Effect of dietary seaweed (Ascophyllum nodosum) supplementation on milk mineral concentrations, transfer efficiency, and hematological parameters in lactating Holstein cows

This study investigated the effect of feeding seaweed (Ascophyllum nodosum) to dairy cows on milk mineral concentrations, feed-to-milk mineral transfer efficiencies, and hematological parameters. Lactating Holstein cows (n = 46) were allocated to 1 of 2 diets (n = 23 each): (1) control (CON; without seaweed) and (2) seaweed (SWD; replacing 330 g/d of dried corn meal in CON with 330 g/d dried A. nodosum). All cows were fed the CON diet for 4 wk before the experiment (adaptation period), and animals were then fed the experimental diets for 9 wk. Samples included sequential 3-wk composite feed samples, a composite milk sample on the last day of each week, and a blood sample at the end of the study. Data were statistically analyzed using a linear mixed effects model with diet, week, and their interaction as fixed factors; cow (nested within diet) as a random factor; and data collected on the last day of the adaptation period as covariates. Feeding SWD increased milk concentrations of Mg (+6.6 mg/kg), P (+56 mg/kg), and I (+1,720 μg/kg). It also reduced transfer efficiency of Ca, Mg, P, K, Mn, and Zn, and increased transfer efficiency of Mo. Feeding SWD marginally reduced milk protein concentrations, whereas there was no effect of SWD feeding on cows' hematological parameters. Feeding A. nodosum increased milk I concentrations, which can be beneficial when feed I concentration is limited or in demographics or populations with increased risk of I deficiency (e.g., female adolescents, pregnant women, nursing mothers). However, care should also be taken when feeding SWD to dairy cows because, in the present study, milk I concentrations were particularly high and could result in I intakes that pose a health risk for children consuming milk.

Health-related quality of life and perceived stress of informal caregivers of children and adolescents with intellectual disabilities and ADHD

Introduction

Informal caregivers of children and adolescents with intellectual disabilities and attention deficit/hyperactivity disorder (ADHD) face numerous challenges. However, no study has yet compared the HRQoL of the caregivers of children and adolescents with these two conditions. We aimed to compare the HRQoL and perceived stress of caregivers of children and adolescents with intellectual disabilities and ADHD.

Methods

The HRQoL and perceived stress of informal caregivers of children and adolescents with intellectual disabilities and ADHD (40 in each group) were compared using the perceived stress scale and the Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form, respectively.

Results

HRQoL was significantly worse in most dimensions in caregivers of children and adolescents with severe ADHD than in caregivers of children and adolescents with severe intellectual disabilities. However, perceived stress was similar.

Conclusion

Differences in the impact of intellectual disability and ADHD on family members' HRQoL should be considered while developing educational programs for patients and their families.

Antibiotic therapy in the emergency room: Optimal prescription is indeed the best

INTRODUCTION

Emergency departments (ED) are pivotal for antibiotic prescription, of which the appropriateness and consequences have rarely been assessed.

METHODS

A retrospective study included patients referred to the ED and hospitalized with an advocated diagnosis of infection. Day-0 (ED initial prescription) and day-2 (reevaluation) antibiotic therapies were graded as optimal (if fully following the guidelines in terms of molecule, dose, and route of administration), adapted (if the prescribed molecule was microbiologically active but not recommended as first-line treatment, or in case of a wrong dose), or inadequate (other situations). The primary endpoint was onset of an unfavorable event (death, transfer to intensive care unit, or re-hospitalization). Prognosis factors associated with survival without unfavorable event were assessed by multivariate analysis.

RESULTS

We included 484 patients. Optimal, adapted, and inadequate initial prescriptions concerned 328 (67.8 %), 110 (22.7 %) and 46 (9.5 %) patients respectively. Compared with an optimal prescription, an initial adapted prescription was associated with a poorer prognosis (HR = 1.95, CI95% [1.18-3.22]; p = 0.01). Reevaluation was performed in 436 (90.1 %) patients. After reevaluation, optimal, adapted, and inadequate prescriptions concerned 326 (74.8 %), 64 (14.7 %), and 46 (10.5 %) patients respectively. After reevaluation, and as compared with optimal prescription, inadequate prescription was significantly associated with unfavorable events (HR = 3.52, CI95% [1.42-8.72]; p = 0.003).

CONCLUSION

Antibiotics are frequently prescribed in EDs. Antibiotic prescription has got to be optimal, and not simply adapted, so as to be associated with significant clinical benefit.

P-553 Response to controlled ovarian stimulation and preimplantation genetic testing for molecular disease (PGT-M) outcomes for Myotonic dystrophy type I (DM1) : A French multicentric study

Study question

Does ovarian response to controlled ovarian hyperstimulation (COH) is altered in female affected by DM1 ?

Summary answer

Ovarian response to COH is not altered in female affected by DM1 as compared to partners of affected males

What is known already

Myotonic dystrophy type 1 is the most common adult muscular dystrophy caused by a CTG trinucleotide repeat expansion which may expand across generation. As this pathology presents an autosomal dominant inheritance, PGT may be an option to achieve a pregnancy with healthy baby. There are conflicting reports about response to COH for affected female. Moreover, few data are available concerning the chance to have a healthy baby after PGT for couple with one member affected by DM1

Study design, size, duration

The present study is a retrospective observational study carried out from January 2006 through January 2020. This multicentric study was conducted in all the five centers performing PGT-M in France.

Participants/materials, setting, methods

A total of 229 couples started at least one COH cycle for the PGT procedure. The patient carrying the mutation was the female for 178 couples and the male for the 51 others. Overall, 648 COH cycles started and 560 oocytes retrieval for subsequent PGT were performed (430 for affected female and 130 for affected male). Parameters of ovarian response and PGT outcomes were compared according to the member affected by DM1.

