D Unal

Assistance Publique Hôpitaux de Marseille, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (131)27.52 Total impact

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    ABSTRACT: Imported malaria is frequently observed in pediatric practices within geographical areas which have a migrant population. All the pediatric malaria cases of a university children's hospital (Marseilles, southern France) had been studied retrospectively. The period of the study was from January 1987 to December 1997. Inclusion criteria were based on clinical diagnosis criteria established by WHO. Three hundred and fifteen clinical cases were observed. Ninety-nine percent were confirmed by blood smears. Eighty-six percent of the patients came from the archipelago of the Comoro Islands in the Indian Ocean. Twenty percent were not given chemoprophylaxis, and 77% of the patients with chemoprophylaxis were not compliant. Fever (92%), splenomegaly (61%), vomiting and/or diarrhea (50%) were frequently observed. Neurological signs (23%), especially headaches (15%), were noted. The causative species was Plasmodium falciparum in 76%; coinfections with two species were observed in 9%. Halofantrine was commonly used for therapy (64%), but relapses were noted with this drug. No death was observed during the study. Imported pediatric malaria is rare in France. Clinical signs may lead to misdiagnosis when splenomegaly is not obvious, or when vomiting and/or diarrhea, cough or otitis occur. Diagnosis relies on blood smears. Curative medications are chloroquine or halofantrine, with special attention to heart troubles. Mefloquine is rarely used in children. Quinine is reserved for serious attacks. Concerning chimioprophylaxy, medical prescriptions should be adapted to the stay abroad, and patient compliance to medications could be improved.
    Archives de Pédiatrie 10/1999; 6(9):935-43. · 0.36 Impact Factor
  • Archives de Pédiatrie 07/1999; 6(9):935-943. · 0.36 Impact Factor
  • Archives de Pédiatrie 04/1999; 6(3):339-40. · 0.36 Impact Factor
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    ABSTRACT: INFANTILE LEISHMANIASIS: The protozoan parasites of the genus Leishmania are the causal agent of various diseases ranging from cutaneous lesions to fatal systemic diseases. In southern France, Leishmania infantum is an endemic species recognized as the causal agent of infantile leishmaniasis (Mediterranean visceral leishmaniasis). Little is known about the pathophysiology of the disease in humans, but models in mice may provide a new approach. INSECT VECTOR: Leishmania infantum are carried by sand flies. Antigenic modifications of the promastigote forms occur in these insects modifying lipophyosphoglycan (LPG) or glyocprotein gp63. Salivary gland lysates from the sand flies also enhance Leishmania infectivity. HUMAN INFESTATION: In humans, LPG and gp63 play a role in complement fixation, cell adhesion and resistance to complement-mediated lysis. Macrophage expression of class I and II major histocompatibility complex antigens is suppressed. T cells and interferon gamma are very important keys in the control of the parasite infection.
    La Presse Médicale 02/1999; 28(1):33-9. · 0.87 Impact Factor
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    ABSTRACT: The newborn immune system differs quantitatively and functionally from adults. At birth, the immune system is partially immature, resulting in deficiency in cell-mediated cytolysis, immunoglobulin synthesis and cytokine production. The most clearly defined deficit in neonatal phagocytosis defenses is diminished neutrophil storage. T cell function is diminished, including T cell-mediated cytotoxicity and T cell help for B cell differentiation. Selective decreases in cytokine production by T cells may contribute to all of these deficits. One of the fundamental differences between adults and newborns for T cell functions resides in whether or not the patient had prior exposure to antigens. Significant immune responses to antigens can be obtained in the neonatal period. These responses are qualitatively different from those induced in adults with a predominance of TH2 pattern.
    Archives de Pédiatrie 02/1999; 6 Suppl 1:14S-9S. · 0.36 Impact Factor
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/1999; 6(3):339-340.
