Delay in Diagnosis of Influenza Virus in an Elderly Hospitalized Patient: a Fatal Outcome

Influenza is a well established cause of seasonal hospitalizations and deaths among older persons. However, influenza is frequently underdiagnosed by physicians, because its clinical presentations are often complex, particularly in elderly patients. We report the case of a 78-year-old woman admitted to the emergency department in January 2008 with fever, vomiting, and a history of asthenia and falls in the preceding three days. Diagnosis of influenza at admission was missed. Influenza was diagnosed by direct fluorescent antibody in a sputum specimen four days later, but the evolution was rapidly unfavorable with fatal respiratory distress syndrome. This case illustrates that, during the influenza season, influenza should be suspected in elderly patients admitted to hospital even if they do not present with classical symptoms. Immunofluorescence testing on sputum specimens can provide a rapid diagnosis and merits further evaluation

Breast cancer: a randomized controlled trial assessing the effect of a decision aid on mammography screening uptake: study protocol

IntroductionBreast cancer (BC) is the primary cancer among women. The World Health Organization recommends a bilateral screening mammogram every 2 years for women aged 50 to 74 years. However, it has been shown that there is an absence of information about the benefits and risks of screening. Shared medical decision-making is important to ensure patients are involved in the decision process. Decision aids can facilitative this decision-making process. This article presents a protocol to evaluate the effect of a decision aid on participation rates in the French organized BC screening program.Methods and analysisDesign and setting. The design is a 2 arm randomized controlled study, performed in the Pays de la Loire region (French West Coast). Randomization will be based on general medicine practices (Primary Care).ParticipantsWomen aged between 50 and 74 years, eligible for BC screening. In this region, there are 75000 women, and 2800 general practitioners eligible for recruitment.InterventionIn the « Decision aid for organized cancer screening » arm, the intervention will distribute invitation letters to eligible women combined with the provision of decision aid to these women and their general practitioners and an incentive to implement shared medical decision-making. In the « Standard organized cancer screening » arm, only the screening invitation will be sent to eligible women.Primary endpointBC screening participation rates will be assessed after an 18-month follow-up period.Statistical analysisIn this non-inferiority trial, the percentage of women who are up-to-date with their screening at 18 months after the intervention will be compared across arms using a generalized mixed linear model.DiscussionThe research team expect to demonstrate that providing a better explanation of the benefits and risks of BC screening is not at odds with screening participation. The study results should help policy makers thinking about implementing shared medical decision-making within the framework of organized BC screening programs in the future.Ethics and disseminationOn 6 December 2021, the protocol received a favorable opinion from the French Committee for the Protection of Persons (2021-A01583-38). This study is registered with ClinicalTrials.gov, number NCT05607849. (Version 1, November 7, 2022; https://www.clinicaltrials.gov/ct2/show/NCT05607849). The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings

16p11.2 600 kb Duplications confer risk for typical and atypical Rolandic epilepsy

Rolandic epilepsy (RE) is the most common idiopathic focal childhood epilepsy. Its molecular basis is largely unknown and a complex genetic etiology is assumed in the majority of affected individuals. The present study tested whether six large recurrent copy number variants at 1q21, 15q11.2, 15q13.3, 16p11.2, 16p13.11 and 22q11.2 previously associated with neurodevelopmental disorders also increase risk of RE. Our association analyses revealed a significant excess of the 600 kb genomic duplication at the 16p11.2 locus (chr16: 29.5-30.1 Mb) in 393 unrelated patients with typical (n = 339) and atypical (ARE; n = 54) RE compared with the prevalence in 65 046 European population controls (5/393 cases versus 32/65 046 controls; Fisher's exact test P = 2.83 × 10−6, odds ratio = 26.2, 95% confidence interval: 7.9-68.2). In contrast, the 16p11.2 duplication was not detected in 1738 European epilepsy patients with either temporal lobe epilepsy (n = 330) and genetic generalized epilepsies (n = 1408), suggesting a selective enrichment of the 16p11.2 duplication in idiopathic focal childhood epilepsies (Fisher's exact test P = 2.1 × 10−4). In a subsequent screen among children carrying the 16p11.2 600 kb rearrangement we identified three patients with RE-spectrum epilepsies in 117 duplication carriers (2.6%) but none in 202 carriers of the reciprocal deletion. Our results suggest that the 16p11.2 duplication represents a significant genetic risk factor for typical and atypical R