Main results and the role of chance

Age and BMI at the first COH cycle were not significantly different between both group but female carried mutation presented lower AMH level than partner of affected male. The starting and total doses of gonadotrophin were significantly higher for mutated females. The number of retrieved and mature oocytes per cycle were not statistically different (12 [8–16] versus 11 [8–16] retrieved oocytes, p = 0.63 and 9 [6–13] versus 9 [6-13] mature oocytes, p = 0.73, respectively). In both group, more than 70% of oocyte retrieval led to embryo biopsy.

The proportion of started cycle allowing the obtention of at least one healthy embryo was significantly lower when the female was affected with DM1 (58.6% vs 70.4%, p = 0.012). In the female affected group, 49.7% of the cycles with oocytes retrieval lead to a fresh embryo transfer and a subsequent live birth rate per transfer of 21.4%. These results were not statistically different from the couple with affected male (58.5% of cycles with fresh embryo transfer (p = 0.08) and 23.6% live birth rate per transfer).

Overall, after fresh or frozen embryo transfer, 30.8% of females with DM1and 41.2% of parter of affected males had at least one live birth from PGT.

Limitations, reasons for caution

This a retrospective study included patients who were selected ovarian reserve parameters before PGT process. Moreover, the large time of inclusion may influence our conclusion.

Wider implications of the findings

Information provided herein extends knowledge about the current state of COH for DM1 affected female. Moreover, PGT results presented here allow to provide patients with proposer counseling before starting PGT process.

Trial registration number

CEROG-2020-GYN-0603

Fijian farmers’ attitude and knowledge towards antimicrobial use and antimicrobial resistance in livestock production systems: a qualitative study

Introduction

Antimicrobial resistance (AMR) is a global health issue to humans and livestock (1). To mitigate AMR risks, responsible use of antimicrobials in livestock production systems have been advocated (1). Studies have demonstrated the patterns of antimicrobial use (AMU) in livestock production systems; however, there is limited information on the drivers of AMU. For successful antimicrobial stewardship (AMS), identifying the psychological (knowledge and attitude) and contextual drivers (environmental factors, economic status, and resource accessibility) for intervention is a crucial first step in the agri-food value chain. The theory of planned behaviour (TPB) has been used to understand behaviour influenced by a person’s intention, attitude, and knowledge; therefore, evaluating behaviour allows understanding of drivers that affect and shape the farmers’ intention and decisions (2).

Aim

To explore and understand the attitude and knowledge of Fijian livestock farmers on AMU and AMR.

Methods

Face to face one-to-one semi-structured qualitative interviews were conducted between September and November 2019 with Fijian livestock farmers and managers located in the Central and Western divisions of Viti Levu, Fiji. A sample of at least 20 participants from the cattle and poultry production systems was targeted and recruited using purposive and snowball sampling methods. TPB informed the development of the semi-structured interview guide. The interviews were audio-recorded and analysed inductively using Braun and Clarke’s reflexive thematic analysis and deductively using the TPB framework (results reported elsewhere). An interpretative approach underpinned the design and conduct of this study.

Results

Nineteen livestock farmers and managers took part in interviews. Our analysis generated four themes: 1) Uninformed use of antimicrobials and unaware of AMR, 2) Safeguarding livestock and generating income source as primary motivators for using medicine, 3) Medicine shortage resulting in hoarding and self-prescribing, and 4) Foreign farmers and veterinarians trusted over Fijian veterinarian and para-veterinarian knowledge. Livestock farmers did not differentiate amongst different types of medicine, including antimicrobials. Therefore, antimicrobials were unwittingly used and without an awareness of the risks of AMR. Medicines, including antimicrobials, were used to protect livestock and promote production for food and financial security. Farmers hoarded medicines and self-prescribed them on the farms. Farmers lacked confidence in the advice on livestock management, and medicine use, provided by Fijian veterinarians and para-veterinarians. They sought help online and from foreign farmers and veterinarians. No participant sought advice from pharmacists who are experts in medicine.

Conclusion

This study uncovered the first documented accounts of Fijian livestock farmers’ attitude and knowledge on AMU and AMR. AMS programmes promoting awareness and rational use of antimicrobials and resistance in Fijian livestock production is recommended. These programmes need to consider the social, economic, and environmental factors driving irrational medicine use by farmers. We acknowledge the views shared by participants may not be representative of all farmers in Fiji; however, we believe all participants provided in-depth insight into the current drivers of AMU. Future studies exploring the attitude and knowledge of Fijian veterinarians, para-veterinarians and pharmacists on AMU and AMR in livestock production can inform the design of AMS programmes that currently do not exist.

References

(1) WHO. Antimicrobial Resistance Geneva Switzerland: World Health Organization; 2021 [cited 2021 1 September]. Available from: http://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance.

(2) Ajzen I. The theory of planned behaviour. Organizational Behaviour and Human Decision Processes. 1991;50(2):179-211.

Évaluation de l’épuisement professionnel chez les internes et jeunes médecins urgentistes

Objectifs : Environnements stimulants mais stressants et exigeants, les structures d’urgences exposent les professionnels de santé à un risque accru de syndrome d’épuisement professionnel (SEP). Notre étude avait pour but d’évaluer la prévalence du SEP chez les internes et jeunes médecins urgentistes de Bourgogne-Franche-Comté.

Méthodes : Étude épidémiologique descriptive, prospective, multicentrique réalisée de juin à août 2020. Les internes de médecine d’urgence (DES MU 1, 2, 3) et médecins urgentistes (senior diplômé du DESC MU ≤ 3 ans) dépendant des universités de Besançon et de Dijon ont répondu à un questionnaire comprenant des outils d’évaluation du SEP, de l’anxiété et de la dépression.

