Preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery: A systematic review and meta-analysis.

OBJECTIVE To provide a systematic assessment of the efficacy of preoperative skin asepsis using chlorhexidine versus povidone-iodine based protocols for surgical site infection (SSI) prevention in veterinary surgery. STUDY DESIGN Systematic meta-analytical review according to PRISMA-P guidelines. SAMPLE POPULATION Studies comparing preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery identified by systematic search between 1990 and 2020. METHODS A search using MEDLINE/Pubmed, Web of Science and CAB Abstracts was performed, followed by secondary searches of Google Scholar, Proquest Dissertation and Theses, and relevant bibliographic articles. Primary and secondary outcome measures were the efficacy of skin asepsis protocols using chlorhexidine versus povidone-iodine on SSI incidence and skin bacterial colonization, respectively. A meta-analysis was performed with a random-effect model, with effect size calculated as risk ratio (RR) or mean standard deviation (MSD) with 95% CI. Statistical significance was set at P < .05. RESULTS Among 1067 publications that met the initial search criteria, 9 relevant studies were eligible for analysis. No difference in the incidence of postoperative SSI or skin bacterial colonization between preoperative asepsis protocols using chlorhexidine versus povidone-iodine was found. Insufficient information and detail were frequent among studies and precluded a clear assessment of bias. CONCLUSION This study showed that asepsis protocols using chlorhexidine were comparable to povidone-iodine in preventing postoperative SSI and reducing skin bacterial colonization. CLINICAL SIGNIFICANCE Given the limitations of the studies that were included in terms of both quality and quantity, more high-quality randomized controlled trials are needed to confirm these conclusions

Rupture du ligament croisé crânial chez le bovin : évaluation de la biocompatibilité d'une nouvelle prothèse en Nitinol tressé et de la stabilité articulaire suite à son implantation chirurgicale

Parmi les blessures traumatiques reliées au grasset chez les bovins, 35 % impliquent une rupture du ligament croisé crânial (LCCr). Une lésion à cette structure engendre une instabilité articulaire et une boiterie. Le traitement chirurgical actuel pour les bovins présente malheureusement des limites importantes, telle qu’une rupture prématurée des implants et leur manipulation diffucile, et est associé à un pronostic réservé. Une nouvelle prothèse ligamentaire, avec des propriétés biomécaniques similaires à celles que le LCCr natif, composée de brins de Nitinol super-élastiques tressés pourrait s’avérer une avenue innovante afin de pallier à ces limites. L’objectif général de ce mémoire est de développer une option chirurgicale viable et sans danger pour les tissus pour le remplacement intra-articulaire du LCCr bovin. Plus spécifiquement, (1) d’assurer la biocompatibilité intra-articulaire du Nitinol et (2) déterminer la technique chirurgicale de remplacement du LCCr qui confère la stabilité articulaire qui reflète le plus celle d'un grasset intact. Nous avons émis comme hypothèses que le Nitinol sera biocompatible en milieu intra-articulaire et que son utilisation sous forme de prothèse rendra au grasset sa stabilité articulaire originale lorsque mis en place isométriquement. Pour répondre aux objectifs de recherche, 192 brins de Nitinol ont été incubés dans du liquide synovial, de la saline physiologique et une solution tamponnée au phosphate pour 1, 3 et 6 mois. La biocompatibilité in vitro du Nitinol en milieu articulaire a été confirmée suite à l’évaluation de sa résistance à la corrosion et la stabilité de ses propriétés mécaniques. Par la suite, la translation tibiale cranio-caudale et le déplacement angulaire médio- latéral ont été évalués chez 15 grassets bovins cadavériques avec un LCCr intact, sectionné puis stabilisé avec la nouvelle prothèse ou un implant de nylon. L’utilisation de la prothèse de Nitinol positionnée de façon isométrique a permis d’augmenter la stabilité articulaire lorsque comparé au nylon. Le présent mémoire a démontré le potentiel de l’utilisation de la nouvelle prothèse en Nitinol tressé comme remplacement intra-articulaire du LCCr chez les bovins afin d’améliorer le pronostic présentement réservé de la condition.Incidence of cranial cruciate ligament (CCL) disruption in cattle represents 35% of problems originating from the stifle. When this ligament is ruptured, articular instability and lameness will develop. Currently in cattle, the surgical treatment for CCL repair is associated with a poor prognosis and premature rupture of implants. A new innovative prosthesis with similar biomechanical properties of intact CCL, and made with braided superelastic Nitinol strands could improve the currently poor surgical outcomes of CCL ligament repair. The global objective of this Master’s thesis is to develop a viable surgical option, through the creation of an innovative prosthesis composed of a braided super-elastic nitinol strands for intra-articular CCL replacement in cattle, thus improving current poor outcomes in order to provide better patient care. More specifically, (1) to determine the intra-articular biocompatibility of Nitinol and (2) determine the surgical technique for CCL replacement that confers articular stability closest to that of an intact CCL bovine stifle. We hypothesized that Nitinol would be biocompatible intra-articularly and that its use in a prosthesis would confers joint stability closest to that on an intact stifle when implanted in isometric fashion. To meet the project objectives, 192 Nitinol strands were incubated in synovial fluid, physiologic saline and phosphate buffered saline for 1, 3 and 6 months. Following incubation, the in vitro intra-articular biocompatibility of Nitinol was confirmed throughout the evaluation of its resistance to corrosion and the stability of its mechanical properties. Thereafter, the total craniocaudal tibial translation, and mediolateral angular displacement was quantified in 15 bovine stifles with CCL intact, transected, and stabilized with either a braided super-elastic Nitinol prosthesis or nylon implants. Isometric implantation of the new Nitinol prosthesis for surgical stabilization showed increased stifle stability following CCL rupture compared to stifle repaired using nylon. In conclusion, this Master’s thesis showed the potential of a new braided Nitinol prosthesis as an intra-articular CCL replacement in cattle, thus improving currently poor surgical outcome of ligament repair

