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University hospital have demonstrated their effectiveness since their creation in 1958. They have risen to the challenge of expertise in research, care and teaching, but also to the challenge of responsibility towards the health territories they serve. The context of the health crisis has prompted them to confirm this commitment while encouraging them to continue the evolution of a model that combines care, research and teaching.
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Hospitales Universitarios , HumanosRESUMEN
INTRODUCTION: Central corneal thickness measurement permits an evaluation of physiological and pathological corneal changes. It allows for an intra-ocular pressure correction factor. Our purpose was to determine the mean central corneal thickness in children aged 0 to 72 months and to examine factors that might affect it. PATIENTS AND METHODS: This was a cross-sectional hospital study which took place from February to December 2019 in the ophthalmology service of YO University Medical Center. It included healthy eyes of children 0-72 months of age examined under general anesthesia. Ultrasonic pachymetry was used to measure the central corneal thickness. The studied variables were age, sex, CCT, corneal diameter, intraocular pressure, and cup/disc ratio. RESULTS: One hundred and twenty-seven healthy eyes of 78 children 0-72 months of age were included. The mean age was 22 months. The overall mean CCT was 554.01±34.21µm. It was 556.58µm for children from 0 to 36 months of age and 536.12µm for subjects over 36 months. The mean CCT was 555.96±32.96µm in boys and 551.80±36.16µm in girls. In patients who underwent bilateral CCT measurement, the mean CCT was 554.74±35.67µm in the right eye and 549.76±24.08µm in the left eye. Lower IOP's were found in patients with thicker corneas (p=0.00). CONCLUSION: The CCT values for black children over 36 months of age was similar to the CCT in black adults.
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Presión Intraocular , Tonometría Ocular , Centros Médicos Académicos , Adulto , Anestesia General , Niño , Córnea/diagnóstico por imagen , Paquimetría Corneal , Estudios Transversales , Femenino , Humanos , Lactante , MasculinoRESUMEN
During the first wave of Covid-19 in France, in spring 2020, healthcare institution's laboratory had to adapt itself quickly to the growing demand for emergency biology, in particular by reorganizing their POCT analyzers: redeployment of analyzers and/or new installations. In order to analyze this management, a subgroup of 15 hospital biologists from the SFBC Working Group "Biochemical markers of Covid-19" sent, in fall 2020, an on-line survey to French hospital laboratories using POCT. Answers analysis (n = 86) shows a territorial disparity related to the severity of the first wave: increased activity essentially in red zones, management of unexpected situations, training of additional nursing staff for 40 % of the laboratories... The survey also showed simplification of aspects related to accreditation those periods of health crisis. An additional survey, carried out in the spring of 2021, showed good overall satisfaction of the healthcare services (n = 139) concerning the services provided by biology in the POCT sector. Because of their great adaptation capacity, the laboratories and their POCT-teams have played a key role in the management of the first wave of Covid-19 in France. However, the success of these organizations requires an essential collaboration between laboratories and healthcare services. The results of this survey are fundamental in the context of the prolongation of the pandemia throughout the world with a POCT sector appearing to be growing.
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COVID-19 , Laboratorios de Hospital , Acreditación , Francia , Humanos , SARS-CoV-2RESUMEN
From 2015 until 2020, Brucella melitensis was isolated four times in our microbiology laboratory. All patients had travelled in endemic-areas. Immediately after the first occurrence, all laboratory staff were risk-stratified and preventive and protective measures were applied according to CDC guidelines. Nineteen workers were exposed and needed chemoprophylaxis and follow-up. At each subsequent occurrence, risk analysis was performed, and additional measures were implemented accordingly, leading to a progressive reduction of exposed staff members to none the fourth time. We describe here the additional measures that permitted this important exposure reduction.
