Uptake Study in Juncus sp. and Salicornia Europaea of Six Pharmaceuticals by Liquid Chromatography Quadrupole Time-of-flight Mass Spectrometry

In this work, eight plants of Juncus sp. and ten of Salicornia europaea were used for an uptake assay of pharmaceuticals (flumequine, cirpofloxacin, enrofloxacin, carbamazepine, diclofenac and ibuprofen) by irrigation at three concentration levels: 10 ng mL−1 (low level); 700 ng mL−1 (medium level) and 10 μg mL−1 (high level). Two plants irrigated with pharmaceutical-free water were set up as controls. For each level, two plants were watered every day with 50 mL (Juncus sp.) and every two days with 20 mL (Salicornia europaea) of aqueous solutions containing all the analytes at the described concentrations. Plants irrigated at 10 μg mL−1 were significantly the most affected, whereas the rest of the plants remained, in general, largely displayed no apparent physiological effects throughout the 30 days (Juncus sp.) and 21 days (Salicornia europaea) assays. Leaves and stems were cut every seven days and roots were collected at the end of the assay. The samples were lyophilized, submitted to a microwave assisted extraction using 5 mL of acetonitrile:water mixture (1:1, v/v) and they were analyzed (in triplicate) in a liquid chromatography-quadrupole time of flight mass spectrometry instrument. Most of the analytes were quantified in many of the samples corresponding to the three exposure levels with the highest concentrations obtained at high exposure levels. Ibuprofen was not detected in any sample and enrofloxacin, ciprofloxacin and diclofenac were not detected in the samples from Salicornia europaea.Ministerio de Economía y Competitividad CTM2015-67902-C-1-PMinisterio de Ciencia e Innovación PGC2018-096608-B-C2

Liquid Chromatography Quadrupole Time-of-flight Mass Spectrometry Determination of Six Pharmaceuticals in Vegetal Biota. Uptake Study in Lavandula Dentata

A procedure based on microwave assisted extraction for the determination of 6 pharmaceuticals in samples of Lavandula dentata, Salicornia ramosissima and Juncus sp. by liquid chromatography-quadrupole time of flight mass spectrometry (LC-QTOF/MS) was optimized and validated. Best results were obtained using microwave assisted extraction of 1.0 g of homogeneous lyophilized samples and 5 mL of a mixture ACN:H2O (1:1 v/v) as extracting solvent. Analytical recoveries ranged from 60 to 107% with relative standard deviation (RSD) lower than 15%. Limits of quantitation (LOQ) for the 6 pharmaceuticals flumequine (FLM), carbamazepine (CBZ), ciprofloxacin (CPR), enrofloxacin (ENR), diclofenac (DCL), and ibuprofen (IBU) were in the range 20.8–125 ng g− 1. The method was satisfactory applied for an uptake study in Lavandula dentata samples finding quantifying concentrations of FLM and CBZ in roots, leaf and stem.Ministerio de Educación, Cultura y Deporte CTM2015-67902-C-1-PEuropean Commission. Fondo Europeo de Desarrollo Regional UNSE10-1E-42

Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

<p>Abstract</p> <p>Background</p> <p>Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT) in critically ill immunocompromised patients.</p> <p>Methods</p> <p>This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis.</p> <p>Results</p> <p>We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years). The general severity (SAPSII) and organ dysfunction (LOD) scores on day 1 were 45 (35-62.7) and 4 (2-6), respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%), HIV infection (31 patients, 26%), and solid cancers (26 patients, 21.8%). Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%); 52 patients (43.7%) had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, <it>P </it>< 0.0001). PCT concentrations on day 1 that were > 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC) curve was 0.851 (0.78-0.92). In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; <it>P </it>= 0.0006). PCT concentrations were not significantly correlated with hospital mortality.</p> <p>Conclusion</p> <p>Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.</p

Performance of the beta-glucan test for the diagnosis of invasive fusariosis and scedosporiosis: a meta-analysis

The (1→3)-β-D-glucan (BDG) is a component of the fungal cell wall that can be detected in serum and used as an adjunctive tool for the diagnosis of invasive mold infections (IMI) in patients with hematologic cancer or other immunosuppressive conditions. However, its use is limited by modest sensitivity/specificity, inability to differentiate between fungal pathogens, and lack of detection of mucormycosis. Data about BDG performance for other relevant IMI, such as invasive fusariosis (IF) and invasive scedosporiosis/lomentosporiosis (IS) are scarce. The objective of this study was to assess the sensitivity of BDG for the diagnosis of IF and IS through systematic literature review and meta-analysis. Immunosuppressed patients diagnosed with proven or probable IF and IS, with interpretable BDG data were eligible. A total of 73 IF and 27 IS cases were included. The sensitivity of BDG for IF and IS diagnosis was 76.7% and 81.5%, respectively. In comparison, the sensitivity of serum galactomannan for IF was 27%. Importantly, BDG positivity preceded the diagnosis by conventional methods (culture or histopathology) in 73% and 94% of IF and IS cases, respectively. Specificity was not assessed because of lacking data. In conclusion, BDG testing may be useful in patients with suspected IF or IS. Combining BDG and galactomannan testing may also help differentiating between the different types of IMI

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

Dosages immunoenzymatiques plasmatiques et intracellulaires des antirétroviraux anti-VIH (développement et applications)

Le développement de méthodes de mesures, adaptées au suivi thérapeutique, des molécules utilisées en thérapie anti-VIH doit permettre d'optimiser l'administration des anti-rétroviraux, d'assurer une meilleure efficacité des traitements et de limiter les effets secondaires. Nous avons développé des dosages immunoenzymatiques (EIA) de l'efavirenz, de la névirapine et du lopinavir. Nous avons synthétisé les immunogènes nécessaires à l'obtention d'anticorps spécifiques par introduction sur ces molécules d'un chaînon possédant une fonction acide carboxylique puis couplage avec la KLH et l'AChE pour obtenir les immunogènes et les traceurs correspondants. Les anticorps anti-EFZ bien que d'une grande sensibilité reconnaissent des métabolites présents dans le plasma des patients et le dosage n'a pas été finalisé. Les anticorps anti-NVP et anti-LPV ont permis la mise au point d'un EIA d'une grande sensibilité (limite de détection < 500 pg/mL). Ces dosages ont été appliqués à la détermination des taux plasmatiques et intracellulaires. Les résultats montrent : qu'il n'y a pas d'accumulation de la NVP ou du LPV à l'intérieur de la cellule, une grande variabilité interpatient et une absence de corrélation entre les concentrations extra- et intracellulaires qui soulignent toute l'importance du dosage intracellulaire pour le suivi thérapeutique. Par ailleurs, à l'aide de ces dosages nous avons montré que les inhibiteurs de protéase s'accumulent de façon dose dépendante dans les cellules adipeuses de différents modèles murins et dans un modèle adipocytaire humain (hMADS). La synthèse de sondes de fluorescence nous a permis de localiser ces drogues notamment dans les gouttelettes lipidiques.NICE-BU Sciences (060882101) / SudocSudocFranceF

Dystonie myoclonique DYT 11 (illustration clinique et électrophysiologique, à propos d'une famille)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF