How to address SARS-CoV-2 airborne transmission to ensure effective protection of healthcare workers? A review of the literature

International audienceSARS-CoV-2 mainly infects the respiratory tract, and presents significantly higher active replication in the upper airways. To remain viable and infectious, the SARS-CoV-2 virion must be complete and integral, which is not easily demonstrated in the environment by positive reverse transcriptase PCR results. Real-life conditions in healthcare settings may be conducive to SARS-CoV-2 RNA dissemination in the environment but without evidence of its viability and infectiveness in air. Theoretically, SARS-CoV-2 shedding and dissemination nonetheless appears to be air-mediated, and a distinction between "air" and "droplet" transmission is too schematic to reflect the reality of the respiratory particles emitted by patients, between which a continuum exists. Airborne transmission is influenced by numerous environmental conditions that are not transposable between different viral agents and situations in healthcare settings or in the community. Even though international guidelines on "droplet" versus "air" precautions and personal protective equipment (surgical versus respirator masks) are under discussion, the existing literature underscores the effectiveness of "droplet" precautions as a means of protecting healthcare workers. Differentiation in guidelines between healthcare venues, community settings and, more generally, confined environments is of paramount importance, especially insofar as it underlines the abiding pandemic-related need for systematic mask wearing by the general population

What is epidemiology? Changing definitions of epidemiology 1978-2017.

ContextEpidemiology is a discipline which has evolved with the changes taking place in society and the emergence of new diseases and new discipline related to epidemiology. With these evolutions, it is important to understand epidemiology and to analyse the evolution of content of definitions of epidemiology.ObjectivesThe main objective of this paper was to identify new definitions of epidemiology available since 1978. Secondary objectives were to analyse the content of these definitions, to compare them with those used by Lilienfeld and to determine whether changes have taken place over the last forty years.MethodsA review of grey literature and published literature was conducted to find the definitions of epidemiology written between 1978 and 2017.Results102 definitions of epidemiology were retained. They helped to highlight 20 terms and concepts related to epidemiology. Most of them were already used in the definitions used by Lilienfeld. Five terms were present in more than 50% of definitions from the period 1978 to 2017: "population", "study", "disease", "health" and "distribution". Several developments have occurred: strengthening of the terms "control" and "health" already used, the concept of "disease" was less frequently encountered whereas the concepts "infectious diseases", "mass phenomenon" are no longer used in definitions from 1978 to 2017.ConclusionThis evolution of content of definition of epidemiology is absent from books on epidemiology. A thematic analysis of definitions of epidemiology could be conducted in order to improve our understanding of changes observed

Comment on: Influence of empirical double-active combination antimicrobial therapy compared with active monotherapy on mortality in patients with septic shock: a propensity score-adjusted and matched analysis

Lettre à l'éditeur ("Journal of Antimicrobial Chemotherapy" vol. 73, n°6)https://academic.oup.com/jac/article/73/6/1731/486611

Frequency Fitting Optimization Using Evolutionary Algorithm in Cochlear Implant Users with Bimodal Binaural Hearing

International audienceOptimizing hearing in patients with a unilateral cochlear implant (CI) and contralateral acoustic hearing is a challenge. Evolutionary algorithms (EA) can explore a large set of potential solutions in a stochastic manner to approach the optimum of a minimization problem. The objective of this study was to develop and evaluate an EA-based protocol to modify the default frequency settings of a MAP (fMAP) of the CI in patients with bimodal hearing. Methods: This monocentric prospective study included 27 adult CI users (with post-lingual deafness and contralateral functional hearing). A fitting program based on EA was developed to approach the best fMAP. Generated fMAPs were tested by speech recognition (word recognition score, WRS) in noise and free-field-like conditions. By combining these first fMAPs and adding some random changes, a total of 13 fMAPs over 3 generations were produced. Participants were evaluated before and 45 to 60 days after the fitting by WRS in noise and questionnaires on global sound quality and music perception in bimodal binaural conditions. Results: WRS in noise improved with the EA-based fitting in comparison to the default fMAP (41.67 ± 9.70% versus 64.63 ± 16.34%, respectively, p = 0.0001, signed-rank test). The global sound quality and music perception were also improved, as judged by ratings on questionnaires and scales. Finally, most patients chose to keep the new fitting definitively. Conclusions: By modifying the default fMAPs, the EA improved the speech discrimination in noise and the sound quality in bimodal binaural conditions

