Investigating the need for therapeutic drug monitoring of imipenem in critically ill patients: Are we getting it right?

Background. The drug levels and clearances of imipenem in critically ill patients are not comprehensively described in current literature, yet it is vital that adequate levels be achieved for therapeutic success. Objectives. To determine the proportion of critically ill patients treated with imipenem/cilastatin with sub-therapeutic imipenem plasma levels, and to compare the clinical outcomes of those patients with therapeutic levels with those who had sub-therapeutic levels. Methods. Trough imipenem plasma levels of 68 critically ill patients from a surgical intensive care unit were measured using a validated high-performance liquid chromatography method. Imipenem trough levels were compared with the minimum inhibitory concentration (MIC) of the causative bacterial agents, based on a target value of 100% time above MIC (ƒT >MIC). Results. The proportion of participants with sub-therapeutic imipenem levels was 22% (95% confidence interval (CI) 13% - 34%). The 14- and 28-day mortality rates in the sub-therapeutic group were 33% and 40%, respectively, compared with 19% (p=0.293) and 26% (p=0.346), respectively, in the therapeutic group. Sub-therapeutic imipenem plasma levels are associated with adjusted hazard ratio of 1.47 (95% CI 0.55 - 3.91). Conclusions. The lower proportion of critically ill patients with sub-therapeutic imipenem plasma levels in this study compared with previous studies may be attributed to the practice of higher dosages and the administration method of extended infusions of imipenem/ cilastatin in our setting. The results demonstrate a trend of higher mortality in patients with sub-therapeutic imipenem levels, although the results were not statistically significant at this sample size

Investigating the need for therapeutic drug monitoring of imipenem in critically ill patients: Are we getting it right?

Background. The drug levels and clearances of imipenem in critically ill patients are not comprehensively described in current literature, yet it is vital that adequate levels be achieved for therapeutic success.Objectives. To determine the proportion of critically ill patients treated with imipenem/cilastatin with sub-therapeutic imipenem plasma levels, and to compare the clinical outcomes of those patients with therapeutic levels with those who had sub-therapeutic levels.Methods. Trough imipenem plasma levels of 68 critically ill patients from a surgical intensive care unit were measured using a validated high-performance liquid chromatography method. Imipenem trough levels were compared with the minimum inhibitory concentration (MIC) of the causative bacterial agents, based on a target value of 100% time above MIC (¦T >MIC).Results. The proportion of participants with sub-therapeutic imipenem levels was 22% (95% confidence interval (CI) 13% - 34%). The 14- and 28-day mortality rates in the sub-therapeutic group were 33% and 40%, respectively, compared with 19% (p=0.293) and 26% (p=0.346), respectively, in the therapeutic group. Sub-therapeutic imipenem plasma levels are associated with adjusted hazard ratio of 1.47 (95% CI 0.55 - 3.91).Conclusions. The lower proportion of critically ill patients with sub-therapeutic imipenem plasma levels in this study compared with previous studies may be attributed to the practice of higher dosages and the administration method of extended infusions of imipenem/cilastatin in our setting. The results demonstrate a trend of higher mortality in patients with sub-therapeutic imipenem levels, although the results were not statistically significant at this sample size.

Unsupervised segmentation of road images. A multicriteria approach

This paper presents a region-based segmentation algorithm which can be applied to various problems since it does not requir e a priori knowledge concerning the kind of processed images . This algorithm, based on a split and merge method, gives reliable results both on homogeneous grey level images and on textured images . First, images are divided into rectangular sectors . The splitting algorithm works independently on each sector, and uses a homogeneity criterion based only on grey levels . The mergin g is then achieved through assigning labels to each region obtained by the splitting step, using extracted feature measurements . We modeled exploited fields (data field and label field) by Markov Random Fields (MRF), the segmentation is then optimall y determined using the Iterated Conditional Modes (ICM) . Input data of the merging step are regions obtained by the splitting step and their corresponding features vector. The originality of this algorithm is that texture coefficients are directly computed from these regions . These regions will be elementary sites for the Markov relaxation process . Thus, a region- based segmentation algorith m using texture and grey level is obtained . Results from various images types are presented .Nous présentons ici un algorithme de segmentation en régions pouvant s'appliquer à des problèmes très variés car il ne tient compte d'aucune information a priori sur le type d'images traitées. Il donne de bons résultats aussi bien sur des images possédant des objets homogènes au sens des niveaux de gris que sur des images possédant des régions texturées. C'est un algorithme de type division-fusion. Lors d'une première étape, l'image est découpée en fenêtres, selon une grille. L'algorithme de division travaille alors indépendamment sur chaque fenêtre, et utilise un critère d'homogénéité basé uniquement sur les niveaux de gris. La texture de chacune des régions ainsi obtenues est alors calculée. A chaque région sera associé un vecteur de caractéristiques comprenant des paramètres de luminance, et des paramètres de texture. Les régions ainsi définies jouent alors le rôle de sites élémentaires pour le processus de fusion. Celui-ci est fondé sur la modélisation des champs exploités (champ d'observations et champ d'étiquettes) par des champs de Markov. Nous montrerons les résultats de segmentation obtenus sur divers types d'images

Starvation ketoacidosis in pregnancy presenting as euglycaemic, high anion gap metabolic acidosis: A case report highlighting the significance of early recognition and prompt intervention

Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of ‘starvation’. Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome. We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient, and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients

Starvation ketoacidosis in pregnancy presenting as euglycaemic high anion gap metabolic acidosis: A case report highlighting the significance of early recognition and prompt intervention

