environment; moreover, minors who are victims of violence and neglect are at greater risk of becoming offenders and minor offenders are at greater risk of suffering violence. Few data are currently available regarding global health and vulnerability factors for minors (i.e. those aged under 18) who have been placed in police custody. This study aimed to describe the judicial and social characteristics of these minors, their medical and psychological health status, with the hypothesis that most minors placed in police custody can be considered as abused or neglected, by presenting factors of vulnerability. We carried out a prospective study, including consecutive minors aged of 13 to 18 years old, who had been detained in custody at the Central Police Station of Nantes (France), from October 2012 to May 2013. The sociodemographic characteristics, scores for global health and the data collected from the welfare and judiciary services were analyzed, to identify abused or neglected minors. Ninety-nine teenagers were included: 78 males and 11 females (mean age±standard deviation: 16.5 years±1.01), who had been placed in custody for robbery, with a remarkable proportion of recidivist minors. Our study has highlighted several worrying characteristics of minors in police custody reflecting their vulnerability, as living conditions (no schooling, no fixed address) and irregular or absent medical follow-up; however their scores for global health were not different from the general population. While 49 minors (49.5 %) had already been identified by the welfare services, our study find that 35 added minors of this population should nonetheless be considered as being abused and/or neglected, based on a very high rate of minors already followed by child protection services and/or already penalized. Systematic health screening in custody could help to detect abused and/or neglected minors, in order to provide them access to appropriate medical and social cares. They could be referring to psychiatric or rehabilitation cares, and to the relevant welfare and judiciary services in order to assess if a specific protection measure is needed.

Impact of COVID-19 pandemic on child abuse and neglect: A cross-sectional study in a French Child Advocacy Center.

OBJECTIVE: This study aimed to describe the impact of the first COVID-19 lockdown in France on the activity of a Child Advocacy Center. METHODS: This cross-sectional, observational study included all children involved in the activity of the CAC during the first lockdown, from March 16 to May 10, 2020 and the next 3 months and the corresponding periods in 2018 and 2019. Cases were considered severe when a hospitalization, social alert and/or judicial report to the prosecutor was decided. RESULTS: Data for 1583 children were analyzed. During the lockdown, the global center activity decreased with 26.4 consultations per 100.000 children in 2018, 46 in 2019 and 20.7 in 2020 (p < 0.001). Judicial activity decreased (forensic examinations and child forensic interview recordings), whereas assessment consultations increased. Cases were more severe during the lockdown than in 2019 and 2018 (12.3, 9.4 and 6.04/100.000 children, respectively, p < 0.0001). The global activity of the center increased in the 3 months after the lockdown as compared with during the lockdown (38.2/100.000 versus 20.7/100.000, respectively, p < 0.001) but did not differ from activity in 2018 and 2019. Severe cases were more frequent in the 3 months after the lockdown than the previous years (13.7/100.000 in 2020, 9.62 in 2019 and 8.17 in 2018, p = 0.0002). CONCLUSION: The CAC activity decreased during the lockdown in France but the increase in incidence of severe abuse cases during the lockdown and the next 3 months confirm the need for optimal screening, care and support of child abuse and neglect victims even in the context of health crisis.

Ice volume and climate changes from a 6000 year sea-level record in French Polynesia.

Mid- to late-Holocene sea-level records from low-latitude regions serve as an important baseline of natural variability in sea level and global ice volume prior to the Anthropocene. Here, we reconstruct a high-resolution sea-level curve encompassing the last 6000 years based on a comprehensive study of coral microatolls, which are sensitive low-tide recorders. Our curve is based on microatolls from several islands in a single region and comprises a total of 82 sea-level index points. Assuming thermosteric contributions are negligible on millennial time scales, our results constrain global ice melting to be 1.5-2.5 m (sea-level equivalent) since ~5500 years before present. The reconstructed curve includes isolated rapid events of several decimetres within a few centuries, one of which is most likely related to loss from the Antarctic ice sheet mass around 5000 years before present. In contrast, the occurrence of large and flat microatolls indicates periods of significant sea-level stability lasting up to ~300 years.

