Aymeric Cantais

Background/Objectives: We examined seasonal changes in bronchiolitis-related hospital use following the introduction of respiratory syncytial virus (RSV) prevention in France. Methods: This single-center observational study included 7083 emergency department presentations over five pre-implementation (2018–2023) and two post-implementation (2023–2025) seasons. Conventional ward hospitalization proportions were compared between infants aged p = 0.025) with Poisson regression but was not significant with quasi-Poisson regression (95% confidence interval 0.950–1.886; p = 0.087). Excluding 2023–2024 removed statistical significance. Conclusions: An age-specific temporal association was observed, with uncertainty across models and seasons. Two post-implementation seasons, maternal vaccination introduced only in the second, incomplete virological ascertainment, absent immunization histories, and changing care organization prevent causal attribution or separation of the contributions of nirsevimab and maternal vaccination.

Les infections des voies respiratoires basses de l’enfant sont extrêmement fréquentes et potentiellement graves. L’étude des agents étiologiques responsables de ces infections a beaucoup accéléré ces dernières années en raison de l’apparition et de la démocratisation de nouvelles méthodes comme la PCR et les tests antigéniques délocalisables.A travers six articles de recherches scientifiques, nous abordons ici l’impact de l’usage de ces tests en pratiques clinique, ce qu’ils peuvent apporter à la science fondamentale et à l’avenir de la prise en charge de ces malades.Deux articles s’attachent à préciser l’usage d’une PCR multiplex sur les infections respiratoires, une étude épidémiologique confirmant la grande part des infections virales dans ces pathologies et une étude randomisé prospective confirmant l’intérêt d’un tel examen pour adapter la prescription à la réalité étiologique.Quatre articles viennent ensuite apporter des précisions sur l’usage des tests antigéniques aux urgences pédiatriques, en pratique clinique. Un premier propose un algorithme de recherche du pneumocoque – germe commensale également – dans les sécrétions rhinopharyngées de l’enfant. Le deuxième et le troisième identifient l’impact et la performance de test grippe et VRS aux urgences pédiatriques.Enfin, un dernier article traite de la détection du SARS-CoV-2 aux urgences pédiatriques, en période pandémique avec un test dans la sensibilité est déterminée par ce travail.L’ensemble de ces travaux concoure à préciser l’utilité et la pertinence d’un diagnostic étiologique précoce et de qualité pour améliorer la qualité des soins.

Cytomegalovirus (CMV)-associated colitis reflects the adverse impact of CMV reactivation on ulcerative colitis (UC). Its diagnosis requires the detection of viral markers in intestinal biopsies sampled during endoscopy, which may constitute invasive and expensive analyses. Moreover, less than 30% of acute flare-ups in steroid refractory UC are associated with CMV colitis. This retrospective study aimed to identify non-invasive factors that are predictive of CMV reactivation, and was conducted from 2014 to 2019 in a cohort of UC patients consulting at the University Hospital of Saint-Etienne, France. Patient characteristics, disease activity, immunosuppressive treatment and tissue CMV DNA load were collected at the time of UC relapse. Factors potentially associated with CMV reactivation were analyzed through a multivariate analysis. A total of 173 UC patients providing 323 pairs of intestinal biopsies were analyzed. In the CMV seropositive subgroup, a Mayo endoscopic score ≥2 (OR 2.553, 95% CI 1.353–4.818, p = 0.004) was identified as a predictive factor of CMV colitis in the multivariate analysis; in contrast, biological parameters exhibited no predictive value. In addition, the use of anti-TNFα monoclonal antibodies was associated with a reduced risk of CMV reactivation (OR 0.384, 95% CI 0.158–0.935, p = 0.035). Intestinal biopsies appear to be unavoidable for assessing disease activity and CMV reactivation in UC patients.

Pediatric bone injuries are traditionally diagnosed using radiography. However, ultrasonography is emerging as an alternative due to its speed and minimal invasiveness. This study assessed the diagnostic capabilities of ultrasound before radiography in a group of 186 children with suspected long bone fractures at Saint Etienne University Hospital (Saint-Priest-en-Jarez, France). Patients with open trauma and severe deformity were excluded. Ultrasonography demonstrated 88.2% sensitivity and 86.4% specificity, with better results for forearm injuries. Of the 186 cases, 162 were consistent with radiography and 24 varied. Factors influencing an accurate diagnosis included the presence of indirect signs, operator experience, and examination duration, while indirect signs often led to misinterpretation. Although ultrasound cannot completely replace radiography due to its limitations in identifying deeper fractures, this study revealed its substantial efficacy and ease, supporting its potential utility in pediatric trauma emergencies.