Résultats : Le taux de réponse a été de 70 % (respectivement de 62 % pour Besançon et de 77 % pour Dijon). Quatrevingt-un praticiens (âge moyen de 29 ans) ont répondu, 41 internes de DES MU et 40 médecins urgentistes. Quarante-trois d’entre eux (53 %) présentaient des critères de SEP, 31 (38 %) des marqueurs d’anxiété et cinq des critères de dépression. On relevait un taux plus important de critères de SEP chez les jeunes seniors versus les internes (16 vs 27, p = 0,02). Il n’y avait pas de différence selon l’âge, le lieu d’exercice ou l’absence de congés récents. Il existait une faible concordance entre les marqueurs de SEP et les marqueurs d’anxiété ou de dépression.

Conclusion : La majorité des jeunes praticiens urgentistes interrogés présente des critères de SEP. Cette problématique doit être prise en compte afin d’améliorer la qualité de vie au travail.

Comparative analysis of Truenat™ MTB Plus and Xpert® Ultra in diagnosing tuberculous meningitis

BACKGROUND: Diagnostic delay and drug resistance not only worsen the outcomes of tuberculous meningitis (TBM), but are also important impediments to TB elimination efforts. Given the need for a near point-of-care test suitable for primary healthcare centres and simultaneous detection of resistance, Truenat™ MTB Plus assay was evaluated on a large cohort of TBM patients.METHODS: Truenat assay was performed on 148 cerebrospinal fluid specimens (76 definite TBM, 32 probable TBM and 40 non-TBM controls) and its performance was compared with Xpert^® Ultra.RESULTS: The overall sensitivity of Truenat and Ultra was respectively 78.7% and 67.6% in diagnosing TBM, and respectively 85.5% and 96% in diagnosing definite TBM. Twenty-three additional cases were detected using Truenat and 11 using Ultra. Truenat missed seven cases of rifampicin (RIF) resistance and indicated false RIF resistance in four cases.CONCLUSION: Performance of Truenat was comparable to that of Ultra in diagnosing TBM and inferior to Xpert Ultra in determining RIF resistance.

O-092 Sperm phenotype, ICSI outcome and genetic diagnosis in case of severe asthenozoospermia with multiple morphological abnormalities of the flagellum

Study question

What are the feasibility and outcome of ICSI in case of presumably genetic severe asthenozoospermia with Multiple Morphological Abnormalities of the Flagellum (MMAF phenotype)?

Summary answer

ICSI outcome for couples with MMAF phenotype does not differ from that of other couples requiring ICSI, regardless to the genetic etiology

What is known already

Severe asthenozoospermia, especially when associated with multiple morphological abnormalities of the sperm flagellum (MMAF phenotype), results in male infertility. Recent findings confirm that a genetic etiology is frequently responsible for this phenotype. In such situations, pregnancies can be obtained using ICSI. However, few studies have provided detailed analyses of the flagellar ultrastructural defects underlying this phenotype, of its genetic etiologies and of the results of ICSI in such cases of male infertility.

Study design, size, duration

We performed a retrospective study including 25 infertile men showing severe asthenozoospermia associated with a MMAF phenotype identified through standard semen analysis. These men were recruited from an academic center for Assisted Reproduction in Paris between 2009 and 2017. Transmission electron microscopy (TEM) and Whole Exome Sequencing (WES) were performed in order to precise the sperm ultra-structural phenotype and identify causal mutations, respectively. Twenty of the 25 patients benefited from assisted reproductive therapy by ICSI.

Participants/materials, setting, methods

MMAF patients were recruited based on reduced sperm progressive motility and increased frequencies of absent, short, coiled or irregular flagella, in comparison with fertile control men. A quantified analysis of the ultrastructural defects was performed for the MMAF patients and for fertile control men. ICSI results for the MMAF patients were compared to those of 528 ICSI attempts performed for non-MMAF individuals considering the sperm parameters and the distribution of ultrastructural axonemal anomalies.

Main results and the role of chance

Thorough categorization by TEM analysis of the flagellar anomalies found in these patients brought important precisions about the structural defects underlying asthenozoospermia and sperm tail abnormalities detectable through standard microscopy. In particular, absence of the central pair of axonemal microtubules was the predominant anomaly, observed significantly more frequently than in control men (p < 0.01). Exome sequencing performed for 24 of the 25 patients (96%), identified in ten of them homozygous or compound heterozygous mutations that were described to be pathogenic (CFAP43, CFAP44, CFAP69, DNAH1, DNAH8, AK7, TTC29, MAATS1). A majority of those patients (55.5%,5/9) displayed the most severe ultra-structural defects of the axoneme. Forty ICSI attempts were performed for 20 MMAF patients. A hypo-osmotic swelling (HOS) test was required in 13 cycles (5 couples). Fertilization rate in MMAF group (65.7%) was not statistically different from the rate obtained for non-MMAF patients (66.0%) and did not differ according to the flagellar phenotype, nor to the use of HOS test, nor to the genotype. Clinical pregnancy rate per embryo transfer did not significantly differ between the MMAF group (23.3%) and the ICSI control group (37.1%). To date, 11 healthy babies were born among 20 MMAF patients.

Limitations, reasons for caution

The outcome of ICSI procedure was retrospectively assessed on a small sample and may be susceptible to recall bias. Moreover, TEM analysis was not available for some of the patients due to too low sperm concentration, and WES results are not yet available for all men included.

Wider implications of the findings

Couples requiring ICSI for presumably genetic severe asthenozoospermia should benefit precociously from appropriate phenotypic and genetic investigations. So far ICSI results appear similar to those observed in other ICSI indications. Identifying a genetic etiology and its mode of inheritance allows providing to these couples a most often reassuring genetic counseling.

