Impact d''une grille de tri à l''accueil d''un service d''urgence pédiatrique

The pediatric nursing staff of the emergency unit has established a list of items for the triage of patients which can be used by the registered nurses. This scale defined 3 stages of severity. OBJECTIVES: 1) to estimate the relevance of this list through the appraisal of the total time necessary to take care of the patients according to their severity stage, and the confrontation of the severity stage determined by the registered nurse and the severity stage determined by the paediatrician; 2) to determine a possible correlation between the severity stage and the rate of hospitalization. METHOD: This prospective study was carried out over a period of 1 month in winter for every child admitted in the pediatric emergency unit for medical reasons (traumatisms excluded). RESULTS: One thousand six hundred and fifty-six children have been included in the study. Among them, 136 have been classified stage I, 1020 stage II and 500 stage III. The children have been taken care of in an average period of 20 min for stage I, 32 min for stage II, 43 min for stage III. The coherence rate between the severity stage determined by the nurse and the severity rate determined by the paediatrician was good. The rate of sub-estimation was low (4,2%). Nevertheless the reception nurses tend to overestimate the stage of severity in 17,6% of the cases. The prediction rate for hospital admittance was good: 68,7% of children classified in stage 1 were admitted, 23,5% of children in stage 2 and only 1,6% of children in stage 3. CONCLUSION: Patients suffering from severe illnesses were taken care without injurious delay which was the main purpose of this list.     

经颈动脉移植骨髓间充质干细胞治疗局灶性大鼠脑缺血损伤

目的:经颈动脉移植骨髓间充质干细胞至大脑中动脉闭塞大鼠体内,观察移植后大鼠缺血性脑损伤神经功能的恢复作用。方法:实验于2006-04/11在天津医科大学环湖医院实验室进行。实验材料:健康成年SD大鼠,体质量250～300g,雄性,由中国军事医学科学院动物中心(北京)提供(SCXK-(军)2002-001)。实验方法:①骨髓间充质干细胞分离、原代培养及诱导:采用梯度密度离心法和贴壁法分离SD大鼠骨髓间充质干细胞,待细胞生长达80%～90%融合时开始进行诱导分化,诱导液为DMEM培养基 2%二甲基亚砜 200μmol/L3-叔丁基-4羟基茴香醚 5mmol/Lβ-巯基乙醇。倒置相差显微镜观察骨髓间充质干细胞形态学变化。②动物模型建立及颈动脉骨髓间充质干细胞移植:采用改良Longa's线栓法阻断SD大鼠左侧大脑中动脉,制成局灶性脑缺血模型。模型建立成功判定:大鼠清醒后,观察其体征,以右侧肢体瘫痪,前肢为重表明模型制作成功。模型建立成功后24h,骨髓间充质干细胞治疗组于同侧颈外动脉注射2×106个Brdu标记的、诱导过的骨髓间充质干细胞,磷酸盐缓冲液组接种同等体积磷酸盐缓冲液,对照组不接种,每组12只。③神经功能缺损评估:在模型制制作后,每3d采用Combs法进行神经功能评估,观察大鼠在行为学方面差异。④实验评估:制备大鼠脑组织石蜡切片,采用免疫组织化学方法检测骨髓间充质干细胞成活情况。结果:36只大鼠中每组各有2只于造模后48h内死亡,死因考虑为急性脑水肿和蛛网膜下腔出血,共30只大鼠进入结果分析。①各组大鼠神经功能缺损评分:骨髓间充质干细胞治疗组大鼠神经功能评分明显高于对照组和磷酸盐缓冲液组(3d:4.45±1.25,2.85±1.01,2.98±0.79;7d:6.67±2.12,4.47±1.08,4.56±1.27;14d:7.94±2.27,5.15±1.66,5.24±1.46,P<0.05)。②免疫组化染色检测骨髓间充质干细胞移植后成活情况:对照组和磷酸盐缓冲液组均未见到Brdu免疫组化阳性细胞着色,骨髓间充质干细胞治疗组各时间点均可见到Brdu阳性细胞,细胞呈圆形,较神经细胞小,阳性细胞主要见于缺血侧大脑皮质、皮质下和海马区。结论:①经颈动脉移植的骨髓间充质干细胞可在缺血性大脑损伤大鼠脑内存活、迁移。②经颈动脉移植骨髓间充质干细胞对缺血性脑损伤神经功能恢复有明显促进作用。     

Spanish Society of Medical Oncology consensus for the use of haematopoietic colony-stimulating factors in cancer patients

Neutropenia is a common complication of cancer chemotherapy. Colony-stimulating factors (CSF) may be used to avoid neutropenia-associated complications. The Spanish Society of Medical Oncology (SEOM) recently constituted a working group to review the main issues concerning the use of CSF and carried out a consensus process about the use of CSF in cancer patients, held in Madrid on 26 May 2006. The group concluded the following recommendations: prophylactic use of CSF is recommended when a rate of febrile neutropenia (FN) higher than 20% is expected without the use of CSF or when additional risk factors for neutropenia exist; therapeutic use of CSF is recommended in order to treat FN episodes but not to treat afebrile neutropenic episodes. In addition, the use of CSF is considered effective when used to mobilise stem cells before high-dose chemotherapy and when used for chemotherapy schedule optimisation in dose-dense and in dose-intense regimens. Supported by an unrestricted educational grant from MSD Oncology     

Prognosis of rash and chilblain-like lesions among outpatients with COVID-19: a large cohort study

European Journal of Clinical Microbiology & Infectious Diseases - In a large regional observational cohort study of adult (≥?18&nbsp;years), outpatients with COVID-19,...     