Different meteorological parameters influence metapneumovirus and respiratory syncytial virus activity

International audienceBackgroundBoth human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) cause epidemics during the cold season in temperate climates.ObjectivesThe purpose of this study was to find out whether climatic factors are associated with RSV and hMPV epidemics.Study designOur study was based on data from 4300 patients admitted to the Dijon University Hospital for acute respiratory infection (ARI) over three winter seasons chosen for their dissimilar meteorological and virological patterns. Cases of hMPV and RSV were correlated with meteorological parameters recorded in the Dijon area. The relationship between virus data and local meteorological conditions was analyzed by univariate and multivariate negative binomial regression analysis.ResultsRSV detection was inversely associated with temperature and positively with relative humidity and air pressure, whereas hMPV was inversely associated with temperature and positively with wind speed.ConclusionsThe association among meteorological variables and weekly ARIs cases due to RSV and hMPV demonstrated the relevance of climate factors as contributors to both hMPV and RSV activities. Meteorological drivers of RSV and hMPV epidemics are different. Low temperatures influence both hMPV and RSV activity. Relative humidity is an important predictor of RSV activity, but it does not influence hMPV activity

Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes

The rupture of hepatocellular carcinoma (rHCC) is uncommon but causes sudden life-threatening bleeding. Selective transarterial embolization (STAE) is an effective bleeding-control option. The optimal embolic agent is unknown, and data on the use of cyanoacrylate glue are lacking. The objective of this study was to report the outcomes of cyanoacrylate-lipiodol embolization for rHCC. We retrospectively reviewed the files of the 16 patients (14 males; mean age, 72 years) who underwent emergency cyanoacrylate-lipiodol STAE at a single center in 2012–2023 for spontaneous rHCC. All 16 patients had subcapsular HCC and abundant hemoperitoneum. The technical success rate was 94% (15/16). Day 30 mortality was 19%; the three patients who died had severe hemodynamic instability at admission; one death was due to rebleeding. Liver enzyme levels returned to baseline by day 30. No rebleeding was recorded during the median follow-up of 454 days in the 10 patients who were alive with available data after day 30. Larger prospective studies with the collection of longer-term outcomes are needed to assess our results supporting the safety and effectiveness of cyanoacrylate-lipiodol STAE for rHCC. Randomized trials comparing this mixture to other embolic agents should be performed

Computed Tomography-Navigation™ Electromagnetic System Compared to Conventional Computed Tomography Guidance for Percutaneous Lung Biopsy: A Single-Center Experience

International audienceThe aim of our study was to assess the efficacy of a computed tomography (CT)-Navigation™ electromagnetic system compared to conventional CT methods for percutaneous lung biopsies (PLB). In this single-center retrospective study, data of a CT-Navigation™ system guided PLB (NAV-group) and conventional CT PLB (CT-group) performed between January 2017 and February 2020 were reviewed. The primary endpoint was the diagnostic success. Secondary endpoints were technical success, total procedure duration, number of CT acquisitions and the dose length product (DLP) during step ∆1 (from planning to initial needle placement), step ∆2 (progression to target), and the entire intervention (from planning to final control) and complications. Additional parameters were recorded, such as the lesion’s size and trajectory angles. Sixty patients were included in each group. The lesions median size and median values of the two trajectory angles were significantly lower (20 vs. 29.5 mm, p = 0.006) and higher in the NAV-group (15.5° and 10° vs. 6° and 1°; p < 0.01), respectively. Technical and diagnostic success rates were similar in both groups, respectively 95% and 93.3% in the NAV-group, and 93.3% and 91.6% in the CT-group. There was no significant difference in total procedure duration (p = 0.487) and total number of CT acquisitions (p = 0.066), but the DLP was significantly lower in the NAV-group (p < 0.01). There was no significant difference in complication rate. For PLB, CT-Navigation™ system is efficient and safe as compared to the conventional CT method

Diagnostic accuracy of four commercial triplex immunochromatographic tests for rapid detection of rotavirus, adenovirus and norovirus in human stool samples

