Identification of Germinal Center B Cells in Blood from HIV-infected Drug-naive Individuals in Central Africa

To better understand the pathophysiology of B cell populations—the precursors of antibody secreting cells—during chronic human immunodeficiency virus (HIV) infection, we examined the phenotype of circulating B cells in newly diagnosed Africans. We found that all African individuals displayed low levels of naive B cells and of memory-type CD27+ B cells, and high levels of differentiated B cells. On the other hand, HIV-infected African patients had a population of germinal center B cells (i.e. CD20+, sIgM-, sIgD+, CD77+, CD138±), which are generally restricted to lymph nodes and do not circulate unless the lymph node architecture is altered. The first observations could be linked to the tropical environment whereas the presence of germinal center B cells may be attributable to chronic exposure to HIV as it is not observed in HIV-negative African controls and HAART treated HIV-infected Europeans. It may impact the management of HIV infection in countries with limited access to HIV drugs and urges consideration for implementation of therapeutic vaccines

International Society of Human and Animal Mycology (ISHAM)-ITS reference DNA barcoding database - the quality controlled standard tool for routine identification of human and animal pathogenic fungi

Human and animal fungal pathogens are a growing threat worldwide leading to emerging infections and creating new risks for established ones. There is a growing need for a rapid and accurate identification of pathogens to enable early diagnosis and targeted antifungal therapy. Morphological and biochemical identification methods are time-consuming and require trained experts. Alternatively, molecular methods, such as DNA barcoding, a powerful and easy tool for rapid monophasic identification, offer a practical approach for species identification and less demanding in terms of taxonomical expertise. However, its wide-spread use is still limited by a lack of quality-controlled reference databases and the evolving recognition and definition of new fungal species/complexes. An international consortium of medical mycology laboratories was formed aiming to establish a quality controlled ITS database under the umbrella of the ISHAM working group on "DNA barcoding of human and animal pathogenic fungi." A new database, containing 2800 ITS sequences representing 421 fungal species, providing the medical community with a freely accessible tool at http://www.isham.org and http://its.mycologylab.org/ to rapidly and reliably identify most agents of mycoses, was established. The generated sequences included in the new database were used to evaluate the variation and overall utility of the ITS region for the identification of pathogenic fungi at intra-and interspecies level. The average intraspecies variation ranged from 0 to 2.25%. This highlighted selected pathogenic fungal species, such as the dermatophytes and emerging yeast, for which additional molecular methods/genetic markers are required for their reliable identification from clinical and veterinary specimens.This study was supported by an National Health and Medical Research Council of Australia (NH&MRC) grant [#APP1031952] to W Meyer, S Chen, V Robert, and D Ellis; CNPq [350338/2000-0] and FAPERJ [E-26/103.157/2011] grants to RM Zancope-Oliveira; CNPq [308011/2010-4] and FAPESP [2007/08575-1] Fundacao de Amparo Pesquisa do Estado de So Paulo (FAPESP) grants to AL Colombo; PEst-OE/BIA/UI4050/2014 from Fundacao para a Ciencia e Tecnologia (FCT) to C Pais; the Belgian Science Policy Office (Belspo) to BCCM/IHEM; the MEXBOL program of CONACyT-Mexico, [ref. number: 1228961 to ML Taylor and [122481] to C Toriello; the Institut Pasteur and Institut de Veil le Sanitaire to F Dromer and D Garcia-Hermoso; and the grants from the Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq) and the Fundacao de Amparo a Pesquisa do Estado de Goias (FAPEG) to CM de Almeida Soares and JA Parente Rocha. I Arthur would like to thank G Cherian, A Higgins and the staff of the Molecular Diagnostics Laboratory, Division of Microbiology and Infectious Diseases, Path West, QEII Medial Centre. Dromer would like to thank for the technical help of the sequencing facility and specifically that of I, Diancourt, A-S Delannoy-Vieillard, J-M Thiberge (Genotyping of Pathogens and Public Health, Institut Pasteur). RM Zancope-Oliveira would like to thank the Genomic/DNA Sequencing Platform at Fundacao Oswaldo Cruz-PDTIS/FIOCRUZ [RPT01A], Brazil for the sequencing. B Robbertse and CL Schoch acknowledge support from the Intramural Research Program of the NIH, National Library of Medicine. T Sorrell's work is funded by the NH&MRC of Australia; she is a Sydney Medical School Foundation Fellow.info:eu-repo/semantics/publishedVersio

