021: Clopidogrel low response and correlation between the different tests: light transmission aggregometry, VerifyNow-P2Y12 and V ASP

BackgroundClopidogrel low response correlates with poor prognosis after percutaneous coronary intervention (PCI). Many biological tests are currently available to test the clopidogrel response. However, the presence of any correlation between the different tests is today poorly reported.MethodsIn this prospective study, clopidogrel response was assessed in 100 consecutive patients. All patients were tested between 18h and 24h after a600mg clopidogrel loading dose using 3 different tests: light transmission aggregometry with 10μmol ADP (LTA, results expressed as platelet inhibition percentage), VerifyNow-P2Y12 (VN, results expressed as PRU) and vasodilatator stimulated phosphoprotein (VASP, results expressed as IRP). Patients under chronic clopidogrel therapy were excluded.ResultsThe mean platelet inhibition percentage, PRU value and IRP value were 38.5±13% by LTA, 178±89 PRU by VN and 52±21% by VASP. When results were analyzed as continuous variables, there was a good correlation between the different tests: LTA/VN (R2=0,642, p<0,001), LTA/VASP (R2=0,409, p<0,001) and VN/VASP (R2=0,616, p<0,001). However, when results were analyzed as pre-specified cut-off points to define patients as “low or good responders” (according to the literature: 50% for LTA, 235 PRU for VN and 50% IRP for VASP), only 47% of the patients were defined as “good” or “low responders” by the 3 tests. Altogether, 33% of the patients were defined as “low responders” by only 1 test, 20% by 2 tests and only 16% by the 3 tests.ConclusionIf the correlation between the different tests is good when results are analyzed as continuous variables, each individual is rarely (less than 50%) defined as “low or good responder” by all the 3 tests when recognized cut-off values are used. In that way, a sole test might not be sufficient to manage antiplatelet therapy in an individual patient

Impact on construction project planning council of aqueduct Fruticas Chipaque

En los últimos años Colombia ha tenido un papel destacado en el escenario internacional por ser un país emergente económicamente, fortaleciendo significativamente los aspectos más relevantes para el desarrollo de un país. Dentro de estos factores relevantes se encuentra la construcción de infraestructurapública, que aporta grandes beneficios y brinda bienestar a la comunidad en general. Sin embargo muchas de estas obras se han visto afectadas por la mala planeación con la que se programan, incurriendo en sobrecostos que han llevado en el mejor de los casos a tiempos más largos de ejecución y en los casos más críticos al abandono de los proyectos, causando un notorio detrimento en el patrimonio de la nación y de los colombianos. Una vez revisada la información concerniente a la construcción del acueducto Fruticas del municipio de Chipaque se pudo determinar que son varios los factores que intervinieron para que su ejecución no se realizara dentro de los tiempos establecidos, siendo los más relevantes una pésima planeación de la obra dentro de su parte inicial y una gestión del riesgo inadecuada e inoportuna. El propósito fundamental de este artículo es hacer un análisis de un caso específico de un mal proyecto de construcción de infraestructura pública en Colombia, con el fin emitir algunas conclusiones, que de ser tenidas en cuenta, contribuyan a evitar que nuevos casos similares a este se presenten, afectando directamente a la economía del país y al mejoramiento de la calidad de vida de todos los colombianos.In recent years Colombia has had a prominent role on the international stage for being an economically emerging country, significantly strengthening the most important for a country's development issues. These relevant factors are the construction of public infrastructure, which provides great benefits and provides welfare to the community. However many of these works have been affected by the poor planning that are programmed with, incurring cost overruns that led to the best at longer runtimes and the most critical project abandonment cases causing a noticeable detriment to the heritage of the nation and Colombians. After reviewing the information concerning the construction of Fruticas aqueduct Township Chipaque it was determined that several factors intervened to your execution is not carried out within the established time, the most important being a lousy planning of the work within part of their initial management and inadequate and inappropriate risk. The main purpose of this paper is to analyze a specific case of a bad project to build public infrastructure in Colombia, to issue some conclusions, which if taken into account, help prevent new cases similar to this one submit, directly affecting the economy and improving the quality of life for all Colombians

Impact of initial clinical presentation on clopidogrel low response

SummaryBackgroundLarge interindividual variability exists in clopidogrel response. Clopidogrel low response correlates with poor prognosis after percutaneous coronary intervention. Some authors also suggest intraindividual variability over time.AimTo assess the impact of initial clinical presentation on clopidogrel low response.MethodsIn this prospective study, clopidogrel response was assessed in 100 patients. Fifty patients presenting with acute coronary syndromes (ACS group) were compared with 50 patients with stable coronary artery disease matched 1:1 for age, sex, body mass index and diabetes (stable group). All patients were tested 18–24h after a 600mg loading dose of clopidogrel using the VerifyNow-P2Y12 test (results expressed as platelet reaction units [PRUs]). Patients under chronic clopidogrel therapy or treated with glycoprotein IIb/IIIa inhibitors, bivalirudin or thrombolytics were excluded.ResultsMean age was 61±12 years in each group; 28% of patients in each group were diabetic; mean body mass index was 27.6±5.6kg/m2 in the ACS group and 27.9±5.9kg/m2 in the stable group (p=0.80). Mean PRU values were 197±81 in the ACS group and 159±94 in the stable group (p=0.03). By multivariable analysis, the ACS group was significantly associated with a higher PRU value (p=0.02). There were significantly more clopidogrel low responders (PRU value>230) in the ACS group (38% vs. 18%; p=0.04).ConclusionOur study confirms that initial clinical presentation, especially ACS, is a strong predictor of clopidogrel low response; this suggests that the evolution of coronary artery disease for one patient influences the clopidogrel response over time. These results are in accordance with recent trials showing a benefit for more aggressive antiplatelet therapy in ACS patients

Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study

Background The SARS-CoV-2 variant B.1.1.7 was first identified in December, 2020, in England. We aimed to investigate whether increases in the proportion of infections with this variant are associated with differences in symptoms or disease course, reinfection rates, or transmissibility. Methods We did an ecological study to examine the association between the regional proportion of infections with the SARS-CoV-2 B.1.1.7 variant and reported symptoms, disease course, rates of reinfection, and transmissibility. Data on types and duration of symptoms were obtained from longitudinal reports from users of the COVID Symptom Study app who reported a positive test for COVID-19 between Sept 28 and Dec 27, 2020 (during which the prevalence of B.1.1.7 increased most notably in parts of the UK). From this dataset, we also estimated the frequency of possible reinfection, defined as the presence of two reported positive tests separated by more than 90 days with a period of reporting no symptoms for more than 7 days before the second positive test. The proportion of SARS-CoV-2 infections with the B.1.1.7 variant across the UK was estimated with use of genomic data from the COVID-19 Genomics UK Consortium and data from Public Health England on spike-gene target failure (a non-specific indicator of the B.1.1.7 variant) in community cases in England. We used linear regression to examine the association between reported symptoms and proportion of B.1.1.7. We assessed the Spearman correlation between the proportion of B.1.1.7 cases and number of reinfections over time, and between the number of positive tests and reinfections. We estimated incidence for B.1.1.7 and previous variants, and compared the effective reproduction number, Rt, for the two incidence estimates. Findings From Sept 28 to Dec 27, 2020, positive COVID-19 tests were reported by 36 920 COVID Symptom Study app users whose region was known and who reported as healthy on app sign-up. We found no changes in reported symptoms or disease duration associated with B.1.1.7. For the same period, possible reinfections were identified in 249 (0·7% [95% CI 0·6–0·8]) of 36 509 app users who reported a positive swab test before Oct 1, 2020, but there was no evidence that the frequency of reinfections was higher for the B.1.1.7 variant than for pre-existing variants. Reinfection occurrences were more positively correlated with the overall regional rise in cases (Spearman correlation 0·56–0·69 for South East, London, and East of England) than with the regional increase in the proportion of infections with the B.1.1.7 variant (Spearman correlation 0·38–0·56 in the same regions), suggesting B.1.1.7 does not substantially alter the risk of reinfection. We found a multiplicative increase in the Rt of B.1.1.7 by a factor of 1·35 (95% CI 1·02–1·69) relative to pre-existing variants. However, Rt fell below 1 during regional and national lockdowns, even in regions with high proportions of infections with the B.1.1.7 variant. Interpretation The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant. Funding Zoe Global, Department of Health (UK), Wellcome Trust, Engineering and Physical Sciences Research Council (UK), National Institute for Health Research (UK), Medical Research Council (UK), Alzheimer's Society

Anatomie des zones implantables (Incidences chirurgicales)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Detection of the eastern edge of the equatorial Pacific warm pool using satellite-based ocean colour observations

International audienceThe analysis of satellite-based ocean color data shows that low concentrations of surface chlorophyll-a (chl-a) found in the equatorial region of the Pacific Ocean varies in phase with the eastern edge of the warm pool. As is true for high sea surface temperatures, the existence and maintenance of these low concentrations are linked to the upper ocean stratification due to salinity. The present study also establishes the quasi permanence of a frontal zone in chlorophyll-a separating the regimes of the western region and the eastern-central cold tongue and, through the identification of this front in satellite-based ocean color data, it provides, for the first time, a reliable method for locating the eastern edge of the warm pool from surface observations only. Finally, the recognition of this front offers the opportunity to define a simple and robust index of the horizontal extension of the equatorial Pacific warm pool within the context of the ENSO variability

On the global estimates of geostrophic and Ekman surface currents

International audienceSurface currents in oceanic environments are of crucial importance because they transport momentum, heat, salt, and tracers over large distances that regulate both the local and large-scale climate conditions, and because they contribute to the Lagrangian displacement of floating material, ranging from living resources to marine pollution. In recent decades, the understanding of surface currents has benefited from the opportunity of observing sea level and wind stress via satellite-derived measurements. Combining these parameters into geostrophic and wind-driven components provides an estimate of surface currents with a quarter-degree horizontal resolution at a global scale and at a daily time scale. In the present study, improvements are made on the consideration of the time dependence of the main parameters implied in the determination of the Ekman wind-driven component, and on the treatment of the equatorial singularity. The resulting Geostrophic and Ekman Current Observatory (GEKCO) estimates were validated with independent observations from both Lagrangian and Eulerian perspectives. The statistics of comparison were significant over the globe for the 2000-2008 period. The only exception was the estimation of meridional current along the equator, which requires further developments of the dynamic model and, probably, more accurate measurements. Applications using our GEKCO surface current estimates in cross-disciplinary approaches from physical oceanography to marine ecology are presented and discussed