Social Protection in Zambia – Whose Politics?

Attempts have been made to explain why social protection systems seem least likely to become established where they are most needed. Often, however, these attempts have not captured the rather complex politics in the countries in question. Analyses have turned the Minister of Finance into the sole representative of political will, have equated low budgetary allocations with a politically unattractive programme design and have ignored the long and erratic histories of social protection in the Western world. The appropriate roles for donors and civil societies in such political economies remain equally unclear. On the basis of other ‘drivers of change’ studies, this article takes a closer look at the political dynamics behind social protection in Zambia. It examines whether the observed or deduced stagnation in social protection is due to stakeholders in Zambia rejecting policy recommendations, the inappropriate nature of these recommendations or a premature assessment of progress made

Pathologies rhinosinusiennes et asthme sévère

Introduction : notre hypothèse était que l’atteinte rhinosinusienne chronique permettait de phénotyper la maladie asthmatique. Nous avons classé nos patients asthmatiques sévères en 3 groupes : No RC (absence de RSC), RCsPN (RSC sans polypose nasosinusienne) et RCaPN (RSC avec polypose nasosinusienne), pour comparer les caractéristiques cliniques, fonctionnelles et biologiques de l’asthme.Méthodes : nous avons mis au point un score de symptôme rhinosinusiens adapté du questionnaire SNOT-22. Le groupe No RC présentait un score nul. Le groupe RCsPN avait un score de symptômes >0 et ne portait pas le diagnostic de polypose nasosinusienne. Le groupe RCaPN avait un score de symptômes >0 et portait un diagnostic de polypose nasosinusienne. Nous avons déterminé : le nombre d’exacerbations dans l’année, le meilleur VEMS, l’éosinophilie sanguine, les tests cutanés, le traitement par corticothérapie générale et/ou biothérapie, le résultat du scanner des sinus et de la consultation ORL, l’intolérance à l’aspirine, la corticothérapie nasale, et l’âge de survenue de l’asthme. Résultats : les 3 groupes de patients avaient des scores de symptômes rhinosinusiens différents : nuls dans le groupe No RC, modérés dans le groupe RCsPN et sévères dans le groupe RCaPN. L’éosinophilie sanguine était plus importante dans le groupe RCaPN que dans le groupe RCsPN, avec la mise en évidence d’une corrélation positive entre la sévérité des symptômes rhinosinusiens et l’éosinophilie sanguine maximale connue. Il existait une corrélation négative entre le score de sévérité des symptômes rhinosinusiens et le VEMS des patients. Le groupe RCaPN, avec la RSC la plus sévère, avait la meilleure fonction respiratoire. L’âge de survenue de l’asthme semblait plus tardif chez les patients atteints de RSC. Le groupe No RC représentaient 5% de l’effectif et se distinguait par une fonction respiratoire significativement inférieure aux autres malades. Conclusion : l’atteinte rhinosinusienne chronique permettait de distinguer nos patients selon des critères fonctionnels et biologiques pertinents : le VEMS et l’éosinophilie sanguine. Ces données suggèrent d’avantage d’inflammation à médiation « non TH2 » dans le groupe No RC et d’avantage d’inflammation à médiation « TH2 » dans le groupe RCaPN. Le groupe RCsPN pourrait être constitué de patients pour lesquels plusieurs mécanismes à l’origine de l’inflammation des voies aériennes se chevauchent

Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives

This article reports the various methods used to assess diaphragmatic function by ultrasonography. The excursions of the two hemidiaphragms can be measured using two-dimensional or M-mode ultrasonography, during respiratory maneuvers such as quiet breathing, voluntary sniffing and deep inspiration. On the zone of apposition to the rib cage for both hemidiaphragms, it is possible to measure the thickness on expiration and during deep breathing to assess the percentage of thickening during inspiration. These two approaches make it possible to assess the quality of the diaphragmatic function and the diagnosis of diaphragmatic paralysis or dysfunction. These methods are particularly useful in circumstances where there is a high risk of phrenic nerve injury or in diseases affecting the contractility or the motion of the diaphragm such as neuro-muscular diseases. Recent methods such as speckle tracking imaging and ultrasound shear wave elastography should provide more detailed information for better assessment of diaphragmatic function

Diaphragmatic motion recorded by M-mode ultrasonography: limits of normality

International audienceChest ultrasonography has proven to be useful in the diagnosis of diaphragm dysfunction. The aim of the present study was to determine the normal values of the motion of both hemidiaphragms recorded by M-mode ultrasonography. Healthy volunteers were studied while in a seated position. Diaphragmatic excursions and diaphragm profiles were measured during quiet breathing, voluntary sniffing and deep breathing. Diaphragmatic excursions were assessed by M-mode ultrasonography, using an approach perpendicular to the posterior part of the diaphragm. Anatomical M-mode was used for the recording of the complete excursion during deep breathing. The study included 270 men and 140 women. The diaphragmatic motions during quiet breathing and voluntary sniffing were successfully recorded in all of the participants. The use of anatomical M-mode was particularly suitable for measurement of the entire diaphragmatic excursion during deep breathing. The statistical analysis showed that the diaphragmatic excursions were larger in men compared to women, supporting the determination of normal values based on sex. The lower and upper limits of normal excursion were determined for men and women for both hemidiaphragms during the three manoeuvres that were investigated. The lower limits of normal diaphragmatic excursions during deep breathing should be used to detect diaphragmatic hypokinesia, i.e. 3.3 and 3.2 cm in women and 4.1 and 4.2 cm in men for the right and the left sides, respectively. The normal values of the diaphragmatic motion and the lower and upper limits of normal excursion can be used by clinicians to detect diaphragmatic dysfunction