Postdetoxification Factors Predicting Alcohol-Related Emergency Room Visits 12 to 24 Months After Discharge: Results from a Prospective Study of Patients with Alcohol Dependence

International audienceBACKGROUND: Relapse is common in patients with alcohol dependence, even after detoxification. The aims of this prospective study were to investigate changes affecting patients during the first 6 months after discharge from hospitalization for detoxification and to determine the influence of these changes on the likelihood of alcohol-related emergency room (ER) visits in the following 18-month period. METHODS: The study included 88 patients hospitalized for participation in a detoxification program in the addiction department of a university hospital in Rennes, France. Alcohol consumption, psychiatric symptoms, and life events were investigated by addiction specialists during hospitalization and 6 months afterward. For each patient, the number of alcohol-related ER visits in the last 6 months was prospectively recorded at the hospital 12, 18, and 24 months after hospitalization. The rate ratios of ER visits as a function of sociodemographic variables and changes observed 6 months after discharge were estimated using Poisson regression with autoregressive errors. RESULTS: Nearly half of the patients (47.7%) had ER visits in the 12- to 24-month period following discharge. The likelihood of ER visits was higher for patients living with friends/parents and for those with aggravated psychiatric symptoms, negative changes in their family life, and who had a medical follow-up in the 6 months after discharge. In contrast, the likelihood of ER visits was lower for patients living with children and those with improved psychiatric morbidity. Alcohol consumption and psychiatric symptoms at baseline had no significant effect. CONCLUSIONS: Monitoring changes in psychiatric symptoms and family life early after a detoxification program may help identify patients who are vulnerable to relapse in the subsequent 18-month period. Systematic screening for these changes as early as possible, in combination with appropriate treatment and the establishment of a social support system, could be fundamental in avoiding further relapses and ER visits

