Impact of chronic obstructive pulmonary disease on incidence, microbiology and outcome of ventilator-associated lower respiratory tract infections

Objectives: To determine the impact of chronic obstructive pulmonary disease (COPD) on incidence, microbiology, and outcomes of ventilator-associated lower respiratory tract infections (VA-LRTI). Methods: Planned ancillary analysis of TAVeM study, including 2960 consecutive adult patients who received invasive mechanical ventilation (MV) > 48 h. COPD patients (n = 494) were compared to non-COPD patients (n = 2466). The diagnosis of ventilator-associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP) was based on clinical, radiological and quantitative microbiological criteria. Results: No significant difference was found in VAP (12% versus 13%, p = 0.931), or VAT incidence (13% versus 10%, p = 0.093) between COPD and non-COPD patients. Among patients with VA-LRTI, Escherichia coli and Stenotrophomonas maltophilia were significantly more frequent in COPD patients as compared with non-COPD patients. However, COPD had no significant impact on multidrug-resistant bacteria incidence. Appropriate antibiotic treatment was not significantly associated with progression from VAT to VAP among COPD patients who developed VAT, unlike non-COPD patients. Among COPD patients, patients who developed VAT or VAP had significantly longer MV duration (17 days (9–30) or 15 (8–27) versus 7 (4–12), p < 0.001) and intensive care unit (ICU) length of stay (24 (17–39) or 21 (14–40) versus 12 (8– 19), p < 0.001) than patients without VA-LRTI. ICU mortality was also higher in COPD patients who developed VAP (44%), but not VAT(38%), as compared to no VA-LRTI (26%, p = 0.006). These worse outcomes associated with VA-LRTI were similar among non-COPD patients. Conclusions: COPD had no significant impact on incidence or outcomes of patients who developed VAP or VAT.publishersversionpublishe

How the greater tuberosity affects clinical outcomes after reverse shoulder arthroplasty for proximal humeral fractures

BACKGROUND: Our purpose was to evaluate the clinical and radiologic outcomes of reverse shoulder arthroplasty for proximal humeral fractures in a large cohort of elderly patients and compare the results in the case of tuberosity excision, failed fixation, or anatomic healing. METHODS: In this retrospective multicenter study, 420 patients underwent review and radiography with a minimum follow-up period of 12 months. The patients were divided into 3 groups according to the status of the greater tuberosity (GT) on the last anteroposterior radiographs: anatomic GT healing (group A, n = 169); GT resorption, malunion, or nonunion (group B, n = 131); and GT excision (group C, n = 120). Complications were recorded; shoulder function, active mobility, and subjective results were assessed. RESULTS: At a mean follow-up of 28 months, the mean Simple Shoulder Value in group A (75%) outperformed the results found in groups B (69%, P < .001) and C (56%, P < .001). Overall, the mean adjusted Constant-Murley score was significantly higher in group A (93% ± 22%) than in group B (82% ± 22%) and group C (80% ± 24%) (P < .001), but there was no difference between groups B and C (P = .88). Anterior active elevation and external rotation were significantly better in group A than in groups B and C (P < .001). The instability rate was significantly higher in group C (n = 15 [12.5%], P < .001) than in group A (n = 2) or group B (n = 3). CONCLUSION: In elderly patients who have undergone a reverse shoulder arthroplasty for acute proximal humeral fractures, anatomic tuberosity healing improves objective and subjective outcomes. GT excision is associated with the worst functional results and increases the risk of postoperative shoulder instability

Ten-year survival and complications of total knee arthroplasty for osteoarthritis secondary to trauma or surgery: A French multicentre study of 263 patients

