Source and Relevance of the BK Polyomavirus Genotype for Infection After Kidney Transplantation.

BACKGROUND: BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN) is a major threat for kidney transplant recipients (KTRs). The role of specific BKPyV genotypes/serotypes in development of BKPyVAN is poorly understood. Pretransplantation serotyping of kidney donors and recipients and posttransplantation genotyping of viremic recipients, could reveal the clinical relevance of specific BKPyV variants. METHODS: A retrospective cohort of 386 living kidney donor-recipient pairs was serotyped before transplantation against BKPyV genotype I-IV viral capsid protein 1 antigen, using a novel BKPyV serotyping assay. Replicating BKPyV isolates in viremic KTRs after transplantation were genotyped using real-time polymerase chain reaction and confirmed by means of sequencing. BKPyV serotype and genotype data were used to determine the source of infection and analyze the risk of viremia and BKPyVAN. RESULTS: Donor and recipient BKPyV genotype and serotype distribution was dominated by genotype I (>80%), especially Ib, over II, III and IV. Donor serotype was significantly correlated with the replicating genotype in viremic KTRs (P < .001). Individual donor and recipient serotype, serotype (mis)matching and the recipient replicating BKPyV genotype were not associated with development of viremia or BKPyVAN after transplantation. CONCLUSIONS: BKPyV donor and recipient serotyping and genotyping indicates the donor origin of replicating BKPyV in viremic KTRs but provides no evidence for BKPyV genotype-specific virulence.

[The use of the permanent sample (eps) to study the returnto- work after cancer. Challenges and opportunities for research]. / Utilisation de l'échantillon permanent (eps) pour l'étude du retour au travail après cancer. Défis et opportunités pour la recherche.

INTRODUCTION: The introduction of early cancer detection and the improvement in treatment efficacy have led to a significant increase in the survival and the prevalence of (ex) cancer patients. Approximately 40 % of new cancer cases are diagnosed every year in the working age population (20-64 years). Maintaining their quality of life results, among others, in their retain on the labour market. Even though it is necessary to realize the scale of the phenomenon and to plan interventions, no measure allows assessing the rate of return to work among of (ex) cancer patients in Belgium nowadays. METHODS: We observe during a five-year period the socio-professional status (inability, disability, unemployment or death) of 645 workers identified in the permanent sample (EPS), having had an oncological multidisciplinary consultation (MOC) in 2011. RESULTS: By the end of follow-up, 24 % of the workers were deceased. Among those who survived 26 % are unable to work, 12 % are unemployed and 63 % do not receive any social benefit. Women and young workers (20-44 years) seemed to have encountered difficulties the most. CONCLUSIONS: The results of this study allow giving a prudent first estimation of the return to work of socially insured Belgian citizens of almost 40 %, five years after the first MOC. Nevertheless, the structure of the EPS presents many limitations to the interpretation and reliability of results. We suggest some modifications of the EPS that might offer scientists better opportunities to improve the performance and reliability of such cohort studies.

INTRODUCTION: L'introduction de la détection précoce des cancers et l'amélioration de l'efficacité des traitements ont mené à une augmentation significative de la prévalence d'(ex) patients. A peu près 40 % des nouveaux cancers sont diagnostiqués chaque année dans la population active (20-64 ans). Le maintien de leur qualité de vie passe, notamment, par leur maintien sur le marché du travail. Bien que nécessaire pour évaluer l'ampleur du phénomène et planifier des interventions spécifiques, aucune mesure ne permet actuellement d'établir avec précision le taux de réinsertion professionnelle des travailleurs atteints de cancer en Belgique. Matériel et Méthodes : Nous observons durant cinq ans le statut socioprofessionnel (incapacité de travail, invalidité, chômage ou décès) de 645 travailleurs identifiés dans l'échantillon permanent (EPS) ayant eu une première consultation oncologique multidisciplinaire (COM) en 2011. Résultats : Au terme du suivi, 24 % des travailleurs sont décédés. Parmi les travailleurs ayant survécu, 26 % sont en incapacité de travail, 12 % sont au chômage et 63 % ne bénéficient d'aucun revenu de remplacement. Les femmes et les jeunes travailleurs (20-44 ans) semblent rencontrer le plus de difficultés pour le retour au travail. CONCLUSIONS: Les résultats de cette étude permettent d'avancer une première estimation du retour au travail des assurés sociaux belges atteints de cancer à un peu moins de 40 %, cinq ans après la première COM. Toutefois, la structure et les données de l'EPS présentent de nombreuses limites pour l'interprétation et la fiabilité des résultats. Nous suggérons quelques modifications des données de l'EPS qui offriront aux scientifiques des opportunités pour améliorer la réalisation et la fiabilité de telles études de cohorte.