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INTRODUCTION: Traumatic injuries and their resulting mortality and disability impose a disproportionate burden on sub-Saharan countries like Rwanda. An important facet of addressing injury burdens is to comprehend injury patterns and aetiologies of trauma. This study is a cross-sectional analysis of injuries, treatments and outcomes at the University Teaching Hospital-Kigali (CHUK). METHODS: A random sample of Emergency Centre (EC) injury patients presenting during August 2015 through July 2016 was accrued. Patients were excluded if they had non-traumatic illness. Data included demographics, clinical presentation, injury type(s), mechanism of injury, and EC disposition. Descriptive statics were utilised to explore characteristics of the population. RESULTS: A random sample of 786 trauma patients met inclusion criteria and were analysed. The median age was 28 (IQR 6-50) years and 69.4% were male. Of all trauma patients 49.4% presented secondary to road traffic injuries (RTIs), 23.9% due to falls, 10.9% due to penetrating trauma. Craniofacial trauma was the most frequent traumatic injury location at 36.3%. Lower limb trauma and upper limb trauma constituted 35.8% and 27.1% of all injuries. Admission was required in 68.2% of cases, 23.3% were admitted to the orthopaedic service with the second highest admission to the surgical service (19.2%). Of those admitted to the hospital, the median LOS was 6 days (IQR 3-14), in the subset of patients requiring operative intervention, the median LOS was also 6 days (IQR 3-16). Death occurred in 5.5% of admitted patients in the hospital. CONCLUSION: The traumatic injury burden is borne more proportionally by young males in Kigali, Rwanda. Blunt trauma accounts for a majority of trauma patient presentations; of these RTIs constitute nearly half the injury mechanisms. These findings suggest that this population has substantial injury burdens and prevention and care interventions focused in this demographic group could provide positive impacts in the study setting.
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INTRODUCTION: Urological emergencies represent 7 % of the outpatients at the emergency department (ED). We assessed the effect of setting up a post-emergency consultation (CPU) after deferred urological medical regulation. METHODS: All patients admitted to the ED in a university center over the period December 2017 to July 2018 and for whom a CPU was scheduled were included. The regulation concerned the date of CPU and supplementary exams. The main outcome was the ability to provide an efficient response according to a predefined grid of specific solutions. RESULTS: One hundred and twenty-eight patients were included. The median age was 57 years (18-97). Efficacy of the CPU was 76 %. This rate was lower in no-show patients or consulting for rare and complex motives (47 %, n=60). The no-show were not reachable on the first call in 51.6 % of cases, with a similar age and motives distribution to the others. Only 6,9 % (n=128) of all consultants (n=1863) had been referred to the CPU by emergency physicians. The decision was a second consultation in 70 % (48), a new exam in 10 % (7), deferred emergency surgery in 12 % (8) and finally 18 % (12) of no follow-up. CONCLUSION: CPU following early regulation by a urologist provides an effective response in 76 % of situations. Assessment of "no-shows" helped to identify groups at risk. LEVEL OF EVIDENCE: III.
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Servicio de Urgencia en Hospital , Tratamiento de Urgencia , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Vías Clínicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derivación y Consulta , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE Robot-assisted stereoelectroencephalography (SEEG) is gaining popularity as a technique for localization of the epileptogenic zone (EZ) in children with pharmacoresistant epilepsy. Here, the authors describe their frameless robot-assisted SEEG technique and report preliminary outcomes and relative complications in children as compared to results with the Talairach frame-based SEEG technique. METHODS The authors retrospectively analyzed the results of 19 robot-assisted SEEG electrode implantations in 17 consecutive children (age < 17 years) with pharmacoresistant epilepsy, and compared these results to 19 preceding SEEG electrode implantations in 18 children who underwent the traditional Talairach frame-based SEEG electrode implantation. The primary end points were seizure-freedom rates, operating time, and complication rates. RESULTS Seventeen children (age < 17 years) underwent a total of 19 robot-assisted SEEG electrode implantations. In total, 265 electrodes were implanted. Twelve children went on to have EZ resection: 4 demonstrated Engel class I outcomes, whereas 2 had Engel class II outcomes, and 6 had Engel class III-IV outcomes. Of the 5 patients who did not have resection, 2 underwent thermocoagulation. One child reported transient paresthesia associated with 2 small subdural hematomas, and 3 other children had minor asymptomatic intracranial hemorrhages. There were no differences in complication rates, rates of resective epilepsy surgery, or seizure freedom rates between this cohort and the preceding 18 children who underwent Talairach frame-based SEEG. The frameless robot-assisted technique was associated with shorter operating time (p < 0.05). CONCLUSIONS Frameless robot-assisted SEEG is a safe and effective means of identifying the EZ in children with pharmacoresistant partial epilepsy. Robot-assisted SEEG is faster than the Talairach frame-based method, and has equivalent safety and efficacy. The former, furthermore, facilitates more electrode trajectory possibilities, which may improve the localization of epileptic networks.
