Effectiveness of a Novel Rapid Infusion Device and Clinician Education for Early Fluid Therapy by Emergency Medical Services in Sepsis Patients: A Pre-Post Observational Study.

OBJECTIVE: Emergency medical services (EMS) clinicians are tasked with early fluid resuscitation for patients with sepsis. Traditional methods for prehospital fluid delivery are limited in speed and ease-of-use. We conducted a comparative effectiveness study of a novel rapid infusion device for prehospital fluid delivery in suspected sepsis patients. METHODS: This pre-post observational study evaluated a hand-operated, rapid infusion device in a single large EMS system from July 2021-July 2022. Prior to device deployment, EMS clinicians completed didactic and simulation-based device training. Data were extracted from the EMS electronic health record. Eligible patients included adults with suspected sepsis treated by EMS with intravenous fluids. The primary outcome was the proportion of patients receiving goal fluid volume (at least 500 mL) prior to hospital arrival. Secondary outcomes included in-hospital mortality, disposition, and length of stay. Multivariable logistic regression was used to compare outcomes between 6-month pre- and post-implementation periods (July-December 2021 and February-July 2022, respectively), adjusting for patient demographics, abnormal prehospital vital signs, and EMS transport interval. RESULTS: Of 1,180 eligible patients (552 in the pre-implementation period; 628 in the post-implementation period), the mean age was 72 years old, 45% were female, and 25% were minority race-ethnicity. Median (interquartile range) fluid volume (in mL) increased between the pre- and post-implementation periods (600 [400,1,000] and 850 [500-1,000], respectively). Goal fluid volume was achieved in 70% of pre-implementation patients and 82% of post-implementation patients. In adjusted analysis, post-implementation patients were significantly more likely to receive goal fluid volume than pre-implementation patients (adjusted odds ratio (aOR) 2.00, 95% confidence interval (CI) 1.51-2.66). Pre-post in-hospital mortality was not significantly different (aOR 0.91, 95% CI 0.59-1.39). CONCLUSION: In a single EMS system, sepsis education and introduction of a rapid infusion device was associated with achieving goal fluid volume for suspected sepsis. Further research is needed to assess the clinical effectiveness of infusion device implementation to improve sepsis patient outcomes.

High hazzard pesticides (HHPs) in Near East and North Africa (NENA), constrains and recommendations to mitigate the risk of HHPs.

This study presents an overview of the current situation of highly hazardous pesticides (HHPs) in North Africa and Near East countries (NENA). This work reviews the registered pesticides in the region and identify HHPs being used according to the criteria 1-8 for HHPs of FAO/WHO Guidelines on HHPs. In addition, to identify the weakness and the need of the region to mitigate the risk from the use of HHPs, the report ended with recommendations needed in the region to improve the pesticide managements and registration, such as improving the agricultural practices by adopting the integrated pest management IPM and including replacing HHPs with ecosystem-friendly alternatives if available. The total number of pesticides registered and used in NENA region is 642 active ingredients (IA). Eighty-nine HHPs are still in use in NENA region and 50% of them are evaluated under 1-7 criteria of GHS HHPs. This evaluation shows that 50% of HHPs are insecticides, 22% fungicides, 10% herbicides, 8% nematocides, and 10% rodenticides. The rest of 38 HHPs are identified under criteria 8. This high number of HHPs still in use in some NENA countries urges the need of technical assistance to reduce the use of HHPs. The type of assistant varies from country to other; to identify the priority of technical and legal assistant needed, a country-based assessments must be carried out at the near future.

Evaluation of the effectiveness of Neoseiulus cucumeris (Oudemans) as a predator of Tuta absoluta (Meyrick).