[Violent outburst from teenagers in the pediatric emergency room: Complex cases]. / Agitation des adolescents dans les services d'accueil des urgences pédiatriques : problématique des cas dits « complexes ¼.

INTRODUCTION: Teenagers admitted to the emergency room for a violent attacks episode are increasingly numerous. The source of agitation is multifactorial for these teenagers, often with a complex course. They jeopardize hospital wards, which are often ill-suited for and overwhelmed during these outbursts. This study aims to identify and describe all the teenagers admitted to the hospital over 1 year for a violent outburst and discuss their management. METHODS AND EQUIPMENT: Retrospective and descriptive study of teenagers admitted to the pediatric emergency department of the Nantes University Hospital for a violent outburst in 2015. RESULTS: During this 1-year study, 99 teenagers out of a total of 182 consultations were admitted for a violent outburst. We noted that 85% of them had a previous history of a violent outburst, 70% of them were seeing a psychologist, and 56% were followed by the child welfare services. Most of the outbursts took place at home and were hetero-aggressive. Upon arrival at the pediatric emergency ward, 90% of the teenagers had calmed down. The mean time spent in the emergency ward was 3h42min. Finally, 31% of the teenagers were hospitalized in the general pediatric unit, 14% in the children's psychiatric department, and 8% in the adult psychiatry ward. CONCLUSION: We observed a high proportion of complex cases in the teenagers admitted to our emergency department for a violent outburst. These teenagers in distress, with a complex previous history, illustrated the relation between violence against themselves and their own violent behavior toward others. Developing short-stay units for a temporary isolation could be an advantageous multidisciplinary approach to allow somatic, psychological, and social evaluation of these vulnerable patients.

[When and how to report suspected child abuse to child protective services. Construction and evaluation of a specific support tool for primary care physicians]. / Évaluation d'un outil spécifique sur l'information préoccupante pour les médecins généralistes de Loire-Atlantique.

INTRODUCTION: The aim of this study was to create a specific tool and evaluate its impact on the knowledge of primary care physicians (PCPs) in reporting child abuse to child protective services (CPS). MATERIAL AND METHODS: Prospective "before/after" study assessing the knowledge of general practitioners (GPs) registered at the medical board in a French administrative area through anonymous questionnaires. The tool was adapted from the guidelines published in 2014 by the French Health authorities. The main criterion was the median score (/100) calculated for each questionnaire before (Q1) and after (Q2) the dissemination of the tool. These median scores were compared and associations between scores and some PCPs' characteristics were tested through multiple linear regression. RESULTS: A total of 279 GPs answered the first questionnaire (Q1) and 172 answered the second (Q2). PCPs who answered were mainly women (68% and 74%), were between 30 and 50 years old (61% and 66%), practiced in association with other physicians (82% and 84), and had 15-30% children in their patient population. For Q1, the general median was 65 [IQR: 40-81] versus 82 [IQR: 71-91] for Q2 (P<0.001). The PCPs' characteristics leading to significant variations in the scores for Q1 were age older than 50 years, being female, and having been trained in diagnosis and management of child abuse, with the ß coefficient at -16.4 [95% CI: -31.1; -1.69], +8.93 [95% CI: 2.58; 15.27] and +12 [95% CI: 6.33; 17.73], respectively. DISCUSSION: This study confirms the significant impact of this new tool on PCPs' knowledge concerning reporting suspected child abuse to the CPS. CONCLUSION: Wider dissemination of this tool could increase PCPs' awareness and comprehension of when and how to make a report to the CPS.