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Electrodos Implantados , Electroencefalografía , Epilepsia/fisiopatología , Epilepsia/cirugía , Procedimientos Quirúrgicos Robotizados , Adolescente , Mapeo Encefálico , Niño , Preescolar , Electrocoagulación/métodos , Epilepsia/diagnóstico por imagen , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Tomógrafos Computarizados por Rayos XRESUMEN
INTRODUCTION: Following the progress made regarding anesthesia reanimation, caesarean have become a much safer procedure. However, factors of mobi-mortality are still numerous. The main objective of this study was to analyze the factors of morbi-mortality arising during a caesarean. PATIENT AND METHOD: A retrospective cross-sectional study was conducted from January 2007 to December 2011 in the gynecology-obstetric and anesthesia reanimation services of the Gabriel TOURE University Hospital. The analysis looked at the medical files of women undergoing a caesarean and hospitalized in the gynecology-obstetric and anesthesia reanimation services. Data analysis was carried out with SPSS.19 (Statistical Package for Social Sciences) and the Epiinfo.7 softwares. Chi2 tests were performed to compare frequencies where a value of p≤0.05 was considered statistically significant. RESULTS: 269 medical files were analysed. Mean age was of 28.46 ± 6.702. The most frequent peroperative morbidity factors were cardiovascular. Death rate was of 5.2%. The most frequent cause of these deaths was eclampsia. Factors influencing morbi-mortalities were iterative caesareans and urgency of the caesarean. The evacuated mothers had presented complications in 37.3% of cases. CONCLUSION: The caesarean is a procedure that is not sufficiently safe in our services and there are a lot of factors of mobi-mortality.
INTRODUCTION: La sécurité au cours de la césarienne est devenue très grande grâce aux progrès de l'anesthésie réanimation. Cependant les facteurs de mobi-mortalité sont nombreux. Le but de ce travail était d'étudier les facteurs de morbi-mortalité au cours de la césarienne. PATIENTES ET MÉTHODE: Il s'agissait d'une étude transversale rétrospective de janvier 2007 à décembre 2011 dans les services de gynéco-obstétrique et d'anesthésie réanimation du centre hospitalier universitaire Gabriel TOURE. Elle a porté sur les dossiers des parturientes césarisées et hospitalisées dans les services de gynéco-obstétrique et d'anesthésie réanimation. L'analyse des données a été faite à l'aide du logiciel SPSS.19 (Statistical package for Social Sciences) et l'Epiinfo.7. Le test de khi2 était utilisé pour comparer les fréquences avec une valeur de p ≤ 0,05 considérée comme significative. RÉSULTATS: Le nombre de dossiers analysés était de 269. L'âge moyen était de 28,46 ± 6,702. Les événements morbides per opératoires fréquents étaient cardio-vasculaires. Le taux de létalité était de 5,2 %. La cause la plus fréquente des décès était l'éclampsie. Les facteurs de morbi-mortalités retrouvés ont été la césarienne itérative, le contexte urgent de la césarienne. Les parturientes évacuées avaient présenté une complication dans 37,3% des cas. CONCLUSION: La césarienne est un acte qui n'est pas suffisamment sûr dans notre structure. Les facteurs de mobi-mortalité sont nombreux.
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Leptin is an adipokine that acts in the central nervous system and regulates energy balance. Animal models and human observational studies have suggested that leptin surge in the perinatal period has a critical role in programming long-term risk of obesity. In utero exposure to maternal hyperglycemia has been associated with increased risk of obesity later in life. Epigenetic mechanisms are suspected to be involved in fetal programming of long term metabolic diseases. We investigated whether DNA methylation levels near LEP locus mediate the relation between maternal glycemia and neonatal leptin levels using the 2-step epigenetic Mendelian randomization approach. We used data and samples from up to 485 mother-child dyads from Gen3G, a large prospective population-based cohort. First, we built a genetic risk score to capture maternal glycemia based on 10 known glycemic genetic variants (GRS10) and showed it was an adequate instrumental variable (ß = 0.046 mmol/L of maternal fasting glucose per additional risk allele; SE = 0.007; P = 7.8 × 10(-11); N = 467). A higher GRS10 was associated with lower methylation levels at cg12083122 located near LEP (ß = -0.072 unit per additional risk allele; SE = 0.04; P = 0.05; N = 166). Direction and effect size of association between the instrumental variable GRS10 and methylation at cg12083122 were consistent with the negative association we observed using measured maternal glycemia. Lower DNA methylation levels at cg12083122 were associated with higher cord blood leptin levels (ß = -0.17 log of cord blood leptin per unit; SE = 0.07; P = 0.01; N = 170). Our study supports that maternal glycemia is part of causal pathways influencing offspring leptin epigenetic regulation.
