Diagnostic stewardship in infectious diseases:a continuum of antimicrobial stewardship in the fight against antimicrobial resistance

Antimicrobial resistance (AMR) has been exacerbated by the inappropriate use of diagnostics, leading to excessive prescription of antimicrobials, and is an imminent threat to global health. Diagnostic stewardship (DS) is an auxiliary to antimicrobial stewardship (AMS) and comprises ordering the right tests, for the right patient, at the right time. It also promotes the judicious use of rapid and novel molecular diagnostic tools to enable the initiation of proper antibiotic therapy, while avoiding excessive use of broad-spectrum antibiotics. Proper interpretation of test results is crucial to avoid overdiagnosis and excessive healthcare costs. Although many rapid diagnostic tools have been developed with a high diagnostic yield, they are often limited by accessibility, cost, and lack of knowledge regarding their use. Careful consideration of clinical signs and symptoms with knowledge of the local epidemiology are essential for DS. This enables appropriate interpretation of microbiological results. Multidisciplinary teams that include well trained professionals should cooperate to promote DS. Challenges and barriers to the implementation of DS are mostly caused by scarcity of resources and lack of trained personnel and, most importantly, lack of knowledge. The lack of resources is often due to absence of awareness of the impact that good medical microbiology diagnostic facilities and expertise can have on the proper use of antibiotics.</p

LONG-TERM FOLLOW-UP AFTER TRANSORAL OUTLET REDUCTION FOR WEIGHT REGAIN AFTER ROUX-EN-Y GASTRIC BYPASS: BACK TO STAGE 0?

Background and study aim: Significant weight regain affects up to a third of patients after Roux-en-Y Gastric Bypass (RYGB) and demands treatment. The transoral outlet reduction (TORe) with Argon Plasma Coagulation (APC) alone or APC plus full-thickness suturing TORe (APC-FTS) is effective in the short. However, no study has investigated the course of the gastrojejunostomy (GJ) or quality of life (QOL) data after the first post-procedural year. Patients and methods: Patients eligible for a 36-month follow-up visit after TORe underwent upper GI endoscopy with measurement of the GJ and answered QOL questionnaires (RAND-36). The primary aim was to evaluate the long-term outcomes of TORe, including weight loss, QOL, and GJA size. Comparisons between APC and APC-FTS TORe were a secondary aim. Results: Among 39 eligible patients, 29 returned for the 3-year follow-up visit. There were no significant differences in demographics between APC and APC-FTS TORe groups. At 3 years, patients from both groups regained all the weight lost at 12 months, and the GJ diameter was similar to the pre-procedure assessment. As to QOL, most improvements seen at 12 months were lost at 3 years, returning to preprocedural levels. Only the energy/fatigue domain improvement was kept between the one and 3-year visits. Conclusions: Obesity is a chronic relapsing disease. Most effects of TORe are lost at 3 years, and redilation of the GJA occurs. Therefore, TORe should be considered an iterant rather than a one-off procedure

Tubularization of the gastric pouch helps sustain weight loss after transoral outlet reduction for post-Roux-en-Y gastric bypass weight recurrence

Background Traditional transoral outlet reduction (TORe) is a minimally invasive endoscopic approach focused on reducing the aperture of the gastrojejunal (GJ) anastomosis, while the tubular transoral outlet reduction (tTORe) consists of tabularization of the distal pouch utilizing an O-shape gastroplasty suturing pattern. The primary aim of this study is to compare the short-term weight loss between TORe and tTORe. Methods Retrospective analysis of a prospectively maintained database was conducted at a tertiary care bariatric center of excellence. The study included patients with history of Roux-en-Y gastric bypass (RYGB) who had an endoscopic revision by TORe or tTORe and had follow-up data in their electronic medical record. The primary outcome was % total body weight loss (%TBWL). Results A total of 128 patients were included (tTORe=85, TORe=43). At 3 and 6 months, the tTORe and TORe cohorts presented similar %TBWL (3 months: 8.5 ±4.9 vs. 7.3 ±6.0, p=0.27 and 6 months: 8.1 ±7.4 vs. 6.8 ±5.6, p=0.44). At 9 months, there was a trend towards greater weight loss in the tTORe cohort (9.7 ± 8.6% vs. 5.1 ± 6.8%, p=0.053). At 12 months, the %TBWL was significantly higher in the tubularization group compared to the standard group (8.2 ±10.8 vs. 2.3 ±7.3%, p=0.01). Procedure time was significantly different between both groups (60.5 vs. 53.4 minutes, p=0.03). The adverse events rate was similar between groups (8.2% vs. 7.0% for tTORe and TORe, respectively, p=0.61). Conclusion The tTORe enhances efficacy and durability of the standard procedure without adding significant procedure-related risks

Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes

: The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines

Réfugiés et migrants au Liban

Petit État aux savants (dés)équilibres communautaires, le Liban compte sur son sol une proportion notable d’« étrangers » : près d’un habitant sur quatre, dont la majeure partie est à présent constituée de réfugiés syriens. Ce dossier dresse un état des lieux de la présence des étrangers au Liban à partir d’enquêtes de terrain conduites par une équipe de recherche franco-libanaise. Mêlant articles de fond et documents, ces recherches mettent en lumière la diversité des interactions entre les migrants et la société libanaise, à travers leurs pratiques commerciales, leurs modes d’installation ou encore leur accès aux systèmes de soin et d’éducation libanais