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The aim was to describe the impact of infective endocarditis (IE) on functional, cognitive and nutritional statuses, and to estimate the influence of these parameters on surgical management and mortality.This was a prospective study over 13 months in 14 French hospitals, including patients ≥75 years of age with definite or possible IE. A comprehensive geriatric assessment (CGA) was performed during the first week of hospitalization, including a retrospective estimation of functional status 2 months before hospitalization, and 3 months after.A total of 120 patients were included (mean age 83.1 ± 5.0 (75-101) years). IE was associated with a dramatic impairment of functional status between 2 months prior hospitalization and the first geriatric evaluation (90.8% able to walk vs. 35.5% (p 0.0001), ADL (Activities in Daily Living) 5.0 ± 1.7 vs. 3.1 ± 2.1 (p 0.0001)). The 19 operated patients (15.8%) had less comorbidities (cumulative illness rating scale geriatric 10.8 ± 8.2 vs. 15.3 ± 7.1 (p 0.0176)), better functional (ADL 5.9 ± 0.4 vs. 4.9 ± 1.8 (p 0.0171) and nutritional (mini nutritional assessment 20.4 ± 5.0 vs. 17.3 ± 6.2 (p 0.0501)) statuses than non-operated patients. Among all infectious, cardiac and geriatric parameters, body mass index (HR 0.9, range 0.8-1, p 0.05) and ADL at the time of the first evaluation (HR 0.7, range 0.6-0.9, p 0.002) were the sole independent predictors of the 3-month (32.5%) and 1-year mortality (42.5%). Three months later, the 57 assessed patients only partially recovered their ADL (3.7 ± 1.9 vs. 5.3 ± 1.4 2 months prior hospitalization and 4.6 ± 1.9 at the first CGA; p 0.0001).Functional and nutritional abilities are crucial components that can be accurately explored through a CGA when managing IE in oldest patients.

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.

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Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare but severe complication. Among 326 patients who underwent TAVI at Grenoble Alpes University Hospital, six (1.8%) cases of IE and 11 (3.4%) cases of bacteraemia were identified. No cases of IE were linked to the intervention; one was due to Staphylococcus aureus despite a screening and targeted decolonization strategy. This underscores the need for randomized studies to evaluate the benefit and cost-effectiveness of this policy.

Introduction Le diagnostic de bacteriemie est souvent fait plusieurs heures apres la realisation des hemocultures, parfois apres la sortie du patient. Ce delai peut impacter la prise en charge des patients des service d’urgences ou ambulatoires. Quand les resultats des hemocultures sont rendus apres la sortie du patient, les services d’infectiologie et de bacteriologie de notre structure contactent habituellement le patient afin de controler son etat clinique, soit via une consultation d’infectiologie dediee, soit via une hospitalisation si necessaire, ou organisent le suivi par le medecin traitant. C’est aussi l’occasion de reevaluer l’antibiotherapie. Materiels et methodes Nous avons realise une etude retrospective sur l’annee 2016, monocentrique, concernant les adultes pour lesquelles une hemoculture etait rendue positive en culture apres la sortie. Nous avons recueilli pour chaque cas, les donnees cliniques et bacteriologiques, le traitement antibiotique (initial et les modifications eventuelles secondaires) et le taux de readmission. Resultats En 2016, 1433 bacteriemies etaient identifiees et 51 (3,6 %) l’etaient apres la sortie du patient. Une reevaluation clinique etait possible pour 46 patients (90,2 %), le diagnostic initial etait corrige lors de la reevaluation clinique pour 25 d’entre eux (54,3 %), dont 5 endocardites infectieuses (9,8 %), 6 infections urinaires (11,8 %) et 8 infections de catheters (15,7 %). Une bacterie consideree comme pathogene etait isolee dans 33 cas (64,7 %) (enterobacteries pour 13 patients, staphylococcus aureus pour 3 patients, streptococcus sp. pour 5 patients), et une bacterie consideree comme une contamination dans 18 cas (35,3 %). Une antibiotherapie etait prescrite avant la sortie des patients dans 24 cas (47,1 %), modifiee pour 14 patients (27,5 %) et debutee pour 15 patients (29,4 %) lors de la reevaluation. Vingt-cinq patients (49,0 %) etaient rehospitalises apres la reevaluation. Conclusion Le suivi clinique des patients sortis a domicile avant le resultat positif de leurs hemocultures permet une correction du diagnostic et de l’antibiotherapie dans la moitie des cas.

