Experimental study of solar adsorption refrigeration device

This work presents an experimental study of a solar adsorption refrigeration device using activated carbon AC-35 /methanol as working pair. The studied device is designed, realized and tested in the Development of Solar Equipment Unit, UDES, Tipaza (Algeria). The adsorption and desorption tests, carried out on the experimental device, were conducted inside the laboratory using a halogen lamp as an energy source instead the sun. The lamp is installed perpendicularly to the surface of the tubular adsorber to test four radiation levels: 800, 820, 1000 and 1020 W/m². A calculation code is developed, using the Dubinin-Astakhov mathematical model, to evaluate the thermodynamic coefficient of performance, COPth, of the experimental device. Thus, a parametric study is presented to examine the influence of the construction material and the weight of the adsorber on the COPth, the amount of cold produced in the evaporator, Qf, and the total heat supplied to the system, Qc

Hydroxychloroquine pharmacokinetic in COVID-19 critically ill patients: an observational cohort study

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Absence of maribavir penetration into the central nervous system: confirmation by multiple cerebrospinal fluid dosages in a solid organ transplant recipient

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A case report of Covid-19 in an autoimmune pulmonary alveolar proteinosis: An association in tune with the times!

International audienceAutoimmune pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the alveoli accumulation of surfactants proteins and lipids, which diagnosis is confirmed by the presence of GM-CSF antibodies in serum. PAP can be evoked when its characteristic images on chest computed-tomography (CT) are present: bilateral and multifocal ground-glass opacities and crazy-paving appearance. Patients with PAP are at an increased risk of opportunistic infections caused by Nocardia, mycobacteria and fungal pathogens due to impaired processing of pulmonary surfactant. We here report a typical case of newly diagnosed autoimmune PAP, with initial indication to realize a whole-lung lavage. Despite this treatment the patient presented a marked clinical worsening, with increasing need for oxygen and finally the need for mechanical ventilation. The chest CT was controlled and found to be typical of PAP, while the search for opportunistic infections remained negative. Finally, SARS-CoV-2 PCR was performed on bronchoalveolar lavage fluid, and was positive, whereas it had previously been negative twice. Our case report highlights the difficulty of distinguishing SARS-CoV-2 infection in the context of PAP, as the chest CT features are similar. We believe that a SARS-CoV-2 RT-PCR should be systematically realized in case of respiratory deterioration in PAP patients

Herpesviridae systemic reactivations in COVID-19 associated ARDS patients

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Does Rivaroxaban Better than Vitamin K Antagonists in Atrial Fibrillation Patients Undergoing PCI?

ACS: Acute Coronary Syndrome; AF: Atrial Fibrillation; DAPT: Dual Antiplatelet Therapy; INR: InternationalNormalized Ratio; MI: Myocardial Infarction; PCI: Percutaneous Coronary Intervention; PIONEER AF-PCI: Open-Label, Randomized, Controlled, Multicenterstudy Exploring two Treatment Strategiesof Rivaroxaban and a Dose-Adjusted Oral Vitamink Antagonist Treatment Strategy in Subjectswith Atrial Fibrillation Who Undergo Percutaneous Coronary Intervention; TIMI: Thrombolysis In Myocardial Infarction; VKA: Vitamin K AntagonistApproximately 15% of AF patients have a history of myocardial infarction. Between 5–15% of them will require stenting at some point in their lives with the need for a triple therapy combining an oral anticoagulant, a P2Y12 Inhibitor and aspirin [1-3]. This combination requires careful evaluation of bleeding risk, stroke risk and the risk of acute coronary syndromes (ACS) to reduce the risk of major hemorrhage [4-6]. In this context, the PIONEER AF-PCI [7], trial was conducted to evaluate the effectiveness and safety of anticoagulation with rivaroxaban plus either one or two antiplatelet agents.</p

Doppler sonography of cerebral blood flow for early prognostication after out-of-hospital cardiac arrest DOTAC study

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Impact of diagnostic investigations in the management of CAR T-cell-associated neurotoxicity

