French Departments Research Articles

Determination of zones at risk for fasciolosis in the department of Haute-Vienne, central France: a retrospective study on natural infections detected in 108,481 Galba truncatula for 37 years.

A retrospective study on the natural infection of Galba truncatula by Fasciola hepatica was carried out in the French department of Haute-Vienne to determine whether there are areas at risk for fasciolosis. Adult snails included in this analysis came from samples collected from pastures on 259 farms and from 121 wild watercress beds between 1970 and 2006. Fasciola hepatica infection rates were examined in relation to altitude and climatic data (mean annual rainfall, mean annual temperature) of each municipality. In a total of 108,481 snails collected in 151 municipalities, the overall prevalence of infection was 3.8% but varied according to the municipalities from which samples were taken (from 1% to 7.4%). The prevalence of F. hepatica infection in snails significantly decreased when the mean altitude of municipalities or their mean annual rainfall increased. However, this prevalence significantly increased with increasing mean annual temperatures. Studying the prevalence of infection in these snails makes it possible to delineate zones at risk for fasciolosis on the acid soils of Haute-Vienne. The risk of infection for livestock would be greater in areas of Haute-Vienne below 400 m above sea level and would gradually decrease when the altitude of the land increases.

Externally imposed institutions and regional growth differences: Evidence from France and Germany

This paper provides a critical examination of effect of French Revolution institutions on regional economic development variations in 19th century by focusing on the experience of France. The argument in Daron Acemoglu et al. (2011) that differences in long-run economic performance of German states stem from differences in externally imposed French and domestic German institutions needs to be investigated further. A difference-in-difference estimation is used to identify a treatment effect causing growth differences between border and interior departments. The proposed treatment effect is the faster industrialization due to intensified minerals mining and railway construction in northern and northeastern France after 1850. It is shown that border departments experienced higher economic growth primarily after 1850 even though Revolution institutions and reforms were imposed in all of French departments. Therefore, externally imposed French Revolution institutions and reforms shouldn?t be counted as primary factors of causing variation in economic development across German polities.

Maximien Parchappe (1800–1866), héros de l’anatomopathologie de la folie et bâtisseur d’asiles

A student of Jean-Étienne Esquirol, Maximien Parchappe (1800–1866) was an alienist whose career consisted of two successive periods. First as an asylum clinician in Normandy, he tried to find an etiology for “madness” through a macroscopic anatomical-pathological study that included nearly eight hundred brains and drew from the nascent field of statistics. Then, once he had been appointed an “asylum inspector”, he would play an important role in the application of the French Law of 1838. His first goal was the construction of asylums in every French department that met architectural standards specific to the care of the insane. He then worked to promote the humanization of treatment and the well-being of those interned through innovations such as ergotherapy. Extremely dedicated to his work, Parchappe regularly published findings from his various studies throughout his career in a number of works. His main results are summarized here, following a brief biography of this man of conviction, a fine example of a nineteenth-century progressive alienist.

Management of Post-Transplant Lymphoproliferative Disorders in the Real Life: The French Attitude Between 2010 and 2013