Mortalité et qualité de vie à long terme après un choc septique

Introduction: le devenir et la qualité de vie à long terme des patients survivants à un choc septique ont été peu étudiés. En effet, la mortalité à court terme reste le critère de jugement le plus fréquemment étudié. Or, ce critère ne prend pas en compte le point de vue du patient. De plus, la persistance d'un handicap sévère représente une charge supplémentaire pour les proches et la société qui mérite d'être évaluée. L'objectif de ce travail monocentrique observationnel était d'évaluer la qualité de vie à 6 mois des patients hospitalisés en réanimation pour choc septique. Matériel et méthodes: cette étude, menée dans le service de réanimation chirurgical du CHU de Rennes d'octobre 2008 à juin 2010, concernait tous les patients admis en choc septique. Leur devenir 6 mois après le début du choc septique était étudié. La qualité de vie était estimée à l'aide du questionnaire MOS SF-36 auprès des patients ou de leur proches avant l'admission et auprès des survivants à 6 mois. Ce questionnaire comprend 36 questions regroupées en huit dimensions, correspondant chacune à un aspect différent de la santé et à partir desquelles deux scores agrégés peuvent être calculés: les scores résumés physique (MCS) et psychique (PCS). Ces scores et dimensions s'étendant de 0 à 100 (100= meilleure qualité de vie). La qualité de vie avant la prise en charge et des survivants à 6 mois était comparée à celle de la population générale française appariée su le sexe et l'âge par un test de Student. Par ailleurs, la qualité de vie avant l'admission était comparée à la qualité de vie à 6 mois par un test de Student sur valeurs appariées. Les résultats sont exprimés en médiane (25ème-75ème quartiles) ou effectif (%) et pour les scores des différentes échelles du SF-36 en moyenne +- écart-type. Résultats: quatre-vingt-seize patients (homme n=65 [70%]) ont été inclus dont l'âge était de 69 ans (61-78), l'IGS II de 55 (47-72), le score SOFA de 10 (9-13). Douze patients (13%) avaient un score de Mc Cabe C. L'origine des sepsis était majoritairement abdominal (n=55 [59%]). La mortalité à 6 mois était de 45% (n=42). Parmi les survivants, 82% étaient rentrés à domicile à 6 mois (n=42), 14% en convalescence (n=7) et 4ù toujours hospitalisés (n=2). Trente-neuf questionnaires SF-36 (41%) portant sur la période avant l'admission ont été recueillis et analysés. Le taux de réponse des survivants au questionnaire SF-36 à 6 mois étaient de 94%. L'ensemble des 8 dimensions était significativement diminué par rapport à la population générale avant la prise en charge et à 6 mois. L'analyse avant/après a porté sur 23 patients, le PCS augmentait significativement à 6 mois, 42 +- 21 vs 52+-16 (p=0,012). Pour le MCS seule une tendance était observée, 47+-17 vs 54+-15 (p=0,07). Discussion: la mortalité 6 mois après un choc septique était élevée. Il existait une altération de la qualité de vie des patients avant la survenue d'un choc septique par rapport à la population générale. Cette qualité de vie bien que s'améliorant à distance de la prise en charge, restait inférieure à celle de la population générale à 6 mois.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Long-term mortality and quality of life after septic shock: a follow-up observational study.

International audiencePURPOSE: In septic shock, short-term outcomes are frequently reported, while long-term outcomes are not. The aim of this study was to evaluate mortality and health-related quality of life (HRQOL) in survivors 6 months after an episode of septic shock. METHODS: This single-centre observational study was conducted in an intensive care unit in a university hospital. All patients with septic shock were included. Mortality was assessed 6 months after the onset of septic shock, and a comparison between patients who survived and those who died was performed. HRQOL was assessed using the MOS SF-36 questionnaire prior to hospital admission (baseline) and at 6 months in survivors. HRQOL at baseline and at 6 months were compared to the general French population, and HRQOL at baseline was compared to 6-month HRQOL. RESULTS: Ninety-six patients were included. Six-month mortality was 45 %. Survivors were significantly younger, had significantly lower lactate levels and SAPS II scores, required less renal support, received less frequent administration of corticosteroids, and had a longer length of hospital stay. At baseline (n = 39) and 6 months (n = 46), all of the components of the SF-36 questionnaire were significantly lower than those in the general population. Compared to baseline (n = 23), the Physical Component Score (CS) improved significantly at 6 months, the Mental CS did not differ. CONCLUSIONS: Mortality 6 months after septic shock was high. HRQOL at baseline was impaired when compared to that of the general population. Although improvements were noted at 6 months, HRQOL remained lower than that in the general population

Infection néonatale tardive : Méningite à Streptocoque Agalactiae chez un nouveau-né de 19 jours.