Background: Stress cardiomyopathy (Takotsubo syndrome) defined as Takotsubo syndrome is defined as a reversible acute myocardial syndrome with myocardial injury with regional wall motion abnormality and no coronary explanations in the context of stress. The pathophysiology remains partially unknown, and these cases are probably underestimated in paediatrics. We report six cases of Takotsubo probably secondary to neurological damage. Case summary: Six patients (10, 13, 16, 10, and 9 years and 5 months) presented with haemodynamic lability with echocardiography data leading to suspicion of Takotsubo syndrome. These cases were secondary to neurological involvement (cerebral haemorrhage, intraventricular haemorrhage, brain damage due to bifrontal oedema, posterior fossa tumour, pneumococcal meningitis, high-grade glioma). All patients were rapidly started on amine. Reversibility of the acute myocardial syndrome was complete in all but one child, who rapidly progressed to encephalic death. Discussion: Neurological distress has been suggested as a potential cause of Takotsubo syndrome. The pathophysiology is possibly related to excessive stimulation of the sympathetic system. This syndrome should probably be considered in the setting of left heart failure with neurological distress so as not to delay the use of amines especially since in the paediatric population the probability of a coronary origin is low.

The interpretation of lung auscultation is highly subjective and relies on non-specific nomenclature. Computer-aided analysis has the potential to better standardize and automate evaluation. We used 35.9 hours of auscultation audio from 572 pediatric outpatients to developDeepBreath: a deep learning model identifying the audible signatures of acute respiratory illness in children. It comprises a convolutional neural network followed by a logistic regression classifier, aggregating estimates on recordings from eight thoracic sites into a single prediction at the patient-level. Patients were either healthy controls (29%) or had one of three acute respiratory illnesses (71%) including pneumonia, wheezing disorders (bronchitis/asthma), and bronchiolitis). To ensure objective estimates on model generalisability,DeepBreathis trained on patients from two countries (Switzerland, Brazil), and results are reported on an internal 5-fold cross-validation as well as externally validated (extval) on three other countries (Senegal, Cameroon, Morocco).DeepBreathdifferentiated healthy and pathological breathing with an Area Under the Receiver-Operator Characteristic (AUROC) of 0.93 (standard deviation [SD] ± 0.01 on internal validation). Similarly promising results were obtained for pneumonia (AUROC 0.75 ± 0.10), wheezing disorders (AUROC 0.91 ± 0.03), and bronchiolitis (AUROC 0.94 ± 0.02). Extval AUROCs were 0.89, 0.74, 0.74 and 0.87 respectively. All either matched or were significant improvements on a clinical baseline model using age and respiratory rate. Temporal attention showed clear alignment between model prediction and independently annotated respiratory cycles, providing evidence thatDeepBreathextracts physiologically meaningful representations.DeepBreathprovides a framework for interpretable deep learning to identify the objective audio signatures of respiratory pathology.

(1) Background: Ulcerative colitis (UC) is an inflammatory bowel disease that causes inflammation of the intestines, which participates in human cytomegalovirus (HCMV) reactivation from its latent reservoir. CMV-associated colitis plays a pejorative role in the clinical course of UC. We took advantage of a model of chemically induced enteritis to study the viral reactivation of murine CMV (MCMV) in the context of gut inflammation. (2) Methods: Seven-week-old BALB/c mice were infected by 3 × 10³ plaque-forming units (PFU) of MCMV; 2.5% (w/v) DSS was administered in the drinking water from day (D) 30 to D37 post-infection to induce enteritis. (3) Results: MCMV DNA levels in the circulation decreased from D21 after infection until resolution of the acute infection. DSS administration resulted in weight loss, high disease activity index, elevated Nancy index shortening of the colon length and increase in fecal lipocalin. However, chemically induced enteritis had no impact on MCMV reactivation as determined by qPCR and immunohistochemistry of intestinal tissues. (4) Conclusions: Despite the persistence of MCMV in the digestive tissues after the acute phase of infection, the gut inflammation induced by DSS did not induce MCMV reactivation in intestinal tissues, thus failing to recapitulate inflammation-driven HCMV reactivation in human UC.