Facteurs De Retard Diagnostique De La Tuberculose Pulmonaire Vus À l’Unité De Soins, De Formation Et De Recherche De Pneumologie Befelatanana

Delay in diagnosis is significant to tuberculosis prognosis. The aim of this study is to evaluate the diagnosis delay of tuberculosis and to identify determinants of “patient delay”, “health system delay”, and “total delay” in the diagnosis of tuberculosis. It is a prospective study of the patients who were hospitalized at the Unité de Soins de Formation et de Recherche (USFR) of Pneumology in Befelatanana, Antananarivo Madagascar, during the period of 1 st October 2014 to 30 April 2015 (7 months). We included all patients with diagnosis of pulmonary tuberculosis. Sixty six patients were also included. The mean time of patient delay, health system delay, and total delay were 26,30± 36,87, 69,56±64, and 96,35±72,65 days respectively. The different variables that affected diagnosis delay were: tobacco smoke (OR : 3,6723), asthenia (OR : 5,4815), anorexia (OR : 2,9524), and hemoptysis (OR : 0,2406) for the total delay. Knowledge about tuberculosis signs (OR : 0,164) and transmissions (OR : 0,243) was for the patient delay. Hemoptysis (OR : 8,1250), asthenia (OR : 0,1081), breathlessness (OR : 0,3556), infiltrative syndrome (OR : 0,2500), and alveolar syndrome (OR : 0,0687) in chest Xray was for the health system delay. Having an understanding of these factors of tuberculosis diagnosis delay will result to a decrease in the diagnosis delay

A prospective randomised trial comparing nasogastric with intravenous hydration in children with bronchiolitis (protocol) The comparative rehydration in bronchiolitis study (CRIB)

<p>Abstract</p> <p>Background</p> <p>Bronchiolitis is the most common reason for admission of infants to hospital in developed countries. Fluid replacement therapy is required in about 30% of children admitted with bronchiolitis. There are currently two techniques of fluid replacement therapy that are used with the same frequency-intravenous (IV) or nasogastric (NG).</p> <p>The evidence to determine the optimum route of hydration therapy for infants with bronchiolitis is inadequate. This randomised trial will be the first to provide good quality evidence of whether nasogastric rehydration (NGR) offers benefits over intravenous rehydration (IVR) using the clinically relevant continuous outcome measure of duration of hospital admission.</p> <p>Methods/Design</p> <p>A prospective randomised multi-centre trial in Australia and New Zealand where children between 2 and 12 months of age with bronchiolitis, needing non oral fluid replacement, are randomised to receive either intravenous (IV) or nasogastric (NG) rehydration.</p> <p>750 patients admitted to participating hospitals will be recruited, and will be followed daily during the admission and by telephone 1 week after discharge. Patients with chronic respiratory, cardiac, or neurological disease; choanal atresia; needing IV fluid resuscitation; needing an IV for other reasons, and those requiring CPAP or ventilation are excluded.</p> <p>The primary endpoint is duration of hospital admission. Secondary outcomes are complications, need for ICU admission, parental satisfaction, and an economic evaluation. Results will be analysed using t-test for continuous data, and chi squared for categorical data. Non parametric data will be log transformed.</p> <p>Discussion</p> <p>This trial will define the role of NGR and IVR in bronchiolitis</p> <p>Trail registration</p> <p>The trial is registered with the Australian and New Zealand Clinical Trials Registry - ACTRN12605000033640</p

Stereocilia-staircase spacing is influenced by myosin III motors and their cargos espin-1 and espin-like

Hair cells tightly control the dimensions of their stereocilia, which are actin-rich protrusions with graded heights that mediate mechanotransduction in the inner ear. Two members of the myosin-III family, MYO3A and MYO3B, are thought to regulate stereocilia length by transporting cargos that control actin polymerization at stereocilia tips. We show that eliminating espin-1 (ESPN-1), an isoform of ESPN and a myosin-III cargo, dramatically alters the slope of the stereocilia staircase in a subset of hair cells. Furthermore, we show that espin-like (ESPNL), primarily present in developing stereocilia, is also a myosin-III cargo and is essential for normal hearing. ESPN-1 and ESPNL each bind MYO3A and MYO3B, but differentially influence how the two motors function. Consequently, functional properties of different motor-cargo combinations differentially affect molecular transport and the length of actin protrusions. This mechanism is used by hair cells to establish the required range of stereocilia lengths within a single cell