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    ABSTRACT: Imported malaria is frequently observed in pediatric practices within geographical areas which have a migrant population. Material and methods All the pediatric malaria cases of a university children's hospital (Marseilles, southern France) had been studied retrospectively. The period of the study was from January 1987 to December 1997. Inclusion criteria were based on clinical diagnosis criteria established by WHO. Results Three hundred and fifteen clinical cases were observed. Ninety-nine percent were confirmed by blood smears. Eightysix percent of the patients came from the archipelago of the Comoro Islands in the Indian Ocean. Twenty percent were not given chemoprophylaxis, and 77% of the patients with chemoprophylaxis were not compliant. Fever (92%), splenomegaly (61%), vomiting and/or diarrhea (50%) were frequently observed. Neurological signs (23%), especially headaches (15%), were noted. The causative species was Plasmodium falciparum in 76%; coinfections with two species were observed in 9%. Halofantrine was commonly used for therapy (64%), but relapses were noted with this drug. No death was observed during the study. Discussion Imported pediatric malaria is rare in France. Clinical signs may lead to misdiagnosis when splenomegaly is not obvious, or when vomiting and/or diarrhea, cough or otitis occur. Diagnosis relies on blood smears. Curative medications are chloroquine or halofantrine, with special attention to heart troubles. Mefloquine is rarely used in children. Quinine is reserved for serious attacks. Concerning chimioprophylaxy, medical prescriptions should be adapted to the stay abroad, and patient compliance to medications could be improved.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/1999; 6(9):935-943.
  • Archives de Pédiatrie 01/1999; 6. · 0.36 Impact Factor
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/1999; 6.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The newborn immune system differs quantitatively and functionally from adults. At birth, the immune system is partially immature, resulting in deficiency in cell-mediated cytolysis, immunoglobulin synthesis and cytokine production. The most clearly defined deficit in neonatal phagocytosis defenses is diminished neutrophil storage. T cell function is diminished, including T cell-mediated cyttoxicity and T cell help for B cell differentiation. Selective decreases in cytokine production by T cells may contribute to all of these deficits. One of the fundamental differences between adults and newborns for T cell functions resides in whether or not the patient had prior exposure to antigens. Significant immune responses to antigens can be obtained in the neonatal period. These responses are qualitatively different from those induced in adults with a predominance of TH2 pattern.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/1999; 6.
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    ABSTRACT: The purposes of this study were to describe the characteristics of pediatric visceral leishmaniasis in southern France and to evaluate a new scheme of therapy. Hospital records of 59 children with visceral leishmaniasis were retrospectively reviewed. The period of the study was from 1981 to 1997. All children but one lived or had previously dwelled in the south of France. None was coinfected with human immunodeficiency virus or known to be immunocompromised. The mean age was 31 months; 10 children were younger than 1 year when admitted to the hospital. The male:female ratio was 0.73. Fever and splenomegaly were present in 90 and 100%, respectively. Anemia, leukopenia and thrombocytopenia were commonly observed, especially in the youngest patients. Hypergammaglobulinemia was noted in 64%. A biopsy sample of the bone marrow was always performed, but direct microscopic examination failed to identify Leishmania in 13 (22%) cases. In these patients specific serology and genomic amplification with polymerase chain reaction were useful tools for the diagnosis. All patients were initially treated with meglumine antimonate (Glucantime). Twenty-six (44%) patients receiving the drug experienced at least one adverse event during treatment. Treatment failure occurred in six children (10%), who were subsequently cured with liposomal amphotericin B. Three additional children were treated with liposomal amphotericin B. All the children were finally cured and no death was observed. Our experience suggests that liposomal amphotericin B is effective therapy for visceral leishmaniasis in children.
    The Pediatric Infectious Disease Journal 09/1998; 17(8):701-4. · 3.57 Impact Factor
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/1998; 5(7):822-822.
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    ABSTRACT: The aim of this prospective study was to evaluate the predictive significance of magnetic resonance imaging (MRI) performed at 4 months of corrected age in 60 neonates after a perinatal neurologic insult. Follow-up ranged from 2 to 5 years of chronological age. MRI examination was normal in 10; isolated external hydrocephalus was found in 15 infants. Twenty-three of these infants developed normally. Focal or multifocal lesions were shown in 6 infants, of whom 2 developed normally. Diffuse brain involvement was present in 29 cases as atrophy (n = 18), leukomalacia (n = 5), basal ganglia lesions (n = 3), and delayed myelination (n = 3). All but 4 infants showed neurologic impairment. MRI performed at 4 months of adjusted age is of prognostic significance in neonates who suffer a moderate or mild neurologic insult.