Effects of eight neuropsychiatric copy number variants on human brain structure

Many copy number variants (CNVs) confer risk for the same range of neurodevelopmental symptoms and psychiatric conditions including autism and schizophrenia. Yet, to date neuroimaging studies have typically been carried out one mutation at a time, showing that CNVs have large effects on brain anatomy. Here, we aimed to characterize and quantify the distinct brain morphometry effects and latent dimensions across 8 neuropsychiatric CNVs. We analyzed T1-weighted MRI data from clinically and non-clinically ascertained CNV carriers (deletion/duplication) at the 1q21.1 (n = 39/28), 16p11.2 (n = 87/78), 22q11.2 (n = 75/30), and 15q11.2 (n = 72/76) loci as well as 1296 non-carriers (controls). Case-control contrasts of all examined genomic loci demonstrated effects on brain anatomy, with deletions and duplications showing mirror effects at the global and regional levels. Although CNVs mainly showed distinct brain patterns, principal component analysis (PCA) loaded subsets of CNVs on two latent brain dimensions, which explained 32 and 29% of the variance of the 8 Cohen’s d maps. The cingulate gyrus, insula, supplementary motor cortex, and cerebellum were identified by PCA and multi-view pattern learning as top regions contributing to latent dimension shared across subsets of CNVs. The large proportion of distinct CNV effects on brain morphology may explain the small neuroimaging effect sizes reported in polygenic psychiatric conditions. Nevertheless, latent gene brain morphology dimensions will help subgroup the rapidly expanding landscape of neuropsychiatric variants and dissect the heterogeneity of idiopathic conditions

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Interprétation du RCF et état néonatal : quels enjeux pour l'expulsion ?

Context: Fetal heart rate monitoring (FHR) is the usual method of perpartum fetal evaluation. French recommendations advise limiting the duration of active pushing to 30 minutes and use Melchior's classification during expulsion. In Anglo-Saxon's countries, FIGO's classification is used during labor and no limit is recommended for expulsion. Objectives: To assess the correlation between FHR and neonatal outcomes comparing FIGO's and Melchior's classification, in order to determine what classification is more predictive for a low neonatal outcome and what situation could allow pushing more than 30 minutes. Materials and methods: 255 low risk primiparous women were included in a retrospective study conducted to Port-Royal's maternity ward. A low neonatal outcome was defined by at least one of the following criteria: 5-minute Apgar Score ≤7, cord blood pH ≤7.20, newborn resuscitation and admission in neonatal intensive unit care. Results: For the expulsion, FIGO's and Melchior's classifications were different. FIGO was more specific than Melchior's classification to predict a low neonatal outcome. Cord blood pH ≤7.20 was significantly correlated with the FHR's type and more associated with FIGO's classification (p< 0,001). The more abnormal the FHR was, the more cord blood pH ≤7.20 were raised. When pushing efforts were prolonged, cord blood pH ≤7.20 (p=0,08) and admission in neonatal intensive unit care (p=0,09) were increased. When the FHR was normal during the second stage of labor, low neonatal outcome was comparable even if the duration of active pushing was more than 30 minutes. 5-minute Apgar Score ≤7 and newborn resuscitation were similar as regards the FHR's type, the classification and the duration of active pushing. Conclusion: FIGO's classification is more predictive than Melchior's classification for a low neonatal outcome and should be preferred to interpret the FHR during the expulsion. FHR's abnormalities may be an important risk factor of a low neonatal outcome. When the FHR is normal during the entire second stage of labor, women could push more than 30 minutes. But our results must be interpreted cautiously and need others studies to confirm it.Contexte : L'enregistrement du rythme cardiaque fœtal est la méthode usuelle de surveillance fœtale pendant le travail. En France, la classification de Melchior (1972) est spécifiquement utilisée pour la phase d'expulsion et la durée recommandée des efforts expulsifs est de 30 minutes. Dans la plupart des pays anglo-saxons, cette limite n'existe pas et la classification de la FIGO (1987) est utilisée pendant tout le travail. But : Évaluer la corrélation entre le RCF et l'état néonatal en comparant les classifications de la FIGO et de Melchior, afin de déterminer quelle classification prédit le mieux le risque de mauvais état néonatal et quelle situation pourrait permettre d'envisager une durée d'efforts expulsifs supérieure à 30 minutes. Matériel et méthode : Étude rétrospective regroupant toutes les primipares à bas risque ayant accouché à la maternité de Port-Royal entre le 1er Janvier et le 30 Juin 2009, soit 255 dossiers. Le critère de jugement principal était la valeur du pH artériel ≤7,20 à la naissance. Les autres indicateurs de mauvais état néonatal recherchés étaient le score d'Apgar ≤7 à 5 minutes de vie, le taux de gestes de réanimation et de transfert néonatal en néonatologie ou réanimation. Résultats : Il existe une différence de gradation des RCF à l'expulsion entre les classifications de Melchior et de la FIGO. La classification de la FIGO semble plus spécifique pour prédire le risque de mauvais état néonatal. Le pH ≤7,20 à la naissance est significativement lié aux types de RCF et mieux corrélé à la classification de la FIGO qu'à celle de Melchior (p <0,001). Plus le RCF est anormal, plus le taux de pH artériel ≤7,20 à la naissance est augmenté. Il y a une augmentation du risque de pH artériel ≤7,20 à la naissance (p=0,08) et de transfert néonatal (p=0,09) en cas d'efforts expulsifs prolongés au-delà de 30 minutes. Si le RCF est normal pendant la phase passive et active du second stade du travail, le mauvais état néonatal est comparable quelque soit la durée des efforts expulsifs. La valeur de l'Apgar et les gestes de réanimation sont comparables quelque soit le type, la classification du RCF et la durée des efforts expulsifs. Conclusion : La classification de la FIGO est plus prédictive d'un mauvais état néonatal, et devrait être préférée à la classification de Melchior pour interpréter le RCF lors des efforts expulsifs. Les anomalies du RCF semblent être un facteur de risque important de mauvais état néonatal. Un RCF considéré comme normal, pendant la totalité du second stade du travail, pourrait permettre d'envisager une durée d'efforts expulsifs supérieure à 30 minutes. Mais nos résultats sont à interpréter avec précaution compte tenu de notre faible effectif et nécessitent d'autres études pour les confirmer