Stereocilia-staircase spacing is influenced by myosin III motors and their cargos espin-1 and espin-like

Hair cells tightly control the dimensions of their stereocilia, which are actin-rich protrusions with graded heights that mediate mechanotransduction in the inner ear. Two members of the myosin-III family, MYO3A and MYO3B, are thought to regulate stereocilia length by transporting cargos that control actin polymerization at stereocilia tips. We show that eliminating espin-1 (ESPN-1), an isoform of ESPN and a myosin-III cargo, dramatically alters the slope of the stereocilia staircase in a subset of hair cells. Furthermore, we show that espin-like (ESPNL), primarily present in developing stereocilia, is also a myosin-III cargo and is essential for normal hearing. ESPN-1 and ESPNL each bind MYO3A and MYO3B, but differentially influence how the two motors function. Consequently, functional properties of different motor-cargo combinations differentially affect molecular transport and the length of actin protrusions. This mechanism is used by hair cells to establish the required range of stereocilia lengths within a single cell

Stereocilia-staircase spacing is influenced by myosin III motors and their cargos espin-1 and espin-like

Hair cells tightly control the dimensions of their stereocilia, which are actin-rich protrusions with graded heights that mediate mechanotransduction in the inner ear. Two members of the myosin-III family, MYO3A and MYO3B, are thought to regulate stereocilia length by transporting cargos that control actin polymerization at stereocilia tips. We show that eliminating espin-1 (ESPN-1), an isoform of ESPN and a myosin-III cargo, dramatically alters the slope of the stereocilia staircase in a subset of hair cells. Furthermore, we show that espin-like (ESPNL), primarily present in developing stereocilia, is also a myosin-III cargo and is essential for normal hearing. ESPN-1 and ESPNL each bind MYO3A and MYO3B, but differentially influence how the two motors function. Consequently, functional properties of different motor-cargo combinations differentially affect molecular transport and the length of actin protrusions. This mechanism is used by hair cells to establish the required range of stereocilia lengths within a single cell

A multicentre randomised controlled trial of levetiracetam versus phenytoin for convulsive status epilepticus in children (protocol): Convulsive Status Epilepticus Paediatric Trial (ConSEPT) - a PREDICT study

Background: Convulsive status epilepticus (CSE) is the most common life-threatening childhood neurological emergency. Despite this, there is a lack of high quality evidence supporting medication use after first line benzodiazepines, with current treatment protocols based solely on non-experimental evidence and expert opinion. The current standard of care, phenytoin, is only 60% effective, and associated with considerable adverse effects. A newer anti-convulsant, levetiracetam, can be given faster, is potentially more efficacious, with a more tolerable side effect profile. The primary aim of the study presented in this protocol is to determine whether intravenous (IV) levetiracetam or IV phenytoin is the better second line treatment for the emergency management of CSE in children. Methods/Design: 200 children aged between 3 months and 16 years presenting to 13 emergency departments in Australia and New Zealand with CSE, that has failed to stop with first line benzodiazepines, will be enrolled into this multicentre open randomised controlled trial. Participants will be randomised to 40 mg/kg IV levetiracetam infusion over 5 min or 20 mg/kg IV phenytoin infusion over 20 min. The primary outcome for the study is clinical cessation of seizure activity five minutes following the completion of the infusion of the study medication. Blinded confirmation of the primary outcome will occur with the primary outcome assessment being video recorded and assessed by a primary outcome assessment team blinded to treatment allocation. Secondary outcomes include: Clinical cessation of seizure activity at two hours; Time to clinical seizure cessation; Need for rapid sequence induction; Intensive care unit (ICU) admission; Serious adverse events; Length of Hospital/ICU stay; Health care costs; Seizure status/death at one-month post discharge. Discussion: This paper presents the background, rationale, and design for a randomised controlled trial comparing levetiracetam to phenytoin in children presenting with CSE in whom benzodiazepines have failed. This study will provide the first high quality evidence for management of paediatric CSE post first-line benzodiazepines. Trial registration: Prospectively registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR): ACTRN12615000129583(11/2/2015). UTN U1111-1144-5272. ConSEPT protocol version 4 (12/12/2014).The study is funded by grants from the Health Research Council of New Zealand (HRC 12/525), Auckland, New Zealand; A+ Trust (Auckland District Health Board), Auckland, New Zealand; Queensland Emergency Medicine Research Foundation, Milton, Queensland, Australia (EMPJ-105R21–2014- FURYK); Private Practice Research and Education Trust Fund, The Townsville Hospital and Health Service, Douglas, Queensland, Australia; Eric Ormond Baker Charitable Fund, Equity Trustees, Clayton, Victoria, Australia; and Princess Margaret Hospital Foundation, Perth, Western Australia, Australia. The PREDICT network is supported as a Centre of Research Excellence for Paediatric Emergency Medicine by the National Health and Medical Research Council, Canberra, Australian Capital Territory, Australia (NHMRC GNT1058560). The Victorian sites were supported by the Victorian Government’s Infrastructure Support Program, Melbourne, Victoria, Australia. FEB’s time was part funded by a grant from the Murdoch Childrens Research Institute and the Royal Children’s Hospital Foundation, Melbourne, Victoria, Australia. SRD’s time was part funded by the Health Research Council of New Zealand (HRC13/556). The study sponsor is Starship Children’s Health, Private Bag 92,024, Auckland 1142, New Zealan

EVALUATION DU TEST GENEXPERT MTB/RIF DANS LA PRISE EN CHARGE DIAGNOSTIQUE DE LA TUBERCULOSE AUX CHU BEFELATANANA ET FENOARIVO

Résumé: Introduction: Nous avons réalisé ce travail pour évaluer l’apport du test GeneXpert MTB/RIF dans le diagnostic de la tuberculose toute localisation confondue, la tuberculose pulmonaire à bacilloscopie négative (TPB-) et la tuberculose pleurale dans deux services de Pneumologie de deux Centres Hospitaliers Universitaires à Antananarivo. Méthodes: Il s’agit d’une étude rétrospective transversale descriptive et analytique de Janvier 2016 à Mars 2019 réalisée chez des patients suspects de tuberculose dans les deux services. Résultats: Deux cent vingt-et-un (50.92%) patients ont été retenus pour l’étude du test GeneXpert MTB/RIF pour la tuberculose toute forme confondue. Les prélèvements pulmonaires représentaient 81% des prélèvements totaux et le reste sont d’origine extra-pulmonaire. La bacilloscopie était positive dans 60.13% (N=153) des cas aux Centre de Diagnostic et de Traitement (CDT), et dans 72% (N=136) des cas dans les laboratoires de référence. Le test GeneXpert MTB/RIF a trouvé 57.72% (N=221) de résultats positifs. Une résistance à la rifampicine a été retrouvée chez 5 patients. Trente-quatre (75.5%) des 45 &nbsp;résultats de culture colligés étaient positifs. Pour tous les prélèvements, le test GeneXpert MTB/RIF a trouvé plus de résultats positifs que la bacilloscopie, et ses résultats ont été tous confirmés par la culture. La valeur de p est significative (&lt;0.05) pour la comparaison des tests des crachats. Cinquante (11.52%) patients ont été inclus dans l’étude du test GeneXpert MTB/RIF pour la TPB-. Les résultats positifs trouvés par une deuxième bacilloscopie dans les laboratoires de référence et le test GeneXpert MTB/RIF sont respectivement de 12.5% et de 58% chez des patients ayant eu au préalable une bacilloscopie négative aux CDT. Pour l’étude de l’apport du test GeneXpert MTB/RIF dans le diagnostic de la pleurésie tuberculeuse, nous avons trouvé les valeurs de la sensibilité, la spécificité, la valeur prédictive positive (VPP) et la valeur prédictive négative (VPN) pour le liquide pleural respectivement de: 20%, 100%, 100% et 62.5%, et pour la pièce biopsique pleurale respectivement de&nbsp;: 15%, 100%, 100% et 58.82% en considérant l’examen anatomo-pathologique comme examen de référence. Conclusion: Le test GeneXpert MTB/RIF est très performant pour le diagnostic de la tuberculose pulmonaire mais l’est moins pour le diagnostic de la tuberculose extra-pulmonaire. Mots-clés: GeneXpert MTB/RIF, diagnostic, tuberculose, TPB-, pleurésie tuberculeuse &nbsp; Abstract: Introduction: We have realied this study to evaluate GeneXpert MTB/RIF’s part in the diagnosis of all areas combined tuberculosis, pulmonary tuberculosis with negative microscopy and pleural tuberculosis in two Pneumology departments of &nbsp;two university hospital centers in Antananarivo. Methods: It is a descriptive and analytic retrospective cross-sectionnal study from January 2016 to March 2019 done in patients where tuberculosis was suspected in the two departments. Results: Two hundred and twenty-two (50.92%) patients were selected for GeneXpert MTB/RIF study for all areas combined tuberculosis. The pulmonary samples represented 81% of all samples and the restis from extra-pulmonary origins. The microscopy was positive in 60.13% (N=153) of the cases in the Diagnosis and Treatment Centers, and in 72% (N=136) of the cases in the reference laboratories. The GeneXpert MTB/RIF test