Characteristics and management of congenital esophageal stenosis: findings from a multicenter study.

BACKGROUND: Congenital esophageal stenosis (CES) is a rare condition frequently associated with esophageal atresia (EA). There are limited data from small series about the presentation, treatment, and outcomes of CES. METHODS: Medical records of all patients with CES included in the French Network on Esophageal Malformations and Congenital Diseases were reviewed retrospectively with regard to diagnosis, treatment, and outcome. RESULTS: Over 18 years, 61 patients (30 boys) had CES, and 29 (47%) of these patients also had EA. The mean age at diagnosis was 24 months (1 day to 14 years) and was younger in patients with CES and EA than in those with isolated CES (7 vs. 126 months, p < 0.05). Twenty-one of the 61 patients with CES had no clinical symptoms: in three patients, the findings were incidental, and in 18 of the 29 patients with associated EA, CES was diagnosed at the time of surgical repair of EA or during a postoperative systematic esophageal barium study. In the 40 other patients, at diagnosis, 50% presented with dysphasia, 40% with vomiting, 50% with food impaction, and 42% with respiratory symptoms. Diagnosis of CES was confirmed by esophageal barium study (56/61) and/or esophageal endoscopy (50/61). Sixteen patients had tracheobronchial remnants (TBR), 40 had fibromuscular stenosis (FMS), and five had membrane stenosis (MS). Thirty-four patients (56%) were treated by dilation only (13/34 remained asymptomatic at follow-up); 15 patients were treated by dilation but required later surgery because of failure (4/15 remained asymptomatic at follow-up); and nine patients had a primary surgical intervention (4/9 were asymptomatic at follow-up). Dilation was complicated by esophageal perforation in two patients (3.4%). At follow-up, dysphagia remained in 36% (21/58) of patients, but the incidence did not differ between the EA and the isolated CS groups (10/29 vs. 7/32, p = 0.27). CONCLUSIONS: CS diagnosis can be delayed when associated with EA. Dilation may be effective for treating patients with FMS and MS, but surgical repair is often required for those with TBR. Our results show clearly that, regardless of the therapeutic option, dysphagia occurs frequently, and patients with CES should be followed over the long term

Le diagnostic anténatal modifie-t-il la prise en charge néonatale et le devenir à 1 an des enfants suivis pour atrésie de l’œsophage de type III ?

OBJECTIVE: Evaluate neonatal management and outcome of neonates with either a prenatal or a post-natal diagnosis of EA type III. STUDY DESIGN: Population-based study using data from the French National Register for EA from 2008 to 2010. We compared children with prenatal versus post-natal diagnosis in regards to prenatal, maternal and neonatal characteristics. We define a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and mortality at 1 year. RESULTS: Four hundred and eight live births with EA type III were recorded with a prenatal diagnosis rate of 18.1%. Transfer after birth was lower in prenatal subset (32.4% versus 81.5%, P<0.001). Delay between birth and first intervention was not significantly different. Defect size (2cm vs 1.4cm, P<0.001), gastrostomy (21.6% versus 8.7%, P<0.001) and length in neonatal unit care were higher in prenatal subset (47.9 days versus 33.6 days, P<0.001). The composite variables were higher in prenatal diagnosis subset (38.7% vs 26.1%, P=0.044). CONCLUSION: Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity related to the EA type (longer gap). Even if it does not modify neonatal management and 1-year outcome, prenatal diagnosis allows antenatal parental counseling and avoids post-natal transfer

Esophageal atresia: data from a national cohort

PURPOSE: A prospective national register was established in 2008 to record all new cases of live-birth newborns with esophageal atresia (EA). This epidemiological survey was recommended as part of a national rare diseases plan. METHODS: All 38 national centers treating EA participated by completing for each patient at first discharge a questionnaire validated by a national committee of experts. Data were centralized by the national reference center for esophageal anomalies. Quantitative and qualitative analyses were performed, with P-values of less than 0.05 considered statistically significant. Results of the 2008-2009 data collection are presented in this report. RESULTS: Three hundred seven new living cases of EA were recorded between January 1, 2008, and December 31, 2009. The male/female sex ratio was 1.3, and the live-birth prevalence of EA was 1.8 per 10,000 births. Major characteristics were comparable to those reported in the literature. Survival was 95%, and no correlation with caseload was noted. CONCLUSIONS: Epidemiologic surveys of congenital anomalies such as EA, which is a rare disease, provide valuable data for public health authorities and fulfill one important mission of reference centers. When compared with previous epidemiological data, this national population-based registry suggests that the incidence of EA remains stable

