Switch of noninvasive ventilation (NIV) to continuous positive airway pressure (CPAP) in patients with obesity hypoventilation syndrome: a pilot study

International audienceObesity is a major worldwide public health issue. The main respiratory complication stemming from obesity is obesity hypoventilation syndrome (OHS). Most of the OHS patients diagnosed during an exacerbation are treated with non invasive ventilation (NIV). Up to date, no prospective study has demonstrated in real life conditions the feasibility of a systematic protocoled switch of NIV to continuous positive airway pressure (CPAP), once stability is achieved

Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure

A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) a-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of “extra-target” RAS suggests the need for RAS screening in all three DAA target regions

A Randomized Controlled Trial of Continuous Positive Airway Pressure on Glucose Tolerance in Obese Patients with Obstructive Sleep Apnea

STUDY OBJECTIVE: Obstructive Sleep Apnea (OSA) is associated with an increased prevalence of metabolic syndrome (MetS), even in patients with morbid obesity. Our goal was to address whether continuous positive airway pressure (CPAP) treatment improved glucose metabolism in this population. DESIGN: Prospective randomized controlled trial SETTINGS: Sleep clinics of Hospital Universitary de Bellvitge and Hospital de la Santa Creu i Sant Pau, Barcelona Spain. PATIENTS: Severe OSA patients with morbid obesity without diabetes. INTERVENTIONS: Patients received conservative (CT) versus CPAP treatment for 12 weeks. MEASUREMENTS: MetS components, homeostasis model assessment of insulin resistance (HOMA-IR) and oral glucose tolerance were assessed at baseline and after treatment. RESULTS: A total of 80 patients completed the study (42 CPAP and 38 CT patients). After 12 weeks of CPAP treatment, weight loss was similar in both groups and physical activity, prevalence of MetS and HOMA-IR did not change in either group. In the CPAP group impaired glucose tolerance (IGT) reversed in 9 patients and none developed IGT, while IGT reversed in 5 patients and 5 developed IGT in the CT group (p=0.039 in the Fisher test). Changes in 2 hour plasma glucose after glucose load were greater in the CPAP group than in the CT group (CPAP: -0.5±1.5 vs CT: 0.33±1.9, p=0.007). CONCLUSIONS: The improvement of glucose tolerance in morbidly obese patients with severe OSA, without changes in HOMA-IR, supports an improvement in peripheral insulin resistance after CPAP treatment

The European Far Right and Islamist Extremism on Twitter:From Radicalisation to Political Participation

This article explores the results of a study on media participation on Twitter in 2018/2019 perceived as contributing to far right and Islamist radical ideologies, in 7 European countries. By combining online ethnography and big data approaches, we see that online far right extremism in Europe is active and ranks are growing, while Islamist extremism has been incapacitated in sharing controversial forms of expression. We describe how the far right uses Twitter as a means for political activism, while Islamist extremists offer lifestyle information, related to local branches of faith, using Twitter as a storefront that re-routes users to other platforms. We consider resources for action, notably on the far right. World leaders influence followers online and support a global conversation between users that paves the way to a far right European milieu thriving on Twitter. To conclude, we delve into the notions of radicalisation and political participation to emphasise the asymmetry between the two forms of media participation in respect to academic discourses and big tech and States’ practises

Impact of obstructive sleep apnea on metabolic dysfunction in severe obesity.

Obstructive Sleep Apnoea (OSA) seems to worsen metabolism. This effect has not evaluated in morbid obesity (MO). We hypothesized that the metabolic profile is more impaired in MO patients with OSA than in those without and investigated whether any specific metabolic dysfunction is related to OSA in MO. A prospective multi-centre cross-sectional study was conducted in consecutive subjects before bariatric surgery. OSA was defined as apnoea-hypopnoea index (AHI)≥15 by overnight polysomnography (PSG). Anthropometrical, blood pressure (BP) and fasting blood measurements were obtained the morning after. Metabolic Syndrome (MetS) was defined according to NCEP ATPIII modified criteria. 159 patients were studied: 72% female, 72% OSA. MetS prevalence was 70% in OSA vs 36% in non-OSA (p<0.001). As AHI severity increased, metabolic parameters progressively worsened, even in those without type 2 diabetes (DM2). AHI was independently associated with systolic and diastolic BP, TG and HbA1c in the total sample and with systolic BP, cHDL and HbA1c in those without DM2. OSA increased the adjusted odds ratio of having MetS by 2.8 (95%CI 1.3-6.2, p 0.009). In MO, OSA is associated with major metabolic impairment caused by higher BP and poorer lipid and glucose control, independent of central obesity or DM2

Pseudomonas aeruginosa et résistance isolée à l’imipénème : clone émergent en milieu hospitalier ?

Cette étude rapporte une épidémie à Pseudomonas aeruginosa résistante à l’imipénème. Neuf souches de P.aeruginosa isolées d’aspirations bronchiques, sur une période de douze semaines (Août- Octobre 2003) chez des patients hospitalisés au sein du service de pneumologie de l’Hôpital Militaire d’Instruction Mohamed V de Rabat ont été étudiées. Elles ont été caractérisées par la détermination de la sensibilité aux antibiotiques, le sérotypage et le typage moléculaire par méthode d’électrophorèse en champ pulsé. Les souches avaient le même antibiotype, caractérisé par une résistance non enzymatique, isolée à l’imipénème, par perte de la porine OprD2 et le même sérotype O:6. L’analyse par électrophorèse en champ pulsé après digestion de l’ADN chromosomique par l’enzyme de restriction SpeI a permis de conclure que les souches circulantes au sein du service appartenaient au même pulsotype. L’enquête épidémiologique environnementale n’a pu être réalisée afin d’établir l’origine exacte de la source de contamination. L’amélioration des conditions d’hygiène a permis l’éradication de la souche épidémique