Trial registration number

Not applicable

Screw versus staple fixation for Akin osteotomy

INTRODUCTION

Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants.

METHODS

We evaluated 74 Akin osteotomies performed in conjunction with first metatarsal osteotomy for hallux valgus. The osteotomy was fixed with a headless compression screw in 39 cases and a staple in 35 cases. We looked at the implant-related complications, removal of metalwork, revision, non-union and cost. Pre- and postoperative hallux valgus interphalangeal (HI) angles and length of the proximal phalanx were measured.

RESULTS

There was 100% union, no failure of fixation, no revision surgery and no delayed union in either group. The radiological prominence of screws was significant (p=0.02), but there was no significant difference in soft-tissue irritation (p=0.36) or removal of implants (p=0.49). Two cortical breaches (5.8%) occurred in staple fixation and 4 (10.2%) in screw fixation (not statistically significant (NS), p=0.50). The mean improvement in HI angle was 4.3° with screw fixation and 4.1° with staple fixation (NS, p=0.69). The mean shortening of the proximal phalanx was 2.5mm with screw fixation and 2.3mm with staple fixation (NS, p=0.64). The total cost was £1,925 for staple fixation and £4,290 for screw fixation.

CONCLUSIONS

Staple and screw fixation are reproducible modalities with satisfactory outcomes, but screw fixation is expensive. We conclude staple fixation is a cost-effective alternative.

A new approach to establish safe levels of available metals in soil with respect to potential health hazard of human

Safe levels of extractable pollutant elements in soil have not been universally established. Prediction of metal solubility in polluted soils and the subsequent transfer of these metals from soil pore water to the human food supply via crops are required for effective risk assessment from polluted soils. Thus an attempt has been made to develop a novel approach to protect human health from exposure to toxic metals through assessing risk from metal polluted soils utilised for agriculture. In this study, we assess the relative efficacy of various forms of 'free ion activity model' (FIAM) for predicting the concentration of cadmium (Cd), lead (Pb), nickel (Ni), zinc (Zn) and copper (Cu) in spinach and wheat as example crops, thereby providing an assessment of risk to human health from consumption of these crops. Free metal ion activity in soil solution was estimated using the Windermere Humic Aqueous Model VII (WHAM-VII) and the Baker soil test. Approximately 91, 81, 75, 94 and 70% of the variability in Cd, Pb, Ni, Zn and Cu content, respectively, of spinach could be described by a FIAM using an estimate of the free ion activity of the metals provided by WHAM-VII. Owing to the different concentration of ethylenediamine tetraacetic acid (EDTA) and diethylenetriamine pentaacetic acid (DTPA) used in the present experiment, higher prediction coefficients were obtained using EDTA (0.05 M), rather than DTPA (0.005 M), as the metal extractant in an integrated solubility-FIAM model. Out of three formulations, the FIAM, based on free ion activity of metals in soil pore water, determined from solution extracted with Rhizon samplers, was distinctly superior to the other formulations in predicting metal uptake by spinach and wheat. A safe level of extractable metal in soil was prescribed using a hazard quotient derived from predicted plant metal content and estimated dietary intake of wheat and spinach by a human population.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12665-021-09988-7.

Comparative analysis of beneficial effects of vancomycin treatment on Th1- and Th2-biased mice and the role of gut microbiota

AIMS

The aim was to understand the time-dependent antibiotic-induced perturbation pattern of gut microbiota and its effect on the innate immune and metabolic profile of the host.

METHODS AND RESULTS

Vancomycin was administered at 50 mg kg^-1 of body weight twice daily for six consecutive days to perturb the gut microbiota of C57BL/6 (Th1-biased) and BALB/c (Th2-biased) mice. Following treatment with vancomycin, we observed a reduction in the abundance of phyla Firmicutes and Bacteroides and an increase in Proteobacteria in the gut for both strains of mice following treatment with vancomycin till day 4. Abundance of Akkermansia muciniphila of Verrucomicrobia phylum also increased, from day 5 onwards following vancomycin treatment. The time-dependent variation of gut microbiota was associated with increased (i) expression of toll-like receptors and inflammatory genes such as TNF-α, IL-6, and IL-17, (ii) gut barrier permeability and (iii) blood glucose level of the host. The results also showed that (i) transplantation of cecal microbiota from vancomycin-treated day 6 mice to day 3 vancomycin-treated mice helped in restoring blood glucose level in C57BL/6 mice and (ii) short-chain fatty acids like acetate, butyrate and propionate changed with the alteration of gut microbiota to induce differential regulation of host immune response.

CONCLUSIONS

The current results revealed that an increase in A. muciniphila led to decreased inflammation and increased rate of glucose tolerance in the host. The treatment, with vancomycin till day 4, increased expression of inflammatory genes. The continuation of vancomycin for two more days reversed the effects. The effects were significantly more in C57BL/6 than BALB/c mice.

SIGNIFICANCE AND IMPACT OF THE STUDY

The current study established that the treatment with vancomycin till day 4 increased pathogenic bacteria but day 5 onwards provided significant health-related benefits to the host by increasing A. muciniphila more in C57BL/6 than BALB/c mice.

Exploring the structure of Xe isotopes in A ~ 130 region: Single particle and collective excitations

High and medium spin structures of 130,131Xe have been studied using α-induced fusion-evaporation reaction and the Indian National Gamma Array (INGA) coupled with a digital data acquisition system. Various new band structures and near yrast levels of 131Xe have been established. The multipolarities of the observed transitions have been assigned on the basis of the DCO ratios and the polarization asymmetry measurements. Band structures based on 1-quasi-particle (qp), 3-qp configurations have been observed. A new Magnetic Rotational (MR) band based on 5-qp configuration has also been established in 131Xe. The MR band has been interpreted in terms of shears mechanism with principal axis cranking (SPAC) calculations. Shell Model calculations are carried out to describe the non yrast states of 131Xe above the 11/2− isomer. New excited states have also been identified in 130Xe, produced in the same reaction.