The leaf miner, Tuta absoluta is continue to be a serious threat to solanaceous plants, especially tomato plant worldwide. Tomato crop in Saudi Arabia has been recently affected by T. absoluta, which is difficult to control due to its unique biological features, such as high fecundity and its potential to develop resistance to chemical pesticides. In this article, the suitability and effectiveness of the predatory mite, Neoseiulus cucumeris (Oudemans) (Acari: Phytoseiidae), an indigenous species usually found in tomato greenhouses of northcentral Saudi Arabia, has been evaluated on eggs and 1st instar larvae of T. absoluta in the laboratory. All experiments were conducted in an incubator at three constant temperatures of 22, 27 and 32°C ± 1°C, 50 ± 4% R.H. and L12:D12 h photoperiod. Adult females and males of N. cucumeris were able to feed and sustain oviposition on eggs and 1st instar larvae of T. absoluta, and could be an effective biocontrol agent against T. absoluta. The N. cucumeris had a clear preference for eggs compared to 1st instar larvae of T. absoluta. The results showed the obvious effect of the temperature on the consumption rate of the predatory mite. The maximum daily consumption rate occurred during the oviposition period, when the females of the predatory mite consumed an average of 4.26 eggs and 2.44 1st instar larvae of T. absoluta. In general, total fecundity was high with T. absoluta eggs as a food source when temperature increased from 22 to 32°C. The highest fecundity rate (42.92 and 20.97 eggs /female) was recorded at 32°C, while the lowest one (26.77 and 10.12 eggs / female) was recorded at 22°C, when N. cucumeris female fed on eggs and 1st instar larvae of T. absoluta, respectively. The results of this study indicated that the predatory mite, N. cucumeris can be considered a promising potential candidate for controlling the leaf miner T. absoluta, and further research is required to assess its effectiveness under greenhouse conditions.

Evaluation of the effectiveness of Neoseiulus cucumeris (Oudemans) as a predator of Tuta absoluta (Meyrick)

Abstract The leaf miner, Tuta absoluta is continue to be a serious threat to solanaceous plants, especially tomato plant worldwide. Tomato crop in Saudi Arabia has been recently affected by T. absoluta, which is difficult to control due to its unique biological features, such as high fecundity and its potential to develop resistance to chemical pesticides. In this article, the suitability and effectiveness of the predatory mite, Neoseiulus cucumeris (Oudemans) (Acari: Phytoseiidae), an indigenous species usually found in tomato greenhouses of northcentral Saudi Arabia, has been evaluated on eggs and 1st instar larvae of T. absoluta in the laboratory. All experiments were conducted in an incubator at three constant temperatures of 22, 27 and 32°C ± 1°C, 50 ± 4% R.H. and L12:D12 h photoperiod. Adult females and males of N. cucumeris were able to feed and sustain oviposition on eggs and 1st instar larvae of T. absoluta, and could be an effective biocontrol agent against T. absoluta. The N. cucumeris had a clear preference for eggs compared to 1st instar larvae of T. absoluta. The results showed the obvious effect of the temperature on the consumption rate of the predatory mite. The maximum daily consumption rate occurred during the oviposition period, when the females of the predatory mite consumed an average of 4.26 eggs and 2.44 1st instar larvae of T. absoluta. In general, total fecundity was high with T. absoluta eggs as a food source when temperature increased from 22 to 32°C. The highest fecundity rate (42.92 and 20.97 eggs /female) was recorded at 32°C, while the lowest one (26.77 and 10.12 eggs / female) was recorded at 22°C, when N. cucumeris female fed on eggs and 1st instar larvae of T. absoluta, respectively. The results of this study indicated that the predatory mite, N. cucumeris can be considered a promising potential candidate for controlling the leaf miner T. absoluta, and further research is required to assess its effectiveness under greenhouse conditions.

Resumo A traça-do-tomateiro, Tuta absoluta, continua sendo uma séria ameaça às plantas solanáceas, especialmente ao tomateiro em todo o mundo. A safra de tomate na Arábia Saudita foi recentemente afetada por T. absoluta, o qual é de difícil controle por causa de suas características biológicas únicas, como alta fecundidade e potencial para desenvolver resistência a pesticidas químicos. Neste artigo, a adequação e a eficácia do ácaro predador Neoseiulus cucumeris (Oudemans) (Acari: Phytoseiidae), uma espécie indígena geralmente encontrada em estufas de tomate no centro-norte da Arábia Saudita, foram avaliadas em ovos e larvas de 1º instar de T. absoluta em condições de laboratório. Todos os experimentos foram conduzidos em uma incubadora em três temperaturas constantes de 22, 27 e 32°C ± 1°C, 50 ± 4% UR e fotoperíodo L12: D12 h. Fêmeas e machos adultos de N. cucumeris foram capazes de se alimentar e sustentar a oviposição em ovos e larvas de 1º instar de T. absoluta, podendo ser um agente de biocontrole eficaz contra T. absoluta. Neoseiulus cucumeris teve uma clara preferência por ovos em comparação com larvas de 1º instar de T. absoluta. Os resultados mostram que mais presas foram consumidas conforme a temperatura aumentou de 22°C para 32°C. A taxa máxima de consumo diário ocorreu durante o período de oviposição, quando as fêmeas consumiram em média 4,26 ovos e 2,44 larvas de 1º instar de T. absoluta. Em geral, a fecundidade total foi maior com ovos de T. absoluta como fonte alimentar e com o aumento da temperatura. A maior taxa de fecundidade (42,92 e 20,97 ovos por fêmea) foi registrada a 32°C, enquanto a mais baixa (26,77 e 10,12 ovos por fêmea) foi a 22°C, quando N. cucumeris se alimentou de ovos e larvas de 1º instar de T. absoluta, respectivamente. Os resultados deste estudo indicam que o ácaro predador N. cucumeris pode ser considerado um potencial candidato para o controle da traça-do-tomateiro T. absoluta, e mais pesquisas são necessárias para avaliar sua eficácia em condições de estufa.