Asymptomatic Carriage of Plasmodium in Urban Dakar: The Risk of Malaria Should Not Be Underestimated

Introduction: The objective of this study was to measure the rate of asymptomatic carriage of plasmodium in the Dakar region two years after the implementation of new strategies in clinical malaria management. Methodology: Between October and December 2008, 2952 households selected in 50 sites of Dakar area, were visited for interviews and blood sampling. Giemsa-stained thick blood smears (TBS) were performed for microscopy in asymptomatic adult women and children aged 2 to 10 years. To ensure the quality of the microscopy, we performed a polymerase chai

Climate-induced redistribution of people is not inevitable

As climate change intensifies, scientific and policy discussions increasingly address questions of future habitability and potential population movements. In this perspective, we caution against premature or top-down characterizations of areas as uninhabitable, or portrayals of large-scale climate-induced displacement as inevitable—particularly when the perspectives and preferences of affected populations are excluded. While we recognize the importance of modelling and scenario-building to assess future risks, we argue that such efforts must be grounded in local realities and include diverse forms of knowledge.
Habitability is not determined by climate alone, but emerges from intersecting environmental, political, economic, and cultural dynamics—including governance, inequality, and historical injustice. Framings that do not consider this risk producing two problematic outcomes: first, by prematurely defining areas as uninhabitable, they may undermine the legitimacy of in-situ adaptation and the agency of affected communities; second, when modelling or the use of modelling results does not consider local context, it may inadvertently contribute to narratives portraying climate-induced mass displacement as inevitable, reinforcing deterministic understandings of migration and overlooking the complex drivers of mobility and immobility.
To counter these risks, we propose five guiding recommendations: (1) avoid declaring hard limits to habitability without inclusive, context-specific assessments; (2) treat model-based projections as possible, not predetermined futures; (3) reject simplistic global North/South assumptions in assessing vulnerability and mobility; (4) uphold people’s right to remain, alongside the right to move; and (5) prioritize investment in in-situ adaptation that addresses structural inequalities. These principles aim to inform more reflexive and justice-oriented approaches to climate mobility and habitability research—approaches that recognize lived experiences, engage diverse knowledge systems, and help secure equitable futures for those most exposed to environmental change

Habitability for a connected, unequal and changing world

As global climate change intensifies, the question of what makes a place habitable or uninhabitable is critical, particularly in the context of a potential future climate outside the realm of lived experience, and the possible concurrent redistribution of populations partly associated with such climatic shifts. The concept of habitability holds the potential for advancing the understanding of the societal consequences of climate change, as well as for integrating systemic understandings and rights-based approaches. However, most ways of analyzing habitability have shortcomings in terms of in-depth integration of socio-cultural aspects and human agency in shaping habitability, in failing to address spatial inequalities and power dynamics, and in an underemphasis of the connectedness of places. Here we elaborate habitability as an emergent property of the relations between people and a given place that results from people’s interactions with the material and immaterial properties of a place. From this, we identify four axes that are necessary to go beyond environmental changes, and to encompass socio-cultural, economic, and political dynamics: First the processes that influence habitability require a systemic approach, viewing habitability as an outcome of ecological, economic, and political processes. Second, the role of socio-cultural dimensions of habitability requires special consideration, given their own operational logics and functioning of social systems. Third, habitability is not the same for everyone, thus a comprehensive understanding of habitability requires an intersectionally differentiated view on social inequalities. Forth, the influence of external factors necessitates a spatially relational perspective on places in the context of their connections to distant places across scales. We identify key principles that should guide an equitable and responsible research agenda on habitability. Analysis should be based on disciplinary and methodological pluralism and the inclusion of local perspectives. Habitability action should integrate local perspectives with measures that go beyond purely subjective assessments. And habitability should consider the role of powerful actors, while staying engaged with ethical questions of who defines and enacts the future of any given place

Movable genetic elements and antibiotic resistance in enterococci

The enterococci possess genetic elements able to move from one strain to another via conjugation. Certain enterococcal plasmids exhibit a broad host range among gram-positive bacteria, but only when matings are performed on solid surfaces. Other plasmids are more specific to enterococci, transfer efficiently in broth, and encode a response to recipient-produced sex phermones. Transmissible non-plasmid elements, the conjugative transposons, are widespread among the enterococci and determine their own fertility properties. Drug resistance, hemolysin, and bacteriocin determinants are commonly found on the various transmissible enterococcal elements. Examples of the different systems are discussed in this review.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47900/1/10096_2005_Article_BF01963632.pd