Immunophenotypic Lymphocyte Profiles in Human African Trypanosomiasis

Human African trypanosomiasis (HAT) is a deadly vector-born disease caused by an extracellular parasite, the trypanosome. Little is known about the cellular immune responses elicited by this parasite in humans. We used multiparameter flow cytometry to characterize leukocyte immunophenotypes in the blood and cerebrospinal fluid (CSF) of 33 HAT patients and 27 healthy controls identified during a screening campaign in Angola and Gabon. We evaluated the subsets and activation markers of B and T lymphocytes. Patients had a higher percentage of CD19+ B lymphocytes and activated B lymphocytes in the blood than did controls, but lacked activated CD4+ T lymphocytes (CD25+). Patients displayed no increase in the percentage of activated CD8+ T cells (HLA-DR+, CD69+ or CD25+), but memory CD8 T-cell levels (CD8+CD45RA−) were significantly lower in patients than in controls, as were effector CD8 T-cell levels (CD8+CD45RA+CD62L−). No relationship was found between these blood immunophenotypes and disease severity (stage 1 vs 2). However, CD19+ B-cell levels in the CSF increased with disease severity. The patterns of T and B cell activation in HAT patients suggest that immunomodulatory mechanisms may operate during infection. Determinations of CD19+ B-cell levels in the CSF could improve disease staging

Venous injection of a triphasic calcium-based implant in a sheep model of pulmonary embolism demonstrates minimal acute systemic effects.

PURPOSE Implant leakage is the most common complication of vertebral augmentation. Alternative injectable materials must demonstrate intravascular safety comparable to or better than polymethyl methacrylate (PMMA). This study assessed the systemic effects of a triphasic calcium-based implant or PMMA injected directly into the femoral vein in a large animal model designed to mimic severe intravascular implant leakage. METHODS Six skeletally mature female sheep were randomly assigned (n = 3) to either the PMMA or the triphasic implant (AGN1, composition: calcium sulfate, β-tricalcium phosphate, brushite) treatment group. Femoral veins of each sheep were directly injected with 0.5 mL of implant material to mimic leakage volumes reported during PMMA vertebroplasty. To compare acute systemic effects of the materials, cardiovascular parameters, laboratory coagulation markers, and calcium and sulfate serum levels were monitored for 60 min after implant injection. Thrombotic and embolic events were evaluated by radiologic imaging, necropsy, and histopathology. RESULTS Heart rate, systemic arterial blood pressure, arterial oxygenation, arterial carbon dioxide content, and coagulation markers remained within physiological range after either AGN1 or PMMA injection. No blood flow interruption in the larger pulmonary vessels was observed in either group. Lung histopathology revealed that the severity of thrombotic changes after AGN1 injection was minimal to slight, while changes after PMMA injection were minimal to massive. CONCLUSION Acute systemic effects of intravascular AGN1 appeared to be comparable to or less than that of intravascular PMMA. Furthermore, in this preliminary study, the severity and incidence of pulmonary histological changes were lower for AGN1 compared to PMMA

Evaluation of the Nutritional and Hematological Status of Sickle Cell Children Monitored in the Pediatric Department of the University Hospital Center of Yalgado Ouedraogo

Objective: To assess the nutritional and hematological status of sickle cell children followed in the department of pediatrics of the Yalgado Ouédraogo University Hospital Centre (CHU-YO).Methodology: This was a cross-sectional study conducted from September 1, 2017, to February 28, 2018. All children with major sickle cell syndrome followed in the department of pediatrics at the CHU-YO and following their follow-up appointments were included in the study.Results: We included 230 children aged 11 months to 16 years with an average age of 8.5 years. The sex M/F ratio was 1.09. The SC heterozygotes were the most represented with 56.52%. The average hemoglobin level was 9.39 g/dl. The prevalences of wasting, stunting and underweight were respectively 23.04%, 15.65%, and 13.89%. In univariate analysis, the factors associated with emaciation was hyperleukocytosis (p=0.002).The factors associated with stunting were leukocytosis (p=0.01), severe anemia (p=0.01), SS phenotype (p=0.002), age range of 5-10 years (p=0.007), Secondary (P=0.007) and higher level (p=0.001) of father’s education, secondary (p=0.027) and higher level (p=0.034)of mothers’education , farmer(p=0.003) trader (p=0.042), and informal occupation of father (p = 0.002),and breastfeeding duration after 24 months (p=0.006). For underweight associated factors in univariate analysis were SS phenotype (p=0.003) and severe anemia (p=0.01).Conclusion: The prevalence of different types of malnutrition deficiency of sickle cell children followed at CHU-YO was high. It is important to strengthen the nutritional monitoring of children with sickle cell disease for better management of the disease

Comparison and optimization of sheep in vivo intervertebral disc injury model.

