Non-lesional status epilepticus in a patient with coronavirus disease 2019

International audienceA 59-year-old man with a history of atrial fibrillation and treated obstructive sleep apnea presented to the emergency department on March 26, 2020 with fever, dry cough, dyspnea and headache. He had no history of personal or familial seizures. A first reverse-transcriptase–polymerase-chain-reaction (RT-PCR) of nasopharyngeal swab test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was negative but SARS-CoV-2 infection was subsequently confirmed by RT-PCR assay performed on tracheal secretions and by computed tomography scan of the chest. The illness rapidly progressed to hypoxemic respiratory failure warranting the initiation of invasive mechanical ventilation on March 28. Lung bacterial overinfection by Hafnia alveii and Proteus vulgaris was diagnosed and sequentially treated with amoxicillin-clavulanic acid/rovamycine (7 days), tazobactam-piperacillin (5 days) and finally with cefepime (7 days). Deep sedation with midazolam was stopped on April 8 and the patient was extubated the following day.From April 10, the patient started to exhibit short episodes of impaired consciousness together with confusion and behavioral disturbances. Forty-nine minute electroencephalogram (EEG), performed when the patient was awake but confused, showed background fluctuating alertness with preserved responses to simple orders (Fig. 1b) and two widespread long rhythmic delta discharges with superimposed spikes in predominantly frontal localization simultaneous with impaired awareness (Fig. 1c), highly suggestive of epileptic seizures. The first seizure lasted 6 minutes (Fig. 1c), followed by a moderate interictal frontal activity (Fig. 1d) and the second seizure lasted at least 5 minutes (Fig. 1e), leading to the diagnosis of non-convulsive status epilepticus. Laboratory blood tests and brain MRI were normal; plasma cefepime concentrations were within the normal range. Routine cerebrospinal fluid (CSF) analysis was unremarkable and CSF SARS-CoV2 RT-PCR was negative. Clobazam (30 mg/day) and levetiracetam (1.5 g/day) were introduced. On April 14, the patient had only one brief episode of impaired consciousness and his long-term EEG monitoring was normal. He is now clinically stable and discharged from ICU

Speckle-Tracking analysis of left ventricular systolic function in the intensive care unit

Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its noveltyrelies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium duringthe cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date,global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is moresensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment.It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensivecare unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-trackinganalysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggestthat GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients,speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gapsto fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated,and there are, to date, too few data to exactly assess potential GLS alterations on the patient’s outcome. Nonetheless,this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may beof primary interest in the evaluation of left-ventricular systolic function in the ICU.  Speckle-tracking analysis is a new available tool in order to assess left ventricular function in cardiology. Its novelty relies on the technological ability to track natural acoustic markers (known as speckle) within the myocardium during the cardiac cycle. This technology allows the evaluation of myocardium strain during systole and diastole. To date, global longitudinal strain (GLS) has been extensively studied in cardiology. It is now well established that GLS is more sensitive than left ventricular ejection fraction with 2D echocardiography in detecting systolic function impairment. It is also superior to left ventricular ejection fraction in the prediction of major cardio-vascular events. In the intensive care unit (ICU) setting, data are scarce. In experimental model and human studies in septic shock, speckle-tracking analysis suggests that GSL is impaired along with preserved left ventricular ejection fraction. Recent data also suggest that GLS impairment could predict in-ICU mortality in septic shock. In severe subarachnoid haemorrhage patients, speckle-tracking analysis could be more sensitive in detecting stress cardiomyopathy. However, there are many gaps to fill in the critically ill patient. For instance, the influence of mechanical ventilation on GLS is not fully elucidated, and there are, to date, too few data to exactly assess potential GLS alterations on the patient’s outcome. Nonetheless, this new tool provides objective and sensitive data with acceptable intra and inter-observer variability and may be of primary interest in the evaluation of left-ventricular systolic function in the ICU.