International audienceIntroduction: Noroviruses (NoV), rotaviruses (RVA), and adenoviruses (AdV) are the main viral agents responsible for acute gastroenteritis (AGE) in humans. We aimed to determine the diagnostic accuracy of four commercial immunochromatographic tests (ICTs) intended for the rapid and simultaneous detection of these three pathogens.Methods: Diagnostic accuracy of bioNexia® Noro/Rota-Adeno (bioMérieux), IMMUNOQUICK® NoRotAdeno (Biosynex), ROTA+ADENO+NORO Combo Card (CerTest Biotec), and RIDA®QUICK Rota/Adeno/Noro Combi (R-Biopharm) ICTs was assessed retrospectively using a collection of 160 stool specimens (including 43 RVA-, 47 AdV- and 42 NoV-positive samples) from French patients with AGE and using molecular methods as the reference standard.Results: For RVA, the four ICTs demonstrated similar high sensitivity (93%) and excellent specificity (97.4-100%).For AdV, the four ICTs demonstrated similar poor sensitivity (54.3-58.7%) but excellent specificity (95.5-100%). They performed the best in AdV-F species (sensitivity: 80.8-84.6%) and worst in AdV non-F species (sensitivity: 22.2-27.8%).For NoV, the RIDA®QUICK Rota/Adeno/Noro Combi ICT exhibited high sensitivity (87.5%), but the sensitivity of the three others was poor (42.5-47.5%). The four ICTs exhibited high specificity (96.6-99.1%). Diagnostic accuracy was genogroup-dependent: when we tested genogroup I NoV, the RIDA®QUICK Rota/Adeno/Noro Combi ICT presented high sensitivity (90%) while the three other ICTs presented poor sensitivity (10-30%); when we tested genogroup II NoV, sensitivity was similar for the four ICTs (65-85%).Conclusion: The four ICTs are suitable first-line tests for the rapid diagnosis of RVA infections. The four ICTs are not suitable for the routine diagnosis of AdV infections but could provide a rapid response in case of positivity, notably in a context of AGE. Only the RIDA®QUICK Rota/Adeno/Noro Combi ICT is suitable for the rapid detection of NoV, while the sensitivity for the detection of genogroup I NoV needs to be improved for the 3 other ICTs before being implemented in the routine diagnosis of NoV

“Does the Salmonella Genomic Island 1 (SGI1) confer invasiveness properties to human isolates?”

Abstract Background In the eighties, a multidrug resistant clone of Salmonella Typhimurium DT104 emerged in UK and disseminated worldwide. This clone harbored a Salmonella genomic island 1 (SGI1) that consists of a backbone and a multidrug resistant region encoding for penta-resistance (ampicillin, chloramphenicol/florfenicol, streptomycin/spectinomycin, sulphonamides and tetracycline (ACSSuT)). Several authors suggested that SGI1 might have a potential role in enhancement of virulence properties of Salmonella enterica. The aim of this study was to investigate whether nontyphoidal S. enterica isolates carrying SGI1 cause more severe illness than SGI1 free ones in humans. Methods From 2011 to 2016, all patients infected with nontyphoidal S. enterica in our hospital were retrospectively included. All nontyphoidal S. enterica isolates preserved in our University Hospital (Dijon, France) were screened for the presence of SGI1. Clinical and biological data of patients were retrospectively collected to evaluate illness severity. Statistical analysis of data was performed by Kruskal-Wallis test or Fisher’s exact test for univariate analysis, and by logistic regression for multivariate analysis. Results A total of 100 isolates of S. enterica (22 serovars) were collected. Twelve isolates (12%) belonging to 4 serovars harbored SGI1: S. Typhimurium, S. Infantis, S. Kentucky, S. St Paul. The severity of the disease was age-related (for invasive infection, sepsis and inflammatory response) and was associated with immunosuppression (for invasive infection, sepsis and bacteremia) but not with the presence of SGI1 or with antimicrobial resistance. Conclusion A rather high proportion (12%) of human clinical isolates belonging to various serovars (for the first time serovar St Paul) and harboring various antimicrobial resistance profile carried SGI1. Diseases due to SGI1-positive S. enterica or to antimicrobial resistant isolates were not more severe than the others. This first clinical observation should be confirmed by a multicenter and prospective study