Infective endocarditis with negative blood cultures, case report

Disciplina Cardiologie, Clinica Medicală nr.3, Departamentul Medicină Internă, USMF „Nicolae Testemiţanu”, IMSP Institutul de CardiologieInfective endocarditis represents an annual incidence of 3-9 cases per 100,000 population. Male / female ratio is 2:1. Patients with prosthetic valves, intracardiac devices, congenital heart disease, or recurrence of infectious endocarditis, develops more frequent IE, 27% -50% patients didn’t have history of predisposing cardiac diseases. Diagnosis IE establishment requires two major DUKE criteria: pathogen detection in three blood cultures and echocardiographic demonstration of endocardial involvement in the infectious process. Incidence of negative blood cultures IE remains high, especially in countries with poorly developed economies (> 50%), which is explained by unjustified antimicrobial medicines intaking, inadequate doses, before the IE diagnosis establishing, or impossibility of specific microorganisms collecting, that can develop IE (mycoplasma, bartonela, fungi, etc). Causative pathogen detection delay negatively influences the evolution and prognosis of disease, causing shortness of early appropriate treatment, according to the antibioticogram. We present a clinical case of IE with negative blood cultures, late diagnosis, which needed an empirical long-term antibacterial therapy with valvular reprotezation. Endocardita infecţioasă prezintă o incidenţă anuală de 3-9 cazuri la 100.000 populaţie. Raportul barbaţi/femei este de 2:1. Pacienţii cu proteze valvulare, dispozitive intracardiace, cardiopatii congenitale, sau recurenţă de endocardita infectioasă, dezvoltă mai frecvent EI, iar 27%-50% din pacienţi nu au antecedente cunoscute de patologii cardiace predispozante. Stabilirea diagnosticului cert de EI necesită 2 criterii majore DUKE: depistarea agentului patogen în 3 hemoculturi şi demonstrarea ecocardiografică a implicării endocardului în procesul infecţios. Incidenţa EI cu hemocultură negativă rămâne înaltă, mai cu seamă în tările cu o economie slab dezvoltată (> 50%), care se explică prin administrarea nejustificată a preparatelor antimicrobiene, în doze neadecvate, înainte de stabilirea diagnosticului de EI, sau de imposibilitatea de a preleva microorganisme specifice, care pot dezvolta EI (micoplasma, bartonela, fungii,etc.). Temporizarea depistării agentul patogen cauzativ influenţează negativ evoluţia şi pronosticul maladiei, provoacă dificultăţi de tratament adecvat precoce, conform antibioticogramei. Prezentăm un caz clinic de EI cu hemoculturi negative, diagnosticat tardiv, care a a necesitat tratament antibacterian empiric, de lungă durată cu reprotezare valvulară

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Introduction du Dossier « Pragmatisme et sciences sociales : explorations, enquêtes, expérimentations »

Ce Dossier de SociologieS a pour finalité de donner un aperçu de la pluralité des réceptions du pragmatisme en sciences sociales dans le monde francophone . Elle s’inscrit dans la continuité d’un séminaire qui s’est tenu pendant l’année 2012-2013 à l’École des hautes études en sciences sociales (EHESS-Paris), coorganisé par Alexandra Bidet, Daniel Cefaï, Antoine Hennion, Roberto Frega, Joan Stavo-Debauge et Cédric Terzi . Ce séminaire s’est poursuivi en 2013-2014 par une coopération de Daniel..

Perceived Quality of Life in Intensive Care Medicine Physicians: A French National Survey

International audiencePurpose: There is a growing interest in the quality of work life (QWL) of healthcare professionals and staff well-being. We decided to measure the perceived QWL of ICU physicians and the factors that could influence their perception. Methods: We performed a survey coordinated and executed by the French Trade Union of Intensive Care Physicians (SMR). QWL was assessed using the French version of the Work-Related Quality of Life (WRQoL) scale, perceived stress using the French version of 10 item-Perceived Stress Scale (PSS-10) and group functioning using the French version of the Reflexivity Scale, the Social Support at Work Questionnaire (QSSP-P). Results: 308 French-speaking ICU physicians participated. 40% perceived low WRQoL, mainly due to low general well-being, low satisfaction with working conditions and low possibility of managing the articulation between their private and professional lives. Decreased QWL was associated with being a woman (p =.002), having children (p =.022) and enduring many monthly shifts (p =.022). Conclusions: This work highlights the fact that ICU physicians feel a significant imbalance between the demands of their profession and the resources at their disposal. Communication and exchanges within a team and quality of social support appear to be positive elements to maintain and/or develop within our structures