Impact of surgical restaging on recurrence in patients with borderline ovarian tumors: A meta-analysis

International audienceObjectiveThe benefits of restaging surgery for patients with a borderline ovarian tumor (BOT) discovered on initial surgery are debatable. We performed a meta-analysis to evaluate the role of restaging surgery on recurrence in patients with BOTs.Study designWe systematically reviewed published studies comparing restaging surgery and incomplete surgery in BOT patients from January 1985 to December 2017. Endpoints were recurrence and mortality rates. Study design features that possibly affected participant selection, reporting of recurrence and death, and manuscript publication were assessed. For pooled estimates of the effect of restaging surgery on recurrence, fixed-effect meta-analytical models were used.ResultsOf the 577 articles initially selected, four retrospective observational studies (Restaging group: 166 patients; Non-Restaging group: 394 patients) met our research criteria. No significant differences in terms of recurrence between the two groups were observed (pooled Peto Odds Ratio [OR] = 0.88; 95 % confidence interval [CI]: 0.41–1.92). The number of deaths was insufficient for statistical analysis.ConclusionsThis meta-analysis based on retrospective studies, suggests that restaging surgery does not significantly reduce recurrence in patients with BOT

Apport de l’échographique 2D/3D dans le suivi de l’élimination du résidu placentaire après traitement conservateur de placenta accreta

International audienceOBJECTIVES:To determinate the potential of 2D and 3D-ultrasound in the follow-up of patients with placenta accreta treated conservatively.PATIENTS AND METHODS:Seven patients with placenta accreta treated conservatively during June 2007 and September 2009 were included. The follow-up consisted in clinical examination and 2D/3D-ultrasound once a month. Criteria studied included clinical outcome, echogenicity at 2D-ultrasound, vascularisation at colour Doppler, Mean Grey at 3D-ultrasound and vascularisation, flow and perfusion index.RESULTS:Seven women with invasive placenta (3 placentas accreta and 2 percreta) were studied. The mean follow-up was 228 days [75-369]. Mean delay for complete elimination of residual placenta was 280 days [120-365]. The two main results were: presence of an increased anechogenicpart in residual placenta before complete resorption for all patients; a systematic and concomitant stop of genital haemorrhage and vascularisation at colour Doppler. High degrees of variability in parameters measured at 3D-ultrasound were observed between patients so that correlations with clinical outcome were found.CONCLUSION:Long and regular follow-up is essential after conservative management but the role of 3D-ultrasound compared to 2D-ultrasound was not demonstrated in this study

Decrease in Antibacterial Use and Facility-Level Variability After the Introduction of Guidelines and Implementation of Physician-Pharmacist-Nurse Quality Circles in Swiss Long-term Care Facilities.

The objective of this study is to describe antibacterial use in long-term care facilities and to investigate the determinants of use. This study is a quality improvement study conducted from January 2011 to December 2016. Long-term care facilities in the canton of Vaud, Western Switzerland, were investigated. Twenty-three long-term care facilities were included in this study. The intervention included the publication of local guidelines on empirical antibacterial therapy and the implementation of physician-pharmacist-nurse quality circles. The main outcome was antibacterial use, expressed as defined daily doses (DDD) per 1000 beds per day. Statistical analyses were performed through a 1-level mixed model for repeated measurements. Antibacterial use decreased from 45.6 to 35.5 DDD per 1000 beds per day (-22%, P < .01) over the 6-year study period, which was mostly explained by reduced fluoroquinolone use (-59%, P < .001). A decrease in range of use among LTCFs was observed during the study period, and 27% of antibacterial use was related to the WATCH group (antibiotics with higher toxicity concerns and/or resistance potential) according to the AWaRe categorization of the WHO, decreasing from 17.3 DDD per 1000 beds per day to 9.5 (-45%) over the study period. The use of antibacterials from the RESERVE group ("last-resort" treatment options) was very low. A reduction in facility-level antibacterial use and in variability across LTCFs was observed over the study period. The dissemination of empirical antibacterial prescription guidelines and the implementation of physician-pharmacist-nurse quality circles in all LTCFs of the canton of Vaud likely contributed to this reduction. Antibacterials from the WATCH group still represented 27% of the total use, providing targets for future antibiotic stewardship activities

Photodegradation of atrazine and ametryn with visible light using water soluble porphyrins as sensitizers

Abstract The photodegradation of the herbicides atrazine and ametryn with visible light in aerated neutral aqueous solutions and 5, 10, 15, 20-tetrakis (2,6-dichloro-3-sulfophenyl) porphyrin or 5, 10, 15, 20-tetrakis (4-sulfophenyl) porphyrin as sensitizers are reported for the first time. Our findings show that the degradation percentage reached 30% for atrazine and 63% for ametryn. The final photoproducts were characterized as dealkylated s-triazines. Photolysis of the pesticides in the presence of a singlet oxygen quencher showed only a minor contribution of this type of mechanism, while a bimolecular quenching reaction between the triplet state of the sensitizer and the pesticides is excluded by flash photolysis studies. It is proposed that the mechanism may involve the formation of a superoxide radical anion from the triplet state of the sensitizer and molecular oxygen, followed by a radical decomposition pathway

Nosocomial influenza in south-western Swiss hospitals during two seasonal epidemics: an observational study.

In Switzerland each year, influenza leads to between 112,000 and 275,000 medical consultations. Data on nosocomial influenza infection are limited. To describe nosocomial cases of seasonal influenza in south-western Switzerland. This study was conducted during two seasonal influenza epidemics from 2016 to 2018 in 27 acute care public hospitals in south-western Switzerland. During these two time-periods, every patient hospitalized for >72 h who was positively screened by reverse transcription-polymerase chain reaction or antigen detection for influenza was included in the survey. Characteristics of patients included age, sex, and comorbidities. Included patients were followed up until discharge or death. Complications and administration of antineuraminidases and/or antibiotics were registered. The median influenza vaccine coverage of healthcare workers was 40%. In all, 836 patients were included (98% with type A influenza virus in 2016-2017; 77% with type B virus in 2017-2018). Most patients (81%) had an unknown vaccine status. Overall, the incidence of nosocomial influenza was 0.5 per 100 admissions (0.35 per 1000 patient-days). The most frequent comorbidities were diabetes (20%), chronic respiratory diseases (19%), and malnutrition (17%). Fever (77%) and cough (66%) were the most frequent symptoms. Seventy-one percent of patients received antineuraminidases, 28% received antibiotics. Infectious complications such as pneumonia were reported in 9%. Overall, the all-cause mortality was 6%. The occurrence of nosocomial influenza underlines the importance of vaccinating patients and healthcare workers, rapidly recognizing community- or hospital-acquired cases, and applying adequate additional measures to prevent dissemination, including the timely administration of antineuraminidases to avoid antibiotic use (and misuse)