P6389Infection and type 2 myocardial infarction: a large observational study from emergency department

Background

Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin.

Methods

Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU (n=82 543), patients with a diagnosis of AI and elevated troponin Ic (≥0.10μg/L) (n=714) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes).

Results

Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract (n=111), urinary tract (n=27), skin (n=15), digestive tract (n=9) or other or indefinite site (n=23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) (OR (95% CI): 0.53 (0.30–0.96)), high temperature (OR: 0.86 (0.74–0.99) per °C) and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs 23%, p=0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent co-variates associated with mortality.

Conclusions

Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, in the absence of temperature elevation, renal insufficiency or history of COPD. In such patients, inflammatory and cardiac biomarkers levels were independently associated with early mortality.

P852Frequency and prognosis of type 2 myocardial infarction vs non ischemic myocardial injury: large observational study from an emergency department

Background

Type 2 Myocardial Infarction (T2MI), due to myocardial oxygen supply-demand mismatch in the absence of atherothrombosis and non-ischemic myocardial injury (NIMI), corresponding to troponin elevation without overt ischemia, are emerging concepts which are suspected to be common in patients hospitalized. However, their respective frequencies, risk profiles and short term prognosis in current routine clinical practice of emergency unit remains to be investigated.

Methods

Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital emergency unit (n=82 543), patients with elevated troponin Ic (≥0.10μg/L) (n=4568) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes), or as NIMI without such signs. Patients with missing biological data on admission (n=112) or T1MI diagnosis (n=2467) were excluded.

Results

Among the 1989 patients included, 539 (27%) were classified as T2MI and 1450 (73%) as NIMI. When compared with patients with NIMI, T2MI had higher troponin levels (0.27 (0.14–0.71) vs 0.22 (0.13–0.54) μg/L, p=0.008, respectively). NIMI and T2MI had similar risk factors (age (84 (74–90) vs 84 (75–91) y, p=0.3), male sex (43 vs 48%, p=0.07), hypertension (67 vs 71%, p=0.133), diabetes (25 vs 25%, p=0.9), prior CAD (24 vs 26%, p=0.342), systemic inflammatory response syndrome (SIRS, 47 vs 49%, p=0.3), and systolic blood pressure (SBP) (130 (111–153) vs 132 (112–153) mmHg, p=0.545). Biological data on admission were also similar (hyperglycemia (glucose ≥11 mmol/L), 14 vs 13%, p=0.37, creatinine (96 (72–148) vs 94 (72–141) μmole/L, p=0.598), anemia (Hemoglobin rate ≤10g/dL, 13 vs 14%, p=0.5), C-reactive protein elevation (CRP ≥3 mg/L, 88 vs 89%, p=0.7)). Moreover, in-hospital mortality was high and similar for both groups (15 vs 18%, p=0.2). In multivariate analysis, age, troponin rate, SIRS, anemia, SBP, hyperglycemia, creatinine and CRP elevation were independent factors associated with hospital mortality, but not T2MI (vs NIMI) (OR: 0.88 (0.66–1.17)). Older age and hyperglycemia were specific covariates associated with increased risk of mortality in T2MI, but not in NIMI.

Conclusions

This large real-life study of non-T1MI inpatients with elevated troponins from emergency department shows that myocardial injury without necrosis and T2MI share the same risk factors, characterized by a high rate of infections and anemia and a high risk of hospital mortality.

Acknowledgement/Funding

University Hospital Center Dijon Bourgogne, France

Influence de l’âge sur les durées de réanimation des arrêts cardiaques préhospitaliers

Introduction : L’objectif de notre étude est de déterminer si l’âge des patients en arrêt cardiaque (AC) a une influence sur les durées de réanimation cardiopulmonaire (RCP) par les équipes préhospitalières.

Patients et méthodes : Nous avons réalisé une étude monocentrique, prospective, à partir des données de notre centre hospitalier universitaire, issues du Registre électronique des arrêts cardiaques. Ont été inclus tous les patients ayant présenté un AC, hormis ceux retrouvés en état de rigidité cadavérique ou qui avaient préalablement exprimé des directives anticipées sur leur fin de vie. Les patients ont été séparés en deux groupes selon leur âge : les moins de 75 ans et ceux de 75 ans et plus. Le critère de jugement principal était la durée de RCP spécialisée décidée par le médecin de l’équipe préhospitalière.

Résultats : Du 1er janvier au 31 décembre 2015, sur 253 patients victimes d’AC, 188 (74 % d’hommes, 78 % d’asystolie) ont bénéficié d’une RCP par une équipe du Service mobile d’urgence et de réanimation. Il y a eu 39 % de récupération d’une activité cardiaque spontanée (RACS). Seuls 31 % des patients étaient admis vivants à l’hôpital, ils étaient 6 % à j30. La durée de RCP était plus importante pour les patients de moins de 75 ans (29 ± 15 vs 23 ± 19 minutes ; p < 0,01). Mais pour les patients ayant une RACS, la durée de RCP était identique entre les deux groupes (16 ± 10 vs 14 ± 9 minutes ; p = 0,34). La survie des patients de 75 ans et plus était de 10 vs 22 % pour les moins de 75 ans (p = 0,35).

Conclusion : Notre étude suggère que l’âge des patients influence négativement les durées de réanimation des équipes préhospitalières.