IntroductionPost-transplant lymphoproliferative disorders (PTLD) are a rare but severe complication occurring after organ transplantation as a result of immunosuppressive therapy (IST). Until recently, there was no consensus regarding best treatment practice. In 2006, a phase 2 trial using a monotherapy with rituximab showed an overall response rate of 44%, with a complete response (CR) rate of 28%. In 2012, the PTLD-1 international multicenter trial evaluating rituximab followed by CHOP chemotherapy proved an efficacy of 90% and an overall survival of 6.6 years in PTLD treatment.K-virogref is a French national expert network created in 2011 to structure and improve the management of viro-induced cancers, occurring in adult after transplantation, including PTLD.Within this network, an epidemiological observational study has been set up in September 2013. The aim of our study was to analyze the management of PTLD in France before the creation of the national database of K-virogref.Patients and methodsWe included solid organ or allogeneic stem cell recipients, aged 18 years and above, with a histologically proven PTLD, diagnosed between January 2010 and September 2013 in 19 French hematology departments. We collected from clinical charts data regarding transplant characteristics, PTLD presentation, first-line treatment and outcomes.ResultsThe study population consisted of 94 patients, 67% were men and median age was 53 years (ranging 18 - 81 years). The majority of patients received kidney transplantation (54%), followed in almost equal proportion by heart (13%), liver (13%) and allogeneic stem cell transplantation (10%). Most of the time (80% of patients), PTLD occurred more than one year after organ transplantation with a median delay of 7.8 years. Histologically, mainly monomorphic PTLD were observed with 66% of diffuse large B cell lymphoma and PTLD was EBV associated in 54%. At the time of diagnosis, 80% were classified as stage IV according to Ann Arbor. The median follow-up time was 28.3 months (ranging 0.2 - 78 months).As far as treatment is concerned, modification of IST was performed in 68% of patients but response was rarely evaluable because a specific treatment was often started at the same time. Surprisingly, first line treatment consisted in rituximab alone or rituximab followed by CHOP chemotherapy in only 32% of the patients. Among these patients, the overall response rate was 81% with 55% of CR. Most patients (56%) received chemotherapy (n=11) or immunochemotherapy (n=46) without previous rituximab therapy. For these patients the overall response rate was 71% with a CR rate of 53%. At 1 and 3 years of follow-up, the relapse-free rates were 56% (95% confidence interval (CI) 46% - 68%) and 47% (95% CI 37% - 60%), respectively. Overall, 49% of patients died during follow-up of which 37% due to infectious complications and 32% due to PTLD progression.ConclusionThis is one of the largest cohort study of PTLD in the literature, providing an overview of epidemiological features, treatments and outcomes of this rare disease. The lag between the management of PTLD and literature data emphasizes the usefulness of a national expert network such as K-virogref in order to generalize a less toxic and more powerful attitude. DisclosuresLeblond:Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; BMS: Honoraria. Choquet:Celgene: Consultancy; Janssen: Consultancy.

Scintigraphie pulmonaire pour suspicion d’embolie pulmonaire aiguë : état des lieux des pratiques en France en 2014

AimThe aim of this study was to assess lung scintigraphy practices in France for the diagnosis of acute pulmonary embolism, especially regarding the proportion of centers using single photon emission computed tomography (SPECT) rather than planar ventilation/perfusion (V/Q) imaging. Materials and methodsAn online survey composed of simple multiple-choice questions was distributed to the 210 french nuclear medicine departments in April and May 2014. The survey covered image acquisition, interpretation criteria for SPECT and planar images, and use of pseudoplanar images and radiopharmaceuticals. Departments were initially solicited by 2 sets of e-mails. They were subsequently contacted by phone. A single response per department was consolidated. ResultsTwo hundred nine responses were collected (participation rate: 99.5%). Sixty-seven percent of french centers indicated use of V/Q SPECT in routine practice. The first intention acquisition protocol was SPECT/CT in 34%, SPECT in 26% and V/Q planar in 34%. The most commonly used criteria for SPECT interpretation were those of the EANM (63%). Criteria used for planar interpretation were heterogeneous (EANM criteria, 39%; no standardized criteria, 28%; PIOPED, 23%). Eighty-three percent of centers used 99mTc aerosol and 17% 81mKr. ConclusionThis survey shows that SPECT has largely replaced planar imaging for PE diagnosis with lung scintigraphy. Acquisition protocols and interpretation criteria are inconsistent (especially for planar imaging).

Infectious complications of a rituximab-based immunosuppressive regimen in patients with glomerular disease.