[Management of post-traumatic aphakia and aniridia: Retrospective study of 17 patients undergoing scleral-sutured artificial iris intraocular lens implantation. Management of aphakia-aniridia with scleral-sutured artificial iris intraocular lenses]. / Prise en charge de l'aphakie et de l'aniridie post-traumatiques. Étude rétrospective de 17 patients opérés d'implants intraoculaires suturés à la sclère à iris artificiel. Gestion de l'aphakie-aniridie par implants suturés à la sclère à iris artificiel.

PURPOSE: To evaluate the long-term outcomes of artificial iris intraocular lenses sutured to the sclera for managing traumatic aphakia and aniridia. METHODS: All consecutive cases receiving a Morcher® combination implant from June 2008 to February 2016 in Edouard-Herriot Hospital (Lyon, France) were included in this single-center retrospective study. Visual acuity, subjective degree of glare, quality of life and surgical complications were evaluated. RESULTS: Seventeen eyes of 17 patients were included, among which 82% were male. The mean age was 42 years. The injuries consisted of 23.5% contusion and 70.5% open globe injuries, of which 41% were globe ruptures. There was one postoperative case. A penetrating keratoplasty was performed at the same time for eight eyes. The mean follow-up was 32 months. Best-corrected visual acuity improved in 41.2%, remained the same in 17.6% and decreased in 41.2% of our cases. Distance vision averaged 1±0.25 line better and near vision 2.2±0.32 lines better when visual acuity was quantifiable before surgery. Glare improved in 80% of patients and remained stable in 20%, decreasing on average from 3.3/5 [min. 3-max. 4; SD: 0.48] before surgery to 1.9/5 [min. 0-max. 4; SD: 1.197] after surgery. Regarding the esthetic results, 78% of the patients declared themselves reasonably to very satisfied; 57% reported no limitation of activities of daily living, and 43% reported mild limitation. Ocular hypertension and glaucoma, found in 40% of eyes, were the main postoperative complications. CONCLUSION: Implantation of prosthetic iris device combined with an intraocular lens appears to be safe and effective in reducing glare disability and improving visual acuity. Close, long-term monitoring is essential for the success of this surgery.

Potential of tannin-rich plants, Leucaena leucocephala, Glyricidia sepium and Manihot esculenta, to reduce enteric methane emissions in sheep.

An in vivo trial was conducted in sheep to investigate the effect of three tropical tannin-rich plants (TRP) on methane emission, intake and digestibility. The TRP used were leaves of Glyricidia sepium, Leucaena leucocephala and Manihot esculenta that contained, respectively, 39, 75 and 92 g condensed tannins/kg DM. Methane was determined with the sulphur hexafluoride tracer technique. Eight rumen-cannulated sheep of two breeds (four Texel, four Blackbelly) were used in two 4 × 4 Latin square designs. Four experimental diets were tested. They consisted in a tropical natural grassland hay based on Dichanthium spp. fed alone (C) or in association with G. sepium (G), L. leucocephala (L) or M. esculenta (M) given as pellets at 44% of the daily ration. Daily organic matter intake was higher in TRP diets (686, 984, 1054 and 1186 g/day for C, G, L and M respectively; p < 0.05) while apparent organic matter total tract digestibility was not affected (69.9%, 62.8%, 65.3% and 64.7% for C, G, L and M respectively; p > 0.05). Methane emission was 47.1, 44.9, 33.3 and 33.5 g/kg digestible organic matter intake for C, G, L and M, respectively, and was significantly lower (p < 0.05) for L and M than for G and C. Our results confirm the potential of some TRP to reduce methane production. The strong decrease in methane and the increase in intake with TRPs may be due to their presentation as pellets.

[Leber-Coats' disease: A retrospective study of 10 patients]. / Maladie de Leber-Coats : étude rétrospective sur 10 cas.