International audienceInternational guidelines regarding the management of immune effector cell-associated neurotoxicity syndrome (ICANS) recommend several diagnostic investigations, including magnetic resonance imaging (MRI), lumbar puncture (LP), and electroencephalogram (EEG) based on ICANS grade. However, the impact of these investigations has not yet been evaluated. Here, we aimed to describe the role of MRI, LP, and EEG in the management of ICANS in a cohort of real-life patients treated with chimeric antigen receptor (CAR) T cells at the University Hospital of Rennes, France. Between August 2018 and January 2023, a total of 190 consecutive patients were treated with CAR T cells. Among those, 91 (48%) developed ICANS. MRI was performed in 71 patients (78%) with ICANS, with a therapeutic impact in 4% of patients, despite frequent abnormal findings. LP was performed in 43 patients (47%), which led to preemptive antimicrobial agents in 7% of patients, although no infection was eventually detected. Systematic EEG was performed in 51 patients (56%), which led to therapeutic modifications in 16% of patients. Our study shows that EEG is the diagnostic investigation with the greatest therapeutic impact, whereas MRI and LP appear to have a limited therapeutic impact. Our results emphasize the role of EEG in the current guidelines but question the need for systematic MRI and LP, which might be left to the discretion of the treating physician

1-hour t-piece spontaneous breathing trial vs 1-hour zero pressure support spontaneous breathing trial and reintubation at day 7: A non-inferiority approach

International audiencePurpose: Physiological data suggest that T-piece and zero pressure support (PS0) ventilation both accurately reflect spontaneous breathing conditions after extubation. These two types of spontaneous breathing trials (SBTs) are used in our Intensive Care Unit to evaluate patients for extubation readiness and success but have rarely been compared in clinical studies. Materials and methods: We performed a prospective observational study to confirm the hypothesis that 1-hour T-piece SBT and 1-h PS0 zero PEEP (ZEEP) SBT are associated with similar rates of reintubation at day 7 after extubation. A non-inferiority approach was used for sample size calculation. Results: The cohort consisted of 529 subjects invasively ventilated for more than 24 h and extubated after successful 1-hour T-piece SBT (n = 303, 57%) or 1-h PS0 ZEEP SBT (n = 226, 43%). The reintubation rate at day 7 was 14.6% with PS0 ZEEP and 17.5% with T-piece (difference - 2.6% [95% confidence interval, -8.3% to 4.3%]; p = 0.40). The reasons for reintubation did not differ significantly when compared between patients with 1-h PS0 ZEEP SBT and patients with 1-hour T-piece SBT. Conclusion: Our results suggest that successful 1-hour T-piece and 1-h PSO ZEEP SBTs are associated with similar reintubation rates at day 7. (c) 2021 Published by Elsevier Inc

Early discontinuation of combination antibiotic therapy in severe community-acquired pneumonia: a retrospective cohort study

Abstract Background Severe community-acquired pneumonia (SCAP) is commonly treated with an empiric combination therapy, including a macrolide, or a quinolone and a β-lactam. However, the risk of Legionella pneumonia may lead to a prolonged combination therapy even after negative urinary antigen tests (UAT). Methods We conducted a retrospective cohort study in a French intensive care unit (ICU) over 6 years and included all the patients admitted with documented SCAP. All patients received an empirical combination therapy with a β-lactam plus a macrolide or quinolone, and a Legionella UAT was performed. Macrolide or quinolone were discontinued when the UAT was confirmed negative. We examined the clinical and epidemiological features of SCAP and analysed the independent factors associated with ICU mortality. Results Among the 856 patients with documented SCAP, 26 patients had atypical pneumonia: 18 Legionella pneumophila (LP) serogroup 1, 3 Mycoplasma pneumonia (MP), and 5 Chlamydia psittaci (CP). UAT diagnosed 16 (89%) Legionella pneumonia and PCR confirmed the diagnosis for the other atypical pneumonia. No atypical pneumonia was found by culture only. Type of pathogen was not associated with a higher ICU mortality in the multivariate analysis. Conclusion Legionella pneumophila UAT proved to be highly effective in detecting the majority of cases, with only a negligible percentage of patients being missed, but is not sufficient to diagnose atypical pneumonia, and culture did not provide any supplementary information. These results suggest that the discontinuation of macrolides or quinolones may be a safe option when Legionella UAT is negative in countries with a low incidence of Legionella pneumonia