High-resolution melting curve analysis of heat shock protein 65 for identification of mycobacterial isolates

Infections caused by non-tuberculous mycobacteria (NTM) often escape detection on traditional diagnostics. We evaluated the ability of heat shock protein 65 (hsp65) polymerase chain reaction and high-resolution melting curve (HRMC) analysis to identify and differentiate Mycobacterium tuberculosis complex (MTC) from NTM in 150 clinical mycobacterial isolates from extra-pulmonary sites. A hundred MTC and 50 NTM isolates were identified. We were able to simultaneously differentiate between seven mycobacterial species using HRMC analysis; a concordance of 100% between hsp65 HRMC analysis, polymerase chain reaction + restriction analysis and hsp65 sequencing was observed.

Influence du dosage systématique par biologie délocalisée du lactate sur le temps de passage des patients admis en salle d’accueil des urgences vitales

Objectif : L’objectif de notre étude était d’évaluer l’impact d’un dosage systématique par biologie délocalisée du lactate (DDL) sur le temps de passage en salle d’accueil des urgences vitales (SAUV).

Méthode : Il s’agit d’une étude prospective bicentrique de type avant/après réalisée dans deux services d’urgences universitaires. Deux phases ont été comparées. Lors de la première phase (septembre à décembre 2014), tous les patients d’âge supérieur ou égal à 18 ans orientés dès l’arrivée par l’infirmière organisatrice de l’accueil (IOA) en SAUV ont été inclus et ont bénéficié d’un DDL systématique. Pendant la seconde (mars à avril 2015) phase, pour les patients d’âge supérieur ou égal à 18 ans orientés dès l’arrivée par l’IOA en SAUV, le dosage du lactate a été laissé à l’appréciation du senior responsable et réalisé au laboratoire central.

Résultats : Les données sont exprimées en moyenne ± ET médiane [interquartile]. Huit cent trente-trois patients ont été inclus dont 397 dans la phase 1 et 436 dans la phase 2 (âge moyen de 63 ± 23 vs 59 ± 24 ans, p = 0,03), dont 16%ont été transférés en réanimation. Dans la phase 1 (avec DDL), la valeur moyenne du lactate (n = 397) était de 2,0 ± 1,9 mmol/l et dans la phase 2 (n = 70/436) de 2,2 ± 1,9 mmol/l (p = 0,55). La durée médiane de passage en SAUV n’était pas significativement diminuée avec DDL (165 [95–265] vs 170 [100–260] minutes, p = 0,76).

Conclusion : Notre étude n’a pas pu démontrer que l’introduction d’un DDL systématique réduit le temps de passage des patients admis en SAUV.

L'insuffisance cardiaque aiguë aux urgences : présentations cliniques, diagnostic et prise en charge thérapeutique

L’insuffisance cardiaque (IC) est une maladie fréquente dont l'incidence croît dans tous les pays développés et dont la morbimortalité est effroyable. Devant une dyspnée aiguë, maître symptôme de la décompensation, le diagnostic d’insuffisance cardiaque aiguë (ICA) reste difficile aux urgences. En effet, les connaissances ayant permis de comprendre les mécanismes physiopathologiques, le concept nosologique d’une seule entité clinique a évolué vers la notion de syndromes d’ICA (SICA) intégrant plusieurs cadres nosographiques de la décompensation d’une IC chronique au tableau de détresse respiratoire aiguë dans l’œdème aigu du poumon cardiogénique, voire au choc cardiogénique. Afin de poser le diagnostic devant ces différentes formes de décompensations aiguës, l'urgentiste a recours à des examens complémentaires qui permettent de déterminer l'étiologie de l'épisode d'IC. Si la réalisation de l'électrocardiogramme et celle de la radiographie thoracique restent indispensables, l’utilisation de biomarqueurs cardiaques, au premier rang desquels les peptides natriurétiques se sont imposés, fait aujourd'hui partie intégrante des outils nécessaires à l'élaboration de la démarche diagnostique. Par ailleurs, la généralisation progressive de l'échographie clinique au sein des services d'urgences permet aujourd'hui d'améliorer la démarche diagnostique et de proposer une approche thérapeutique plus rapide. Ainsi, le concept moderne de « Time-to-therapy » prend-il tout son sens aux urgences où l'utilisation optimisée des différents traitements médicamenteux doit s'associer aux supports d'oxygénothérapie souvent nécessaires à la prise en charge de la dyspnée aiguë. Cet article se propose de faire une revue de la littérature et des recommandations actuelles afin d'assurer une prise en charge optimale des SICA aux urgences et en extrahospitalier.

Caractéristiques des patients centenaires consultants dans un service d’accueil et d’urgences

Introduction : Le nombre de consultations des personnes âgées aux urgences est en constante augmentation. Cette étude avait pour but d’évaluer les caractéristiques des patients centenaires, consultants dans un service d’accueil d’urgences et leur devenir.

Patients et méthode : Etude monocentrique, rétrospective, sur la période de janvier 2012 à mars 2015, incluant tous les centenaires consultants aux urgences d’un hôpital universitaire. Les données ont été comparées à une première période d’étude 10 ans auparavant (2002-2005) (travail déjà publié).

Résultats : Durant cette période, 21 550 (14%) des patients ayant consulté avaient plus de 75 ans, et 129 (<1%) patients avaient 100 ans et plus. Sept dossiers incomplets ont été exclus, et un total de 122 dossiers a donc été retenu pour l’étude. L’âge moyen des patients était de 102 +/- 1,4 ans. En 2002-2005, 81% des patients centenaires ont été adressés au SAU après un premier contact de leur médecin traitant ou du médecin de garde, contre 56% en 2012-2015 (p<0,001). Les principaux motifs de consultation aux urgences restaient les chutes (42% vs. 39%, p=0,66), suivies des symptômes respiratoires (22% vs. 21%, p=0,88). La durée moyenne de séjour a diminué de 10 jours à 7 jours, entre les 2 périodes. Le taux d’hospitalisation restait stable (57% vs. 67%, p=0,06), ainsi que la mortalité hospitalière (24% sur les deux périodes, p=0,95).