BACKGROUND: Previous surgical procedures raise technical challenges in performing total knee arthroplasty (TKA) and may affect TKA outcomes. Survival rates of TKA done after trauma or surgery to the knee have not been accurately determined in large populations. The objectives of this retrospective study in 263 patients with TKA after knee trauma or surgery and a follow-up of 10 years were to assess survival, functional outcomes, and the nature and frequency of complications. HYPOTHESIS: Knee trauma or surgery before TKA increases the risk of complications and decreases implant survival. MATERIAL AND METHODS: Two hundred and sixty-three patients (122 [47%] females and 141 [53%] males) underwent TKA between 2005 and 2009 at nine centres in France. Mean age at surgery was 61 years. The patients had knee osteoarthritis secondary to a fracture (n=66), osteotomy (n=131), or ligament injury (n=66). Mean time from trauma or surgery to TKA was 145 months (range, 72-219 months). RESULTS: Major complications were infection (n=12, 4.5%), skin problems (n=8, 3%), and stiffness (n=8, 3%). Ten-year survival to implant exchange for any reason was 89%±2.8%. Flexion range increased by 2.5°±17° (p=0.02) to a mean of 110° (range, 30° to 140°); extension range increased by 4°±7° (p<0.001) to a mean of -1.19 (range, -20° to 0°). Of the 263 patients, 157 (60%) reported little or no pain at last follow-up. Mean postoperative hip-knee-ankle angle was 179°±3.2° (range, 171°-188°). CONCLUSION: TKA performed after knee injury or surgery carries a risk of specific complications (infection, skin problems, and stiffness) and may have a lower survival rate compared to primary TKA

Characterization, Modeling and Mapping of the landslide affecting the centre-town of Azazga (Algeria)

The morphology of the North Algerian basins characterized by precarious stability constitutes an important issue for the development and the economy of many cities in the region. The landslide affecting the city of Azazga represents one of the most active and dramatic land movements experienced by the region in recent years. The city affected by the movement is situated at about 20 Kms in the East of the Wilaya of Tizi - Ouzou (in northern Algeria); the instability is located in a slope, composed of flysch (Azazga flysch are compounds of two terms of marly clay with small sandstone beds), with an inclination of about 13 °. Several factors have acted to activate this instability. Furthermore, water factor and geological conditions of this region are the main parameters of the susceptibility of the site to landslides. The Geographic Information Systems (GIS) are an effective alternative for the analysis of large-scale instabilities (such as Azazga landslides). GIS made for the site of Azazga allowed better management and interpretation of spatial data as well as good understanding of deformation mechanisms and the extent of this landslide. Geological profile has been defined for this slope using the results of spatial data analysis. Numerical modeling of this slope was then carried out, using the finite element software PLAXIS2D, with taking in consideration the effect of the water level. Those studies show the important influence of the position of water table on the activity of the landslide and the safety factor

Anaphylaxis admissions in pediatric intensive care units: follow up and risk of recurrence

Abstract Background Data about the risk of anaphylaxis recurrence in children are lacking. We assessed anaphylaxis recurrence and medical follow-up in a cohort of children previously hospitalized in a French pediatric intensive care unit (PICU) for anaphylaxis. Methods We conducted a telephone survey of 166 children (?18y) hospitalized from 2003 to 2013. Results In all, 106 (64%) completed the survey [boys, 59%; mean age (SD):15.3y (5.5)]. The main index triggers were drugs (45%) and foods (37%). The mean duration follow-up was of 7.7y (SD: 2.4). Thirty-eight (36%) children experienced 399 new allergic reactions during a follow-up period of 282 patient-years (incidence rate: 1.4/100 patients/year; 95% CI: 0.64?2.04). Twelve children experienced 19 anaphylaxis reactions including five requiring PICU admission (anaphylaxis recurrence rate: 0.20/100 patients/year; 95%CI non-calculable). Food was the trigger for 79% of recurrent reactions, drugs for 8%. The food trigger was previously known in 83%, the same as the index trigger in 69%. Overall, 1.5% of the recurrent reactions were treated with adrenaline injection and 8% an emergency hospital admission. Patients with recurrence had more likely a history of food allergy (

Under-corrected knees do not fail more than aligned knees at 8 years in fixed severe valgus total knee replacement