INTRODUCTION: Retrospective study analyzing clinical characteristics and treatment of children affected by Leber-Coats' disease. METHOD: Children with Leber-Coats' disease seen in Edouard-Herriot Hospital, Lyon, between January 2004 and September 2013 were included. The following clinical characteristics were reported: sex, age at diagnosis, presenting symptom, Shields' stage, treatment used, and visual outcomes. RESULTS: Ten children were included in our study. Mean age at diagnosis was 5.5 years. The disease was unilateral in 9/10 cases. The presenting symptom was loss of vision in 7/10 cases, strabismus in 3/10 cases, and microphthalmos in 1 case. The diagnosis was made fortuitously during a follow-up of familial congenital cataract in 2 patients. No cases of leukocoria were seen. Shields' stages were distributed as follows: stage 1, 2A and 2B: 1 case each, stage 3A1: 7 cases, stage>3A1: no cases. Laser photocoagulation was used up to stage 2B, combined with cryotherapy in stage 3A. Stage 1 and 2A were associated with relatively good final visual acuity. Significant macular lipid exudate (stage>2A) was associated with a worse prognosis. CONCLUSION: These epidemiological data help us to better characterize these patients' prognosis. Early diagnosis seems to improve visual outcomes.

The physiological consequences of crib-biting in horses in response to an ACTH challenge test.

Stereotypies are repetitive and relatively invariant patterns of behavior, which are observed in a wide range of species in captivity. Stereotypic behavior occurs when environmental demands produce a physiological response that, if sustained for an extended period, exceeds the natural physiological regulatory capacity of the organism, particularly in situations that include unpredictability and uncontrollability. One hypothesis is that stereotypic behavior functions to cope with stressful environments, but the existing evidence is contradictory. To address the coping hypothesis of stereotypies, we triggered physiological reactions in 22 horses affected by stereotypic behavior (crib-biters) and 21 non-crib-biters (controls), using an ACTH challenge test. Following administration of an ACTH injection, we measured saliva cortisol every 30 min and heart rate (HR) continuously for a period of 3h. We did not find any differences in HR or HR variability between the two groups, but crib-biters (Group CB) had significantly higher cortisol responses than controls (Group C; mean ± SD: CB, 5.84 ± 2.62 ng/ml, C, 4.76 ± 3.04 ng/ml). Moreover, crib-biters that did not perform the stereotypic behavior during the 3-hour test period (Group B) had significantly higher cortisol levels than controls, which was not the case of crib-biters showing stereotypic behavior (Group A) (B, 6.44 ± 2.38 ng/ml A, 5.58 ± 2.69 ng/ml). Our results suggest that crib-biting is a coping strategy that helps stereotypic individuals to reduce cortisol levels caused by stressful situations. We conclude that preventing stereotypic horses from crib-biting could be an inappropriate strategy to control this abnormal behavior, as it prevents individuals from coping with situations that they perceive as stressful.

[Assessment of anesthesiologist intervention during cataract surgery under topical anesthesia]. / Évaluation du recours à l'anesthésiste-réanimateur lors de la chirurgie de la cataracte réalisée sous anesthésie topique.

OBJECTIVES: The current demographic situation in France regarding anesthesiologists calls for a reconsideration of anesthesia management for patients undergoing cataract surgery under topical anesthesia. This prospective observational study aimed to assess the requirement for anesthesiologist intervention during cataract surgery performed under topical anesthesia. PATIENTS AND METHODS: Patients operated between November 2, 2011 and July 31, 2012 were included after indication of topical anesthesia for phacoemulsification proposed by the surgeon and confirmed by the anesthesiologist. Each patient was premedicated. All patients were monitored and supervised during the surgery by a nurse anesthesiologist. An anesthesiologist could be called at any time at the request of the surgeon or nurse anesthesiologist. For each patient, medical histories were recorded as well as the event "anesthesiologist called", along with the reason and the treatment performed. RESULTS: Five hundred and seventy-five phacoemulsifications were performed in 486 patients. The event "anesthesiologist called" was recorded 20 times: 18 times for hypertension, once for anxiety and once for non-emergent conversion to general anesthesia after a surgical complication. Each episode of hypertension was successfully treated by following the nicardipine protocol. Preoperatively uncontrolled hypertension was the only significant predictive risk factor for anesthesiologist requirement. CONCLUSIONS: These results question the usefulness of preoperative anesthesia consultation for all patients who underwent phacoemulsification under topical anesthesia, since this consultation does not lead to an anesthesiologist service. Intraoperative medical complications may be treated according to medical protocols developed jointly by surgeons and anesthesiologists. This practice may free up anesthesiologists' time, without compromising patient safety.