Cortisol total/CRP ratio for the prediction of hospital-acquired pneumonia and initiation of corticosteroid therapy in traumatic brain- injured patients

International audienceBACKGROUND:To propose a combination of blood biomarkers for the prediction of hospital-acquired pneumonia (HAP) and for the selection of traumatic brain-injured (TBI) patients eligible for corticosteroid therapy for the prevention of HAP.METHODS:This was a sub-study of the CORTI-TC trial, a multicenter, randomized, double-blind, controlled trial evaluating the risk of HAP at day 28 in 336 TBI patients treated or not with corticosteroid therapy. Patients were between 15 and 65 years with severe traumatic brain injury (Glasgow coma scale score ≤ 8 and trauma-associated lesion on brain CT scan) and were enrolled within 24 h of trauma. The blood levels of CRP and cortisoltotal&free, as a surrogate marker of the pro/anti-inflammatory response balance, were measured in samples collected before the treatment initiation. Endpoint was HAP on day 28.RESULTS:Of the 179 patients with available samples, 89 (49.7%) developed an HAP. Cortisoltotal&free and CRP blood levels upon ICU admission were not significantly different between patients with or without HAP. The cortisoltotal/CRP ratio upon admission was 2.30 [1.25-3.91] in patients without HAP and 3.36 [1.74-5.09] in patients with HAP (p = 0.021). In multivariate analysis, a cortisoltotal/CRP ratio > 3, selected upon the best Youden index on the ROC curve, was independently associated with HAP (OR 2.50, CI95% [1.34-4.64] p = 0.004). The HR for HAP with corticosteroid treatment was 0.59 (CI95% [0.34-1.00], p = 0.005) in patients with a cortisoltotal/CRP ratio > 3, and 0.89 (CI95% [0.49-1.64], p = 0.85) in patients with a ratio  3 upon admission may predict the development of HAP in severe TBI. Among these patients, corticosteroids reduce the occurrence HAP. We suggest that this ratio may select the patients who may benefit from corticosteroid therapy for the prevention of HAP

Feasibility and impact of the implementation of a clinical scale-based sedation-analgesia protocol in severe burn patients undergoing mechanical ventilation. A before-after bi-center study

International audienceBackground: Severe burn patients undergo prolonged administration of sedatives and analgesics for burn care. There are currently no guidelines for the dose adaptation of sedation-analgesia in severe burn patients.Methods:We performed a before-after 2-center study to demonstrate the feasibility and efficacy of a sedation-analgesia scale-based protocol in severely burned patients receiving ≥24 h of invasive mechanical ventilation. Before the intervention, continuous infusion of hypnotic and morphine derivatives was continued. During the Intervention phase, general anesthesia was relayed from day 1 by RASS/BPS-titrated continuous infusion of hypnotic and morphine derivatives and with short half-life drugs adminstered for daily burn dressings. The primary outcome was the duration of invasive mechanical ventilation in the ICU.Results: Eighty-seven (46.2%) patients were included in the Control phase and 101 (53.7%) in the Intervention phase. The median burned cutaneous surface was 20% [11%–38%] and median ABSI was 7 [5–9]. The durations of hypnotic and opioid infusions were not statistically different between the 2 phases (8 days [2–24] vs. 6 days [2–17] (P = 0.3) and 17 days [4–32] vs. 8 days [3–23] (P = 0.06), respectively). The duration of mechanical ventilation was 14 days [3-29] in the Control phase and 7 days [2–24] in the Intervention phase (P = 0.7). When taking into account the competition between mortality and weaning from mechanical ventilation, we found no significant difference between the 2 phases (Gray test, P = 0.4). The time-series analysis showed no difference for the duration of mechanical ventilation in the Intervention phase (P = 0.6). Eighteen (20.7%) patients died in the Control phase, and 18 (18%) in the Intervention phase (P = 0.6).Conclusion: Scale-based lightening of continuous sedation-analgesia with repeated short general anesthesia for dressing is feasible in severe burn patients but failed to demonstrate a decrease in the duration of invasive mechanical ventilatio

Exploring social-ecological dynamics of a coral reef resource system usingparticipatory modeling and empirical data