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Epigénesis Genética , Regulación de la Expresión Génica , Hiperglucemia/genética , Leptina/genética , Intercambio Materno-Fetal , Adulto , Estudios de Cohortes , Metilación de ADN , Femenino , Glucosa/metabolismo , Humanos , Recién Nacido , Masculino , Análisis de la Aleatorización Mendeliana/métodos , EmbarazoRESUMEN
AIM OF THE STUDY: To determine the epidemiology of urological emergencies in a university hospital and the interest of a dedicated urological emergency unit. PATIENTS AND METHODS: In 2008, a dedicated urological emergency unit was individualized in our department of urology. We conducted a retrospective study including all patients consulting in this unit in 2009 with epidemiological, clinical and therapeutic data. RESULTS: During 2009, 1257 patients consulted in this unit. Main diagnoses were acute urinary retention (303, 24.11%), renal colic (219, 17.42%), urinary infections (278, 22.11%), postoperative complications (141, 11.22%), symptomatic benign prostate hyperplasia (65, 5.17%), genitourinary cancers (61, 4.85%), trauma of urinary apparel (41, 3.26%), and spermatic cords torsion (10, 0.8%). In 99 cases (7.88%) diagnosis did not involved the urinary system. The treatment was surgical in 213 (17.7%) cases, technical procedure under local anesthesia in 368 (29.3%) and a medical treatment in 675 (53.7%) cases. Six hundred and sixty (52.5%) patients were managed ambulatory whereas 596 (47.5%) needed hospitalization. CONCLUSION: The opening of a dedicated urological emergency unit lead to 1257 emergency consultations. Frequent etiologies were acute urinary retention, renal colic and urinary infection. The creation of this unit allowed to register and to valorize this emergency activity through the ATU emergency amount.
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Servicio de Urgencia en Hospital , Enfermedades Urológicas/epidemiología , Urología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Urgencias Médicas , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades Urológicas/terapia , Adulto JovenRESUMEN
Pyrethroid pesticides are commonly used in tropical regions such as the Caribbean as household insecticides, pet sprays, and where malaria is endemic, impregnated into mosquito-repellent nets. Of particular concern is exposure during pregnancy, as these compounds have the potential to cross the placental barrier and interfere with fetal development, as was shown in limited animal studies. The objective of this study was to evaluate exposure to pyrethroids to pregnant women residing in 10 English-speaking Caribbean countries. Pyrethroid exposures were determined by analyzing five pyrethroid metabolites in urine samples from 295 pregnant women: cis-DBCA, cis-DCCA, trans-DCCA, 3-PBA, and 4-F-3-PBA. Pyrethroid metabolite concentrations in Caribbean pregnant women were generally higher in the 10 Caribbean countries than levels reported for Canadian and U.S. women. In Antigua & Barbuda and Jamaica participants the geometric mean concentrations of cis-DBCA was significantly higher than in the other nine countries together (p<0.0001 and <0.0012 respectively). For cis- and trans-DCCA, only Antigua & Barbuda women differed significantly from participants of the other nine Caribbean countries (p<0.0001). Urinary 4-F-3-PBA and 3-PBA levels were significantly higher in Antigua & Barbuda (p<0.0028 and p<0.0001 respectively) as well as in Grenada (p<0.0001 and p<0.007 respectively). These results indicate extensive use of pyrethroid compounds such as permethrin and cypermethrin in Caribbean households. In Antigua & Barbuda, the data reveals a greater use of deltamethrin. This study underscores the need for Caribbean public health authorities to encourage their populations, and in particular pregnant women, to utilize this class of pesticides more judiciously given the potentially adverse effects of exposure on fetuses and infants.