has found 57.72% (N=221) positive results. A resistance to rifampicine has been found in 5 patients. Thirty-four (75.5%) of the 45 gathered culture results were positive. For all samples, the GeneXpert MTB/RIF has found more positive results than the microscopy, and its results were all confirmed by the culture. P-value was significant (&lt;0.05) for sputum tests. Fifty (11.52%) patients were included in the GeneXpert MTB/RIF study of negative microscopy pulmonary tuberculosis. The positive results found by a second microscopy in the reference laboratories and the GeneXpert MTB/RIF test were&nbsp; respectively 12.5% and 58% in patients having previously had a negative microscopy in the Diagnostic and Treatment Center. For the GeneXpert MTB/RIF’s contribution in pleural tuberculosis’diagnosis, we have found respectively a sensitivity, a specificity, a positive predictive value, a negative predictive value for pleural fluid of&nbsp;: 20%, 100%, 100% and 62.5% and for pleural biopsy of&nbsp;: 15%, 100%, 100% and 58.82% by considering histology as gold standard. Conclusion: The GeneXpert MTB/RIF test is a very effective tool for pulmonary tuberculosis diagnosis but less effective for extra-pulmonary tuberculosis diagnosis

Silicose Classique Et Compliquée Chez Deux Jeunes Frères Lapidaires

Les maladies professionnelles, qui se manifestent surtout chez les mineurs et les lapidaires, ne sont pas encore maîtrisées à Madagascar. Les conditions de travail et la pauvreté constituent des facteurs de gravité des pneumoconioses. Dans cet article deux cas de jeunes frères lapidaires sont rapportés, atteints d’une silicose diagnostiquée au stade tardif reflétant cette réalité. La symptomatologie était dominée par une dyspnée chronique d’aggravation progressive compliquée d’une insuffisance respiratoire chronique et d’un cœur pulmonaire chronique chez les deux patients. Les investigations étaient limitées par le manque de moyens financiers. La radiologie a montré une image de miliaire pour le premier patient, et une atélectasie de deux lobes pulmonaires à droite pour le deuxième. Le traitement était basé sur l’usage de corticoïdes, de bronchodilatateurs et surtout sur l’oxygénothérapie de longue durée. Leur évolution clinique a été favorable au début de l’hospitalisation mais s’est détériorée au bout de quelques semaines. La silicose est une affection grave, notamment par ses complications. À Madagascar, le système de santé jouerait un grand rôle dans sa prévention. Occupational diseases, which occur especially among mineworkers and stonecutters, are yet to be controlled in Madagascar. Working conditions and poverty are factors of pneumoconiosis gravity. This paper focuses on two cases of two young stonecutters’ brothers affected by a silicosis diagnosed at a late stage, reflecting this reality. The symptomatology was dominated by a chronic dyspnea with gradual worsening, complicated by chronic respiratory failure and chronic cor pulmonale in the two patients. The investigations were limited by the lack of financial resources. Radiology showed miliary for the first patient and two lobes’ atelectasis for the second patient. The treatment was based on the use of corticoids and bronchodilators, most especially, on long term oxygen therapy. Their clinical evolution was successful at the beginning of their hospitalization but later worsened after some weeks. Silicosis is a serious condition, particularly by its complications. In Madagascar, the health care system aims to play a significant role in its prevention

