Early Union of Grafted Bone in Ankylosing Spondylitis: Comparative Study with Degenerative Spinal Disease

Patients with ankylosing spondylitis (AS) achieve early bone union compared to those with other spinal diseases. This study compared the time to bone union after surgery between AS patients and degenerative spinal disease patients. Patients with degenerative spinal diseases (control group) and AS (experimental group) underwent pedicle subtraction osteotomy followed by posterolateral fusion, and decompression and posterolateral fusion, respectively. There were 10 patients in the experimental group. The control group included 26 patients who were less than 50 years of age and underwent two-level autogenous grafting after decompression and spinal fusion. Autogenous grafts and a range of bone substitutes were used in the experimental group, whereas only autogenous grafts were used in the control group. Bone union was determined on the radiographs and 3-dimensional CT scan images. The level of union was assessed using the Lenke's and Christensen's classification systems. In the experimental group, the mean age was 41.3 years (range, 30 to 67 years), the mean follow-up period was 21.7 months (range, 12 to 43 months), and bone union was confirmed at an average of 3.5 months (range, 3 to 5 months) after surgery. In the control group, the mean age was 43.1 years (range, 35 to 50 years), the mean follow-up period was 21.8 months (range, 12 to 74 months), and bone union was observed at an average of 5.6 months (range, 4 to 12 months) after surgery. The difference in the time to bone union between the two groups was significant (p = 0.023). The union of grafted bone was obtained earlier in patients with AS than in those with degenerative spinal diseases. Therefore, future studies should examine the factors affecting the early union in AS patients

C51 - Conciliation médicamenteuse à l’admission des urgences médicales du Centre Hospitalier Universitaire Pédiatrique Charles De Gaulle

Introduction : De nombreuses erreurs médicamenteuses surviennent lors de la transition du patient de la communauté à hôpital. La conciliation médicamenteuse constitue un moyen de prévention des iatrogénies médicamenteuses et la promotion de soins de santé de qualité et sécurisés. Objectif : Cette étude avait pour but d’implémenter la conciliation des traitements médicamenteux au sein de l’unité des urgences médicales du CHUP-CDG et d’évaluer son acceptabilité par l’équipe médicale. Méthodologie : Les patients admis dans les 12 heures ont été recensés et enrôlés suivant un consentement verbal d’un des parents ou de l’accompagnant durant la période du 15 Mars au 30 Avril 2023. Une fiche de conciliation validée par une préenquête a servi à la collecte des données relatives aux traitements du patient avant et à l’admission aux urgences médicales. Les données ont été colligées grâce au logiciel Kobocollect® puis analysées grâce au logiciel Kobotoolbox® et les divergences relevées ont été caractérisées. Résultats : Au total, 135 patients enrôlés ont présenté 412 lignes de traitement sur une période de six semaines. Le temps moyen de conciliation par patient était de 57 minutes. Soixante-et-onze (71) divergences non intentionnelles ont été recueillies, dont 39 omissions, 24 erreurs de posologie et 8 erreurs de dosage. Mille cent quatre-vingt-dix-huit (1198) divergences intentionnelles ont été répertoriées, dont 1125 documentées. Quarante-et-neuf (49) divergences non intentionnelles ont été corrigées après intervention pharmaceutique soit 69,01%. Conclusion : les résultats de cette étude permettent de justifier la nécessité d’intégrer la conciliation médicamenteuse dans la pratique clinique de routine. Il convient de conduire d’autres études à l’échelle de l’hôpital en vue d’explorer les conciliations de transfert et de sortie à partir des unités d’hospitalisation

P5 Caractérisation des erreurs médicamenteuses survenues au Centre de néonatologie du Centre Hospitalier Universitaire Charles de Gaulle en avril 2023

