a retrospective multicenter study

Funding This study was supported in part by a grant from the French government through the « Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). Prof. Ignacio Martin-Loeches has been supported by SFI (Science Foundation Ireland), Grant number 20/COV/0038. The funders of the study had no role in the study design, data collection, analysis or interpretation, writing of the report or deci sion to submit for publication.BACKGROUND: Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox's proportional hazard models with adjustment on pre-specified confounders. RESULTS: Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17-1.31) at day 2, 0.95 (0.63-1.42) at day 7, 1.48 (1.01-2.16) at day 14 and 1.94 (1.09-3.46) at day 21. CONCLUSIONS: No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.publishersversionpublishe

a planned ancillary analysis of the coVAPid cohort

Funding: This study was supported in part by a grant from the French government through the «Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). The funders of the study had no role in the study design, data collection, analysis, or interpreta tion, writing of the report, or decision to submit for publication.BACKGROUND: Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox's regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. FINDINGS: Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16-2.47), p = 0.006), and influenza groups (1.75 (1.03-3.02), p = 0.045), but not in the no viral infection group (1.07 (0.64-1.78), p = 0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. INTERPRETATION: VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov, number NCT04359693.publishersversionpublishe

Fluid challenges in intensive care: the FENICE study A global inception cohort study

Fluid challenges (FCs) are one of the most commonly used therapies in critically ill patients and represent the cornerstone of hemodynamic management in intensive care units. There are clear benefits and harms from fluid therapy. Limited data on the indication, type, amount and rate of an FC in critically ill patients exist in the literature. The primary aim was to evaluate how physicians conduct FCs in terms of type, volume, and rate of given fluid; the secondary aim was to evaluate variables used to trigger an FC and to compare the proportion of patients receiving further fluid administration based on the response to the FC.This was an observational study conducted in ICUs around the world. Each participating unit entered a maximum of 20 patients with one FC.2213 patients were enrolled and analyzed in the study. The median [interquartile range] amount of fluid given during an FC was 500 ml (500-1000). The median time was 24 min (40-60 min), and the median rate of FC was 1000 [500-1333] ml/h. The main indication for FC was hypotension in 1211 (59 %, CI 57-61 %). In 43 % (CI 41-45 %) of the cases no hemodynamic variable was used. Static markers of preload were used in 785 of 2213 cases (36 %, CI 34-37 %). Dynamic indices of preload responsiveness were used in 483 of 2213 cases (22 %, CI 20-24 %). No safety variable for the FC was used in 72 % (CI 70-74 %) of the cases. There was no statistically significant difference in the proportion of patients who received further fluids after the FC between those with a positive, with an uncertain or with a negatively judged response.The current practice and evaluation of FC in critically ill patients are highly variable. Prediction of fluid responsiveness is not used routinely, safety limits are rarely used, and information from previous failed FCs is not always taken into account

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/)

Optimal measurement counting time and statistics in gamma spectrometry analysis: The time balance

The optimal measurement counting time for gamma-ray spectrometry analysis using HPGe detectors was determined in our laboratory by comparing twelve hours measurement counting time at day and twelve hours measurement counting time at night. The day spectrum does not fully cover the night spectrum for the same sample. It is observed that the perturbation come to the sun-light. After several investigations became clearer: to remove all effects of radiation from outside (earth, the sun, and universe) our system, it is necessary to measure the background for 24, 48 or 72 hours. In the same way, the samples have to be measured for 24, 48 or 72 hours to be safe to be purified the measurement (equality of day and night measurement). It is also possible to not use the background of the winter in summer. Depend on to the energy of radionuclide we seek, it is clear that the most important steps of a gamma spectrometry measurement are the preparation of the sample and the calibration of the detector

Precision measurement of radioactivity in Gamma-rays spectrometry using two HPGe detectors (BEGe-6530 and GC0818-7600SL models) comparison techniques: Application to the soil measurement.

