Efficacy and safety of continuous infusions with elastomeric pumps for outpatient parenteral antimicrobial therapy (OPAT): an observational study.

This study aimed to evaluate the efficacy and safety of continuous antimicrobial infusion using elastomeric pumps in an outpatient setting, while simultaneously documenting circulating antibiotic concentration exposure achieved with this mode of administration. Clinical outcomes, adverse events and antibiotic plasma concentrations were recorded for all patients treated by continuous infusion with elastomeric pumps at the outpatient parenteral antimicrobial therapy (OPAT) unit of the University Hospital of Lausanne between December 2013 and January 2017. The study was registered under ClinicalTrials.gov identifier NCT03221140. One hundred and fifty outpatients were treated by continuous intravenous infusions using flucloxacillin (70 patients), cefepime (36), vancomycin (32) and piperacillin/tazobactam (12). The calculated free fractions of each antibiotic were above the epidemiological cut-off values for resistance (ECOFF) of the treated microorganisms in 92% of measurements. Cure was achieved in 143 patients (95%) 3 months after the end of treatment. Four patients needed unexpected readmission and three had a relapse. In none of the patients with unsuccessful treatment was the ratio of free antibiotic plasma concentration/ECOFF <1. Sixteen patients (11%) had an adverse event, none of them being of severity grade 4 or 5. Continuous infusions of flucloxacillin, cefepime, vancomycin and piperacillin/tazobactam using elastomeric pumps seem to be an effective and safe approach to treat outpatients. The number of treatment successes was very high and adverse events occurred at a similar rate as reported by other OPAT centres. The measured antibiotic plasma concentrations confirmed adequate drug concentration exposure for the vast majority of patients

Mutations in the pH-Sensing G-protein-Coupled Receptor GPR68 Cause Amelogenesis Imperfecta

Amelogenesis is the process of dental enamel formation, leading to the deposition of the hardest tissue in the human body. This process requires the intricate regulation of ion transport and controlled changes to the developing enamel matrix pH. The means by which the enamel organ regulates pH during amelogenesis is largely unknown. We identified rare homozygous variants in GPR68 in three families with Amelogenesis Imperfecta, a genetically and phenotypically heterogeneous group of inherited conditions associated with abnormal enamel formation. Each of these homozygous variants (a large in-frame deletion, a frameshift deletion and a missense) were predicted to result in loss of function. GPR68 encodes a proton sensing G-protein-coupled receptor with sensitivity in the pH range that occurs in the developing enamel matrix during amelogenesis. Immunohistochemistry of rat mandibles confirmed localisation of GPR68 in the enamel organ at all stages of amelogenesis. Our data identify a role for GPR68 as a proton sensor that is required for proper enamel formation

Vaccination des requérants d'asile dans le canton de Vaud [Vaccination of asylum seekers in the canton Vaud, Switzerland].

Even if only a small proportion of asylum seekers obtains a permanent resident permit, a significant number of them stay for a prolonged or indefinite period in Switzerland in a legal or illegal way. The asylum seekers can be either vectors or victims of infectious diseases. Some of these diseases can be prevented by vaccination. This article summarizes the recent decisions which have been taken in the canton Vaud concerning the vaccination of asylum seekers. These new recommendations privilege a large coverage of a maximum number of asylum seekers. Vaccinations against varicella and human papillomavirus will be proposed in addition to the already previously recommended vaccines. Finally the medical visits for the vaccinations will also be an opportunity to screen for chronic hepatitis B which has been neglected until now

Méningo-encéphalite verno-estivate dans le Nord vaudois [Tick-borne encephalitis in the North part of the canton de Vaud].

Tick-borne encephalitis (TBE) is described in Switzerland since 1969. More than 200 cases are reported every year to the Federal office of public health (FOPH) and new sites of endemic disease have been documented recently, in particular in the North part of the canton de Vaud. The aim of this article is to review the clinical pictures of 11 patients hospitalised in Yverdon-les-Bains with a diagnosis of TBE between 2003 and August 2007. The occurrence of 5 new cases exposed in the North part of the canton de Vaud over these last 18 months confirms the presence of endemic foci in this area and should prompt the vaccination against the MEVE which is recommended by the FOPH in endemic zones. The sequels of MEVE being observed mainly in the elderly, vaccination should be afforded also to this group of patients

Evidence de nouveaux foyers d'endémie de méningo-encéphalite verno-estivale en Suisse romande [Evidence of new foci of tick-borne encephalitis in the French speaking part of Switzerland].

The incidence of tick-borne encephalitis (TBE) has more than doubled in Switzerland in recent years. In the French part of Switzerland several patients seem to have acquired the infection outside of known endemic foci. Thirty patients with TBE living or having acquired the infection in the French speaking part of Switzerland between 2000 and 2005 were identified. For one patient it wasn't possible to obtain precise information about the place of acquisition of the infection and 16 patients were infected in known endemic foci. Among the 13 remaining patients, 6 were infected on the southern shores of the lake of Neuchâtel and 7 in the plaine of Orbe. We conclude that there are new foci of TBE in the northern regions of the canton of Vaud. Vaccination should be proposed to the population at risk of these regions. In addition it is important that persons with outdoor activities in this regions respect the preventiv