Pretransplantation Donor-Recipient Pair Seroreactivity Against BK Polyomavirus Predicts Viremia and Nephropathy After Kidney Transplantation.

Kidney transplant donors are not currently implicated in predicting BK polyomavirus (BKPyV) infection in kidney transplant recipients. It has been postulated, however, that BKPyV infection originates from the kidney allograft. Because BKPyV seroreactivity correlates with BKPyV replication and thus might mirror the infectious load, we investigated whether BKPyV seroreactivity of the donor predicts viremia and BKPyV-associated nephropathy (BKPyVAN) in the recipient. In a retrospective cohort of 407 living kidney donor-recipient pairs, pretransplantation donor and recipient sera were tested for BKPyV IgG levels and correlated with the occurrence of recipient BKPyV viremia and BKPyVAN within 1 year after transplantation. Donor BKPyV IgG level was strongly associated with BKPyV viremia and BKPyVAN (p < 0.001), whereas recipient BKPyV seroreactivity showed a nonsignificant inverse trend. Pairing of high-BKPyV-seroreactive donors with low-seroreactive recipients resulted in a 10-fold increased risk of BKPyV viremia (hazard ratio 10.1, 95% CI 3.5-29.0, p < 0.001). In multivariate analysis, donor BKPyV seroreactivity was the strongest pretransplantation factor associated with viremia (p < 0.001) and BKPyVAN (p = 0.007). The proportional relationship between donor BKPyV seroreactivity and recipient infection suggests that donor BKPyV seroreactivity reflects the infectious load of the kidney allograft and calls for the use of pretransplantation BKPyV serological testing of (potential) donors and recipients.

Viral loads and antiviral resistance of herpesviruses and oral ulcerations in hematopoietic stem cell transplant recipients.

Ulcerative oral mucositis and infection are frequent complications in hematopoietic stem cell transplant (HSCT) recipients. The aim of this study was to investigate the relationship between oral ulcerations and HSV-1, EBV and CMV excretion and the presence of aciclovir-resistant HSV-1 strains in HSCT recipients. This prospective observational study included 49 adult patients who underwent allogeneic HSCT. In total, 26 patients received myeloablative and 23 received non-myeloablative conditioning. Ulcerations on non-keratinized and keratinized oral mucosa were scored and oral rinsing samples were taken twice weekly. Viral loads were determined by real-time PCR. Samples from patients remaining HSV-1 positive despite antiviral treatment were studied for resistance to antivirals. Having an HSV-1 or EBV DNA-positive sample was a significant predictor for ulceration of keratinized mucosa. HSV-1 was a significant predictor for ulcerations on non-keratinized mucosa as well. Persistent HSV-1 infection occurred in 12 of 28 patients treated with antiviral medication and aciclovir-resistant HSV-1 was found in 5 persistent infections. In conclusion, HSV-1 is a predictor of ulcerations on non-keratinized as well as keratinized oral mucosa following HSCT. The role of EBV deserves further study. Persistent HSV-1 replication despite antiviral treatment is common and is due to resistance in 18% of treated patients.

[Health problems in textile industry in Democratic Republic of Congo]. / Problèmes de santé dans l'industrie textile en République Démocratique du Congo.