Selection for residual feed intake in growing pigs: effects on sow performance in a tropical climate.

The aim of the study was to evaluate the consequences of a divergent selection for residual feed intake (RFI) during growth in a temperate environment (TEMP) on sow performance in a tropical environment (TROP). Sows came from a selection experiment conducted at INRA in which 2 lines were selected for larger (RFI(+)) or smaller (RFI(─)) feed intake than predicted from performance. In the first analysis, a subsample of data obtained in TROP conditions (49 lactations) was compared to those obtained in TEMP on their sibs mated with the same boars (54 lactations). In the second analysis, data obtained in the TROP environment (82 lactations) were analyzed for testing the effect of season (warm vs. hot) and line on sow performance. Except for the lactation length, the interaction between line and climatic environment was not significant for the others traits (P > 0.05). The ADFI expressed per kilogram of litter BW gain tended to be higher in the RFI(+) line bred in the TROP environment (P = 0.080), together with piglet BW at weaning, which tended to be lower (P = 0.080). The ADFI was lower in TROP than in TEMP (4.56 vs. 5.86 kg/d; P = 0.003), with negative consequence on litter BW gain and maternal BW loss. The RFI(-) sows tended to eat less feed than RFI(+) sows during lactation (4.55 vs. 5.86 kg/d; P = 0.099). Litter BW at weaning was higher in the RFI(─) line. The RFI(─) sows ate significantly less feed to produce 1 kg of litter than the RFI(+) sows and tended to lose a larger amount of BW during lactation than the RFI(+) sows (2.40 vs. 3.02 kg/kg and -0.66 vs. -0.39 kg/d, respectively, P < 0.10). Whatever the line, ADFI was reduced by about 21% in the hot season (P < 0.05). Litter BW gain was depressed (P < 0.05) in the hot season (1.72 vs. 2.08 kg/d in the warm season; P = 0.023). Lactation maternal BW loss tended to increase in the hot season (1.10 vs. 0.71 kg/d in the warm season; P = 0.016), but back fat loss remained constant (P = 0.295). In the TROP environment, the amount of feed required to produce 1 kg of litter was not influenced by the line in the warm season (2.53 kg/kg on average; P = 0.99), but it tended to be lower in the RFI(─) line when compared to the RFI(+) line in the hot season (2.06 vs. 3.45 kg/kg; P = 0.050). This higher apparent efficiency in RFI(─) sows was mainly related to greater maternal body reserve mobilization (i.e., BW and back fat losses). In conclusion, selection for low RFI during growth in a TEMP environment did not impair sow and litter performance in tropical conditions.

[Epidermolysa bullosa acquisita and graft-versus-host disease]. / Épidermolyse bulleuse acquise et réaction du greffon contre l'hôte.