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Insecticidas/metabolismo , Exposición Materna , Permetrina/metabolismo , Piretrinas/metabolismo , Adulto , Región del Caribe/epidemiología , Femenino , Humanos , Lactante , Insecticidas/orina , Permetrina/orina , Embarazo , Piretrinas/orinaRESUMEN
BACKGROUND: Distinguishing retrograde nodal conduction from extranodal conduction using an accessory pathway (AP) can sometimes be challenging. OBJECTIVE: To distinguish nodal from extranodal ventriculoatrial (VA) conduction regardless of AP location by proposing a simple method. This method is based on the principle that moving the pacing site progressively from the basal region toward the entrance of the His-Purkinje system should shorten VA time for nodal but not for AP conduction. METHODS: Sixty-seven patients with supraventricular tachycardia were prospectively recruited. Quadripolar catheters were placed at the right ventricular (RV) apex, right atrium, and His and coronary sinus. The RV septum was sequentially paced at 4 sites: (1) basal, (2) high midventricle, (3) low midventricle, and (4) apex at a cycle length 100 ms shorter than the resting cycle length. The stimulus-to-atrial (SA) interval was measured by using the proximal coronary sinus atrial electrogram. RESULTS: Group 1 (n = 33) had nodal VA conduction; all patients had typical atrioventricular nodal reentrant tachycardia. Group 2 (n = 34) had extranodal VA conduction via an AP: 19 left-sided, 6 right-sided, and 9 posteroseptal. In group 1, the SA interval decreased significantly as pacing site moved closer toward the apex (site 1: 166 ± 35 ms, site 2: 153 ± 32 ms, site 3: 149 ± 32 ms, site 4: 154 ± 33 ms, P < .001, respectively, at sites 2-4 compared with site 1). In contrast, in group 2, the SA interval increased significantly toward the apex (site 1: 149 ± 45 ms, site 2: 158 ± 43 ms, site 3: 161 ± 43 ms, and site 4: 163 ± 40 ms, P < .001, respectively, at sites 2-4 compared with site 1). The SA interval at the high midventricular site (site 2) - SA interval at the base (site 1) ≤ 0 ms for nodal and > 0 ms for extranodal conduction had optimal sensitivity and specificity (nodal: selectivity = 97.0% and specificity = 85.3%; extranodal: selectivity = 85.3% and specificity = 97.0%). CONCLUSIONS: Differential sequential pacing of the RV septum reliably distinguishes retrograde atrioventricular nodal conduction from AP conduction.
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Fascículo Atrioventricular Accesorio/terapia , Fascículo Atrioventricular/fisiopatología , Estimulación Cardíaca Artificial/métodos , Atrios Cardíacos/fisiopatología , Taquicardia por Reentrada en el Nodo Atrioventricular/terapia , Fascículo Atrioventricular Accesorio/diagnóstico , Fascículo Atrioventricular Accesorio/fisiopatología , Adulto , Nodo Atrioventricular/fisiopatología , Diagnóstico Diferencial , Técnicas Electrofisiológicas Cardíacas , Femenino , Estudios de Seguimiento , Tabiques Cardíacos , Humanos , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/diagnóstico , Taquicardia por Reentrada en el Nodo Atrioventricular/fisiopatologíaRESUMEN
BACKGROUND: Human metapneumovirus (HMPV) is a recently discovered paramyxovirus that is a major cause of respiratory infections worldwide. OBJECTIVES: We aim to describe the molecular evolution of the HMPV F (fusion) and G (attachment) surface glycoproteins because they are targets for vaccines, monoclonal antibodies and antivirals currently in development. STUDY SETTING: Nasopharyngeal aspirates were collected in children <3 years old with acute respiratory infection in Quebec City during 2001-2010. HMPV-positive samples (n = 163) underwent HMPV-F and -G gene sequencing. Furthermore, HMPV-F (n = 124) and -G (n = 217) sequences were obtained from GenBank and other studies. Evolutionary analyses (phylogenetic reconstruction, sequence identity, detection of recombination and adaptive evolution) were computed. RESULTS: Sequences clustered into 5 genetic lineages (A1, A2a, A2b, B1 and B2). Multiple lineages circulated each year in Quebec City. With the exception of B1, each of the 5 subgroups was the predominant lineage during ≥1 season. The A1 lineage was not detected since 2002-2003 in our local cohort. There was no evidence of inter- or intragenic recombination. HMPV-F was highly conserved, whereas HMPV-G exhibited greater diversity. HMPV-F demonstrated strong evidence of purifying selection, both overall and in an abundance of negatively selected amino acid sites. In contrast, sites under diversifying selection were detected in all HMPV-G lineages (range, 4-15), all of which were located in the ectodomain. CONCLUSIONS: Predominant circulating HMPV lineages vary by year. HMPV-F is highly constrained and undergoes significant purifying selection. Given its high genetic variability, we found a modest number of positively selected sites in HMPV-G.