Search

Background: Reporting on and monitoring epidemics is a public health priority. Several initiatives and platforms provide epidemiological data, such as the EM-DAT International Disaster Database, which has 1525 epidemics and their impact reported since 1900, including 892 epidemics between 2000 and 2023. However, EM-DAT has inconsistent coverage and deficiencies regarding the systematic monitoring of epidemics data due to the lack of a standardized methodology to define what will be included under an epidemic disaster., Methods: We conducted a sequential study that included an online survey of experts in infectious diseases, public health emergencies, and related data, followed by committee discussions with disaster experts. This approach aimed to identify appropriate definitions and entry criteria for archiving disease outbreak events., Results: The survey had 21 respondents from universities and international organizations, with experts primarily specialized in infectious disease surveillance. Experts agreed that epidemics should be considered as disasters. Experts cited challenges in defining epidemic thresholds. However, they proposed pathogen-based criteria and agreed that disruption to society, especially to the healthcare system, serves as a determinant of epidemic disasters. The experts favored deaths and confirmed cases as key indicators, alongside suggestions on refining EM-DAT's entry criteria and improving epidemic impact assessment., Discussion: This article offers valuable insights into epidemic disasters, a topic previously underdefined in the literature, thereby enhancing understanding for policymakers and public health professionals., Competing Interests: Declarations. Ethics approval and consent to participate: The processing of survey participants' data complies in all respects with the obligations of the General Data Protection Regulation (GDPR) in the current version of the OJ L 119, 04.05.2016; cor. OJ L 127, 23.5.2018. the official text of the Regulation (EU) 2016/679 is available here https://gdpr-info.eu/ . All study participants completed the survey online and provided informed consent to participate in the published study. Two participants asked not to be named. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Daptomycin (DAP) is a cyclic lipopeptide antibiotic with bactericidal activity against gram-positive bacteria. The most common adverse reaction is myotoxicity characterized by rhabdomyolysis. Other reported adverse reactions include gastrointestinal symptoms, skin lesions, bleeding, and pulmonary involvement. Neurotoxicity is rare and its mechanism remains partially elucidated. We report a case of confusion consistent with DAP-induced neurotoxicity. A 73-year-old obese man was treated with DAP 9 mg/kg for methicillin-resistant Staphylococcus aureus  (MRSA) bacteremia associated with foot osteitis and cervical posterior inter-apophyseal arthritis. On the fifth day of treatment, he developed spatial disorientation, and serum DAP concentrations were very high. DAP-induced neurotoxicity was suggested. His neurological status returned to normal after treatment was stopped. This observation describes a relationship between confusion and DAP that is favored by obesity. Clinicians should be alert for neurologic disorders associated with DAP. It is prudent to reduce doses in obese patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Randrianarisoa et al.)

Arterial blood gases (pH, pO2, p CO2) were studied in 100 patients with documented pulmonary embolism (Group A), confirmed by pulmonary angiography (n = 51) or scintigraphy ( n = 49). The pO2 ranged from 32 to 97 mm Hg (average 60,5 +/- 13 mm Hg). Hypoxaemia was found in 97 cases and would therefore seem to be a reliable sign of pulmonary embolism. In the three cases in which it was absent, the embolism was small. Hypoxaemia was associated with hypocapnia and alkalosis in 91 cases. However, hypoxaemia was not a specific finding; it was also present in 49 patients with suspected pulmonary embolism (Group B) in whom the diagnosis was excluded by pulmonary angiography or scintigraphy. A previous history of cardiovascular disease was found in 37 patients (76%) in this group: of the 12 remaining patients, 6 were heavy smokers and 4 were significantly obese. No correlation was found between the degree of hypoxaemia and the extent of amputation of the vascular bed on pulmonary angiography or scintigraphy. Nevertheless, a pO2 of under 50 mm Hg was always associated with a severe embolism with amputation of over 40% of the pulmonary vascular bed. A significant correlation was found between the severity of hypoxaemia and the degree of cyanosis (p less than 0,05) and ECG changes (p less than 0,01). The average pO2 was 59 +/- 12 mm Hg in patients with cardiovascular disease ( n = 21) and 55 +/- 11 mm Hg with known pulmonary disease ( n = 6). A higher average pO2 was found when these conditions were absent (61,5 +/- 13 mmHg). The difference was not statistically significant unless previous cardiac and pulmonary disease were associated (pO2 = 51 +/- 14 mm Hg, p less than 0,05).