The objective of this work was to highlight the influence of the occupational conditions on the textile sector workers' health in Democratic Republic of Congo (DRC). We conduct an exploratory cross-sectional study of two populations within a plant located at the North of the DRC: workers (N=114) and executive or employees (N=96). Our total sample data (N=210) were collected by a questionnaire focused on the procedures, the exposures and the effects on health. Odds ratio (OR) and confidence interval at 95% were estimated. For each significant diseases symptom, a regression model has been achieved in order to estimate OR adjusted for association of disease symptoms and occupational statute. Workers compared to employees present high frequencies and exposure rates for many diseases symptoms. These OR are respectively for cough (OR = 5.1; IC: 2.93-10.68); respiratory difficulty (OR = 2.9; IC: 1.42-6.42) thoracic pain (OR = 2.6; IC: 1.31-5.24); fever (OR = 2.4; IC: 1.27-4.50); upper limbs pain (OR = 4.8; IC: 2.55-8.80); neck-shoulder pain (OR = 3.8; IC: 2.02-7.31); ocular diseases (OR = 2.2; IC: 1.17-3.89) and cutaneous diseases (OR = 2.5; IC: 1.18-5.46). The OR related to the libido loss is highest (OR = 5.5; IC: 2.84-10.71). In the other hand, the OR of the neuropsychics disorders are lower than 1 in this comparison and are respectively of 0.5 (0.28-0.95) for tiredness; 0.2 (0.08-0.28) for the lack of concentration and 0.07 (0.04-0.18) for the stress. In conclusion, the frequencies and high OR observed attest differences of the health issues between the workers and employees whose causes could be under the live and work conditions. These results should be confronted with those of other studies in health at the work.

[Health impact of working conditions at the Ruashi mine in the Democratic Republic of Congo]. / Impact des conditions de travail sur la santé des artisans miniers de la Ruashi (République Démocratique du Congo).

OBJECTIVE: The purpose of this study was to evaluate the health impact of working conditions at the Ruashi mine in the Katanga Province in the Democratic Republic of Congo. MATERIALS AND METHODS: A cross-sectional etiological study was conducted in two cohorts including 100 miners and 109 students. Data necessary to allow comparison disease symptoms in the two cohorts were collected using a questionnaire. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated. A secondary analysis was performed to compare different mine workstations, i.e., diggers (n=61) versus non-diggers (n=39). Two logistical regression models were used to estimate adjusted OR and 95% CI for the association between occupation/workstation and disease symptoms. RESULTS: In comparison with students, miners exhibited higher frequencies for all symptoms even after adjustment. The highest ORs were observed for musculoskeletal disorders, i.e., low back pain (OR=36.5) and upper (OR = 20.7) or lower (OR = 18.3)] extremity pain. They were followed by respiratory disorders (OR = 5.91) and headache (OR = 5.34). CONCLUSION: The high exposure frequencies and OR's observed in this study underline the negative health impact of mine working conditions. Further occupational study will be needed to obtain and compare more data.

[Occupational physician roles]. / Les rôles du médecin du travail.

Occupational medicine is an important medical discipline in Belgium, with about one thousand of experts. Roles of the occupational physicians must be analyzed on the basis both of legal prescriptions and real practice. The examination of the roles of the occupational physician in various countries shows that regulation are an important legal framework from which he can deploy his practice. A contrario it is also the means which makes it possible to the unions and the management to force him. However the real roles are definitely broader than the regulations let understand, concerning very diverse fields which make this medical discipline a real preventive general medicine. It is less and less a public health discipline and approaches gradually in practice the clinical disciplines, in the sense that the singular colloquium, the knowledge of the particular work places and risks of every worker and the individualization of the action are its bases. On the other hand, fitness for work assessments and its procession of authoritarian medical and administrative acts, heritages of the public health, hardly efficient, should largely disappear from the prescriptions. It will allow for a wider deployment of the activity of the occupational physician towards the industrial organisations, by proposing the necessary adaptations of the work places, the limitations of exposure to harmful effects, the remediation of the psychosocial load, etc, through "preventive prescriptions". Complementarily, the population ageing imposes new solutions to rehabilitate the old workers, and this will be likely to modify, not only the medical approach in work environment, but also already imposes a closer cooperation with the general practitioner, which is likely to improve the action abilities of both medical disciplines.

[Relations between the occupational physician and the general practitioner]. / Les relations entre le médecin du travail et le médecin généraliste.