BackgroundRecent years have seen increasing use of rituximab (RTX) for various types of primary and secondary glomerulopathies. However, there are no studies that specifically address the risk of infection related to this agent in patients with these conditions.MethodsWe reviewed the outcomes of all patients who received RTX therapy for glomerular disease between June 2000 and October 2011 in eight French nephrology departments. Each case was analysed for survival, cause of death if a non-survivor and/or the presence of infectious complications, including severe or opportunistic infection occurring within the 12 months following RTX infusion.ResultsAmong 98 patients treated with RTX, 25 presented with at least one infection. We report an infection rate of 21.6 per 100 patient-years. Five patients died within 12 months following an RTX infusion, of whom four also presented with an infection. The median interval between the last RTX infusion and the first infectious episode was 2.1 months (interquartile range 0.5–5.1). Most infections were bacterial (79%) and pneumonia was the most frequent infection reported (27%). The presence of diabetes mellitus (P = 0.006), the cumulative RTX dose (P = 0.01) and the concomitant use of azathioprine (P = 0.03) were identified as independent risk factors. Renal failure was significantly associated with an increased infection risk by bivariate analysis (P = 0.03) and was almost significant by multivariate analysis (P = 0.05). Nephrotic syndrome did not further increase the risk of infection and/or death.ConclusionThe risk of infection after RTX-based immunosuppression among patients with glomerulopathy must be considered and patients should receive close monitoring and appropriate infection prophylaxis, especially in those with diabetes and high-dose RTX regimens.

Treatment of acute cardiac failure in the emergency department. Improve our practices? Data from the RESURCOR network

In 2015, the European Society of cardiology published guidelines on the pre-hospital and early hospital management of acute cardiac failure (ACF), which included: -use of intravenous vasodilators (nitrates) when systolic blood pressure is>110mmHg; -non-invasive ventilation if oxygen saturation is<90% and/or respiratory rate is>25/min despite nasal oxygen; -using a reduced dose of intravenous furosemide (20-40mg or equivalent of the oral morning dose if already on chronic diuretic therapy) and; -early performance of echocardiography. We sought to compare the gap between these recommendations and clinical practices in French emergency departments (EDs). We undertook a retrospective evaluation of clinical practices in 834 consecutive patients with ACF admitted in 2013 to the EDs of 16 French hospitals. Data, including patient characteristics and practices were collected from the medical records. Patients' mean±standard deviation age was 82±10 years and 49% were men. Clinical practices in relation to the guideline recommendations are shown in the Table 1. These initial data which precede publication of the current guidelines, show that use of nitrates, non-invasive ventilation, reduced diuretic dose and early echocardiography were relatively infrequent at the first point of medical care for patients presenting with ACF. These findings indicate the need for a sizable shift in practice in order to meet the new guideline recommendations. We will conduct a repeat evaluation in 2016, after implementation of a programme aimed to improve practices at these sites.

Antimicrobial therapy for patients with community-acquired pneumonia in the emergency department: results from a French national audit

Background: The updated French guidelines for the management of antimicrobial therapy and site-of-care for adults’ community-acquired pneumonia (CAP) were published in July, 2010, stratifying patients in 6 groups depending on age, significant underlying disorders and organ failure. Objectives: We conducted the first national audit of adherence to the latest CAP guidelines. Methods: A web-based audit tool was developed as part of the guidelines. French Emergency Departments (EDs) were invited to participate in the audit capturing data on adults visiting EDs with suspected CAP within the study period(15th October-15th December, 2010). Results: A total of 3.166 cases were provided from 72 EDs. Median age was 75 years (range 15-106 years), 55% were male. CRB65 score was 0 in 22.9 %, 1-2 in 67.8%, and 3-4 in 9.2%; 2630 (83.5%) patients were admitted after ED visit including 335 (12.7%) in intensive care units. Median delay to first antibiotics was 3h45min. Initial empirical antimicrobial treatment was in accordance with French CAP guidelines in 895 (28.3 %) patients. However, adherence widely varied (0%-66.9%) in the patient groups. Of note, 354 (11.2%) did not receive any antibiotics and antimicrobial agents were not in adherence with guidelines in 1917 (60.5%) patients. Conclusions: Management of CAP often differs from guidelines in French emergency departments. This result questions whether emergency physicians are aware of the recommendations or whether recommendations are adequate for emergency CAP patients. Keywords: Audit; Antimicrobial agent; Emergency department; Community-Acquired pneumonia; Site of care