International audienceCoral reef resource systems are complex adaptive social-ecological systems providing vital and valuableecosystem services for human societies such as food provision, coastal protection and recreational activities.Their sustainability is questioned in many places around the world as they experience combined effects ofmultiple chronic anthropogenic and natural drivers at local to global scales. From a management perspective,there is a crucial need to understand how the impact of these drivers cascade through the social-ecologicalsystem components. This study develops a transdisciplinary and participatory approach to investigating thesocial-ecological dynamics of a Polynesian coral reef coastal system. A preliminary conceptual model using theDriver-Pressure-State-Impact (DPSI) framework is first being built through participatory modeling workshops.Then, pressure-state relationships are assessed with the help of empirical datasets as a first step towards thevalidation of the DPSI model. Results shows striking social-ecological interactions with different patterns in thelagoon and in the fore reef. Local management should be: (1) less resource-focused to account more specificallyto the existing typology of actors; (2) more spatially-explicit to better distinguish management objectives andactions for the lagoon and the fore reef sub-systems; and (3) more coordinated with terrestrial agencies for acoherent land-sea connection and integration that would both (i) account for existing land-sea interactions and(ii) better reflect the Polynesian cultural heritage that considers nature from ridge to reef as a whole. Suchconceptual models of social-ecological systems are a useful tool to build exploratory scenarios to ultimatelysupport planning decision-making processes

National security to guarantee the business entrepreneurship as a form of participation in the productive development of the country under the post-conflict

La presente investigación está orientada a evidenciar que en la actualidad el emprendimiento representa un elemento fundamental para el desarrollo del país toda vez que coadyuvan a renovar el tejido productivo de la sociedad y ofrecer nuevas oportunidades de desarrollo socio-económico que potencien el desarrollo de empresas que propendan por alcanzar niveles de productividad acorde a las necesidades apremiantes del país. En este ensayo, se evidenciará el primera medida, una reflexión y análisis del concepto del Emprendimiento desde lo conceptual y epistemológico que permitirá ir avanzando a la definición del emprendimiento empresarial, teniendo en cuenta que el modelo económico y la situación colombiana, presenta la potestad de dinamizar la economía a las empresas y personas; que con los procesos de integración económicas obliga para lo local y también con una visión global. El modelo económico actual, es catalogado como neoliberal, impregnado de máximas como: competitividad, productividad, rentabilidad; significando para algunas empresas y personas: absorción de mercados, alianzas, fusiones; y, para muchos, fracaso, fragmentación, exclusión y pobreza, entre otros flagelos. Lo cierto es que las tendencias son la integración y globalización de las economías y los mercados. Ante esa realidad, se describe la situación del caso colombiano, como sigue: el mercado, marca la diferencia entre países desarrollados, y los llamados “subdesarrollados” o en palabras de (Drucker’s, 2006) “mal administrados”, por muchas razones, sobresaliendo sus condicionamientos históricos, acentuado por procesos de violencia, migración, asilo interno o desplazamiento ante la colonización que según las épocas, se ha disfrazado con diferentes palabras y actores.The present investigation is orientated to demonstrate that at present the entrepreneurship represents a fundamental element for the development of the country although they contribute to renewing the productive fabric of the company and offering new opportunities of socio-economic development that promote the development of companies that they tend for reaching levels of identical productivity to the urgent needs of the country. In this test, there will be demonstrated the first measure, a reflection and analysis of the concept of the entrepreneurship from the conceptual thing and epistemology that will allow to be advancing to the definition of the managerial entrepreneurship, bearing in mind that the economic model and the Colombian situation, presents the legal authority to stir the economy into action to the companies and persons; that with the processes of integration economic forces for the local thing and also with a global vision. The economic current model, is catalogued as neoliberal impregnated with maxims as: competitiveness, productivity, profitability; meaning for some companies and persons: absorption of markets, alliances, mergers; and, for many, I fail, fragmentation, exclusion and poverty, between other scourges. The certain thing is that the trends are the integration and globalization of the economies and the markets. Before this reality, there is described the situation of the Colombian case, as it continues: the market, it marks the difference between developed countries, and the so called "underdeveloped ones" or in words " badly administered" (Drucker’s, 2006), for many reasons, standing out his historical conditionings, accentuated by processes of violence, migration, internal asylum or displacement before the settling that according to the epochs, has disguised itself with different words and actors

Tara Pacific V9 18S rDNA metabarcoding dataset

data setThis data is the result of the primary analysis of the V9 18S rDNA metabarcoding sequencing data from the Tara Pacific expedition. The analysis was conducted using cutadapt, vsearch, swarm and lulu. Please refer to the readme file for more details