The occupational physician (OP) and the general practitioner (GP) both aim at maintaining and promoting public health. The attending physician is the physician who has been freely chosen by the patient whilst the occupational physician is assigned by the company. Although synergy between both professions might seem obvious, in reality it is not always so. The focus of the occupational physician's work is on the worker in his work place. Through health monitoring action and knowledge of jobs and positions, the occupational physician aims to contribute to the improvement of well-being at work. Medical examinations result in drafting a form stating the person's ability or inability to occupy his/her assigned job. In line with the required respect for the patient's rights and, hence, with his/her authorization, the GP may transmit the medical information the said GP deems useful to the OP, e.g. back-to-work medical examinations and pre-back-to-work medical consultations are opportunities to establish a contact between both practitioners in view of considering the possibilities of adapting the workplace situation at the time of resumption of work. The GP should know that there exists an appeal opportunity with the Office in charge of Monitoring Well-being at Work (Employment Federal Public Service) against a decision that by which the worker is not allowed to stay in his assigned work task. During the medical examinations the OP may endorse the action of the GP by strengthening the worker/patient's awareness of the fact that his/her health problems must be adequately taken into account and by organizing information sessions about general interest campaigns about, for instance, cardiovascular risk prevention or a campaign about quitting smoking or reducing alcohol consumption to a more sensible and reasonable level. Knowledge of delayed effects of professional exposure should be consolidated in GPs; the possibility of drawing attention to one's suspicions about occupational illnesses to the Fund for Occupational Illnesses must also again brought to mind. In order to establish a follow-up program on the health of patients beyond their professional activity, it is necessary to draft a "liaison document", between the OP and the GP, which identifies the professional risks workers/patients have been exposed to. In sum, it is important to provide GPs with means to identify the patient's OP and consolidate their knowledge of occupational medicine by organizing on-going training modules.

[The missions of the Occupational Diseases Fund. Under-claim and recognition of occupational lung cancer, in particular those related to asbestos]. / Les missions du Fonds des Maladies Professionnelles. La sous-déclaration des cancers respiratoires professionnels, en particulier dus a l'amiante.

The missions of the Occupational Diseases Fund are defined in application of the law regarding the insurance against occupational diseases. The workers covered by this law are granted several rights, such as a financial compensation in case of temporary or permanent disability, a further compensation if they have to be taken away from the risk in the workplace, the reimbursement of health care costs related to the occupational disease, or the payment of an annuity to the widow(er) if death is its ultimate consequence. Among the compensable diseases, we shall focus on lung cancer, and especially the one related to asbestos exposure. This type of cancer is clearly under-registrated in Belgium as in most countries of the European Union, leading to an insufficient number of cases entitled to compensation by our institution. In this instance, the insurance against occupational diseases and all related social advantages are hugely under-exploited in our country. It is our duty to increase doctors' awareness of the problem and spread accurate information to reverse this trend and provide occupational cancer cases with a legitimate compensation, in particular those related to asbestos. A wider knowledge of the occupational history of cancer patients, thanks to occupational physicians, and a better use of mineralogical analyses on lung samples, would improve this situation inacceptable on any level : medical, social or even human.

Impact des conditions de travail sur la sante des artisans miniers de la Ruashi (Republique democratique du Congo)

Objectif. Ce travail visait a mettre en evidence les impacts des conditions de travail sur la sante des artisans miniers de la mine de la Ruashi dans la Province du Katanga. Materiels et methodes. Nous avons procede a une etude transversale a visee etiologique de deux populations: mineurs (n=100) et etudiants (n=109). Les donnees de notre echantillon (n=209) ont ete recueillies sur base d'un questionnaire en vue d'une comparaison des symptomes de maladies. Les Odds ratios (OR) et leurs intervalles de confiance a 95ont ete estimes. Une analyse secondaire a permis de faire la comparaison entre les postes de travail des artisans miniers creuseurs (n=61) et non-creuseurs (n=39). Deux modeles de regression logistique ont ete utilises pour estimer les OR ajustes pour l'association activite professionnelle / poste de travail et les symptomes de maladie. Resultats. Par rapport aux etudiants; les artisans miniers ont des frequences elevees pour tous les symptomes. Les OR des troubles musculo-squelettiques etaient les plus eleves [douleurs dorsales (OR=36;5); douleurs des membres superieurs (OR=20;7); des membres inferieurs (OR=18;3)] et cela meme apres ajustement. Venaient ensuite les troubles respiratoires (OR=5;91) et les maux de tete (OR=5;34). Conclusion. Les frequences et cotes d'exposition elevees observees dans ce travail attestent de l'impact negatif des conditions de travail des artisans mineurs sur leur sante. Ces resultats devraient etre confrontes avec ceux d'autres etudes en sante au travail dans ce milieu

Adenovirus infection in children after allogeneic stem cell transplantation: diagnosis, treatment and immunity.