EU annual serosurveillance programs show that domestic duck flocks have the highest seroprevalence of H5 antibodies, demonstrating the circulation of notifiable avian influenza virus (AIV) according to OIE, likely low pathogenic (LP). Therefore, transmission characteristics of LPAIV within these flocks can help to understand virus circulation and possible risk of propagation. This study aimed at estimating transmission parameters of four H5 LPAIV (three field strains from French poultry and decoy ducks, and one clonal reverse-genetics strain derived from one of the former), using a SIR model to analyze data from experimental infections in SPF Muscovy ducks. The design was set up to accommodate rearing on wood shavings with a low density of 1.6 ducks/m 2 : 10 inoculated ducks were housed together with 15 contact-exposed ducks. Infection was monitored by RNA detection on oropharyngeal and cloacal swabs using real-time RT-PCR with a cutoff corresponding to 2–7 EID50. Depending on the strain, the basic reproduction number ( R 0 ) varied from 5.5 to 42.7, confirming LPAIV could easily be transmitted to susceptible Muscovy ducks. The lowest R 0 estimate was obtained for a H5N3 field strain, due to lower values of transmission rate and duration of infectious period, whereas reverse-genetics derived H5N1 strain had the highest R 0 . Frequency and intensity of clinical signs were also variable between strains, but apparently not associated with longer infectious periods. Further comparisons of quantitative transmission parameters may help to identify relevant viral genetic markers for early detection of potentially more virulent strains during surveillance of LPAIV.

Controlling antibiotic use in healthcare establishments limits their consumption and the emergence of bacterial resistance.To evaluate the efficiency of an innovative antibiotic stewardship strategy implemented over three years in a university hospital.An antimicrobial multi-disciplinary team (AMT) [pharmacist, microbiologist and infectious disease specialist (IDS)] conducted a postprescription review. Specific coding of targeted antibiotics (including broad-spectrum β-lactams, glycopeptides, lipopeptides, fluoroquinolones and carbapenems) in the computerized physician order entry allowed recording of all new prescriptions. The data [patient, antibiotic(s), prescription start date, etc.] were registered on an AMT spreadsheet with shared access, where the microbiologist's opinion on the drug choice, based on available microbiology results, was entered. When the microbiologist and pharmacist did not approve the antibiotic prescribed, a same-day alert was generated and sent to the IDS. That alert led the IDS to re-evaluate the treatment.From 2012 to 2014, 2106 targeted antibiotic prescriptions were reviewed. Among them, 389 (18.5%) generated an alert and 293 (13.9%) were re-evaluated by the IDS. Recommendations (mostly de-escalation or discontinuation) were necessary for 136 (46.4%) and the prescribers' acceptance rate was 97%. The estimated intervention time was30 min/day for each AMT member. This system allowed correct use of targeted antibiotics for 91.8% of prescriptions, but had no significant impact on targeted antibiotic consumption.This computerized, shared access, antibiotic stewardship strategy seems to be time saving, and effectively limited misuse of broad-spectrum antibiotics.

The behavior of the hydrodynamic journal bearings is now very well known because of the many experimental and numerical studies that have been carried out on the topic. This interest in two-lobe journal bearings is due to the fact that their simplicity, efficiency and low cost have led them to being widely used in industry. These mechanical components tend to be subjected to numerous start-ups and stops. During transient periods, direct contact between the journal and bearing induces high friction in the lubricated contact and hence wear of the lining. The aim of this work is, firstly, to present experimental data obtained on a journal lobed bearing subjected to numerous starts and stops. Then, a comparison is made between the measured bearing performance and numerical results, these being obtained on the assumption that the regime is a thermohydrodynamic (THD) one. The wear after more than 2,000 cycles was measured and used to generate numerical simulations. The aim here was to compare experimental data with theoretical results. It was observed that hydrodynamic pressure increases, whereas the temperature at the film/bush interface slightly decreases on both the upper and lower lobes. These trends are confirmed by the numerical simulations, theoretical results being very close to experimental data. The final value for wear was measured, the maximum being found to be located at an angular coordinate of 180° and reaching nearly 9 μm. The present study demonstrates that, for the case studied, while the bearing behavior is clearly affected by wear, the bearing still remains useable and safe.Copyright © 2006 by ASME

