0357 : Platypnea orthodeoxia syndrome: focus on predisposing anatomical factors

Platypnea orthodeoxia syndrome (POS) is a rare situation with hypoxia and breathlessness in the upright position recovering in the recumbent position. A mechanical inter-atrial septum distortion, causing redirection of flow from the right to the left atrium through a patent foramen ovale (PFO), despite normal pulmonary pressure, is suggested to explain POS. Prevalence of predisposing anatomical factors remain little knownMethodsAll patients who underwent a PFO closure for a POS were retrospectively included from 2 CHU. Predisposing anatomical factors were investigated.Results67 patients (Median age 72 y.o., interquartile range 61-80; 58.2% men) were included. All patients had dyspnea (76.2% NYHA III or IV, 53.7% under oxygen-therapy). The remaining patients had a refractory hypoxemia (38.2%) without POS. Most frequent predisposing anatomical factor was an enlarged or unwound aorta (n=29, 43.3% 95CI 31.2-56.0) with an aortic aneurysm in 25 patients (37.3%, 95CI 25.8-50.0). Other factors identified were pneumonectomy (n=8, 11.9% CI95 5.3-22.2), a history of cardiac surgery (n=7, 10.5%, 95CI 4.3-20.3), mechanical ventilation (n=6, 9.0% 95CI 3.4-18.5), kyphoscoliosis (n=4, 6.0% 95CI 1.7-14.6), hepatomegaly (n=4, 6.0% 95CI 1.7-14.6, 2 patients with hepato-renal polycystic disease, one hemochromatosis and one cirrhosis), right ventricle failure (n=2,3.0% 95CI 0.4-10.4), pericardial effusions (n=2,3.0% 95CI 0.4-10.4), right ventricle arrhythmogenic dysplasia (n=2,3.0% 95CI 0.4-10.4), diaphragmatic paralysis (n=1, 1.5% 95CI 0.1-8.0), carcinoid syndrome with tricuspid regurgitation (n=1, 1.5% 95CI 0.1-8.0), a right atrium pace-maker lead (n=1, 1.5% 95CI 0.1-8.0) and a tako-tsubo syndrome (n=1, 1.5% 95CI 0.1-8.0).ConclusionAortic aneurysm and pneumonectomy are the most frequent situation leading to a POS. Other causes were observed such as hepato-renal polycystic kidney, or atrial pacemaker probe that may be underdiagnosed in clinical practice

Characterization of acute kidney injury in critically ill patients with severe coronavirus disease 2019

Abstract Background Coronavirus disease 2019 (COVID-19)-associated acute kidney injury (AKI) frequency, severity and characterization in critically ill patients has not been reported. Methods Single-centre cohort performed from 3 March 2020 to 14 April 2020 in four intensive care units in Bordeaux University Hospital, France. All patients with COVID-19 and pulmonary severity criteria were included. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. A systematic urinary analysis was performed. The incidence, severity, clinical presentation, biological characterization (transient versus persistent AKI; proteinuria, haematuria and glycosuria) and short-term outcomes were evaluated. Results Seventy-one patients were included, with basal serum creatinine (SCr) of 69 ± 21 µmol/L. At admission, AKI was present in 8/71 (11%) patients. Median [interquartile range (IQR)] follow-up was 17 (12–23) days. AKI developed in a total of 57/71 (80%) patients, with 35% Stage 1, 35% Stage 2 and 30% Stage 3 AKI; 10/57 (18%) required renal replacement therapy (RRT). Transient AKI was present in only 4/55 (7%) patients and persistent AKI was observed in 51/55 (93%). Patients with persistent AKI developed a median (IQR) urine protein/creatinine of 82 (54–140) (mg/mmol) with an albuminuria/proteinuria ratio of 0.23 ± 20, indicating predominant tubulointerstitial injury. Only two (4%) patients had glycosuria. At Day 7 after onset of AKI, six (11%) patients remained dependent on RRT, nine (16%) had SCr >200 µmol/L and four (7%) had died. Day 7 and Day 14 renal recovery occurred in 28% and 52%, respectively. Conclusion Severe COVID-19-associated AKI is frequent, persistent, severe and characterized by an almost exclusive tubulointerstitial injury without glycosuria

Les mutations contemporaines du droit de l’animal

Le droit de l’animal a connu des mutations d’ampleur au cours des vingt dernières années. Il s’est structuré en champ disciplinaire autonome, a pris une importance croissante dans le débat public et a fait l’objet de réformes remarquées. Le présent ouvrage rend compte de ces évolutions en publiant les actes d’une université d’automne qui s’est tenue à la faculté de droit d’Aix-en-Provence en octobre 2021. Il rassemble les contributions des auteurs – juristes, politistes et historiens – autour de sept thématiques : le droit de l’animal comme champ disciplinaire ; les mots du droit de l’animal ; la fabrique du droit de l’animal ; droit de l’animal et participation démocratique ; droit de l’animal, droits fondamentaux et droit constitutionnel ; la représentation des animaux devant les juridictions et l’action au nom et pour le compte d’un animal ; juridictions pénales et animaux. Le lecteur pourra apprécier, en les parcourant, l’intérêt et la richesse d’une matière en plein essor, particulièrement en phase avec les préoccupations de son temps

Albumin liver dialysis as pregnancy-saving procedure in cholestatic liver disease and intractable pruritus

Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus

Swab cloths as a tool for revealing environmental contamination by Q fever in ruminant farms

International audienc

Facteurs associés à la détection de <em>Coxiella burnetii d</em>ans les prélèvements de poussière en élevages de ruminants domestiques

International audienc

Early formative objective structured clinical examinations for students in the pre-clinical years of medical education: A non-randomized controlled prospective pilot study.