Geographical variations in incidence, management and survival of hepatocellular carcinoma in a Western country

Information on the incidence, management, and prognosis of hepatocellular carcinoma (HCC) is derived from population samples, regional data, or registries. Comprehensive national evaluations within a given country are lacking. This study aimed to investigate regional variations in HCC care within France. This observational study analysed data from French administrative databases for more than 30,000 patients with HCC diagnosed between 2009 and 2012, and followed-up until 2013. The incidence of HCC, access to surgery, and survival, at both the national level and two geographical levels (the 21 French regions and 95 French departments into which France is divided administratively), were determined. The influence on outcome of the structure of the hospital where HCC was first managed was assessed. At the national level, the median survival was 9.4months and only 22.8% of patients had curative treatment. There were marked variations between regions and departments in incidence, access to curative treatment (range 1.3-28.8% and 8.1-32.3% respectively), and in median survival (range 5.7-12.1 and 4.3-16.5months respectively). The administrative type and annual HCC-caseload of the hospital where patients were first admitted also had an independent influence on treatment and survival. Despite full insurance coverage for all citizens, national measures to reduce inequities in the management of cancer patients, standardised recommendations for HCC surveillance and management, the percentage of patients undergoing curative treatment and their survival may vary four-fold depending on their postcode. The hospital in which patients are first managed has a clear influence on accessibility to both good care and survival. Population-based studies have highlighted large and sometimes unexpected differences between countries in the survival of patients with malignancy. As these differences are considered to indicate the overall effectiveness of health systems, in addition to the incidence of the cancer or quality of registration, variations within a given country should be minimal. However, similar to between countries differences, this study shows differences within the same country in the incidence, curative treatment rate, and survival of patients with HCC. Evidence that access to care and survival varies within a country can strengthen the impetus for government and clinicians to address these disparities.

New Rickettsia species in soft ticks Ornithodoros hasei collected from bats in French Guiana

In French Guiana, located on the northeastern coast of South America, bats of different species are very numerous. The infection of bats and their ticks with zoonotic bacteria, especially Rickettsia species, is so far unknown. In order to improve knowledge of these zoonotic pathogens in this French overseas department, the presence and diversity of tick-borne bacteria was investigated with molecular tools in bat ticks.In the beginning of 2013, 32 bats were caught in Saint-Jean-du-Maroni, an area close to the coast of French Guiana, and the ticks of these animals were collected. A total of 354 larvae of Argasidae soft ticks (Ornithodoros hasei) from 12 bats (Noctilio albiventris) were collected and 107 of them were analysed. DNA was extracted from the samples and quantitative real-time PCR was carried out to detect Rickettsia spp., Bartonella spp., Borrelia spp. and Coxiella burnetii. All tested samples were negative for Bartonella spp., Borrelia spp. and Coxiella burnetii. Rickettsia DNA was detected in 31 (28.9%) ticks. An almost entire (1118 base pairs long) sequence of the gltA gene was obtained after the amplification of some positive samples on conventional PCR and sequencing. A Bayesian tree was constructed using concatenated rrs, gltA, ompA, ompB, and gene D sequences. The study of characteristic sequences shows that this Rickettsia species is very close (98.3–99.8%) genetically to R. peacockii. Nevertheless, the comparative analysis of sequences obtained from gltA, ompA, ompB, rrs and gene D fragments demonstrated that this Rickettsia is different from the other members of the spotted fever group. The sequences of this new species were deposited in GenBank as Candidatus Rickettsia wissemanii. This is the first report showing the presence of nucleic acid of Rickettsia in Ornithodoros hasei ticks from South American bats.

