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Purpose: To identify national consensus criteria for the management of children with chemotherapy-induced febrile neutropenia (FN) and for evidence-based step-down treatment approaches for patients classified as having a low risk of severe infection. Methods: In August 2018, a five-section, 38-item survey was e-mailed to all pediatric hematology and oncology units in France. The five sections contained statements on possible consensus criteria for (i) the definition of FN, (ii) the initial management of children with FN, (iii) the conditions required for initiating step-down therapy in low-risk patients, (iv) the management strategy for low-risk patients, and (v) antibiotic treatment on discharge. Consensus was defined as 75% of “somewhat agree” + “strongly agree” answers. Results: Sixty-five physicians, all specialists in pediatric onco-hematology, from 18 centers completed the survey questionnaire (participation rate: 58%). A consensus was reached on 22 of the 38 statements, including the definition of FN, the criteria for step-down therapy in children at low risk of severe infection, and the initial care of patients with FN. There was no consensus on the type and duration of antibiotic therapy on discharge for patients at low risk of severe infection. Conclusion: A consensus has been reached on the criteria for initiating evidence-based step-down treatment of children with FN and a low risk of severe infection. The lack of consensus on the step-down antimicrobial regimen means that the post-discharge antibiotic treatment can be defined according to local preferences.

Among 74 patients with an immediate hypersensitivity reaction (IHR) to iodinated contrast media (ICM), the rate of allergic patients confirmed by positive prick test or diluted intradermal test (IDT) was 8.1%. 12.5% of re-exposed patients had a recurrent IHR despite negative skin tests. Investigations on pure IDT to ICM and development of drug provocation test may provide additional safety nets to uncover recurrent ICM reactors. Agreements among allergists are needed to unify practices.

Resume Contrairement aux allergies respiratoires, alimentaires et aux venins d’hymenopteres qui concernent des allergenes proteiques, la prise en charge des allergies aux medicaments necessite rarement le recours aux examens biologiques pour obtenir la preuve d’un mecanisme allergique IgE-dependant. Un nombre tres restreint de dosages d’IgE specifiques de medicaments est disponible car la grande majorite des medicaments sont des haptenes. L’utilisation rationnelle des outils biologiques disponibles selon les donnees actualisees de la science est a meme de garantir l’efficience diagnostique. Le mesusage de la biologie de l’allergie et/ou leur interpretation erronee risque d’aboutir a des attitudes therapeutiques inadaptees voire dangereuses. Consciente de cet enjeu, la Societe francaise d’allergologie (SFA) a mis en place un groupe de travail multidisciplinaire pour l’actualisation des recommandations de biologie de l’allergie, les precedentes recommandations elaborees en 2005 par la Haute autorite de sante (HAS) etant devenues en partie obsoletes en raison de l’evolution des techniques et concepts. La methodologie utilisee est celle des recommandations pour la pratique clinique (RPC) elaboree par la HAS, meme si le texte n’a pas ete labellise par celle institution. Le groupe de travail a redige 11 recommandations gradees sur l’allergie aux medicaments. Bien que non exhaustives, ces 11 questions repondent aux preoccupations les plus courantes des prescripteurs qu’ils soient allergologues ou non pour la prise en charge des patients ayant une suspicion d’allergie aux medicaments, tout en tenant compte du contexte reglementaire francais.

International audience; Introduction: Bronchiolitis is the leading cause of hospitalization for infants but its economic burden is not well documented. Our objective was to describe the clinical evolution and to assess the 1-month cost of a first episode of acute bronchiolitis presenting to the emergency department (ED).Methods: Our study was an epidemiologic analysis and a cost study of the cohort drawn from the clinical trial GUERANDE, conducted in 24 French pediatric EDs. Infants of 6 weeks to 12 months of age presenting at pediatric EDs with a first episode of bronchiolitis were eligible. The costs considered were collected from a societal viewpoint, according to the recommendations of the French National Health Authority.Results: A total of 777 infants were included with a median age of 4 months. A total of 57% were hospitalized during the month following the first consultation in the ED, including 28 (3.6%) in an intensive care unit. The mean length of stay was 4.2 days (SD = 3.7). The average time to relief of all symptoms was 13 days (SD = 7). Average total cost per patient was €1919 (95% confidence interval: 1756-2138) from a societal perspective, mostly due to hospitalization cost. The estimated annual cost of bronchiolitis in infants was evaluated to be between €160 and €273 million in France.Discussion: Bronchiolitis represent a high cost for the health care system and broadly for society, with hospitalizations costs being the main cost driver. Thus significant investments should be made to develop innovative therapies, to reduce the number of hospitalizations and length of stay.

The management of cracked teeth represents a difficulty because their diagnosis is complex and there is no consensus concerning their treatment. The present article explains this pathology within enamel and dentin and also focuses on the clinical consequences of crack development in dental tissue. As cracks have both biologic and mechanical implications, a complete review of the literature on the subject has enabled the development of a comprehensive diagnostic approach to identify cracked teeth and optimize their management. The elements of diagnosis are the bite test, transillumination, the pulp sensitivity test, the periodontal test, radiologic examinations, removal of existing restorations, and the use of quantitative light-induced fluorescence. Finally, the management of biologic and mechanical imperatives relating to the treatment of cracked teeth has allowed the proposal of a reliable and reproducible therapeutic strategy based on two pillars: the arrest of bacterial infiltration using immediate dentin sealing, and the limitation of crack propagation using relative cuspal coverage. In this article, the proposed clinical protocol is explained through the use of a decision map and is illustrated by a clinical case example.