BACKGROUND: Epidermolysis bullosa acquisita (EBA) is a rare acquired blistering disorder caused by production of auto-antibody directed against type-VII collagen. Autoimmune disorders can occur after allogenic bone marrow transplantation as manifestations associated with chronic graft-versus-host disease (GVHD). To date, there have been 10 cases reported in the literature concerning autoimmune blistering diseases following allogenic stem-cell transplants. Herein we describe a new case involving EBA. OBSERVATION: A 46-year-old woman developed EBA 4 years after allogenic cord blood transplantation for non-Hodgkin T-cell lymphoma complicated by acute digestive and cutaneous GVHD. At physical examination, she had some cutaneous blisters on the abdomen, arms and face, as well as numerous erosions in the buccal cavity. Direct immunofluorescence microscopy revealed linear IgG and C3 deposits along the dermal-epidermal basement membrane zone. Indirect immunofluorescence showed weak IgG G4 anti-basement membrane zone antibodies, which reacted with the dermal side of 1M NaCl-split skin; the autoantibodies were directed against type-VII collagen. This second case of EBA was evocative of a GVHD blistering disease. After the therapeutic failure of dapsone and of combined mycophenolate-prednisone, treatment with rituximab proved effective. DISCUSSION: EBA may form part of the autoimmune signs associated with chronic GVH. The destruction of basement membrane and of epidermal basal cells that occurs in GVH could give rise to autoimmune bullous disease. However, in our patient, in whom manifestation of chronic GVH was restricted to the lungs, it is difficult to rule out the fortuitous onset of EBA, which presented at a sizeable interval after acute GVH.

[Congenital toxoplasmosis: long-term ophthalmologic follow-up praised by patients]. / Toxoplasmose congénitale; le suivi ophtalmologique à long terme plébiscité par les patients.

INTRODUCTION: Ocular lesions of congenital toxoplasmosis may occur and relapse unpredictably even a long time after birth. There is no consensus concerning the necessity or timing of ophthalmologic follow-up for these patients. We surveyed adults with congenital toxoplasmosis followed regularly since birth, in order to learn their perceptions of this follow-up. The goal of this study was to provide doctors with patient-reported information on how they perceived the long-term monitoring of their disease. METHODS: Enrolled patients were given a two-question questionnaire addressing the way they perceived the long-term follow-up and their attitudes toward continuing it. Eligible patients had to be 18 years or older and to have undergone ophthalmologic follow-ups, including funduscopy, every year since birth. The last ophthalmologic examination had to be within one year of the patient's inclusion in the study. RESULTS: Of the 102 patients finally included in the study, 98% stated that the follow-up was useful and 92% reassuring. Among the 11% of patients who found the follow-ups frightening, the proportion of patients with low visual acuity and low score on the visual function test was significantly higher than among the others. All patients except two wished to continue with regular follow-up. CONCLUSION: Without general agreement or guidelines on how patients with congenital toxoplasmosis should be monitored, the patient's wishes are important in making a decision. Our study brought out a clear fact; the majority of patients found long-term follow-up useful and reassuring and wished to continue.

Micro-wires self-assembled and 3D-connected with the help of a nematic liquid crystal.

We discuss a method for producing automatic 3D connections at right places between substrates in front of one another. The idea is based on the materialization of disclination lines working as templates. The lines are first created in the nematic liquid crystal (5CB) at the very place where microwires have to be synthesized. Due to their anchoring properties, colloids dispersed into the nematic phase produce orientational distortions around them. These distortions, which may be considered as due to topological charges, result in a nematic force, able to attract the colloids towards the disclinations. Ultimately, the particles get trapped onto them, forming micro- or nano-necklaces. Before being introduced in the nematic phase, the colloids are covered with an adhering and conducting polypyrrole film directly synthesized at the surface of the particles (heterogeneous polymerization). In this manner, the particles become conductive so that we may finally perform an electropolymerization of pyrrole monomers solved in 5CB, and definitely stick the whole necklace. The electric connection thus synthesized is analyzed by AFM, and its strength is checked by means of hydrodynamic tests. This wiring method could allow Moore's law to overcome the limitations that arise when down-sizing the electronic circuits to nanometer scale.

[Clinical and etiological aspects of uveitis: a retrospective study of 121 patients referred to a tertiary centre of ophthalmology]. / Aspects cliniques et étiologiques des uvéites: étude rétrospective de 121 patients adressés à un centre tertiaire d'ophtalmologie.