La Réforme LMD au Département de Français Bilan et Perspectives

The introduction of the system LMD in Algeria sparked a truly reflection among specialists, shared between enthusiasm and reluctance, ‎ their position is far from unanimous. Unprecedented change is born, which sparked in us a strong desire to explore perceptions and representations of teachers from the French language department in respect of the new system. ‎ It is in this perspective that fits this contribution; ‎ the objective is to ‎ diagnose problems, ‎ better managing tensions and ‎ offer aid operations .

La perte de l’intérêt dans l’étude de la langue française chez les étudiants universitaires au Nigéria : le cas des étudiants de l’Universityé de l’État d’Osun

Loss of Interest in Studying the French Language Among University Students in Nigeria: The case of Osun State University students&#x0D; In principle, language is an instrument of communication between communities. As the world has become a global village, we are entering an era where the future of a nation will have to be based on multilingualism, a situation with serious consequences. In view of this multilingual context, it is therefore important to learn a foreign language. Based on Skinner's behaviorist theory, this study examines the reasons or factors responsible for the loss of interest and lack of motivation to learn French among university students. The study maintains that students’ interest, motivation and satisfaction must be taken into account in school activities. Using the questionnaire for 50 students which will serve as a tool for a qualitative result, we would identify this alarming challenge among students in the French department of Uniosun. This study concludes that it would therefore be necessary to let learners in foreign language departments decide for themselves whether they want to learn French instead of forcing them to learn the language. France also has an important role in promoting its language (teaching and learning) in Nigeria.

Critical incidents in a French department of paediatric anaesthesia

BackgroundSeveral studies have highlighted the importance of critical incident (CI) reporting in order to enhance patient safety. We have implemented an anonymous procedure for CI reporting in our department of paediatric anaesthesia. This study aims at analysing those CIs so as to improve patient care and risk management. Material and methodsCIs were reported by the anaesthetic team using the World Health Organization classification and analysed using the ORION methodology. CIs were classified according to type, surgery and complications. Risk factors and consequences for patients and for the institution were analysed. Risk factors with high degree of harm for the patient were identified using a univariate analysis and odds ratios (OR). ResultsOver an 18-month period, 114 CIs were reported for 103 patients (median age: 7.0 years [95% CI: 3.6–9.8]). We found that 29.9% of reported CIs had consequences for the patients and 76.3% were considered preventable. The two main types of CI were “respiratory” (28.8%) and “drug-related” (22.8%) incidents. The main risk factor was ‘human error’ (42.3%). Several consequences for the patient and the hospital were identified. An ASA score≥3 (OR: 2.52; [95% CI: 1.10–5.78]) was an independent risk factor for a high degree of patient harm. ConclusionImproving quality of care must be a priority for paediatric anaesthesiologists as most of the CIs observed are preventable and have consequences for the patient and the institution.

Slave descendants’ views regarding national policies on reparations: A Martinican perspective

The present study concerned the views regarding the acceptability of possible national policies related to slavery by people whose families were directly affected in the past. It was conducted in the island of Martinique (an overseas French department), and 298 descendants of slaves participated. Three qualitatively different personal positions were found; these positions were designated Skeptics (28% of the sample), Reparationists (35%) and Undetermined (37%). For people holding a Skeptic position, nothing meaningful can be done to repair the horrors of slavery. However a national policy that includes public acknowledgment of past wrongs can be considered as tolerable provided it is accompanied by material compensations. For people holding a Reparationist position, any national policy that involves public acknowledgment of past wrongs is considered as acceptable, whether or not it is accompanied by material compensation. Policies of amnesia and/or exaltation of the past or policies that involve only material compensations are viewed as not acceptable. In addition reparation policies are considered as more acceptable in cases where socio-economic integration of slave descendants has been achieved than in cases where it has not. For people holding an Undetermined position, slavery and the slave trade are part of the deep past; as a result, it is difficult to have strong views about it or about related policies. These three personal positions were related to educational level and religious involvement in a meaningful way. In particular, undetermined people were less educated and more religious than others.

Inter-regional medical cooperation in the Caribbean: a major asset for the influence of the French medicine.