In an era where multilingualism has become mainstream and where Western societies are more focused on writing than ever, this study explores the relationship to writing of high school students who speak African languages of oral tradition for whom French is a second language. Little highlighted, this student profile is nevertheless frequent in France.The objective of this research is threefold: first to exploring the relationship to writing of pupils who speak African languages of oral tradition in order to understand their specificities, also to apprehend the mechanisms of construction and the evolution of the relationship to writing over time and according to the life experiences of the pupils, and finally to propose didactic paths for the teaching of French as a second language but also of other school subjects which make extensive use of writing. The present work proposes to explore the relationship to writing of plurilingual high school students whose language repertoires present African languages and cultures of oral tradition, by adopting a diachronic and contextualizing approach. From a theoretical point of view, this research is based on work from the didactics of French (French as a mother tongue and French as a second language) and the field of literacies on the one hand, but it also borrows notions from sociology and social anthropology. The vision of writing as a process comes from the contribution of textual genetics in didactics. The objective of this work is twofold: on the one hand, it is to explore the relationship to writing of learners with heterogeneous language repertoires in order to understand their specificities and to consider how didactics could use this notion to support learning in French as a second language. On the other hand, it is a question of apprehending the construction and the evolution of the relationship to writing from a more theoretical point of view. For this purpose, a diachronic and contextualizing approach has been chosen. It is a question of apprehending the mechanisms of construction of the notion, the elements which can exert an influence on this process of construction and evolution. Thus, within the framework of this qualitative research, twenty-two semi-directive interviews were conducted, and seventeen versions of written productions produced in a school context by ten of the interviewees were collected and then analyzed. Many of the participants are Unaccompanied Minors and have had little and/or irregular schooling. The results of the exploration of the relationship to writing allowed for the formulation of didactic recommendations. Also, the exploration of the socialization environments brought to light the links between these environments on the one hand, and the processes of construction and evolution of the relationship to writing on the other hand. Finally, this diachronic and contextualizing approach has made it possible to put forward hypotheses and a proposed schematization concerning the notion of a relationship to writing., À une époque où le plurilinguisme a le vent en poupe et où les sociétés occidentales sont plus que jamais centrées sur l’écrit, cette étude propose d’explorer le rapport à l’écrit de lycéens locuteurs de langues africaines de tradition orale pour qui le français est une langue seconde. Peu mis en lumière, ce profil d’élève est pourtant fréquent en France. L’objectif de cette recherche est triple : il s’agit d’explorer le rapport à l’écrit d’élèves locuteurs de langues africaines de tradition orale afin d’identifier les éventuels liens entre ces langues et leur relation avec l’écrit, d’appréhender les mécanismes de construction et d’évolution du rapport à l’écrit au fil du temps et en fonction des expériences de vie des élèves et, enfin, de proposer des pistes didactiques pour l’enseignement du français langue seconde mais également d’autres matières scolaires qui recourent largement à l’écrit. Le présent travail propose d'explorer le rapport à l'écrit de lycéens plurilingues dont les répertoires langagiers présentent des langues et cultures africaines de tradition orale, en adoptant une approche diachronique et contextualisante. D'un point de vue théorique, cette recherche prend appui sur les travaux issus de la didactique du français (Français Langue Maternelle et Français Langue Seconde) et du champ des littéracies d'une part, mais elle emprunte également des notions à la sociologie et à l'anthropologie sociale. La vision de l'écriture comme processus découle quant à elle de l'apport en didactique, de la génétique textuelle. L'objectif de ce travail est double : d'une part, il s'agit d'explorer le rapport à l'écrit d'apprenants dont les répertoires langagiers sont hétérogènes afin d'en comprendre les spécificités et d'envisager la façon dont la didactique pourrait recourir à cette notion, pour soutenir les apprentissages en français langue seconde. D'autre part, il s'agit d'appréhender la construction et l'évolution du rapport à l'écrit d'un point de vue plus théorique. Pour cela, une approche diachronique et contextualisante a été choisie. Il s’agit d’appréhender les mécanismes de construction de la notion, les éléments qui peuvent exercer une influence sur ce processus de construction et d’évolution. Ainsi, dans le cadre de cette recherche qualitative, vingt-deux entretiens semi-directifs ont été menés et dix-sept versions de productions écrites réalisées en contexte scolaire par dix des interviewés, ont été collectées puis analysées. Nombre des participants sont des mineurs non accompagnés et ont été peu et/ou irrégulièrement scolarisés. Les résultats découlant de l’exploration du rapport à l’écrit ont permis de formuler des recommandations didactiques. Aussi, l’exploration des environnements de socialisation a mis en lumière des liens entre ces environnements d’une part, et les processus de construction et d’évolution du rapport à l’écrit d’autre part. Enfin, cette approche diachronique et contextualisante a permis d’émettre des hypothèses et une proposition de schématisation concernant la notion de rapport à l'écrit.