[Remote dermatological advice: a survey in three French regions]. / Avis dermatologiques à distance : une enquête interrégionale.

BACKGROUND: General practitioners and specialists often seek advice from dermatologists based on digital pictures. This time-consuming activity is currently not valued nor well-established. We therefore conducted a survey to assess the extent and nature of such requests. PATIENTS AND METHODS: A questionnaire was sent to dermatologists working either at university hospitals or in private practice in three regions of France (Loire Atlantique, Rhone Alpes and Normandy). For two months, the dermatologists completed the same questionnaire for each specialized request. The following items were recorded: status of the dermatologist asked to provide a specialized opinion, region in which the request was made, status of the requesting practitioner, mode of request, type of disease, question asked, time taken to answer the request and result of the specialized advice. RESULTS: Thirty dermatologists, including 11 in private practice, participated in this study. We identified 287 requests. The majority of these requests came from general practitioners (30%) and dermatologists working in private practice (29%). These requests were sent by e-mail using a non-secure professional e-mail address in 49% of cases or via smartphone in 29% of cases. The purpose of the requests was either diagnostic/therapeutic (36%) or solely therapeutic (39%). Relevant requests concerned dermatological manifestations in paediatric or cancer patients (23% and 21% respectively), general dermatological diseases (21%) and wound management (14%). Nearly half of the specialized advice was provided in under 5minutes, and in 60% of cases a consultation with a dermatologist was avoided. CONCLUSION: Despite the small number of physicians taking part in the study, this non-exhaustive survey confirms the usefulness of remote dermatological reviews and consultations, and identifies the main intervening physicians involved in this type of procedure. The study also raises potential medico-legal issues regarding the lack of data security covering medical information. There is thus a need for dermatologists to organize their activity in order to respond to such requests without exposing themselves to medico-legal consequences.

Risk of recurrence after a single, unprovoked, generalized tonic-clonic seizure.

A cohort of 119 two- to 16-year-old patients was followed to assess the risk of recurrence after a single, unprovoked, generalized tonic-clonic seizure. Only children with a normal neurological examination and intellectual development, and an EEG showing no focal abnormality, were studied. The risk of recurrence at six months was 22 per cent, at one year 28.5 per cent, at three years 32.6 per cent and at eight years 37.7 per cent. 58 per cent of recurrences occurred within the first six months and 87 per cent within the first two years. Initial EEGs showing generalized, unprovoked spikes and waves, generalized paroxysmal discharges precipitated by intermittent photic stimulation, or isolated slowing, were associated with risks of recurrence at two years of 40, 50 and 26 per cent, respectively. These results do not differ significantly from those obtained when the initial EEG was normal (29 per cent). Age, seizure duration and history of epilepsy in the family were not associated with a significantly higher risk of recurrence. The risk of recurrence was similar for treated and untreated patients.

Fer de Lance virus (FDLV): a probable paramyxovirus isolated from a reptile.

A new virus has been isolated by inoculation of lung tissues of diseased snakes into snake embryos. Homogenates of infected embryo tissues caused c.p.e. in cell cultures incubated at 30 degrees C. The virus replicates in a wide variety of reptilian or mammalian cell types incubated at 30 degrees C, inducing either syncytium formation or minimal or no cytopathic changes. Efficient replication occurs in embryonated hens' eggs at 27 to 30 degrees C. The virus haemagglutinates guinea pig and chick erythrocytes; it possesses a neuraminidase similar to the receptor-destroying enzyme of Vibrio cholera. Electron microscopic observations of infected cells examined in thin section revealed pleomorphic viruses 146 to 321 nm in diam. resembling known myxoviruses. Internal nucleocapsid strands are 15 to 16 nm in diam.; nucleocapsid observed in negatively stained preparations measures 14 nm in diam. The virus was determined to possess a nucleoprotein core containing a 50S single-stranded unsegmented RNA genome. All characters of the virus are similar to those of the paramyxovirus group except that the nucleocapsid diam. is intermediate between that of paramyxoviruses and pneumoviruses. The virus is antigenically distinct from known myxoviruses and is unique among myxoviruses in its restriction to growth at temperature below 37 degrees C.

[Reproduction of Bothrops moojeni Hoge in captivity]. / Observations sur la reproduction de Bothrops moojeni Hoge en captivité

It is stated that there are sufficient different morphological characteristics in order to distinguish the sexes with a certain practice, but that each of these characteristics by itself does not alone represent a completely valid criterium. These observations have shown in the periods of reproduction a chifting of six months after six years of captivity. Then the various phases of sexual behaviour are related: the male-fight, the courtship, the conquest of the partner by sexual display and finally the copulation. It is established moreover that the period between the copulation and parturition does not necessarily constitute the duration of gestation, which seems in fact shorter because of retarded fertilizations. However, there is quite a constant average of a period of gestation of 200 days. There follows a complete inventory of the 29 copulations and 67 layings that were observed.