Martinique was accepted as an associate member by the Council of Ministers of the Organization of Eastern Caribbean State since February 2015. This membership constitutes a major asset in bringing Martiniquais closer to the other Caribbean populations and should play a key role as it relates to regional cooperation especially in the domain of healthcare. Martinique and several Caribbean countries share common health issues such as; dengue, chikungunya virus, Zika Virus leptospirosis, snakebite, severe cardiovascular diseases (CVD), HTLV-1, sickle cell diseases and so on. This medical cooperation is mainly based in three important areas: training, teaching and transport (medical evacuations). The Inter-regional cooperation between the French Departments of the Americas and all other Caribbean countries is essential for the implementation and improvement of health care. It is urgent for the Caribbean professionals to discuss the possibilities of developing common solid relationships in training, collective scientific research, and continuous medical education.

Géographie des ménages fortunés en France

L'article s'intéresse à la localisation géographique des ménages détenteurs de hauts patrimoines, considérés comme une nouvelle cible des politiques d'attractivité des territoires. L'étude est menée à partir d'une base de données géolocalisées des ménages assujettis à l'impôt de solidarité sur la fortune ( Isf ) et des caractéristiques géographiques et socioéconomiques des départements français (base Insee ). En spécifiant un modèle Durbin spatial, nous avons étudié les liens entre les dimensions obtenues par l'analyse factorielle des caractéristiques des départements et les variables Isf en tenant compte d'éventuelles autocorrélations spatiales. Les résultats montrent une forte attractivité des territoires les plus urbanisés, une faible répulsivité des territoires en crise et l'absence d'attractivité des territoires touristiques. Classification JEL : D10, E62, R10, 015, 018

Can the Adoption of Organic Farming Be Predicted by Biogeographic Factors? A French Case Study

Organic farming adoption is on the rise in many countries, due to the increased awareness of farmers, citizens, governments and other stakeholders of its more sustainable nature. Various studies have investigated the socio-economic drivers (e.g., consumer demand, support measures, agricultural policies) of organic farming adoption, but less attention has been paid to whether biogeographic factors could also be associated with variation in rates of organically managed farms in certain regions within countries. We investigate whether biogeographic factors are associated with variation in the proportion of land under organic farming in French departments. The proportion of land under organic farming increased with decreasing latitude and increasing department area. Non-significant factors were number of plant taxa, proportion of Natura 2000 protected areas, connectivity, longitude, altitude and department population. These results were robust to controlling for spatial autocorrelation. Larger and southern French departments tend to have a greater adoption of organic farming, possibly because of the more extensive nature of agriculture in such regions. Biogeographic factors have been relatively neglected in investigations of the drivers of organic farming adoption, but may have an important explanatory value.

Performance Testing of PCR Assay in Blood Samples for the Diagnosis of Toxoplasmic Encephalitis in AIDS Patients from the French Departments of America and Genetic Diversity of Toxoplasma gondii: A Prospective and Multicentric Study.

BackgroundToxoplasmic encephalitis in patients with AIDS is a life-threatening disease mostly due to reactivation of Toxoplasma gondii cysts in the brain. The main objective of this study was to evaluate the performance of real-time PCR assay in peripheral blood samples for the diagnosis of toxoplasmic encephalitis in AIDS patients in the French West Indies and Guiana.Methodology/Principal FindingsAdult patients with HIV and suspicion of toxoplasmic encephalitis with start of specific antitoxoplasmic therapy were included in this study during 40 months. The real-time PCR assay targeting the 529 bp repeat region of T. gondii was performed in two different centers for all blood samples. A Neighbor-Joining tree was reconstructed from microsatellite data to examine the relationships between strains from human cases of toxoplasmosis in South America and the Caribbean. A total of 44 cases were validated by a committee of experts, including 36 cases with toxoplasmic encephalitis. The specificity of the PCR assay in blood samples was 100% but the sensitivity was only 25% with moderate agreement between the two centers. Altered level of consciousness and being born in the French West Indies and Guiana were the only two variables that were associated with significantly decreased risk of false negative results with the PCR assay.Conclusion/SignificanceOur results showed that PCR sensitivity in blood samples increased with severity of toxoplasmic encephalitis in AIDS patients. Geographic origin of patients was likely to influence PCR sensitivity but there was little evidence that it was caused by differences in T. gondii strains.Trial RegistrationClinicalTrials.gov NCT00803621