PURPOSE: Uveitis consists of a large group of diseases characterized by intraocular inflammation involving the uveal tract. This heterogeneity makes the diagnosis and the treatment of uveitis frequently challenging. The purpose of this study was to describe the various clinical and etiologic aspects of uveitis, through the new standardized uveitis classification and the use of modern investigations for its diagnostic work-up. METHODS: The medical records of 121 new patients with uveitis referred to our tertiary ophthalmologic centre between January 2002 and December 2006 were retrospectively reviewed. Uveitis associated to human immunodeficiency virus and secondary to exogenous endophthalmitis were excluded. All patients had a complete ophthalmological examination and appropriate clinical and paraclinical examination. The diagnosis was established according to the recent international criteria. RESULTS: One hundred and twenty-one patients were included. The four main etiologies were: toxoplasmosis (14%), sarcoidosis (11.6%), spondylarthritis or HLA B27-associated uveitis (13.2%) and Herpes virus infections (9.1%) that represented almost half of the uveitis causes (47.9%). Various diseases constituted the remaining causes of the uveitis (20.9%). Uveitis remained unexplained in the remaining 36 patients (29.7%). Overall, associated systemic diseases were diagnosed in 35.5% of our uveitis patients (34 patients), associated infectious conditions in 26.4% (32 patients) and specific ocular diseases in 8.3% (12 patients). CONCLUSION: Despite a limited number of patients, our study showed an etiologic distribution similar to that of the main series reported in the literature. Nevertheless, we observed an elevated frequency of sarcoidosis and systemic diseases, which emphasizes a management that takes into account standardized clinical and paraclinical criteria and the usefulness of a collaboration with the internist.

Hospital initiation of a vaccinal schedule improves the long-term vaccinal coverage of ex-preterm children.

Preterm infants are experiencing delays in receiving routine schedule vaccines. We evaluated up-to-date immunisation status of 602 preterm infants at 5 and 24 months for DTCoqPolioHib and pneumococcal conjugate vaccine (defined by 3 and 4 doses, respectively). At 5 months, 39% (CI 95% [35-43]) of children were up-to-date for DTCoqPolioHib and 22% (CI 95% [19-26]) for pneumococcal conjugate, while at 24 months 67% (CI 95% [64-71]) were up-to-date for DTCoqPolioHib and 36% (CI 95% [32-40]) for pneumococcal conjugate. After adjustment for gestational age, a primary vaccine before discharge remained linked with a better vaccinal coverage (p<.005, OR=5.0; CI 95% [2.9-8.5]).

[Surgery of perforating ocular injuries of the posterior segment by lead shot: two case studies]. / Chirurgie des traumatismes oculaires perforants du segment postérieur par plombs: à propos de deux cas.

INTRODUCTION: Treatment of retinal detachment secondary to perforating ocular trauma (POT) is difficult due to the fragility of the sclera, the number, size, and location of the retinal wounds, the vitreoretinal incarceration into the scleral wound, and the high risk of vitreoretinal proliferation. We report our experience of pars plana vitrectomy to prevent secondary retinal detachment in two cases of POT of the posterior segment caused by lead shot. OBSERVATIONS: Two males, about 20 years old, suffered from a perforating ocular injury caused by a single pellet. In both cases, the entrance wound was more than 5mm posterior to the corneoscleral limbus and the exit wound was located in the posterior pole. In both cases, initial visual acuity was limited to perception of hand motions and the Ocular Trauma Score (OTS) was 2. Both patients underwent two surgical procedures, the first procedure consisting only in entrance wound closure. The second procedure was delayed 17 days (case 1) and 10 days (case 2). It consisted in pars plana vitrectomy including careful shaving of the incarcerated vitreous into the wounds and detachment of the posterior hyaloid. Surgery was completed by cryopexy of the retina beneath the entrance wound and by focal scleral buckling between the entrance and the exit wound. Cryopexy was not done on the exit wound. Final visual acuity was 40/200 (case 1) and 30/200 (case 2) after 36 and 8 months, respectively. No retinal detachment was observed. CONCLUSION: This report highlights the advantage of early pars plana vitrectomy to prevent retinal detachment in POT related to lead shot.