Inhibitory Effect of Curcumin on the Contractility of Isolated Caprine Detrusor Muscle

Curcumin is a naturally occurring compound which has been used in traditional medicine in India for a long time. This study investigated the ability of curcumin to inhibit the contractility of isolated caprine (goat) detrusor muscle. The ability of three concentrations of curcumin (30, 100 and 300 µM) to inhibit the 100 µM acetylcholine-induced contractility of the isolated caprine urinary bladder detrusor muscle was investigated. The effect of raising the concentration of acetylcholine from 100, 200 and 400 µM to overcome the curcumin-induced inhibition of detrusor contractility and the effects of the reversal agents tetraethylammonium, a potassium channel blocker (100 µM), glibenclamide, an ATP-sensitive potassium channel blocker (10 µM), and propranolol, a beta adrenergic receptor blocker (1 µM), on the inhibitory effect of detrusor contractility was also studied. Curcumin caused a concentration-dependent inhibition of acetylcholine-induced contractility of the isolated detrusor muscle which was statistically significant at all three concentrations of curcumin used. This inhibition was partially overcome by raising the concentration of ACh to 200 and 400 µM. The inhibition was overcome by the concurrent administration of tetraethylammonium. Glibenclamide reversed the inhibitory effect of 100 µM curcumin, but not that of 300 µM curcumin. Propranolol reversed the inhibitory effect of 100 µM curcumin but not that of 300 µM curcumin. These results suggest that curcumin inhibited the contractions of the isolated detrusor muscle. The results further suggest that the inhibitory effect is mediated by various mechanisms: stimulation of beta adrenergic receptors; an anticholinergic effect; and the opening of ATP-sensitive potassium channels.     

Encephalitis with Infiltration by CD8+ Lymphocytes in HIV Patients Receiving Combination Antiretroviral Treatment

We report the neuropathological findings in 10 HIV‐infected patients treated by combination antiretroviral therapy who developed subacute encephalopathy of rapidly progressive onset. Brain biopsy showed encephalitic lesions variably associated with myelin loss and slight axonal damage. There was inconstant, weak expression of HIV protein p24; tests for other pathogens were negative. The most striking feature was diffuse, perivascular and intraparenchymal infiltration by CD8+ T‐lymphocytes. Six patients improved after the treatment. Four had an unfavorable outcome and died within a year. Post‐mortem in one case confirmed HIV leukoencephalitis with p24‐positive multinucleated giant cells, associated with acute demyelinating encephalomyelitis (ADEM) in the cerebellum. There was diffuse infiltration by CD8+ lymphocytes; CD4+ cells were virtually absent. These cases may represent a specific clinicopathological entity, of which a few comparable cases have been already described. They can be included in the wide framework of immune reconstitution disease. Such syndromes have been described with opportunistic infections, but only seldom with HIV infection of the central nervous system (CNS). Our findings support the hypothesis that CD8+ cytotoxic lymphocytes can be harmful in immune reconstitution disease, particularly in the absence of CD4+ lymphocytes. CD8 cytotoxicity produces an acutization of a smoldering infection and/or an immunopathological reaction similar to ADEM.     

Consideration of age at admission for selective screening to identify methicillin-resistant Staphylococcus aureus carriers to control dissemination in a medical ward

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly important pathogen responsible for hospital-acquired infections. Our study was to evaluate the efficiency of our selective screening program for methicillin-resistant Staphylococcus aureus (MRSA) carriers at admission to nonintensive care units. METHODS: During 6 months, all patients were screened at admission to an internal medicine ward, at which time they were classified as patients at risk of carriage (PRC) and those with no known risk factor. The amplitude of cross transmission was estimated using various indicators during this universal screening period and during the same calendar period of the preceding year (selective screening). RESULTS: The prevalence of MRSA carriage at admission was 5.5%. Among the 22 carriers identified, only 10 were PRC. Age >80 years was significantly associated with MRSA carriage upon admission (OR, 3.5; P < .01). All estimation indicators of MRSA dissemination amplitude were significantly lower during universal screening (relative risks varied from 2.79 to 26.4 according to indicators), demonstrating the need to broaden our criteria defining PRC. CONCLUSION: Adding patients >80 years of age to our PRC definition would increase screening sensitivity (15 carriers identified for 128 patients sampled) and would enable early implementation of barrier precautions for the additional carriers identified.