Clinical Characteristics and Risk Factors of Extensive Macular Atrophy with Pseudodrusen: The EMAP Case-Control National Clinical Trial

To assess the association of clinical and biological factors with extensive macular atrophy with pseudodrusen (EMAP) characterized by bilateral macular atrophy occurring in patients aged 50 to 60 years and a rapid progression to legal blindness within 5 to 10 years. A national matched case-control study. Participants were recruited in 10 French Departments of Ophthalmology and their associated clinical investigation centers. All 115 patients with EMAP had symptoms before the age of 55 years due to bilateral extensive macular atrophy with a larger vertical axis and diffuse pseudodrusen. Three controls without age-related macular degeneration (AMD) or retinal disease at fundus examination were matched for each patient with EMAP by gender, age, and geographic area (in total 415). Subjects and controls underwent an eye examination including color, red-free autofluorescent fundus photographs and spectral-domain optical coherence tomography with macular analysis. The interviews collected demographic, lifestyle, family and personal medical history, medications, and biological data. Associations of risk factors were estimated using conditional logistic regression. Extensive macular atrophy with pseudodrusen status (cases vs. controls). Extensive macular atrophy with pseudodrusen most frequently affected women (70 women, 45 men). After multivariate adjustment, family history of glaucoma or AMD was strongly associated with EMAP (odds ratio [OR], 2.3, P= 0.008 and OR, 1.5, P= 0.01, respectively). No association was found with cardiac diseases or their risk factors. Mild and moderate kidney disease and higher neutrophil rate were associated with a reduced risk of EMAP (OR, 0.58, P= 0.04; OR, 0.34, P= 0.01; and OR, 0.59, P= 0.003, respectively). On the contrary, eosinophilia (OR, 1.6; P= 0.0002), lymphocytosis (OR, 1.84; P= 0.0002), increased erythrocyte sedimentation rate (OR, 6.5; P= 0.0005), decreased CH50 (P= 0.001), and high plasma C3 level (P= 0.023) were significantly associated with a higher risk of EMAP. This study documents an association between EMAP and family history of AMD and glaucoma, a clear female predominance, and a systemic inflammatory profile. The reduced CH50 and increased C3 plasma values could reflect a more severe complement pathway dysfunction than in AMD, leading to early pseudodrusen and rapid development of geographic atrophy. There is no association of EMAP with AMD cardiac diseases or cardiac risks, including cigarette smoking.

Surgical management of necrotizing cellulitis: Results of a survey conducted in French plastic surgery departments

ObjectiveNecrotizing cellulitis (NC) is a severe infection of the skin and soft tissues, requiring an urgent multidisciplinary approach. We aimed to clarify the surgical management of NC in French plastic surgery departments. Patients and methodThirty-two French plastic surgery departments were invited to complete a survey sent by email. Questions focused on diagnostic and therapeutic management of NC in France. ResultsTwenty-five plastic surgery departments completed the survey (78%) and each center had a lead plastic surgeon. Overall, 88% of surgeons declared to have managed at least five NC patients within the year. The plastic surgeon was the lead surgical specialist for NC in 80% of cases. Conversely, 76% of interviewed facilities reported not to have any lead medical specialist. Time between surgical indication and surgical management was less than six hours in 92% of cases. Overall, 24% of responding facilities declared that access to the operating room never delayed management. Finally, 80% of facilities declared to be in favor of dedicated care pathways to improve the management of necrotizing cellulitis patients. ConclusionOur study results highlight the heterogeneity of necrotizing cellulitis management in France. The lack of a dedicated care pathway may lead to diagnostic and treatment delays.