To obtain high quality of results in gamma spectrometry, it is necessary to select the best HPGe detector for particular measurements, to calibrate energy and efficiency of gamma detector as accurate as possible. To achieve this aim, the convenient detector model and gamma source can be very useful. The purpose of this study was to evaluate the soil specific activity using two HPGe model (BEGe-6530 and GC0818-7600SL) by comparing the results of the two detectors and the technics used according to the detector type. The relative uncertainty activity concentration was calculated for 226Ra, 232Th and 40K. For broad energy germanium detector, BEGe-6530, the relative uncertainty concentration ranged from 2.85 to 3.09% with a mean of 2.99% for 226Ra, from 2.29 to 2.49% with a means of 2.36% for 232Th and from 3.47 to 22.37% with a mean of 12.52% for 40K. For GC0818-7600SL detector, it was ranged from 10.45 to 25.55% with a mean of 17.10% for 226Ra, from 2.54 to 3.56% with a means of 3.10% for 232Th and from 3.42 to 7.65% with a mean of 5.58% for 40K. The average report between GC0818-7600SL model and BEGe-6530 model was calculated and showed the mean value of 3.36. The main study was based on the following points: • Determination of The relative uncertainty activity concentration of 226Ra, 232Th and 40K • Determination of the relative uncertainty related to the radium equivalent activity to compare the performance of the two detection systems • Proved that the activity concentration determination in gamma spectrometry depended on the energy range emitted by a radionuclide. This study showed that the standard deviation measurement was less important to the result realized with BEGe-6530 HPGe model. Our findings were demonstrated that the results of the Broad Energy Germanium detector were more reliable

Barite concrete-based cement composites for ²⁵²Cf spontaneous neutron and ⁶⁰Co/¹⁹²Ir shielding based on Monte Carlo computation

Abstract Barite concrete composite materials have been investigated for 252Cf spontaneous neutron and 60Co/192Ir gamma sources’ shielding using Monte Carlo computational method. The Particle and Heavy Ion Transport code System (PHITS) was used to compute the shielding properties of three different materials (barite concrete, barite cement, and barite aggregate) used as structural walls in fixed neutron & gamma industrial radiography for Non-Destructive Testing applications. The obtained results displayed good properties of barite concrete in shielding spontaneous neutrons emitted from the 252Cf source, as the effective dose drops about 108 times in only 140 cm wall thickness, and it was found to be about 10 times more effective than other materials investigated. In addition, the investigated gamma shielding properties of the barite concrete showed a relatively smaller wall thickness compared to the ordinary concrete. The decision-making process based on the ALARA principle of dose limitation showed that the use of barite concrete in such facilities is more effective than the use of barite cement and barite aggregate, for both gamma and neutron radiography shielding design. To achieve an average value of 1 μSv/h, the obtained result shows that 80 cm of Barite concrete is needed, while 125 and 130 cm of barite cement and barite aggregate are needed, respectively to shield the Co-60 source. Meanwhile, 50 cm of wall made of barite concrete is sufficient to cut down the effective dose rate to 1 μSv/h (for 50 Ci and 55 cm for 150 Ci 192Ir), which is an appropriate design for the public area adjacent to the industrial radiographic facility. It was therefore concluded from the obtained data that barite concrete is the most effective shielding material for radioactive sources (60Co, 192Ir, and 252Cf) used in radiographic applications

Early Strokes Are Associated with More Global Cognitive Deficits in Adults with Sickle Cell Disease