Twenty patients suffering from primary hyperaldosteronism were studied. Sixteen had a single adenoma of the adrenal and four had bilateral hyperplasia affecting both adrenals. Cases of primary hyperaldosteronism due to a tumour were characterised by a higher degree of hypermineralocorticism than was seen in the patients with hyperplasia. Plasma aldosterone, after acute volaemic expansion, did not fall below 13 ng/100 ml in the adenoma patients whilst it was lower in the case of hyperplasia. Adrenal phlebography is a useful tool in preoperative diagnosis.

A new case of right coronary artery abnormally issued from the pulmonary trunk is reported. The patient was an asymptomatic young man in whom a continuous cardiac murmur was discovered by chance and an angiographic examination disclosed the coronary abnormality. A review of the literature yielded 37 cases of this anomalous origin which was either isolated, as in the case reported here, or associated with another congenital or acquired cardiopathy. The diagnosis may be suspected on the presence of a continuous murmur in an usually asymptomatic subject and is confirmed by angiography. The abnormality is generally well tolerated owing to an inter-coronary collateral circulation resulting in retrograde perfusion of the right coronary artery from the left coronary artery. This good tolerance explains why an isolated abnormality of that type is often discovered belatedly, in contrast with the anomalous origin of the left coronary artery from the pulmonary trunk, which is usually revealed at birth by clinical signs of acute coronary insufficiency. However, the likelihood of either cardiac failure due to the left-to-right shunt in elderly people or, chiefly, acute myocardial ischaemia by coronary steal with a risk of sudden death in young people makes it imperative in such cases to perform reimplantation surgery.

This coronary spasm provocation test with methyl-ergometrine maleate was carried out during coronary arteriography in 47 patients presenting with spontaneous chest pain. Coronary spasm was triggered in 16 cases, reproducing the chest pain in 11 patients, and accompanied by electrical changes in 15 cases, 12 subepicardial ischaemias and 3 subendocardial ischaemias. This test is not without danger to the patient as arrhythmias and conduction defects were recorded in 6 cases although the spasm was readily reversible on injection of intravenous glyceryl trinitrate. Of 7 patients with Prinzmetal variant angina, the test was positive 6 times, in three of which on pre existing severe organic lesions, so confirming the mechanism of this syndrome and the reliability of the test. Of 40 patients presenting with spontaneous chest pain, 10 had a positive test. In 2 of these cases the chest pain was subsequently observed with subepicardial ischaemic electrical changes, so confirming the screening value of this test. In the 7 cases where coronary spasm gave rise to electrical changes with or without pain, the logical diagnosis would appear to be spastic angina. In the 30 cases where the test was negative the subsequent outcome did not provide any proof in favour of a coronary origin of the chest pain.

Ionized serum calcium was determined, using a selective electrode, after administration of 80 ml of radiological contrast medium. The ionized calcium concentration was significantly diminished during five minutes after injection (control: 0,98 +/- 0,02 mmol/l; 3 min: 0,94 +/- 0,02 mmol/l, p less than 0,01; 5 min: 0,94 +/- 0,01 mmol/l, p less than 0.05). Determinations were also performed in vitro on whole blood and separated plasma after addition of contrast medium. These determinations revealed a direct interaction between ionized calcium and contrast medium and the importance of the delay after mixing. Clinical consequences under the conditions of the study are probably null but this secondary effect of the contrast medium can explain incidents or accidents observed during the first local circulation of contrast medium especially during coronarography.