Introduction : Les erreurs médicamenteuses sont fréquentes en néonatologie. Elles sont parfois critiques en situation de prématurité. Le but de la présente étude était de caractériser les erreurs médicamenteuses commises de la prescription à l’administration des traitements des patients admis au centre de néonatologie du CHU pédiatrique Charles de GAULLE.   Matériel et méthodes : il s’est agi d’une étude observationnelle à visée descriptive. Elle s’est déroulée durant le mois d’avril 2023 au centre de néonatologie du Centre Hospitalier Universitaire Charles de Gaulle (CHUP-CDG). La population d’étude était constituée des nouveau-nés admis pour soins au centre. Résultats : Au total 38 nouveau-nés ont été inclus dans l’étude. Deux cent quatorze (214) prescriptions, 36 préparations ou reconstitutions de médicaments, 54 administrations et 102 délivrances de traitement médicamenteux aux patients ont été analysées. Au total 179 erreurs médicamenteuses ont été identifiées. La prescription et l’administration des médicaments étaient les étapes qui comptaient le plus grand nombre d’erreur avec des proportions de 53,07 % et 40,78 %. La préparation/reconstitution des médicaments et la dispensation des traitements ont été sources d’erreurs médicamenteuses dans des proportions de 1,2% et 5,03%. Les erreurs de dose ont représenté 53,14 % des interventions pharmaceutiques. Selon le degré de réalisation, 41,90 % étaient des erreurs potentielles et la totalité des erreurs médicamenteuses n’avaient pas de conséquences significatives sur la santé des patients. Conclusion : Cette étude a permis détecter et de caractériser les erreurs survenues lors de processus du circuit clinique du médicament au centre de néonatologie du CHUP-CDG. Des renforcements de capacités des acteurs permettront de corriger les insuffisances relevées

Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013

CITATION: Dahourou, D. L. et al. 2016. Missed opportunities of inclusion in a cohort of HIV-infected children to initiate antiretroviral treatment before the age of two in West Africa, 2011 to 2013. Journal of the International AIDS Society, 19:20601, doi:10.7448/IAS.19.1.20601.The original publication is available at http://www.jiasociety.orgIntroduction: The World Health Organization (WHO) 2010 guidelines recommended to treat all HIV-infected children less than two years of age. We described the inclusion process and its correlates of HIV-infected children initiated on early antiretroviral therapy (EART) at less than two years of age in Abidjan, Côte d’Ivoire, and Ouagadougou, Burkina Faso. Methods: All children with HIV-1 infection confirmed with a DNA PCR test of a blood sample, aged less than two years, living at a distance less than two hours from the centres and whose parents (or mother if she was the only legal guardian or the legal caregiver if parents were not alive) agreed to participate in the MONOD ANRS 12206 project were included in a cohort to receive EART based on lopinavir/r. We used logistic regression to identify correlates of inclusion. Results: Among the 217 children screened and referred to the MONOD centres, 161 (74%) were included and initiated on EART. The main reasons of non-inclusion were fear of father’s refusal (48%), mortality (24%), false-positive HIV infection test (16%) and other ineligibility reasons (12%). Having previously disclosed the child’s and mother’s HIV status to the father (adjusted odds ratio (aOR): 3.20; 95% confidence interval (95% CI): 1.55 to 6.69) and being older than 12 months (aOR: 2.05; 95% CI: 1.02 to 4.12) were correlates of EART initiation. At EART initiation, the median age was 13.5 months, 70% had reached WHO Stage 3/4 and 57% had a severe immune deficiency. Conclusions: Fear of stigmatization by the father and early competing mortality were the major reasons for missed opportunities of EART initiation. There is an urgent need to involve fathers in the care of their HIV-exposed children and to promote early infant diagnosis to improve their future access to EART and survival.http://www.jiasociety.org/index.php/jias/article/view/20601Publisher's versio

Predicting recurrence in osteosarcoma via a quantitative histological image classifier derived from tumour nuclear morphological features