A multicentre randomised controlled trial of levetiracetam versus phenytoin for convulsive status epilepticus in children (protocol): Convulsive Status Epilepticus Paediatric Trial (ConSEPT) - a PREDICT study

Background: Convulsive status epilepticus (CSE) is the most common life-threatening childhood neurological emergency. Despite this, there is a lack of high quality evidence supporting medication use after first line benzodiazepines, with current treatment protocols based solely on non-experimental evidence and expert opinion. The current standard of care, phenytoin, is only 60% effective, and associated with considerable adverse effects. A newer anti-convulsant, levetiracetam, can be given faster, is potentially more efficacious, with a more tolerable side effect profile. The primary aim of the study presented in this protocol is to determine whether intravenous (IV) levetiracetam or IV phenytoin is the better second line treatment for the emergency management of CSE in children. Methods/Design: 200 children aged between 3 months and 16 years presenting to 13 emergency departments in Australia and New Zealand with CSE, that has failed to stop with first line benzodiazepines, will be enrolled into this multicentre open randomised controlled trial. Participants will be randomised to 40 mg/kg IV levetiracetam infusion over 5 min or 20 mg/kg IV phenytoin infusion over 20 min. The primary outcome for the study is clinical cessation of seizure activity five minutes following the completion of the infusion of the study medication. Blinded confirmation of the primary outcome will occur with the primary outcome assessment being video recorded and assessed by a primary outcome assessment team blinded to treatment allocation. Secondary outcomes include: Clinical cessation of seizure activity at two hours; Time to clinical seizure cessation; Need for rapid sequence induction; Intensive care unit (ICU) admission; Serious adverse events; Length of Hospital/ICU stay; Health care costs; Seizure status/death at one-month post discharge. Discussion: This paper presents the background, rationale, and design for a randomised controlled trial comparing levetiracetam to phenytoin in children presenting with CSE in whom benzodiazepines have failed. This study will provide the first high quality evidence for management of paediatric CSE post first-line benzodiazepines.Stuart R. Dalziel, Jeremy Furyk, Megan Bonisch, Ed Oakley, Meredith Borland … Kochar Amit … et al

Desire and Dread from the Nucleus Accumbens: Cortical Glutamate and Subcortical GABA Differentially Generate Motivation and Hedonic Impact in the Rat

Background: GABAergic signals to the nucleus accumbens (NAc) shell arise from predominantly subcortical sources whereas glutamatergic signals arise mainly from cortical-related sources. Here we contrasted GABAergic and glutamatergic generation of hedonics versus motivation processes, as a proxy for comparing subcortical and cortical controls of emotion. Local disruptions of either signals in medial shell of NAc generate intense motivated behaviors corresponding to desire and/or dread, along a rostrocaudal gradient. GABA or glutamate disruptions in rostral shell generate appetitive motivation whereas disruptions in caudal shell elicit fearful motivation. However, GABA and glutamate signals in NAc differ in important ways, despite the similarity of their rostrocaudal motivation gradients. Methodology/Principal Findings: Microinjections of a GABAA agonist (muscimol), or of a glutamate AMPA antagonist (DNQX) in medial shell of rats were assessed for generation of hedonic ‘‘liking’ ’ or ‘‘disliking’ ’ by measuring orofacial affective reactions to sucrose-quinine taste. Motivation generation was independently assessed measuring effects on eating versus natural defensive behaviors. For GABAergic microinjections, we found that the desire-dread motivation gradient was mirrored by an equivalent hedonic gradient that amplified affective taste ‘‘liking’ ’ (at rostral sites) versus ‘‘disliking’ ’ (at caudal sites). However, manipulation of glutamatergic signals completely failed to alter pleasure-displeasure reactions to sensory hedonic impact, despite producing a strong rostrocaudal gradient of motivation