L’incendie industriel du 26 septembre 2019 à Rouen : Cartes sur la ville.

International audienceDuring the night of September 26, 2019, a fire broke out in the chemical storage of the Lubrizol plant and in the neighboring company Normandie Logistique in Rouen (Seine-Maritime). For several hours, a thick cloud of smoke covers part of the metropolis as it spreads northwards. This gigantic fire, which was brought under control at around 3 p.m. after a long and difficult response by the fire department, did not result in any deaths or direct injuries. How did the population experience this day? This paper presents in the form of maps the first results of a survey that we carried out, by emphasizing in particular the diversity of the perception of the event by the inhabitants of the Rouen conurbation.Dans la nuit du 26 septembre 2019, un incendie se déclare dans les entrepôts de stockage de produits chimiques de l'usine Lubrizol et dans l'entreprise voisine Normandie Logistique à Rouen (Seine-Maritime). Pendant plusieurs heures, un épais nuage de fumée recouvre une partie de la métropole en se propageant vers le nord. Ce gigantesque incendie, qui a pu être maîtrisé vers 15 heures au bout d'une longue et difficile intervention des services d'incendie, n'a pas entraîné de décès ni de blessés directs. Comment la population at -elle vécu cette journée ? Cet article présente sous forme de cartes les premiers résultats d'une enquête auprès de la population, en insistant notamment sur la dimension spatiale et temporelle de la perception de l'événement par les habitants de l'agglomération rouennaise

L’incendie industriel du 26 septembre 2019 à Rouen : Cartes sur la ville.

International audienceDuring the night of September 26, 2019, a fire broke out in the chemical storage of the Lubrizol plant and in the neighboring company Normandie Logistique in Rouen (Seine-Maritime). For several hours, a thick cloud of smoke covers part of the metropolis as it spreads northwards. This gigantic fire, which was brought under control at around 3 p.m. after a long and difficult response by the fire department, did not result in any deaths or direct injuries. How did the population experience this day? This paper presents in the form of maps the first results of a survey that we carried out, by emphasizing in particular the diversity of the perception of the event by the inhabitants of the Rouen conurbation.Dans la nuit du 26 septembre 2019, un incendie se déclare dans les entrepôts de stockage de produits chimiques de l'usine Lubrizol et dans l'entreprise voisine Normandie Logistique à Rouen (Seine-Maritime). Pendant plusieurs heures, un épais nuage de fumée recouvre une partie de la métropole en se propageant vers le nord. Ce gigantesque incendie, qui a pu être maîtrisé vers 15 heures au bout d'une longue et difficile intervention des services d'incendie, n'a pas entraîné de décès ni de blessés directs. Comment la population at -elle vécu cette journée ? Cet article présente sous forme de cartes les premiers résultats d'une enquête auprès de la population, en insistant notamment sur la dimension spatiale et temporelle de la perception de l'événement par les habitants de l'agglomération rouennaise