A comparison of methods for delineation of wave boundaries in 12 Lead ECG

Présentation posterInternational audienceObjective: In the diagnosis of cardiac diseases, the delineation of electrocardiogram is crucial in order to efficiently classify cardiac events. Delineation consists in detecting the different peaks and boundaries of the QRS-complex, P-wave and T-wave. Several techniques have been proposed to face this issue. The objective is to assess the detection performances of a recent approach (non-negative matrix factorization) that has never been applied to ECG delineation and to compare its results with three known methods: morphological approach, discrete wavelet transform and difference operation method

Expansion du pin d'Alep. Rôle des processus allélopathiques dans la dynamique successionnelle.

L'objet de cet article est de montrer quel peut être le rôle des processus allélopathiques dans le cas d'espèces ligneuses constituant des éléments majeurs des successions secondaires en région méditerranéenne. Les études confirment les propriétés allélopathiques du pin d'Alep, propriétés qu'il faut nuancer en fonction des stades dynamiques et en fonction des sources d'allélochimiques (pluviolessivats ou exsudats racinaires). Enfin la mise en évidence de phénomènes d'autotoxicité amène une réflexion sur les régulations de la dynamique populationnelle de ce pin et sur ses conséquences sur la succession végétale

Systematic overdosing of oxa- and cloxacillin in severe infections treated in ICU: risk factors and side effects

Additional file 1: Figure S1. Flowchart of patients included between 2012 and 2014

R-peak detection in holter ECG signals using non-negative matrix factorization

International audienceHolter monitoring is mainly used for medical follow- up and diagnosis of patients with suspected cardiac ar- rhythmia such as heart rhythm irregularities that can be missed during classical electrocardiogram recording (ECG). However, these long-term continuous recordings represent a large amount of data that cannot be processed by hand. In this article, we present a new method based on Non-negative Matrix Factorization (NMF) to detect R- peaks in Holter signals. The approach consists in two stages: source separation based on the different time- frequency patterns of the QRS complexes and the other waves of the signal (P and T waves) and R-peak detection using Automatic Objective Thresholding (AOT). The pro- posed approach is validated on the MIT-BIH Arrhythmia database and achieves an average sensitivity of 99.59% and a precision of 99.69%. Using the MIT-BIH Noise Stress Test database, we also show the ability of our ap- proach to discriminate R-peaks in signals contaminated with different noises

Validation of a host response test to distinguish bacterial and viral respiratory infection.

BACKGROUND: Distinguishing bacterial and viral respiratory infections is challenging. Novel diagnostics based on differential host gene expression patterns are promising but have not been translated to a clinical platform nor extensively tested. Here, we validate a microarray-derived host response signature and explore performance in microbiology-negative and coinfection cases. METHODS: Subjects with acute respiratory illness were enrolled in participating emergency departments. Reference standard was an adjudicated diagnosis of bacterial infection, viral infection, both, or neither. An 87-transcript signature for distinguishing bacterial, viral, and noninfectious illness was measured from peripheral blood using RT-PCR. Performance characteristics were evaluated in subjects with confirmed bacterial, viral, or noninfectious illness. Subjects with bacterial-viral coinfection and microbiologically-negative suspected bacterial infection were also evaluated. Performance was compared to procalcitonin. FINDINGS: 151 subjects with microbiologically confirmed, single-etiology illness were tested, yielding AUROCs 0•85-0•89 for bacterial, viral, and noninfectious illness. Accuracy was similar to procalcitonin (88% vs 83%, p = 0•23) for bacterial vs. non-bacterial infection. Whereas procalcitonin cannot distinguish viral from non-infectious illness, the RT-PCR test had 81% accuracy in making this determination. Bacterial-viral coinfection was subdivided. Among 19 subjects with bacterial superinfection, the RT-PCR test identified 95% as bacterial, compared to 68% with procalcitonin (p = 0•13). Among 12 subjects with bacterial infection superimposed on chronic viral infection, the RT-PCR test identified 83% as bacterial, identical to procalcitonin. 39 subjects had suspected bacterial infection; the RT-PCR test identified bacterial infection more frequently than procalcitonin (82% vs 64%, p = 0•02). INTERPRETATION: The RT-PCR test offered similar diagnostic performance to procalcitonin in some subgroups but offered better discrimination in others such as viral vs. non-infectious illness and bacterial/viral coinfection. Gene expression-based tests could impact decision-making for acute respiratory illness as well as a growing number of other infectious and non-infectious diseases

Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients

Background: Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections. Methods: We included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates. Findings: Among 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species, Haemophilus influenzae (226/1,087, 20.8%), Pseudomonas aeruginosa (180/1087, 16.6%) and Streptococcus pneumoniae (123/1087, 11.3%) were the three most common bacterial pathogens in the laboratory-confirmed co-infection group. Respiratory viruses co-infected with non-pneumococcal streptococci or methicillin-resistant Staphylococcus aureus was associated with the highest death rate [9/30 (30%) and 13/48 (27.1%), respectively] in this cohort. Compared with other infection groups, patients with laboratory-confirmed co-infection had higher ICU admission rate (p < 0.001) and mortality rate at 30 days (p = 0.028), and these results persisted after adjustment for potential confounders using propensity score matching. Furthermore, patients with laboratory-confirmed co-infection had significantly higher mortality compared to patients with bacterial infection alone. Interpretation: In our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection

Relationship between ventilator-associated pneumonia and mortality in COVID-19 patients: a planned ancillary analysis of the coVAPid cohort