Human adenoviruses (HAdV) are a frequent cause of potentially fatal infections in patients after allogeneic stem cell transplantation, especially in children. Monitoring of serum/plasma by real-time quantitative PCR is a sensitive tool for the recognition of patients at risk of a potentially fatal infection and for the evaluation of the efficacy of treatment. Data from a retrospective study and from a prospective study demonstrate that recovery of immunity after transplantation is essential for the elimination of HAdV infection. The feasibility of several approaches for the manipulation of immunity in the immunocompromised host to prevent a fatal course of the infection is discussed.

[Noise in neonatology, the impact of hospital staff]. / Le bruit en néonatologie, impact du personnel hospitalier.

OBJECTIVES: To identify the various sources of noise in a neonatal intensive care unit in a university hospital centre and to assess the noise level. METHODS: The nursing staff was interviewed to obtain a qualitative assessment of the noise in the department. Quantitative observations using a sound level meter and a dosimeter were then made. The measurements presented here were carried out in two different units caring for the newborn: on the heated table and in an incubator. RESULTS: Many sources of noise were identified in the unit. They were responsible for a noisy environment, the level of which was far greater than current recommendations and left few periods of quiet. The alarms of the various monitors and maintenance apparatuses, the crying of the newborn and the activity of the staff were the principal sources of noise. CONCLUSION: The impact of hospital staff on the extent and frequency of sources of noise is crucial. An enhanced awareness strategy should therefore be developed.

[The precautionary principle applied to lung cancer risk caused by residential radon]. / Le principe de précaution appliqué au risque de cancer du poumon causé par le radon domestique.

Residential radon seems to represent a major health hazard. The studies, which investigate the pulmonary risk of cancer caused by radon, are of different nature and their results are divergent. Thus, there persist scientific uncertainties concerning the real size of this risk. The application of the precautionary principle is based on an analysis of these uncertainties. Studies on miners, studies concerning residential radon (at individual and ecological level), as well as experimental data allow for the organisation of the uncertainty of each one of these specific approaches taking into account their proper limitations. The first risk that is linked to radon is the risk of pulmonary cancer. Miner occupational exposure studies appear compatible with the results of case-control studies concerning residential radon. However, the case-control studies, where the risk appears more present, are contradicted by ecological studies, often not very convincing about the existence of a risk. The case-control studies have an intrinsic advantage over the ecological studies because they limit the classification errors by the individualization of the relation-exposure effect. In addition, the experimental data are not in contradiction with the existence of effects for very small exposures. Consequently, the inherent scientific uncertainties of the totality of these data, can be classified and permit the application of the precautionary principle in a better proportioned way. The utilisation of the precautionary principle implies the necessity to limit, as far as possible, the exposure to residential radon. Precautionary principle is based on the debated hypothesis of no threshold linear relation between radon exposition and health consequences. This relation has been established on professional and residential exposures. The implementation of this epidemiological model shows the "residential radon" risk as the second cause of pulmonary cancer and responsible of about 10% of these specific cancers.

The risk linked to ionizing radiation: an alternative epidemiologic approach.

Radioprotection norms have been based on risk models that have evolved over time. These models show relationships between exposure and observed effects. There is a high level of uncertainty regarding lower doses. Recommendations have been based on the conservative hypothesis of a linear relationship without threshold value. This relationship is still debated, and the diverse observations do not allow any definitive conclusion. Available data are contradictory, and various interpretations can be made. Here we review an alternative approach for defining causation and reconciling apparently contradictory conclusions. This alternative epidemiologic approach is based on causal groups: Each component of a causal group is necessary but not sufficient for causality. Many groups may be involved in causality. Thus, ionizing radiation may be a component of one or several causal groups. This formalization reconciles heterogeneous observations but implies searching for the interactions between components, mostly between critical components of a causal profile, and, for instance, the reasons why specific human groups would not show any effect despite exposure, when an effect would be expected.

[The European Directive 96/29/Euratom through the history of radiation protection]. / La Directive européenne 96/29/Euratom vue à travers l'histoire de la radioprotection.

The new european directive concerning the radiation protection 96/29/Euratom is currently being transposed in national regulations. This directive is registered in a historical context. This context allows us to understand how it is realised and what philosophy underlies the actual structure and its possible shortcomings. Current developments of the radiobiology and the radio-epidemiology, notably important modifications of our knowledge about natural irradiation, the attention for genetic fragile populations and relationships between irradiation and cancer are likely to modify our perception of the radiation protection.