Status epilepticus (SE) is a condition requiring emergency care, which is often poorly managed in developing countries due to the lack of personnel, drugs, and insufficient technical and medical means. This study aims at determining the epidemiologic and etiologic characteristics and the difficulty in treating SE under the existing medical practice conditions in a developing country such as Senegal. A retrospective study was therefore carried out based on SE medical files at the University Hospital of Dakar over the period January 1988 to December 1998, and included several hospital departments, i.e., paediatrics, infectious diseases and neurology. Over an 11-year period 697 cases were recorded; of these, 48.2% of patients were under 5 years of age. The seizures were generalized in 58.2% of cases, partial in 21.2%, partial secondarily generalized, or with an association of both clinical presentations in 20.6% of cases. The etiology was as follows: mainly infectious (67%), followed by resistant and/or unbalanced epilepsy (9.9%), epilepsy of vascular origin (8%), and various other causes. The overall mortality rate was 24.8%. A long period between the onset of clinical symptoms and hospital treatment was noted, with an average time lapse of 16.6 h before treatment. The drugs utilized were diazepam and phenobarbitol, administered by injection. The overall outcome could be improved by better management, i.e., better prevention and an efficient treatment of infectious diseases, a reduction in the time before treatment, and improved means of intensive care.

Hydrodynamic journal bearings are essential components of high-speed machinery. In severe operating conditions, the thermal dissipation is not a negligible phenomenon. Therefore, a three-dimensional thermohydrodynamic (THD) analysis has been developed that includes lubricant rupture and re-formation phenomena by conserving the mass flowrate. Then, the predictions obtained with the proposed numerical model are validated by comparison with the measurements reported in the literature. The effects of various geometric factors (length, diameter and radial clearance) and operating conditions (rotational speed, applied load and lubricant) on the journal bearing behaviour are analysed and discussed in order to inform bearing designers. Thus, it can be predicted that the bearing performance obtained highly depends on operating conditions and geometric configuration.

A new ursane derivative, 3-oxo-15alpha,19alpha-dihydroxyursa-1,12-dien-28-oic acid, was isolated from the roots of Canthium multiflorum (Rubiaceae) along with 10-O-acetylgeniposidic acid, 6,7-dimethoxycoumarin, hymexelsin, scopoletin, and 5,6,7-trimethoxycoumarin.

WOS: 000340538700017, PubMed ID: 24789652, The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

The process of wastewater treatment was studied by modeling the relationships between physical, chemical, and biological (bacteria, phytoplankton, zooplankton) components of the sewage treatment lagoons of an urban wastewater center, based upon a two-year sampling program. The models of interactions between variables were tested by path analysis. The path coefficients were computed from the results of ridge regression, instead of linear multiple regression. The results show that fecal coliforms were effectively controlled by the environmental variables included in the model, which have a cyclic seasonal behavior. This control grew stronger with distance from the input (R (2)=0.71) to the output (R (2)=0.88) of the treatment plant, resulting in effective elimination of most enteric bacteria. Simultaneously, the ecosystem's community of aerobic heterotrophic bacteria became more independent from the model's predictive variables, with increased distance from the sewage input, thus demonstrating its maturation as an autonomous community in the lagoon ecosystem. Consequences of modeling are discussed, with respect to the understanding of biological wastewater treatment mechanisms and ecosystem dynamics and to plant management.

Following the emergence of highly pathogenic avian influenza (AI), active surveillance of infections due to the H5 and H7 subtypes in poultry has increased and been made compulsory in Europe since 2002, by means of annual serological surveys using the haemagglutination inhibition (HI) test. Domestic anseriforms, particularly ducks and geese, are more frequently infected by H5 low pathogenic AI virus, often subclinically, and represent a threat for other terrestrial poultry. 1783 sera, mainly from ducks, have been used to evaluate and compare a commercial ELISA kit detecting H5 antibodies with the currently recommended HI test. Different approaches to calculating specificity and sensitivity have been used, including the original Bayesian method. Results were similar when data were analyzed at the individual and batch levels, and when using different methods of calculation. However, results showed that H5 ELISA had both a higher sensitivity and a lower specificity than the HI test. Given that sensitivity is the most important factor for a screening test, H5 ELISA could therefore be recommended for AI surveillance, followed in cases of positivity by molecular tests aimed at detecting the virus gene.