International audiencePURPOSES:A fixed severe valgus knee is a surgical challenge. A safe post-operative Hip-Knee-Ankle angle (HKA) range of 180° ± 4 was recommended, but recent studies mentioned equal results from outliers of this range. Nevertheless, no distinction was made between varus and valgus knees, as well as over-corrected or under-corrected knees. Did post-operative nonaligned total knee replacements (TKR) from fixed severe valgus knees behave differently from the properly aligned population? Did over-corrected knees behave differently from under-corrected knees?METHODS:Through a multi-center retrospective cohort study, we provided 557 knees of at least 10° of minimal pre-operative valgus; in this population 75 presented a post-operative Hip-Knee-Ankle angle (HKA) outside of the 180° ± 4 range; 23 of them had at least 5° of varus; 52 of them had at least 5° of valgus. Median pre-operative HKA of the entire cohort was 194° (range 190-198). Median follow-up was 8 years (range 5-11); Knee Society Score (KSS) results, HKA, Femoral and Tibial Mechanical Angles (FMA, TMA) and complication rates were obtained. The outlier group (HKA ≤ 175 or ≥ 185) was compared to the control group (HKA 180 ± 4); over-corrected (HKA ≤ 175) and under-corrected (HKA ≥ 185) sub-groups were individually tested against the control group.RESULTS:The outlier group had a lower Final Knee Score than the aligned group (p = 0.023). In the over-corrected sub-group, median post-operative FMA was 88° (SD 4°) and median TMA was 87° (SD 4°). The complication rate was higher (p = 0.019). Knee (p = 0.018), Function (p = 0.034) and Final Knee Scores (p = 0.03) were statistically lower than in the control group. In the under-corrected sub-group, mean post-operative FMA was 93° (SD 2°) and mean TMA was 91° (SD 2°). The complication rate was lower (p = 0.019) and there was no difference with the control group concerning KSS.CONCLUSIONS:In case of pre-operative fixed severe valgus knee, one should avoid over-correcting HKA angle and especially the TMA. Over-correction of a severe preoperative valgus in a post-operative varus was prejudicial for TKA survival. Keeping a severe valgus knee in low valgus to avoid using a more constrained implant and/or ligament releases will not decrease the 5-10 year implant survival and functional scores

Effects of pyrolysis conditions on the porous structure development of date pits activated carbon

International audienceActivated carbons were prepared from biomass of Algerian date pits for developing efficient and cheap adsorbents in the aim to remove heavy metals from waste water. Carbon adsorbents were obtained following two successive treatments: pyrolysis under dry nitrogen flow and physical activation under wet nitrogen flow. Pyrolysis process was optimized by varying some operating parameters such as temperature, nitrogen flow, heating rate and pyrolysis hold time in order to determine their effects on the porous structure development of date pits activated carbon. Chars obtained from pyrolysis process were activated with the same operating conditions (activation temperature of 700 degrees C, 50% nitrogen + 50% water flow rate of 150 cm(3)/min and heating rate of 10 degrees C/min) except for the activation hold time which varied from 0.5 to 4h. Experimental results showed that pyrolysis conditions have significant effects on the chars and activated carbons properties prepared from date pits. The best rnicroporous activated carbon (surface area of 464 m(2)/g, microporous volume of 0.203 cm(3)/g and total pore volume of 0.220 cm(3)/g) was obtained by pyrolysis at 10 degrees C/min up to 700 degrees C for 1 h under 150 cm(3)/min of nitrogen. Activation hold time has also an impact on activated carbons porosity. The best surface area. microporous volume and total pore volume were obtained after activation for 4 h: 1467 m(2)/g. 0.711 cm(3)/g and 0.725 cm(3)/g respectively. The best adsorbents prepared from date pits were then tested for the removal of Fe3+ and Cu2+ from aqueous solutions. Results show that these adsorbents have higher metallic cation adsorption capacities than usual commercial activated carbons because of the presence of both carboxylic and phenolic groups at the surface witch improves the cation-exchange and complexation properties of these adsorbents in addition of the greater specific surface area. Adsorption data were analyzed with Langmuir and Freundlich isotherms. The better fit is obtained with the Langmuir model