Geographical migration and fitness dynamics of Streptococcus pneumoniae

Streptococcus pneumoniae is a leading cause of pneumonia and meningitis worldwide. Many different serotypes co-circulate endemically in any one location1,2. The extent and mechanisms of spread and vaccine-driven changes in fitness and antimicrobial resistance remain largely unquantified. Here using geolocated genome sequences from South Africa (n = 6,910, collected from 2000 to 2014), we developed models to reconstruct spread, pairing detailed human mobility data and genomic data. Separately, we estimated the population-level changes in fitness of strains that are included (vaccine type (VT)) and not included (non-vaccine type (NVT)) in pneumococcal conjugate vaccines, first implemented in South Africa in 2009. Differences in strain fitness between those that are and are not resistant to penicillin were also evaluated. We found that pneumococci only become homogenously mixed across South Africa after 50 years of transmission, with the slow spread driven by the focal nature of human mobility. Furthermore, in the years following vaccine implementation, the relative fitness of NVT compared with VT strains increased (relative risk of 1.68; 95% confidence interval of 1.59–1.77), with an increasing proportion of these NVT strains becoming resistant to penicillin. Our findings point to highly entrenched, slow transmission and indicate that initial vaccine-linked decreases in antimicrobial resistance may be transient

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

Sudden death due to cerebral malaria: A case report

International audienceMalaria is generally diagnosed ante-mortem. Few post-mortem cases have been described in the literature. Post-mortem cases may present as sudden and unexpected deaths of young individuals rising suspicious of unnatural death, and may therefore be investigated by medical examiners. We present the case of a 24-year-old man who died a few days after returning from a trip to Mali (Africa). Death was attributed to cerebral malaria after a thorough post-mortem investigation. The pathological aspects underlying the fatal outcome are discussed

SAPS 3 admission score: an external validation in a general intensive care population

OBJECTIVES: To validate the SAPS 3 admission score in an independent general intensive care case mix and to compare its performances with the APACHE II and the SAPS II scores. DESIGN: Cohort observational study. SETTING: A 26-bed general ICU from a Tertiary University Hospital. PATIENTS AND PARTICIPANTS: Eight hundred and fifty-one consecutive patients admitted to the ICU over an 8-month period. Of these patients, 49 were readmissions, leaving 802 patients for further analysis. INTERVENTION: None. MEASUREMENTS AND RESULTS: APACHE II, SAPS II and SAPS 3 variables were prospectively collected; scores and their derived probability of death were calculated according to their original manuscript description. The discriminative power was assessed using the area under the ROC curve (AUROC) and calibration was verified with the Hosmer-Lemeshow goodness-of-fit test. The AUROC of the APACHE II model (AUROC = 0.823) was significantly lower than those of the SAPS II (AUROC = 0.850) and SAPS 3 models (AUROC = 0.854) (P = 0.038). The calibration of the APACHE II model (P = 0.037) and of the SAPS 3 global model (P = 0.035) appeared unsatisfactory. On the contrary, both SAPS II model and SAPS 3 model customised for Central and Western Europe had a good calibration. However, in our study case mix, SAPS II model tended to overestimate the probability of death. CONCLUSION: In this study, the SAPS 3 admission score and its prediction model customised for Central and Western Europe was more discriminative and better calibrated than APACHE II, but it was not significantly better than the SAPS II

Traumatismes fermés du rein avec rupture de la voie excrétrice : existe-t-il encore des indications à une dérivation endoscopique ?

International audienc

Société d'Histoire du Droit et des Institutions des pays flamands, picards et wallons. Journées Internationales d'Arlon (19-21 mai 1967)

Bongert Yvonne, Semmler J., Block D.P, Balon Joseph, Despy Georges, Douxchamps-Lefèvre Cécile, Ankum Hans, Warlomont René, Lefrancq Paul, Van den Bergh G. C. J. J., Waquet Jean. Société d'Histoire du Droit et des Institutions des pays flamands, picards et wallons. Journées Internationales d'Arlon (19-21 mai 1967). In: Revue du Nord, tome 50, n°196, Janvier-mars 1968. pp. 109-120

Technique de cystectomie-Bricker pour vessie neurologique totalement intra-corporelle cøelioscopique robot-assistée

International audienc

Société d'Histoire du Droit et des Institutions des pays flamands, picards et wallons. Journées Internationales d'Arlon (19-21 mai 1967)

Bongert Yvonne, Semmler J., Block D.P, Balon Joseph, Despy Georges, Douxchamps-Lefèvre Cécile, Ankum Hans, Warlomont René, Lefrancq Paul, Van den Bergh G. C. J. J., Waquet Jean. Société d'Histoire du Droit et des Institutions des pays flamands, picards et wallons. Journées Internationales d'Arlon (19-21 mai 1967). In: Revue du Nord, tome 50, n°196, Janvier-mars 1968. pp. 109-120

Open prostatectomy versus 180-W XPS GreenLight laser vaporization: Long-term functional outcome for prostatic adenomas > 80 g

International audienceNTRODUCTION:GreenLight photoselective vaporisation of the prostate (PVP) offers an endoscopic alternative to open prostatectomy (OP) for treatment of large adenomas. This study compares long-term functional outcome of both techniques in patients with Benign prostatic obstruction (BPO)>80g.MATERIAL AND METHOD:Data from patients who underwent surgical treatment for BPO>80g from January 2010 to February 2015 at our institution were retrospectively collected and compared according to surgical technique. Patient's demographics, surgeon's experience, operative data and long-term functional results were analyzed, using IPSS and International continence society (ICS) male questionnaire associated with Quality of life scores (IPSS-QL and ICS-QL). Predictors of long-term outcome were also assessed.RESULTS:In total, 111 consecutive patients, 57 PVP and 54 OP, were included in the study with a mean follow-up of 24 and 33 month respectively. Patient's age, Charlson score, preoperative IPSS and urinary retention rates were similar. Mean prostatic volume was superior in the OP group (142 versus 103g, P<0.001). Transfusion rate was lower after PVP (P=0.02), despite a more frequent anticoagulant use. Length of hospital stay and urinary catheterization were shorter after PVP (P<0.001), with however a higher rate of recatheterization (RR=4.74) and rehospitalization (RR=10.42). Long-term scores were better after OP for IPSS (1 versus 5, P<0.001), IPSS-QL, ICS, ICS-QL. On multivariate analysis, prostatic residual volume was the only predictor of long-term IPSS but not ICS.CONCLUSION:Long-term functional outcome are better after OP compared to PVP. However, PVP offers good results, allowing to safely operate patients taking anticoagulants, regardless of prostatic volume. Endoscopic enucleation may the compromise between both techniques