This study sought to link neurocognitive profiles in sickle cell disease (SCD) patients with clinical characteristics. We conducted a prospective cohort study of adults with SCD who underwent comprehensive neuropsychological assessment at the UMGGR clinic at Henri Mondor Hospital, Créteil (France). A cluster analysis was performed based on neuropsychological testing scores. The association between clusters and clinical profiles was assessed. Between 2017 and 2021, 79 patients with a mean age of 36 [range 19–65] years were included. On principal component analysis, a 5-factor model presented the best fit (Bartlett’s sphericity test [χ2 (171) = 1345; p n = 24) presented deficits in all five factors compared to Cluster 3 (n = 33). Cluster 2 (n = 22) had deficits in all factors, but to a lesser extent than Cluster 1. MoCA scores mirrored the severity of these cognitive deficits. Age, genotype and stroke prevalence did not differ significantly between clusters. However, the time of first stroke occurrence differed significantly between Cluster 1 and 2–3: 78% of strokes occurred during childhood, whereas 80% and 83% occurred during adulthood in Clusters 2 and 3, respectively. Educational attainment was also reduced in Cluster 1. SCD patients with childhood stroke seem to be at increased risk of a global cognitive deficit profile. In addition to existing methods of primary and secondary stroke prevention, early neurorehabilitation should be prioritized in order to reduce the long-term cognitive morbidity of SCD

Assessment of natural radioactivity and associated radiation hazards in sand building material used in Douala Littoral Region of Cameroon, using gamma spectrometry

Twenty-four sand samples were collected from different sand quarries from Douala Littoral Region (Wouri, Dibamba, Mungo and Docteur Anse rivers and Atlantic Sea) along the Guinea Golf. These samples were investigated using gamma-ray spectrometry system. Highest values of 226Ra, 232Th and 40K measured specific activities expressed in Bq Kg−1 units were, respectively, 146.7 (in Youpoue–Bamenda 2) 102.9 (in Village 1) and 928 (in Northern Akwa 6) while the lowest values were found to be, respectively, 11.8 (in Northern Akwa 6), 8.0 (in Bonaberi–Bonamikano 4) and 54.0 (Youpoue 3). The potential radiological hazards parameters were assessed by calculating successively radium equivalent activity (Raeq), outdoor absorbed gamma dose rate (Dout), annual effective dose rate, internal hazard (Hin) and external hazard (Hex) indices and alpha and gamma index from using those sand in the construction of dwellings and large buildings. Results obtained show that annual dose absorbed by inhabitants due to sand construction use in Douala is below 1.0 mSv year−1. Therefore, most of the types of sands studied and incorporated in constructions appear to be safe as building material. The outputs from this research will be useful to assess the radiation hazards of sand building material in humans and to initiate a sand database together with a radiological map of the area at stake

Incidence and predictive score for delayed hemolytic transfusion reaction in adult patients with sickle cell disease

International audienceDelayed hemolytic transfusion reaction (DHTR) is a life-threatening complication of transfusion in sickle cell disease (SCD). The frequency of DHTR is underestimated because its symptoms mimic those of vaso-occlusive crisis and antibodies (Abs) are often not detectable. No predictive factors for identifying patients likely to develop DHTR have yet been defined. We conducted a prospective single-center observational study over 30 months in adult sickle cell patients. We included 694 transfusion episodes (TEs) in 311 patients, divided into occasional TEs (OTEs: 360) and chronic transfusion program (CTEs: 334). During follow-up, 15 cases of DHTR were recorded, exclusively after OTEs. DHTR incidence was 4.2% per OTE (95% CI [2.6; 6.9]) and 6.8% per patient during the 30 months of the study (95% CI [4.2; 11.3]). We studied 11 additional DHTR cases, to construct a predictive score for DHTR. The DHTR mortality is high, 3 (11.5%) of the 26 DHTR patients died. The variables retained in the multivariate model were history of DHTR, number of units previously transfused and immunization status before transfusion. The resulting DHTR-predictive score had an area under the ROC curve of 0.850 [95% CI: 0.780-0.930], a negative-predictive value of 98.4% and a positive-predictive value of 50%. We report in our study population, for the first time, the incidence of DHTR, and, its occurrence exclusively in occasionally transfused patients. We also describe a simple score for predicting DHTR in patients undergoing occasional transfusion, to facilitate the management of blood transfusion in SCD patients