A bioactivity guided fractionation of roots of Canthium multiflorum led to the isolation of the new ursenoic acid derivative 19alpha-hydroxy-3-oxo-ursa-1,12-dien-28-oic acid (1), which showed antiplasmodial effect without inducing change of the shape of membranes of erythrocytes.

Prevalence of avian influenza infection in free-range mule ducks (a cross between Muscovy [Cairina moschata domesticus] and Pekin ducks [Anas platyrhychos domesticus]) is a matter of concern and deserves particular attention. Thus, cloacal swabs were collected blindly from 30 targeted mule flocks at 4, 8, and 12 wk of age between October 2004 and January 2005. They were stored until selection. On the basis of a positive H5 antibody detection at 12 wk of age with the use of four H5 antigens, the samples from eight flocks were selectively analyzed. Positive samples were first screened with a matrix gene-based real-time reverse transcriptase-polymerase chain reaction assay before virus isolation. Eight avian influenza subtypes (H5N1, H5N2, H5N3, H6N2, H6N8, and H11N9) and three avian paramyxovirus type 1 viruses were isolated. All 11 are characterized as low pathogenicity (LP) and avirulent, respectively, by in vivo tests and, when relevant, nucleotide sequencing of the hemagglutinin (or fusion [F]) protein cleavage site. Regarding H5 isolates, all of their eight genes belong to the avian lineage and some particular genetic traits were determined. H5 genes were fully sequenced and phylogenetically analyzed; they all belong to the Eurasian lineage, lack additional glycosylation sites, and do not cluster, suggesting separate introductions from the wild reservoir. None were grouped with the Asian isolates. The N1 gene (H5N1 isolate) was very close genetically to an Italian LP-H7N1 gene. Antigenic relationships between these H5 isolates and others were assessed comparatively by crossed hemagglutination inhibition tests. All these data are very useful to control the evolution of H5 viruses at the genetic and antigenic level to better understand the source of new outbreaks (new introductions from wild birds or the result of spread among poultry) and to assess the immunity afforded by available vaccines. These data are useful also to update antigens for avian influenza survey and to choose the most suitable vaccine in the case of preventive vaccination of ducks.

Kurubasch aldehyde, a sesquiterpenoid with an hydroxylated humulene skeleton, was isolated as free alcohol from Trichilia emetica Vahl. (Meliaceae), belonging to the order Sapindales. Related substances have been previously found in plants as esters of aromatic acids, and these plants were species belonging to the distant order Apiales. This is the first report of humulenes found in the genus Trichilia and only the second of humulenes in the order Sapindales. The aldehyde is a modest inhibitor of the growth of Plasmodium falciparum (IC50 76 microM) and slow-proliferating breast cancer cells MCF7 (78 microM), but a potent inhibitor of proliferation of S180 cancer cells (IC50 7.4 microM).

The present study was designed to investigate the blocking of calcium by the hydroalcoholic extract of Tapinanthus dodoneifolius (Tapidod), "in vitro", on rat trachea. To evaluate this effect, the contractile activity of tracheal chains from Wistar Kyoto rats was isometrically recorded. On the isolated tracheal rings the extract produced the following effects: (a) a reduction of the contraction obtained by BaCl2, (b) a bronchorelaxing action, on strips precontracted by KCl, which was not influenced by TEA (3x10-3 M), (c) a concentration-dependent decrease of the spasm evoked by calcium chloride (CaCl2) in K+-rich Ca2+-free physiological salt solution, before and after intracellular calcium depletion (d), an inhibitory effect on contraction induced by acetylcholine in Ca2+-free Krebs-Heinseleit solution supplemented with EDTA (5x10-4M). It is concluded that: 1. The activation of the potassium channels does not play a significant role in the relaxant effect of Tapidod. 2. The antispasmodic property of Tapidod seems to be mediated by the blockade of intracellular Ca2+ release. 3. Most likely an inhibition of the intracellular Ca2+-regulating proteins is involved.