Patients with angina but with "normal coronarography" results, are not a rare finding during angiographic investigations, more especially in the case of women. The authors review the clinical, electrical, hemodynamic and metabolic characteristics of these cases, and discuss the principal known etiologies, and limits of "normality" with respect to coronary artery angiography results.

Selective adrenal phlebography with measurement of hormone levels was used to investigate the majority of 58 cases of primary hyperaldosteronism. The authors stress the importance of pre-operative diagnosis of the lesion as surgery is indicated for adenomas only, and because of their small size they are often missed in adrenal scintigrams and on manual exploration during operation. They are in agreement with most other authors that adrenal phlebography is the most valid investigation, as it gives a precise diagnosis of the lesion in 92% of cases. The angiographic findings in the most common lesions are described, the difficulty in diagnosing peripheral small adenomas stressed, and the problems associated with the diagnosis of nodular hyperplasias outlined. They also underline the fundamental importance of selective hormone levels measurement, as these results are of equal value to those of the images themselves.

The hemodynamic consequences of the translumbar intra-aortic injection of 80 ml of contrast media were studied in 28 patients, in whom cardiac output was determined using thermodilution. These measurements revealed that the vasoplegia produced by the intra-aortic injection of contrast media is of smaller amplitude and longer duration than that evidenced during regional flow determinations. Moreover, the decrease in vascular peripheral resistances and the increase in cardiac output, accompanied by bradycardia, persist for several minutes. These phenomenons are related to an increase in ventricular filling, resulting from the expansion of the intravascular compartment secondary to plasma hyperosmolality.

For a short-term evaluation of the patency of aortocoronary bypass vein grafts, 54 consecutive patients who underwent this operation alone were examined, irrespective of their functional state, 12.4 +/- 2.1 months after surgery. Examinations included coronary arteriography, selective opacification of the graft and ventriculography. The patients were 47 men and 7 women who had coronary arteriography for stable angina pectoris (22.4%) or a recent episode of unstable angina (59.3%) or a recent myocardial infarction (18.5%). Coronary arteriography showed one-vessel (5.5%), two-vessel (27.8%) or three-vessel (42.6) disease or stenosis of the main left coronary artery (24.1%). The mean number of distal anastomoses in multiple-vessel patients was 2.6. Peri-operative mortality was 1.04%, and the proportion of peri-operative electrocardiographic signs of necrosis was 11%. At the time of control examination, 82% of the patients had few or no symptoms, and 88% were improved by at least one functional class. 79% (97/123) of distal venous anastomoses were patent. All anastomoses were patent in 59% (22/54) and all were occluded in 7% (4/54) of the patients. Localized stenosis of the graft was found in 11% and diffuse stenosis in 4% of the cases. The patency of vein grafts was higher when the distal bed was of normal size than when it was small or poorly visualized at the initial angiography (85% vs 62%, p less than 0.01), or when the diameter of the artery bypassed was greater than 1.3 mm.(ABSTRACT TRUNCATED AT 250 WORDS)

An unusual association of agenesis of the left internal carotid artery and coarctation of the aorta is reported. There was also an aneurysm of the thoracic aorta distal to the coarctation. The subclavian artery was obstructed and revascularization occurred through the vertebral artery via anastomoses with the occipital artery. An embryological hypothesis for this association is proposed.

The authors present their experience of radiological investigation of pheochromocytoma based on a series of 80 patients. The aim of radiological investigation are defined and primarily involve a topographical diagnosis and a preoperative assessment of the tumour. Each technique is discussed critically and their indications defined. At present, nephrourotomography by rapid injection is the technique of choice for the diagnosis of an adrenal lesion. Echotomography and scanning do not give as much precision. The assessment of the tumour requires above all arteriography, but staggered measurements from the vena cava is a promising new technique.