Background Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. Methods Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox's regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. Findings Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 group (adjusted HR 1.65 (95% CI 1.11-2.46), p = 0.013), but not in influenza (1.74 (0.99-3.06), p = 0.052), or no viral infection groups (1.13 (0.68-1.86), p = 0.63). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. Interpretation VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality

a retrospective multicenter study

Funding This study was supported in part by a grant from the French government through the « Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). Prof. Ignacio Martin-Loeches has been supported by SFI (Science Foundation Ireland), Grant number 20/COV/0038. The funders of the study had no role in the study design, data collection, analysis or interpretation, writing of the report or deci sion to submit for publication.BACKGROUND: Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox's proportional hazard models with adjustment on pre-specified confounders. RESULTS: Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17-1.31) at day 2, 0.95 (0.63-1.42) at day 7, 1.48 (1.01-2.16) at day 14 and 1.94 (1.09-3.46) at day 21. CONCLUSIONS: No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.publishersversionpublishe

Cardiac safety of dihydroartemisinin-piperaquine and sulfadoxine pyrimethamine among pregnant women with and without asymptomatic parasitaemia in Tanzania: results from an open-label, parallel-group, randomised phase II trial

Background: Dihydroartemisinin-Piperaquine (DP) can induce transient prolongation of the corrected QT interval (QTc) and is a candidate for use with sulfadoxine-pyrimethamine (SP) in intermittent preventive treatment of malaria in pregnancy (IPTp). Pregnancy can alter pharmacokinetics of antimalarial drugs. Acute malaria infection can increase QTc prolongation. Whether DP alters cardiac function in pregnant women with or without asymptomatic parasitaemia is not well characerised. Methods: This was an open-label, parallel-group, randomised phase 2 study among pregnant women in Handeni, Tanzania (NCT02909712). Women were screened for P. falciparum by microscopy and, if positive, received a rapid diagnostic test (RDT). If RDT-positive, they received DP or SP, and the next microscopy-negative woman was randomly allocated to receive DP or SP. Enrolment and allocation continued in this alternating manner to reach 200 (50/group): Grp 1 (neg; SP), Grp 2 (pos; SP), Grp 3 (neg: DP), Grp 4 (pos: DP). Standard 12-lead ECGs were used to record cardiac function in triplicate. DP groups were measured on day 0 (predose), day 2 (predose and hours 3,4,5,6,7,8), and day 7; SP groups had day 0 (predose), and day 7 ECGs. Results: DP resulted in QTcF prolongation that peaked ~30 msec at 5-h post dose 3 on day 2 (schedule: days 0,1,2). The mean maximum increase was slightly more in group 4 compared to group 3 (33.1 vs 29.1 msec). On day 7, QTcF returned to baseline in group 3; a small and non-clinically significant increase of 3.4 (90%CI: 0.3, 6.5) msec was still present among RDT-positive women. QTcB measurements were similar. There was a marked decrease in heart rate (HR) among all DP recipients on day 2, which appeared greater in group 4 compared to group 3 (13.3 vs 8.9 bpm), baseline HR was higher in group 4 than group 3 (92.7 vs 88.5 bpm). This potentially represents a regression towards the mean. On day 7, HR had returned to baseline in both groups. Conclusion: Parasite presence did not alter the effect of DP on the different ECG parameters with the possible exception of HR. No marked differences were observed between pregnant women with and without asymptomatic parasitaemia

a planned ancillary analysis of the coVAPid cohort

Funding: This study was supported in part by a grant from the French government through the «Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). The funders of the study had no role in the study design, data collection, analysis, or interpreta tion, writing of the report, or decision to submit for publication.BACKGROUND: Patients with SARS-CoV-2 infection are at higher risk for ventilator-associated pneumonia (VAP). No study has evaluated the relationship between VAP and mortality in this population, or compared this relationship between SARS-CoV-2 patients and other populations. The main objective of our study was to determine the relationship between VAP and mortality in SARS-CoV-2 patients. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort. VAP was diagnosed using clinical, radiological and quantitative microbiological criteria. Univariable and multivariable marginal Cox's regression models, with cause-specific hazard for duration of mechanical ventilation and ICU stay, were used to compare outcomes between study groups. Extubation, and ICU discharge alive were considered as events of interest, and mortality as competing event. FINDINGS: Of 1576 included patients, 568 were SARS-CoV-2 pneumonia, 482 influenza pneumonia, and 526 no evidence of viral infection at ICU admission. VAP was associated with significantly higher risk for 28-day mortality in SARS-CoV-2 (adjusted HR 1.70 (95% CI 1.16-2.47), p = 0.006), and influenza groups (1.75 (1.03-3.02), p = 0.045), but not in the no viral infection group (1.07 (0.64-1.78), p = 0.79). VAP was associated with significantly longer duration of mechanical ventilation in the SARS-CoV-2 group, but not in the influenza or no viral infection groups. VAP was associated with significantly longer duration of ICU stay in the 3 study groups. No significant difference was found in heterogeneity of outcomes related to VAP between the 3 groups, suggesting that the impact of VAP on mortality was not different between study groups. INTERPRETATION: VAP was associated with significantly increased 28-day mortality rate in SARS-CoV-2 patients. However, SARS-CoV-2 pneumonia, as compared to influenza pneumonia or no viral infection, did not significantly modify the relationship between VAP and 28-day mortality. CLINICAL TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov, number NCT04359693.publishersversionpublishe