Starvation ketoacidosis (SKA) constitutes an important consideration in the pregnant patient who presents with profound metabolic acidosis. Pregnancy-related changes predispose the patient to develop SKA following relatively short periods (12 - 14 hours) of ‘starvation’. Patients also typically look clinically well in relation to the significant metabolic derangements that accompany the condition. Prompt recognition and early institution of appropriate therapy is therefore extremely important in terms of optimising maternal and fetal outcome. We describe a pregnant patient with SKA who presented with profound euglycaemic ketoacidosis that resolved rapidly following the early initiation of appropriate therapy. Furthermore, appropriate therapy resulted in our patient avoiding the need for an emergency caesarean section, which is often reported in this scenario. The ensuing discussion addresses SKA in pregnancy, the unique features of our patient, and management considerations from a maternal and fetal perspective. We also discuss the various causes of ketoacidosis such as diabetic ketoacidosis (DKA), euglycaemic DKA, alcohol-induced euglycaemic ketoacidosis and SKA in pregnant patients

Is There Semantic Conflict in the Stroop Task? Further evidence from a modified two-to-one Stroop paradigm combined with single-letter coloring and cueing

This research addressed current controversies concerning the contribution of semantic conflict to the Stroop interference effect and its reduction by a single-letter coloring and cueing procedure. On the first issue, it provides, for the first time, unambiguous evidence for a contribution of semantic conflict to the (overall) Stroop interference effect. The reported data remained inconclusive on the second issue, despite being collected in a considerable sample and analyzed with both classical (frequentist) and Bayesian inferential approaches. Given that in all past Stroop studies, semantic conflict was possibly confounded with either response conflict (e.g., when semantic-associative items [SKYblue] are used to induce semantic conflict) or with facilitation (when color-congruent items [BLUEblue] are used as baseline to derive a magnitude for semantic conflict), its genuine contribution to the Stroop interference effect is the most critical result reported in the present study. Indeed, it leaves no doubt - in complete contrast to dominant single-stage response competition models (e.g., Roelofs, 2003) - that selection occurs at the semantic level in the Stroop task. The immediate implications for the composite (as opposed to unitary) nature of the Stroop interference effect and other still unresolved issues in the Stroop literature are outlined further

Perceived discrimination based on the symptoms of covid-19, mental health, and emotional responses–the international online COVISTRESS survey

Background Despite the potential detrimental consequences for individuals’ health and discrimination from covid-19 symptoms, the outcomes have received little attention. This study examines the relationships between having personally experienced discrimination based on the symptoms of covid-19 (during the first wave of the pandemic), mental health, and emotional responses (anger and sadness). It was predicted that covid-19 discrimination would be positively related to poor mental health and that this relationship would be mediated by the emotions of anger and sadness. Methods The study was conducted using an online questionnaire from January to June 2020 (the Covistress network; including 44 countries). Participants were extracted from the COVISTRESS database (Ntotal = 280) with about a half declaring having been discriminated due to covid-19 symptoms (N = 135). Discriminated participants were compared to non-discriminated participants using ANOVA. A mediation analysis was conducted to examine the indirect effect of emotional responses and the relationships between perceived discrimination and self-reported mental health. Results The results indicated that individuals who experienced discrimination based on the symptoms of covid-19 had poorer mental health and experienced more anger and sadness. The relationship between covid-19 personal discrimination and mental health disappeared when the emotions of anger and sadness were statistically controlled for. The indirect effects for both anger and sadness were statistically significant. Discussion This study suggests that the covid-19 pandemic may have generated discriminatory behaviors toward those suspected of having symptoms and that this is related to poorer mental health via anger and sadness.publishedVersio

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

MFC bioanodes constituted of nickel sulfide nanoparticles and electroactive biofilm.

International audienceMicrobial fuel cells (MFCs) are eco-friendly and sustainable energy bioelectrochemical systems (BES), which convert chemical energy directly to electricity, through the bio-catalytic oxidation of organic compounds by electro-active bacteria1,2. The improvement of microbial fuel cell (MFC) performances requires the increase in cell voltage as well as discharge current densities. The choice of an efficient cathode is a problem3 and often limits the performance of the MFC. Nevertheless, it is possible to increase the whole performance by improving bioanode operating. The modification of bioanode surface by nanoparticles4 is a suitable way to increase the efficiency of electron transfer from the bacteria and anodic current collector. For this purpose, metal sulfides are interesting compounds because they involve various redox processes occurring in natural anaerobic environments. Very few studies reported these compounds as bioanodes materials5. In this communication, we will present the results that we obtained during the study of nickel sulfide / biofilm bioanodes formed by polarization at -0.2V/AgCl/Ag in KCl-garden compost solution filled with sodium acetate as an organic substrate long-term current time transients of these bioanodes and comparison to classical carbon or stainless steel bioanodes, microscopy observations of the surface of bioanodes, discussion on the electrochemical coupling between nickel sulfide nanoparticles and electroactive bacteria

Descripteurs d'images en contexte routier : une revue bibliographique

National audienceComputer vision is increasingly present on the road, bothon the infrastructure for traffic monitoring and in vehiclesfor driving assistance. Implemented algorithms use imagefeatures for many operations. Image features are thereforecrucial. This state of the art reference computer vision al-gorithms of the road context under a new approach, puttingthem in parallel with image features, which offers manypossibilities for analysis.La vision artificielle est présente sur les routes, à la fois surl’infrastructure pour la surveillance du trafic, et à bord desvéhicules pour les aides à la conduite. Comme tout pre-mier élément de la chaine de traitement, les descripteursd’images jouent un rôle important dans les algorithmes.Cet état de l’art passe en revue les algorithmes de visionartificielle du contexte routier sous une approche nouvelle,en les mettant en parallèle avec les descripteurs d’images,ce qui offre de nombreuses possibilités d’analys