Abstract Recurrence is the key factor affecting the prognosis of osteosarcoma. Currently, there is a lack of clinically useful tools to predict osteosarcoma recurrence. The application of pathological images for artificial intelligence‐assisted accurate prediction of tumour outcomes is increasing. Thus, the present study constructed a quantitative histological image classifier with tumour nuclear features to predict osteosarcoma outcomes using haematoxylin and eosin (H&E)‐stained whole‐slide images (WSIs) from 150 osteosarcoma patients. We first segmented eight distinct tissues in osteosarcoma H&E‐stained WSIs, with an average accuracy of 90.63% on the testing set. The tumour areas were automatically and accurately acquired, facilitating the tumour cell nuclear feature extraction process. Based on six selected tumour nuclear features, we developed an osteosarcoma histological image classifier (OSHIC) to predict the recurrence and survival of osteosarcoma following standard treatment. The quantitative OSHIC derived from tumour nuclear features independently predicted the recurrence and survival of osteosarcoma patients, thereby contributing to precision oncology. Moreover, we developed a fully automated workflow to extract quantitative image features, evaluate the diagnostic values of feature sets and build classifiers to predict osteosarcoma outcomes. Thus, the present study provides a novel tool for predicting osteosarcoma outcomes, which has a broad application prospect in clinical practice

Missed Opportunities for Early Access to Care of HIV-Infected Infants in Burkina Faso

International audienceObjective: The World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso.Methods: We conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW).Results: In 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%-1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW.Conclusions: The PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou

An epidemiological study to assess Plasmodium falciparum parasite prevalence and malaria control measures in Burkina Faso and Senegal

Background: Malariometric information is needed to decide how to introduce malaria vaccines and evaluate their impact in sub-Saharan African countries. Methods: This cross-sectional study (NCT01954264) was conducted between October and November, 2013, corresponding to the high malaria transmission season, in four sites with Health and Demographic Surveillance Systems (DSS) [two sites with moderate-to-high malaria endemicity in Burkina Faso (Nouna and Sapone) and two sites with low malaria endemicity in Senegal (Keur Soce and Niakhar)]. Children (N = 2421) were randomly selected from the DSS lists of the study sites and were stratified into two age groups (6 months-4 years and 5-9 years). A blood sample was collected from each child to evaluate parasite prevalence of Plasmodium falciparum and other Plasmodium species and gametocyte density by microscopy, and rapid diagnosis test in the event of fever within 24 h. Case report forms were used to evaluate malaria control measures and other factors. Results: Plasmodium falciparum was identified in 707 (29.2%) children, with a higher prevalence in Burkina Faso than Senegal (57.5 vs 0.9% of children). In Burkina Faso, prevalence was 57.7% in Nouna and 41.9% in Sapone in the 6 months-4 years age group, and 75.4% in Nouna and 70.1% in Sapone in the 5-9 years age group. Infections with other Plasmodium species were rare and only detected in Burkina Faso. While mosquito nets were used by 88.6-97.0 and 64.7-80.2% of children in Burkina Faso and Senegal, other malaria control measures evaluated at individual level were uncommon. In Burkina Faso, exploratory analyses suggested that use of malaria treatment or any other medication within 14 days, and use of insecticide spray within 7 days decreased the prevalence of malaria infection; older age, rural residence, natural floor, grass/palm roof, and unavailability of electricity in the house were factors associated with increased malaria occurrence. Conclusions: Plasmodium falciparum infection prevalence in children younger than 10 years was 57.5% in Burkina Faso and 0.9% in Senegal, and variability was observed, among others, by age, study site and malaria control measures

Reasons for Ouagadougou laboratory non conformance in 2010.

<p>Reasons for Ouagadougou laboratory non conformance in 2010.</p

Staff involved in HIV pediatric care per health district or university hospitals, and qualification, in Ouagadougou, in 2010.

<p>Others: pharmacy assistants and laboratory assistants.</p><p>Staff involved in HIV pediatric care per health district or university hospitals, and qualification, in Ouagadougou, in 2010.</p