The phage therapy paradigm: prêt-à-porter or sur-mesure?

The present opinion is the result of discussions on the future of phage therapy (personalized or large-scale uniform therapy?) during the first International Congress on Viruses of Microbes, held at the Institut Pasteur in Paris on June 21–25, 2010

The Corinth Rift Laboratory, Greece (CRL): A Multidisciplinary Near Fault Observatory (NFO) on a Fast Rifting System

The western rift of Corinth (Greece) is one of the most active tectonic structures of the euro-mediterranean area. Its NS opening rate is 1.5 cm/yr ( strain rate of 10-6/yr) results into a high microseismicity level and a few destructive, M>6 earthquakes per century, activating a system of mostly north dipping normal faults. Since 2001, monitoring arrays of the European Corinth Rift Laboratory (CRL, www.crlab.eu) allowed to better track the mechanical processes at work, with short period and broad band seismometers, cGPS, borehole strainmeters, EM stations, …). The recent (300 kyr) tectonic history has been revealed by onland (uplifted fan deltas and terraces) and offshore geological studies (mapping, shallow seismic, coring), showing a fast evolution of the normal fault system. The microseismicity, dominated by swarms lasting from days to months, mostly clusters in a layer 1 to 3 km thick, between 6 and 9 km in depth, dipping towards north, on which most faults are rooting. The diffusion of the microseismicity suggests its triggering by pore pressure transients, with no or barely detected strain. Despite a large proportion of multiplets, true repeaters seem seldom, suggesting a minor contribution of creep in their triggering, although transient or steady creep is clearly detected on the shallow part of some majors faults. The microseismic layer may thus be an immature, downward growing detachment, and the dominant rifting mechanism might be a mode I, anelastic strain beneath the rift axis , for which a mechanical model is under development. Paleoseismological (trenching, paleoshorelines, turbidites), archeological and historical studies completed the catalogues of instrumental seismicity, motivating attempts of time dependent hazard assessment. The Near Fault Observatory of CRL is thus a multidisciplinary research infrastructure aiming at a better understanding and modeling of multiscale, coupled seismic/aseismic processes on fault systems.Grant for Researchers (CC) ID 188753

Characteristics and outcomes of reversed patients admitted to an emergency department for VKA-related intramuscular hematoma

Background According to the International Society on Thrombosis and Haemostasis (ISTH), intramuscular hematoma without other severity criteria is not considered a major bleeding. Objectives: In a large cohort of reversed vitamin K antagonist (VKA) patients admitted to the emergency unit for muscular hematoma, we assess frequency, severity, and anticoagulation management based on whether ISTH criteria were met or not. Materials and methods We performed a retrospective single-center study involving patients admitted to an emergency unit for VKA-induced intramuscular hematoma whose bleeding was reversed with prothrombin complex concentrates. Results During the study period, 631 VKA-induced bleeding events occurred in our emergency unit, of which 73 (11.6%) were intramuscular hematomas and half met ISTH criteria. The mean age was 75.5 years (95% CI = 72.6–78.3). Admission blood tests showed that patients with ISTH criteria had higher international normalized ratio (7.0 ± 4.6 vs. 4.1 ± 3.0, p = 0.002) and lower hemoglobin (8.1 ± 1.8 vs. 11.9 ± 2.2, p < 0.001) than those without. Patients with ISTH criteria were more likely to have intramuscular hematoma in the iliopsoas, gluteal, and pectoral muscles than those without. Interestingly, two-thirds of rectus sheath hematomas involved patients without ISTH criteria. However, patients with or without ISTH criteria exhibited a similar hospitalization duration and rate of re-bleeding. Conclusion We showed that half of the patients admitted with intramuscular hematoma could not be qualified as having ISTH-criteria major bleeding. Interestingly, these patients displayed a similar hospitalization duration and rate of re-bleeding to those with ISTH-criteria major bleeding

Evaluation of the efficacy and tolerance of a short 7 day third-generation cephalosporin treatment in the management of acute pyelonephritis in young women in the emergency department

International audienc

Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial

AIMS: The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. METHODS AND RESULTS: Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient's opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. CONCLUSIONS: For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Risk Factors for Antibiotic-Resistant Escherichia coli Isolated from Hospitalized Patients with Urinary Tract Infections: a Prospective Study

From November 1998 to February 1999 we prospectively evaluated the prevalence of resistance to penicillins, cephalosporins, carbapenem, quinolones, aminoglycosides, and trimethoprim-sulfamethoxazole (SXT) in 320 Escherichia coli isolates isolated from hospitalized patients with acute urinary tract infections (UTIs). We also studied for these strains risk factors for resistance to amoxicillin-clavulanic acid (AMC), fluoroquinolones (FQs), and SXT. Resistance rates were consistent with those from major recent studies reported in the literature. Multivariate analyses selected the following factors as being significantly associated with E. coli resistance: (i) for resistance to AMC, prior (1 year) UTI (odds ratio [OR] = 2.71, P = 0.006), prior (1 year) urinary catheter (OR = 2.98, P = 0.0025), and prior (6 months) antibiotic exposure (OR = 2.68, P = 0.005); (ii) for resistance to FQs male sex (OR = 3.87, P = 0.03), with a trend toward significance for age >65 years (OR = 7.67, P = 0.06) and prior (1 year) UTI (OR = 2.98, P = 0.07); and (iii) for resistance to SXT, male sex (OR = 1.91, P = 0.046), hospitalization in an intermediate-term-care unit (OR = 2.18, P = 0.008), and prior (1 year) UTI (OR = 2.03, P = 0.03). Ours results suggest that prior UTI is a common risk factor for resistance to the different antibiotics tested. Although few studies on risk factors for E. coli resistance to antibiotics have been published, careful interpretation of their findings, taking into consideration the population, infection site, and period studied, should contribute to the formulation of a better strategy that can be used to overcome antibiotic resistance