Conclusion : Cette étude souligne la spécificité des besoins des patients centenaires aux urgences, en matière de prise en charge non programmée.

Intérêt du scanner abdominopelvien chez les patients âgés de plus de 75 ans consultant aux urgences pour douleurs abdominales

Introduction : Déterminer l’étiologie des syndromes abdominaux aigus (SAA) chez les personnes âgées nécessite souvent une imagerie abdominale. L’objectif de notre étude était d’étudier la place du scanner abdominal chez les patients âgés de plus de 75 ans consultant aux urgences, et de rechercher des facteurs prédictifs de scanner pathologique.

Patients et méthodes : Il s’agissait d’une étude rétrospective, monocentrique, observationnelle, effectuée aux urgences de l’hôpital Tenon entre le 1er janvier et le 31 décembre 2014, chez les patients âgés de plus de 75 ans consultant pour un SAA. Deux groupes distincts étaient définis et comparés : un groupe « scanner normal » et un groupe « scanner pathologique », défini selon le compte-rendu du radiologue.

Résultats : Cent soixante-dix-huit patients (d’âge moyen de 84 ans) ont été inclus. Cent quatre-vingt-six scanners ont été effectués durant l’année 2014, parmi lesquels 41 scanners (22 %) étaient normaux. Les pathologies retrouvées le plus fréquemment étaient les occlusions (40 %), les pathologies urinaires (23 %), et les pathologies biliopancréatiques (22 %). Il n’existe aucun facteur clinique ou biologique prédictif de scanner pathologique.

Conclusion : Le scanner semble être un examen d’une grande rentabilité diagnostique chez la personne âgée, dont l’indication doit être large, car aucune donnée clinicobiologique n’est associée à un scanner pathologique.

Orientation des traumatisés du membre supérieur (épaule exclue) dès l’accueil en radiologie par l’infirmière organisatrice : étude Ontario

Introduction : L’objectif principal de cette étude est de déterminer l’effet d’un protocole de demande anticipée de radiographies par l’infirmier organisateur de l’accueil (IOA) sur le temps de passage des patients au service d’accueil des urgences (SAU).

Patients et méthodes : Cette étude monocentrique prospective a été réalisée en deux phases : une phase-avant (de décembre 2016 à janvier 2017) et une phase-après (de mai à juin 2017), où les patients bénéficiaient d’une demande anticipée de radiographie dès l’IOA. Les patients de plus de 18 ans, valides, ayant consulté au SAU pour un traumatisme du membre supérieur (épaule exclue) de moins de 48 heures et présentant au moins deux critères parmi douleur, tuméfaction, déformation ou impotence fonctionnelle étaient inclus.

Résultats : Deux cent treize patients ont répondu aux critères d’inclusion : 112 en phase 1 et 101 en phase 2. Le temps médian de passage global a diminué de manière significative entre la phase 1 et la phase 2 (188 vs 124 min, p < 0,001) ainsi que le temps médian de prise en charge médicale (76 vs 17 min). Plus de 90 % des infirmiers diplômés d’État (IDE) et plus de 75 % des médecins estiment que le protocole a un intérêt pour diminuer le temps de passage. Un tiers des IDE considère que ce protocole entraîne une surcharge de travail pour l’IOA et une surprescription de radiographies.

Conclusion : Cette étude suggère que l’application d’un protocole de demande anticipée de radiographies par l’IOA chez les patients ayant un traumatisme du membre supérieur (épaule exclue) permet de réduire le temps de passage au SAU.

mHealth - an Ultimate Platform to Serve the Unserved

Objectives: To summarize major current developments and research in the field of mobile health (mHealth) services.

Methods: Reports on the unique characteristics of mHealth platform and its role in delivering health services to the resource poor settings. Also, it evaluates different mHealth applications and identifies key success factors and challenges.

Results and Conclusion: mHealth, based on the most ubiquitous and widely accepted technology, offers an unprecedented opportunity to serve the unserved by right time medical information services. There is growing evidence that it has already transformed healthcare delivery in many resource poor settings through its low cost, high reach and versatile applications. However, challenges still remain with regard to the development of consumer centric solutions, and services quality in terms of knowledge and competence of the provider, integration of the information systems and interoperability of the information services. Additional problems arise from the collaboration, partnership and regulation perspectives. There are noticeable trends towards solutions for these problems.

Évaluation de l'intérêt d'une consultation post-urgence d'urologie : étude rétrospective sur trois ans

Introduction : L'objectif principal de ce travail était d'évaluer l'intérêt de la consultation post-urgence d'urologie (CPUU) mise en place dans notre institution.

Patients et méthodes : Il s'agit d'une étude transversale, monocentrique et rétrospective sur trois années distinctes : 2014, 2015 et 2016 de trois mois consécutifs (janvier à mars). Seuls les patients de plus de 18 ans ayant consulté aux urgences pour un motif urologique et relevant de la CPUU ont été inclus.