    Biology of the Neonate 01/1998; 73(4):207-19. · 1.90 Impact Factor
  • Archives de Pédiatrie 10/1997; 4(9):903. · 0.36 Impact Factor
  • Archives de Pédiatrie 09/1997; 4(9):903-903. · 0.36 Impact Factor
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    ABSTRACT: Polymorphonuclear elastase is an early and sensitive indicator of neonatal infection when performed at the beginning of clinical symptoms. To investigate the diagnostic value of elastase measurement in cord blood immediately after birth, 211 neonates (103 boys vs 108 girls, 154 vaginal delivery vs 57 cesarean section). Mean gestational age 38.9 weeks (range: 30-42), mean birth weight 3,260 g (range: 1,430-4,920 g). After clinical, bacterial and biological screening, the infants were classified in three groups. Group A (n = 118): none infectious risk factor neither clinical signs of infection; group B (n = 79): one or more risk factors but no evidence of infection; group C (n = 14): proved or probable infection. Polymorphonuclear elastase was measured in cord blood of all infants using an heterogeneous enzyme-linked-immunosorbent assay. We observed higher elastase values in group C (176 +/- 67 micrograms/L) than in group A (91 +/- 64 micrograms/L) and B (67 +/- 61 micrograms/L) (mean +/- SD, P = 0.0001). With a cutoff value fixed at 80 micrograms/L, the sensitivity of this test applicated to neonates presenting materno-fetal infectious risk factor(s) was 85% (12/14), specificity 74% (59/79), positive predictive value 37%, and negative predictive value 96%. Because two of the 14 infected infants (15%) were not detected by elastase dosage in cord blood, this test cannot be used as an early indicator of materno-fetal infection.
    Archives de Pédiatrie 06/1997; 4(5):406-10. · 0.36 Impact Factor
  • Archives de Pédiatrie 06/1997; 4(5):485. · 0.36 Impact Factor
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    ABSTRACT: Indication for intubation and mechanical ventilation in premature infants may be reduced by initiating continuous positive airway pressure (CPAP) in delivery room. Immediately after birth, respiratory support with CPAP was given to all infants with gestational age less than 32 weeks. In case of apnea or progressing symptoms with hypoxemia or carbonic acidosis, with PCO2 increasing to more than 60 mmHg, infants were treated with nasotracheal intubation and ventilation. One hundred and fifty one infants, with mean gestational age 29.6 +/- 1.9 weeks and mean birth weight 1,326 +/- 378 g were delivered in the obstetrical department of Marseille. In delivery room, 63% were treated with CPAP, and only 13% with nasotracheal intubation. The need for subsequent mechanical ventilation was reduced to 40% of the population. Surfactant therapy was used in 17% of this cohort. Two infants were given surfactant and extubated. Three of 14 deaths (9.2%) were caused by respiratory disease. Early CPAP reduces the indication of mechanical ventilation in premature infants. Incidence of pulmonary complications such as pneumothorax or bronchopulmonary dysplasia is low among those infants who require mechanical ventilation later. Early CPAP takes place in a general policy to decrease neonatal morbidity.
    Archives de Pédiatrie 02/1997; 4(1):15-20. · 0.36 Impact Factor
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    ABSTRACT: Background. — Indication for intubation and mechanical ventilation in premature infants may be reduced by initiating continuous positive airway pressure (CPAP) in delivery room. Population and methods. — Immediately after birth, respiratory support with CPAP was given to all infants with gestational age less than 32 weeks. In case of apnea or progressing symptoms with hypoxemia or carbonic acidosis, with PCO2 increasing to more than 60 mmHg, infants were treated with nasotracheal intubation and ventilation. Results. — One hundred and fifty one infants, with mean gestational age 29.6 ± 1.9 weeks and mean birth weight 1,326 ± 378 g were delivered in the obstetrical department of Marseille. In delivery room, 63% were treated with CPAP, and only 13% with nasotracheal intubation. The need for subsequent mechanical ventilation was reduced to 40% of the population. Surfactant therapy was used in 17% of this cohort. Two infants were given surfactant and extubated. Three of 14 deaths (9.2%) were caused by respiratory disease. Conclusions. — Early CPAP reduces the indication of mechanical ventilation in premature infants. Incidence of pulmonary complications such as pneumothorax or bronchopulmonary dysplasia is low among those infants who require mechanical ventilation later. Early CPAP takes place in a general policy to decrease neonatal morbidity.
    Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/1997; 4(1):15-20.
  • Archives De Pediatrie - ARCHIVES PEDIATRIE. 01/1997; 4(5):485-485.