Background The current standard of care for intervertebral disc (IVD) herniation, surgical discectomy, does not repair annulus fibrosus (AF) defects, which is partly due to the lack of effective methods to do so and is why new repair strategies are widely investigated and tested preclinically. There is a need to develop a standardized IVD injury model in large animals to enable comparison and interpretation across preclinical study results. The purpose of this study was to compare in vivo IVD injury models in sheep to determine which annulus fibrosus (AF) defect type combined with partial nucleus pulposus (NP) removal would better mimic degenerative human spinal pathologies. Methods Six skeletally mature sheep were randomly assigned to one of the two observation periods (1 and 3 months) and underwent creation of 3 different AF defect types (slit, cruciate, and box-cut AF defects) in conjunction with 0.1 g NP removal in three lumbar levels using a lateral retroperitoneal surgical approach. The spine was monitored by clinical CT scans pre- and postoperatively, at 2 weeks and euthanasia, and by magnetic resonance imaging (MRI) and histology after euthanasia to determine the severity of degeneration (disc height loss, Pfirrmann grading, semiquantitative histopathology grading). Results All AF defects led to significant degenerative changes detectable on CT and MR images, produced bulging of disc tissue without disc herniation and led to degenerative and inflammatory histopathological changes. However, AF defects were not equal in terms of disc height loss at 3 months postoperatively; the cruciate and box-cut AF defects showed significantly decreased disc height compared to their preoperative height, with the box-cut defect creating the greatest disc height loss, while the slit AF defect showed restoration of normal preoperative disc height. Conclusions The tested IVD injury models do not all generate comparable disc degeneration but can be considered suitable IVD injury models to investigate new treatments. Results of the current study clearly indicate that slit AF defect should be avoided if disc height is used as one of the main outcomes; additional confirmatory studies may be warranted to generalize this finding

FOXL2 is a Progesterone Target Gene in the Endometrium of Ruminants

Forkhead Box L2 (FOXL2) is a member of the FOXL class of transcription factors, which are essential for ovarian differentiation and function. In the endometrium, FOXL2 is also thought to be important in cattle; however, it is not clear how its expression is regulated. The maternal recognition of pregnancy signal in cattle, interferon-Tau, does not regulate FOXL2 expression. Therefore, in the present study, we examined whether the ovarian steroid hormones that orchestrate implantation regulate FOXL2 gene expression in ruminants. In sheep, we confirmed that FOXL2 mRNA and protein was expressed in the endometrium across the oestrous cycle (day 4 to day 15 post-oestrus). Similar to the bovine endometrium, ovine FOXL2 endometrial expression was low during the luteal phase of the oestrous cycle (4 to 12 days post-oestrus) and at implantation (15 days post-oestrus) while mRNA and protein expression significantly increased during the luteolytic phase (day 15 post-oestrus in cycle). In pregnant ewes, inhibition of progesterone production by trilostane during the day 5 to 16 period prevented the rise in progesterone concentrations and led to a significant increase of FOXL2 expression in caruncles compared with the control group (1.4-fold, p < 0.05). Ovariectomized ewes or cows that were supplemented with exogenous progesterone for 12 days or 6 days, respectively, had lower endometrial FOXL2 expression compared with control ovariectomized females (sheep, mRNA, 1.8-fold; protein, 2.4-fold; cattle; mRNA, 2.2-fold; p < 0.05). Exogenous oestradiol treatments for 12 days in sheep or 2 days in cattle did not affect FOXL2 endometrial expression compared with control ovariectomized females, except at the protein level in both endometrial areas in the sheep. Moreover, treating bovine endometrial explants with exogenous progesterone for 48h reduced FOXL2 expression. Using in vitro assays with COS7 cells we also demonstrated that progesterone regulates the FOXL2 promoter activity through the progesterone receptor. Collectively, our findings imply that endometrial FOXL2 is, as a direct target of progesterone, involved in early pregnancy and implantation