Two uncommon cases of Pneumococcal pyomyositis

International audienceWe report two new cases of pneumococcal pyomyositis managed at an inter-regional referral centre for bone and joint infections in the south of France. One of our patients had heterozygous sickle-cell disease, and the second had no apparent immunodeficiency. The pneumococcal pyomyositis was localized primarily to the psoas muscle and was complicated by hip arthroplasty infection in one of our cases. In the other case, it was localized to the abductor muscle, which has not been reported previously

Irrational decision-making among entrepreneurs? Unraveling escalation of commitment bias through a motivated cognition perspective

Irrational decision-making among entrepreneurs? Unraveling escalation of commitment bias through a motivated cognition perspectiv

Ultrasound Assessment of Diaphragm Thickness and Thickening: Reference Values and Limits of Normality When in a Seated Position

International audienceBackground: Diagnosing diaphragm dysfunction in the absence of complete paralysis remains difficult. The aim of the present study was to assess the normal values of the thickness and the inspiratory thickening of both hemidiaphragms as measured by ultrasonography in healthy volunteers while in a seated position. Methods: Healthy volunteers with a normal pulmonary function test were recruited. The diaphragmatic thickness was measured on both sides at the zone of apposition of the diaphragm to the rib cage during quiet breathing at end-expiration, end-inspiration, and after maximal inspiration. The thickening ratio, the thickening fraction, and the thickness at end-inspiration divided by the thickness at deep breathing were determined. The mean values and the lower and upper limits of normal were determined for men and women. Results: 200 healthy volunteers (100 men and 100 women) were included in the study. The statistical analysis revealed that women had a thinner hemidiaphragm than men on both sides and at the various breathing times studied. The lower limit of normality of the diaphragm thickness measured at end-expiration was estimated to be 1.3 mm in men and 1.1 mm in women, on both sides. The thickening fraction did not differ significantly between men and women. In men, it ranged from 60 to 260% on the left side and from 57 to 200% on the right side. In women, it ranged from 58 to 264% on the left side and from 60 to 229% on the right side. The lower limits of normality of the thickening fraction were determined to be 40 and 39% in men and 39 and 48% in women for the right and left hemidiaphragms, respectively. The upper limit for normal of the mean of both sides of the ratio thickness at end-inspiration divided by the thickness at deep breathing was determined to be 0.78 in women and 0.79 in men. Conclusion: The normal values of thickness and the indexes of diaphragmatic function should help clinicians with detecting diaphragm atrophy and dysfunction

Low Dose Chest CT and Lung Ultrasound for the Diagnosis and Management of COVID-19

International audienceBackground: The COVID-19 pandemic has provided an opportunity to use low- and non-radiating chest imaging techniques on a large scale in the context of an infectious disease, which has never been done before. Previously, low-dose techniques were rarely used for infectious diseases, despite the recognised danger of ionising radiation. Method: To evaluate the role of low-dose computed tomography (LDCT) and lung ultrasound (LUS) in managing COVID-19 pneumonia, we performed a review of the literature including our cases. Results: Chest LDCT is now performed routinely when diagnosing and assessing the severity of COVID-19, allowing patients to be rapidly triaged. The extent of lung involvement assessed by LDCT is accurate in terms of predicting poor clinical outcomes in COVID-19-infected patients. Infectious disease specialists are less familiar with LUS, but this technique is also of great interest for a rapid diagnosis of patients with COVID-19 and is effective at assessing patient prognosis. Conclusions: COVID-19 is currently accelerating the transition to low-dose and “no-dose” imaging techniques to explore infectious pneumonia and their long-term consequences

Different pattern of the second outbreak of COVID-19 in Marseille, France

International audienc

Low-dose chest CT for diagnosing and assessing the extent of lung involvement of SARS-CoV-2 pneumonia using a semi quantitative score

International audienceObjectives The purpose is to assess the ability of low-dose CT (LDCT) to determine lung involvement in SARS-CoV-2 pneumonia and to describe a COVID19-LDCT severity score. Materials and methods Patients with SARS-CoV-2 infection confirmed by RT-PCR were retrospectively analysed. Clinical data, the National Early Warning Score (NEWS) and imaging features were recorded. Lung features included ground-glass opacities (GGO), areas of consolidation and crazy paving patterns. The COVID19-LDCT score was calculated by summing the score of each segment from 0 (no involvement) to 10 (severe impairment). Univariate analysis was performed to explore predictive factor of high COVID19-LDCT score. The nonparametric Mann-Whitney test was used to compare groups and a Spearman correlation used with p<0.05 for significance. Results Eighty patients with positive RT-PCR were analysed. The mean age was 55 years +/- 16, with 42 males (53%). The most frequent symptoms were fever (60/80, 75%) and cough (59/80, 74%), the mean NEWS was 1.7 +/- 2.3. All LDCT could be analysed and 23/80 (28%) were normal. The major imaging finding was GGOs in 56 cases (67%). The COVID19-LDCT score (mean value = 19 +/- 29) was correlated with NEWS (r = 0.48, p<0.0001). No symptoms were risk factor to have pulmonary involvement. Univariate analysis shown that dyspnea, high respiratory rate, hypertension and diabetes are associated to a COVID19-LDCT score superior to 50. Conclusions COVID19-LDCT score did correlate with NEWS. It was significantly different in the clinical low-risk and high-risk groups. Further work is needed to validate the COVID19-LDCT score against patient prognosis