BackgroundThe value of formative objective structured clinical examinations (OSCEs) during the pre-clinical years of medical education remains unclear. We aimed to assess the effectiveness of a formative OSCE program for medical students in their pre-clinical years on subsequent performance in summative OSCE.MethodsWe conducted a non-randomized controlled prospective pilot study that included all medical students from the last year of the pre-clinical cycle of the Université Paris-Cité Medical School, France, in 2021. The intervention group received the formative OSCE program, which consisted of four OSCE sessions, followed by debriefing and feedback, whereas the control group received the standard teaching program. The main objective of this formative OSCE program was to develop skills in taking a structured medical history and communication. All participants took a final summative OSCE. The primary endpoint was the summative OSCE mark in each group. A questionnaire was also administered to the intervention-group students to collect their feedback. A qualitative analysis, using a convenience sample, was conducted by gathering data pertaining to the process through on-site participative observation of the formative OSCE program.ResultsTwenty students were included in the intervention group; 776 in the control group. We observed a significant improvement with each successive formative OSCE session in communication skills and in taking a structured medical history (pConclusionOur findings suggest that an early formative OSCE program is suitable for the pre-clinical years of medical education and is associated with improved student performance in domains targeted by the program

Factors associated with the detection of coxiella burnetii in dust samples from domestic ruminant herds

La fièvre Q est une maladie abortive des ruminants transmise par voie aérienne à partir de l’environnement contaminé par les produits d’avortements, de mises-bas et par les excréments. Néanmoins, la relation entre survenue d’avortements et contamination environnementale reste mal définie. Notre objectif était d’estimer la fréquence de détection et les charges de Coxiella burnetii dans la poussière des bâtiments d’élevage en relation avec l’occurrence d’épisodes abortifs attribués à la fièvre Q. Des échantillons de poussière (n=109) ont été prélevés dans les élevages bovins, ovins et caprins, cliniquement atteints de fièvre Q ou non. L’ADN de C. burnetii a été détecté par PCR quantitative dans de nombreux échantillons. La probabilité de détection était plus grande dans les élevages caprins et ovins que dans les élevages bovins, et dans les élevages cliniquement atteints de fièvre Q que dans les élevages non cliniquement atteints. La poussière des bâtiments pourrait donc constituer un indicateur du statut des élevages pour la fièvre Q.Q fever is an abortive disease of ruminants aerially transmitted by environmental dust contaminated by abortion or parturition products and by faeces. Nevertheless, the relationship between the occurrence of abortions and environmental contamination remains poorly understood. The aim of our study was to estimate Coxiella burnetii’s detection frequency and bacterial loads in environmental dust from farm buildings and to determine whether this environmental contamination was associated with the occurrence of abortive episodes attributed to Q fever. Dust samples (n=109) were collected from cattle, sheep and goat farms suspected or not for clinical Q fever. Many of them were positive by quantitative PCR. The probability to detect C. burnetii’s DNA was higher on goat or sheep farms than on cattle farms, and on farms suspected for clinical Q fever than on non-suspected farms. Dust from farm buildings might therefore be an indicator of the status of herds regarding Q fever

Early non-invasive ventilation and high-flow nasal oxygen therapy for preventing endotracheal intubation in hypoxemic blunt chest trauma patients: the OptiTHO randomized trial

International audienceBackground The benefit–risk ratio of prophylactic non-invasive ventilation (NIV) and high-flow nasal oxygen therapy (HFNC-O 2 ) during the early stage of blunt chest trauma remains controversial because of limited data. The main objective of this study was to compare the rate of endotracheal intubation between two NIV strategies in high-risk blunt chest trauma patients. Methods The OptiTHO trial was a randomized, open-label, multicenter trial over a two-year period. Every adult patients admitted in intensive care unit within 48 h after a high-risk blunt chest trauma (Thoracic Trauma Severity Score ≥ 8), an estimated PaO 2 /FiO 2 ratio < 300 and no evidence of acute respiratory failure were eligible for study enrollment (Clinical Trial Registration: NCT03943914). The primary objective was to compare the rate of endotracheal intubation for delayed respiratory failure between two NIV strategies: i) a prompt association of HFNC-O 2 and “early” NIV in every patient for at least 48 h with vs. ii) the standard of care associating COT and “late” NIV, indicated in patients with respiratory deterioration and/or PaO 2 /FiO 2 ratio ≤ 200 mmHg. Secondary outcomes were the occurrence of chest trauma-related complications (pulmonary infection, delayed hemothorax or moderate-to-severe ARDS). Results Study enrollment was stopped for futility after a 2-year study period and randomization of 141 patients. Overall, 11 patients (7.8%) required endotracheal intubation for delayed respiratory failure. The rate of endotracheal intubation was not significantly lower in patients treated with the experimental strategy (7% [5/71]) when compared to the control group (8.6% [6/70]), with an adjusted OR = 0.72 (95%IC: 0.20–2.43), p = 0.60 . The occurrence of pulmonary infection, delayed hemothorax or delayed ARDS was not significantly lower in patients treated by the experimental strategy (adjusted OR = 1.99 [95%IC: 0.73–5.89], p = 0.18, 0.85 [95%IC: 0.33–2.20], p = 0.74 and 2.14 [95%IC: 0.36–20.77], p = 0.41 , respectively). Conclusion A prompt association of HFNC-O 2 with preventive NIV did not reduce the rate of endotracheal intubation or secondary respiratory complications when compared to COT and late NIV in high-risk blunt chest trauma patients with non-severe hypoxemia and no sign of acute respiratory failure. Clinical Trial Registration : NCT03943914, Registered 7 May 2019