Résultats : Au total, 465 patients ont été programmés en CPUU, dont 265 (57 %) se sont présentés à la consultation. Deux cent vingt-deux patients (48 %) ont finalement répondu aux critères d'inclusion. Les principaux diagnostics relevant de la CPUU étaient principalement les coliques néphrétiques (45 %), la rétention aiguë d'urine (14 %) et les infections de l'appareil urinaire (16 %). On note une diminution significative du délai de CPUU passant à moins de deux semaines pour 60 % des patients en 2016 contre 30 et 38 % respectivement en 2014 et 2015 (p = 0,003). Le nombre de modifications diagnostiques à la sortie de la CPUU reste faible (6 % sur les trois ans ; p = 0,94). La modification thérapeutique par les urologues était principalement chirurgicale (22 % ; p = 0,75). La CPUU a permis d'instaurer un suivi au long cours pour plus de la moitié des patients (60 % ; p = 0,31).

Conclusion : La CPUU semble démontrer un intérêt tant sur le plan diagnostique que sur le plan du suivi spécialisé dans notre centre.

Quality Assessments of HMO Diagnosis Databases Used to Monitor Childhood Vaccine Safety

Objective: To assess the quality of automated diagnoses extracted from medical care databases by the Vaccine Safety Datalink (VSD) study.

Methods: Two methods are used to assess quality of VSD diagnosis data. The first method compares common automated and abstracted diagnostic categories (“outcomes”) in 1-2% simple random samples of study populations. The second method estimates positive predictive values of automated diagnosis codes used to identify potential cases of rare conditions (e.g., acute ataxia) for inclusion in nested case-control medical record abstraction studies.

Results: There was good agreement (64-68%) between automated and abstracted outcomes in the 1-2% simple random samples at 3 of the 4 VSD sites and poor agreement (44%) at 1 site. Overall at 3 sites, 56% of children with automated cerebella ataxia codes (ICD-9 = 334) and 22% with “lack of coordination” codes (ICD-9 = 781.3) met objective clinical criteria for acute ataxia.

Conclusions: The misclassification error rates for automated screening outcomes substantially reduce the power of screening analyses and limit usefulness of screening analyses to moderate to strong vaccine-outcome associations. Medical record verification of outcomes is needed for definitive assessments.

Safe limit of arsenic in soil in relation to dietary exposure of arsenicosis patients from Malda district, West Bengal- A case study

Safe limit of arsenic in soil in relation to dietary exposure of arsenicosis patients was established in Malda district of West Bengal. Out of 182 participants examined, 80 (43.9%) participants showed clinical features of arsenicosis, characterized by arsenical skin lesion (pigmentation and keratosis), while 102 participants did not have any such lesion (control). Experimental results of the twenty eight soils (own field) of the participants showed the mean Olsen extractable and total arsenic concentration of 0.206 and 6.70mgkg^-1, respectively. Arsenic concentration in rice grain ranged from 2.00 to 1260μgkg^-1 with the mean value of 146μgkg^-1. The hazard quotient (HQ) for intake of As by human through consumption of rice varied from 0.03 to 3.52. HQ exceeds 1.0 for drinking water and rice grain grown in the study area in many cases. As high as 77.6% variation in As content in rice grain could be explained by the solubility-free ion activity model. Toxic limit of extractable As in soil for rice in relation to soil properties and human health hazard, associated with consumption of rice grain by human, was established. For example, the permissible limit of Olsen extractable As in soil would be 0.43mgkg^-1 for rice cultivation, if soil pH and organic carbon content were 7.5% and 0.50%, respectively. However, the critical limit of Olsen extractable As in soil would be 0.54mgkg^-1, if soil pH and organic carbon were 8.5% and 0.75%, respectively. The conceptual framework of fixing the toxic limit of arsenic in soils with respect to soil properties and human health under modeling-framework was established.

Molecular characterisation of antimicrobial resistance in Pseudomonas aeruginosa and Acinetobacter baumannii during 2014 and 2015 collected across India

BACKGROUND

Surveillance of antimicrobial resistance (AMR) is of great importance. Pseudomonas aeruginosa and Acinetobacter baumannii are important pathogens and emergence of resistance in these have increased the morbidity and mortality rates. This surveillance study was initiated by the Government of India - Indian Council of Medical Research. The aim of this study is to determine the antimicrobial susceptibility profile and to characterise the enzyme mediated antimicrobial resistance such as extended spectrum beta-lactamases (ESBLs) and carbapenemases among multidrug-resistant (MDR) P. aeruginosa and A. baumannii.

MATERIALS AND METHODS

A multi-centric study was conducted from January 2014 to December 2015 with a total number of 240 MDR P. aeruginosa and 312 MDR A. baumannii isolated from blood, cerebrospinal fluid, respiratory, pus, urine and intra-abdominal infections. Kirby-Bauer disc diffusion was done to determine the antimicrobial susceptibility profile. Further, MDR isolates were characterised by multiplex polymerase chain reaction to determine the resistance genes for ESBLs and carbapenemases.

RESULTS

Among the ESBLs, blaVEB (23%), blaTEM (5%) and blaSHV (0.4%) in P. aeruginosa and blaPER (54%), blaTEM (16%) and blaSHV (1%) in A. baumannii were the most prevalent. Likewise, blaVIM (37%), blaNDM (14%), blaGES (8%) and blaIMP (2%) in P. aeruginosa and blaOXA-23like (98%), blaOXA-58like (2%), blaNDM (22%) and blaVIM (3%) in A. baumannii were found to be the most prevalent carbapenemases. blaOXA-51like gene, intrinsic to A. baumannii was present in all the isolates tested.

CONCLUSION

The data shown highlight the wide difference in the molecular mechanisms of AMR profile between P. aeruginosa and A. baumannii. In P. aeruginosa, plasmid-mediated mechanisms are much lesser than the chromosomal mediated mechanisms. In A. baumannii, class D oxacillinases are more common than other mechanisms. Continuous surveillance to monitor the trends in AMR among MDR pathogens is important for implementation of infection control and to guide appropriate empirical antimicrobial therapy.