Les infections à Streptocoques du groupe B (SGB ou Streptococcus Agalactiae) sont, dans 80% des cas, précoces ( 7 jours de vie). Dans cette seconde catégorie, 35% des infections sont des méningites et engendrent une morbidité importante chez l’enfant. Nous présentons le cas d’un garçon de 19 jours, né à terme par césarienne, ayant développé une méningite à Streptocoques B, avec un dépistage maternel négatif. A l’admission, l’enfant est septique. Un bilan complet met en évidence une méningite à Streptocoque Agalactiae. Une antibiothérapie empirique à base d’Ampicilline 200mg/kg/j, Céfotaxime 100mg/kg/j et Amikacine 15mg/kg/j est initiée. Ce traitement est maintenu 5 jours ; ensuite, poursuite du Céfotaxime en monothérapie pour une durée totale de 14 jours. Les complications précoces (présentes dans 62% des cas) ne sont pas mises en évidence par les différentes explorations réalisées : mesure du périmètre crânien ; échographie transfontanellaire à la recherche d’une hydrocéphalie ou d’abcès cérébraux ; électroencéphalogramme pour exclure des phénomènes paroxystiques. A moyen et long terme, une surveillance clinique, iconographique, ophtalmologique et de l’audiogramme devra être faite afin d’exclure un retard développemental, des troubles sensoriels ainsi qu’une hydrocéphalie, une encéphalomalacie, une atrophie cérébrale ou une porencéphalie. L’incidence des infections précoces à streptocoques B a pu être réduite grâce au dépistage maternel anténatal et à une antibioprophylaxie en cas de positivité du test. Cependant, l’administration perpartale systématique d’antibiotiques ne permet pas de diminuer le nombre et la gravité des infections tardives, la contamination étant, dans ces cas, essentiellement horizontale. Le taux de complications à 5 ans des méningites à SGB est estimé à 49%, ce qui justifie, chez ces enfants, un suivi neuropédiatrique et sensoriel à long terme

Does the participation of a senior plastic surgeon improve perioperative care in craniosynostosis repair surgery?

International audienceINTRODUCTION: The real impact of the participation of other surgical specialties together with neurosurgeons on perioperative care in craniosynostosis repair surgery has not been determined. The purpose of this study was to determine whether the participation of a second senior surgeon (plastic surgeon) during surgical repair of pediatric monosutural craniosynostosis improved perioperative medical care. MATERIAL AND METHODS: The authors retrospectively reviewed 2 cohorts of patients who had consecutively undergone primary repair surgery for trigonocephaly and unicoronal craniosynostosis. Infants were operated on by a single senior pediatric neurosurgeon before December 2017, and with the collaboration of a senior plastic surgeon after January 2018. RESULTS: Overall, 60 infants were included in the study: 29 in group 1 (single surgeon, 2011-2017), and 31 in group 2 (pair of surgeons, 2018-2021). Median surgery time was significantly shorter in group 2 than group 1: 180 vs 167 minutes; p = 0.0045. There was no significant difference between the 2 groups in blood loss or intra/postoperative packed erythrocyte transfusion. Postoperative drain output was significantly lower in group 2. Median length of hospital and intensive care stay were significantly shorter in group 2, by 1 and 2 days, respectively; p < 0.0001. Volume of infused solution, diuresis, immediate postoperative hemoglobin level, hematocrit, hemostasis (platelet count, fibrinogen, prothrombin time and activated partial thromboplastin time), and return to oral feeding did not differ from one group to the other. CONCLUSION: Results confirmed our impression of an improvement in perioperative medical care. However, the role of surgical experience and the influence of the medical/nursing staff must not be minimized in these complex surgical procedures

Évaluation psychologique et psychopathologique de la douleur

International audienc

Évaluation psychologique et psychopathologique de la douleur.

International audienc

Transvesical Intra-Abdominal Pressure Measurement in Newborn: What Is the Optimal Saline Volume Instillation?

International audienceOBJECTIVE: To determine the optimal saline volume bladder instillation to measure intravesical pressure in critically ill newborns weighing less than 4.5 kg, and to establish a reference of intra-abdominal pressure value in this population. DESIGN: Prospective monocentric study. SETTING: Neonatal and PICU. PATIENTS: Newborns, premature or not, weighing less than 4.5 kg who required a urethral catheter. MEASUREMENTS AND MAIN RESULTS: Patients were classified into two groups according to whether they presented a risk factor for intra-abdominal hypertension. Nine intravesical pressure measures per patient were performed after different volume saline instillation. The first one was done without saline instillation and then by increments of 0.5 mL/kg to a maximum of 4 mL/kg. Linear models for repeated measurements of intravesical pressure with unstructured covariance were used to analyze the variation of intravesical pressure measures according to the conditions of measurement (volume instilled). Pairwise comparisons of intravesical pressure adjusted mean values between instillation volumes were done using Tukey tests, corrected for multiple testing to determine an optimal instillation volume. Forty-seven patients with completed measures (nine instillations volumes) were included in the analysis. Mean intravesical pressure values were not significantly different when measured after instillation of 0.5, 1, or 1.5 mL/kg, whereas measures after instillation of 2 mL/kg or more were significantly higher. The median intravesical pressure value in the group without intra-abdominal hypertension risk factor after instillation of 1 mL/kg was 5 mm Hg (2-6 mm Hg). CONCLUSIONS: The optimal saline volume bladder instillation to measure intra-abdominal pressure in newborns weighing less than 4.5 kg was 1 mL/kg. Reference intra-abdominal pressure in this population was found to be 5 mm Hg (2-6 mm Hg