Prioritising pathogens for the management of severe febrile patients to improve clinical care in low- and middle-income countries.

BACKGROUND: Severe febrile illness without a known source (SFWS) is a challenge for clinicians when deciding how to manage a patient, particularly given the wide spectrum of potential aetiologies that contribute to fever. These infections are difficult to distinguish clinically, and accurate diagnosis requires a plethora of diagnostics including blood cultures, imaging techniques, molecular or serological tests, and more. When laboratory services are available, a limited test menu hinders clinical decision-making and antimicrobial stewardship, leading to empiric treatment and suboptimal patient outcomes. To specifically address SFWS, this work aimed to identify priority pathogens for a globally applicable panel for fever causing pathogens. METHOD: A pragmatic two-pronged approach combining currently available scientific data in an analytical hierarchy process and systematically gathered expert input, was designed to address the lack of comprehensive global aetiology data. The expert re-ranked list was then further adapted for a specific use case to focus on community acquired infections in whole blood specimens. The resulting list was further analysed to address different geographical regions (Asia, Africa, and Latin America), and Cohen kappa scores of agreement were calculated. RESULTS: The expert ranked prioritized pathogen list generated as part of this two-pronged approach included typhoidal Salmonella, Plasmodium species and Mycobacterium tuberculosis as the top 3 pathogens. This pathogen list was then further adapted for the SFWS use case to develop a final pathogen list to inform product development. Subsequent analysis comparing the relevance of the SFWS pathogen list to multiple populations and geographical regions showed that the SFWS prioritized list had considerable utility across Africa and Asia, but less so for Latin America. In addition, the list showed high levels of agreement across different patient sub-populations, but lower relevance for neonates and symptomatic HIV patients. CONCLUSION: This work highlighted once again the challenges of prioritising in global health, but it also shows that taking a two-pronged approach, combining available prevalence data with expert input, can result in a broadly applicable priority list. This comprehensive utility is particularly important in the context of product development, where a sufficient market size is essential to achieve a sustainable commercialized diagnostic product to address SFWS

J.-K. Huysmans and medicine : from the “clinicien ès lettres” to the physiologist of the soul

Étudier les liens entre Huysmans (1848-1907) et la médecine, c’est se pencher sur un paradoxe : celui d’un écrivain d’abord naturaliste, fortement influencé par Zola et une médecine triomphante dont la méthode est érigée en modèle pour les romanciers, qui conserve après sa conversion au catholicisme, au début des années 1890, une écriture fortement imprégnée d’images relevant de la physiologie et d’un lexique médical. Ces derniers sont caractéristiques du style de l’écrivain, le « naturalisme spiritualiste », qui entend dire l’âme sans faire abstraction du corps. Si les éléments biographiques dont nous disposons, correspondance à l’appui, témoignent de la part de Huysmans d’une expérience personnelle de la maladie et d’une fréquentation de médecins, on constate, plus encore, une appétence érudite et un goût de la documentation médicale qui ne faiblira pas, documentation insérée parfois à l’état brut au point de menacer le roman dans sa définition générique. Il s’agit donc de s’intéresser au savoir médical de l’écrivain, acquis souvent par la lecture de petites revues ou de sources de seconde main, mais aussi de s’interroger sur le devenir d’une certaine déception à l’égard de la clinique, à partir d’À Rebours et de manière plus visible encore dans Là-Bas. Comment Huysmans offre-T-Il dans son œuvre à la fois une critique de la médecine et l’idée d’une physiologie des âmes, associée à l’image d’une Église thérapeute ? Comment la médecine, de référence naturaliste, devient-Elle l’expression du mystère d’un Dieu incarné ? Le sujet entend donc se situer à un nœud entre histoire des sciences et des idées, histoire de la littérature et connaissance de Huysmans lui-Même.Studying relations between Huysmans (1848-1907) and medicine, it is looking over a paradox; the one of a writer who first was a naturalist strongly influenced by Zola and medicine whose method was at that time a model for writers. Despite a conversion into Catholicism, at the beginning of the 1890s, Huysmans writing is impregnated with pictures issued from physiology and medical vocabulary. These last two items are specific of the author style “the spiritualist naturalism” which is meant to tell the soul without excluding the flesh. We can notice, reading the biographical elements at our disposal, particularly letters, that Huysmans had an intimate knowledge of disease and acquaintance with doctors, as well as a real taste for medical documentation; this strong and particular taste didn’t fade, Huysmans will include medical sources and documents as they were, up to point of threatening, in his works, the very name of novel. The main interest will be focused on the writer medical knowledge built upon reading medical and scientific journals and sources. This work will also lead to question the path followed by Huysmans upon a certain deception about the clinic, starting with À Rebours and more obviously in Là-Bas. How can he offer in his novels a combination of a critical review of medicine and the idea of a soul physiology, these associated with the picture of the Church as a therapist? How medicine from a naturalistic point of view can become the way to express the mystery of an embodied God?The subject of this work means to locate itself at the crossing point between sciences and ideas history, literature history and knowledge of Huysmans himself

Additional file 1 of Prioritising pathogens for the management of severe febrile patients to improve clinical care in low- and middle-income countries

AHP absolute evaluation methodology for: "Prioritising pathogens for the management of severe febrile patients to improve clinical care in low- and middle-income countries"

Effect of Azithromycin on Airflow Decline–Free Survival After Allogeneic Hematopoietic Stem Cell Transplant

International audienc

More Than 50 Percent Reduction in LDL Cholesterol in Patients With Target LDL <70 mg/dL After a Stroke

International audienceBACKGROUND: Whether a strategy to target an LDL (low-density lipoprotein) cholesterol 50% from baseline rather than 50% LDL cholesterol reduction from baseline during the trial had a higher baseline LDL cholesterol and a lower LDL cholesterol achieved as compared to patients who had 50% LDL reduction had a significant reduction in the primary outcome as compared to the higher target group (hazard ratio, 0.61 [95% CI, 0.43–0.88]; P =0.007) and patients with <50% LDL reduction from baseline had little reduction (hazard ratio, 0.96 [95% CI, 0.73–1.26]; P =0.75). CONCLUSIONS: In this post hoc analysis of the TST trial, targeting an LDL cholesterol of <70 mg/dL reduced the risk of primary outcome compared with 100±10 mg/dL provided LDL cholesterol reduction from baseline was superior to 50%, thereby suggesting that the magnitude of LDL cholesterol reduction was as important to consider as the target level to achieve. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01252875. URL: https://clinicaltrialsregister.eu ; Unique identifier: EUDRACT2009-A01280-57.gov; Unique identifier: NCT01252875. URL: https://clinicaltrialsregister.eu; Unique identifier: EUDRACT2009-A01280-57.URL: https://www