The present study was designed to investigate the blocking of calcium by the hydroalcoholic extract of Tapinanthus dodoneifolius (Tapidod), \"in vitro\", on rat trachea. To evaluate this effect, the contractile activity of tracheal chains from Wistar Kyoto rats was isometrically recorded. On the isolated tracheal rings the extract produced the following effects: (a) a reduction of the contraction obtained by BaCl2, (b) a bronchorelaxing action, on strips precontracted by KCl, which was not influenced by TEA (3x10-3 M), (c) a concentrationdependent decrease of the spasm evoked by calcium chloride (CaCl2) in K+ -rich Ca2+ -free physiological salt solution, before and after intracellular calcium depletion (d), an inhibitory effect on contraction induced by acetylcholine in Ca2+ -free Krebs-Heinseleit solution supplemented with EDTA (5x10-4M). It is concluded that: 1. The activation of the potassium channels does not play a significant role in the relaxant effect of Tapidod. 2. The antispasmodic property of Tapidod seems to be mediated by the blockade of intracellular Ca2+ release. 3. Most likely an inhibition of the intracellular Ca2+-regulating proteins is involved. Key Words: Extract of Tapinanthus dodoneifolius (Tapidod); Trachea; Calcium. Afr. J. Trad. CAM (2005) 2 (2): 166-176

Aqueous extracts of Mitragyna inermis (AEMI) used traditionally as antihypertensive agents produced a concentration-dependent (0.1-3 mg/ml) ex vivo increase in cardiac contractile response and coronary flow but did not modify heart rate in the rat. Interestingly, AEMI produced relaxation in isolated porcine coronary artery at concentration up to 3 mg/ml that was exclusively dependent on the presence of endothelium. This relaxation involved partial depolarization (KCl 20, 40 mM) and NO synthase inhibitor-sensitive mechanisms but was not sensitive to the blockade of cyclo-oxygenase pathway. In contrast, the relaxant effect of AEMI was not dependent on the presence of endothelium in rat tail artery. Taken together, the present study demonstrates hypotensive, cardiotropic and vasodilatory properties of AEMI that contribute to better understanding of its beneficial effect against cardiovascular diseases.

Status epilepticus (SE) is a condition requiring emergency care, which is often poorly managed in developing countries due to the lack of personnel, drugs, and insufficient technical and medical means. This study aims at determining the epidemiologic and etiologic characteristics and the difficulty in treating SE under the existing medical practice conditions in a developing country such as Senegal. A retrospective study was therefore carried out based on SE medical files at the University Hospital of Dakar over the period January 1988 to December 1998, and included several hospital departments, i.e., paediatrics, infectious diseases and neurology. Over an 11-year period 697 cases were recorded; of these, 48.2% of patients were under 5 years of age. The seizures were generalized in 58.2% of cases, partial in 21.2%, partial secondarily generalized, or with an association of both clinical presentations in 20.6% of cases. The etiology was as follows: mainly infectious (67%), followed by resistant and/or unbalanced epilepsy (9.9%), epilepsy of vascular origin (8%), and various other causes. The overall mortality rate was 24.8%. A long period between the onset of clinical symptoms and hospital treatment was noted, with an average time lapse of 16.6 h before treatment. The drugs utilized were diazepam and phenobarbitol, administered by injection. The overall outcome could be improved by better management, i.e., better prevention and an efficient treatment of infectious diseases, a reduction in the time before treatment, and improved means of intensive care.

France produces a large number of ducks (100 million in 2005 including Muscovy (Cairina moschata domesticus), Pekin (Anas platyrhynchos domesticus) and mule: the hybrid between Muscovy and Pekin). Whereas Muscovy meat ducks and breeder ducks are reared indoors, mule ducks are reared as free-range ducks from 4 to 12 wk-old then they are transferred indoors for force-feeding. Since duck can play a pivotal role in the epidemiology of avian influenza (AI), prevalence of AI infection in free-range ducks is a matter of concern and deserves particular attention.

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