Evaluation of the effectiveness of Neoseiulus cucumeris (Oudemans) as a predator of Tuta absoluta (Meyrick) / Avaliação da eficácia de Neoseiulus cucumeris (Oudemans) como predador de Tuta absoluta (Meyrick)

The leaf miner, Tuta absoluta is continue to be a serious threat to solanaceous plants, especially tomato plant worldwide. Tomato crop in Saudi Arabia has been recently affected by T. absoluta, which is difficult to control due to its unique biological features, such as high fecundity and its potential to develop resistance to chemical pesticides. In this article, the suitability and effectiveness of the predatory mite, Neoseiulus cucumeris (Oudemans) (Acari: Phytoseiidae), an indigenous species usually found in tomato greenhouses of northcentral Saudi Arabia, has been evaluated on eggs and 1st instar larvae of T. absoluta in the laboratory. All experiments were conducted in an incubator at three constant temperatures of 22, 27 and 32°C ± 1°C, 50 ± 4% R.H. and L12:D12 h photoperiod. Adult females and males of N. cucumeris were able to feed and sustain oviposition on eggs and 1st instar larvae of T. absoluta, and could be an effective biocontrol agent against T. absoluta. The N. cucumeris had a clear preference for eggs compared to 1st instar larvae of T. absoluta. The results showed the obvious effect of the temperature on the consumption rate of the predatory mite. The maximum daily consumption rate occurred during the oviposition period, when the females of the predatory mite consumed an average of 4.26 eggs and 2.44 1st instar larvae of T. absoluta. In general, total fecundity was high with T. absoluta eggs as a food source when temperature increased from 22 to 32°C. The highest fecundity rate (42.92 and 20.97 eggs /female) was recorded at 32°C, while the lowest one (26.77 and 10.12 eggs / female) was recorded at 22°C, when N. cucumeris female fed on eggs and 1st instar larvae of T. absoluta, respectively. The results of this study indicated that the predatory mite, N. cucumeris can be considered a promising potential candidate for controlling the leaf miner T. absoluta, and further research is required to assess its effectiveness under greenhouse conditions.

A traça-do-tomateiro, Tuta absoluta, continua sendo uma séria ameaça às plantas solanáceas, especialmente ao tomateiro em todo o mundo. A safra de tomate na Arábia Saudita foi recentemente afetada por T. absoluta, o qual é de difícil controle por causa de suas características biológicas únicas, como alta fecundidade e potencial para desenvolver resistência a pesticidas químicos. Neste artigo, a adequação e a eficácia do ácaro predador Neoseiulus cucumeris (Oudemans) (Acari: Phytoseiidae), uma espécie indígena geralmente encontrada em estufas de tomate no centro-norte da Arábia Saudita, foram avaliadas em ovos e larvas de 1º instar de T. absoluta em condições de laboratório. Todos os experimentos foram conduzidos em uma incubadora em três temperaturas constantes de 22, 27 e 32°C ± 1°C, 50 ± 4% UR e fotoperíodo L12: D12 h. Fêmeas e machos adultos de N. cucumeris foram capazes de se alimentar e sustentar a oviposição em ovos e larvas de 1º instar de T. absoluta, podendo ser um agente de biocontrole eficaz contra T. absoluta. Neoseiulus cucumeris teve uma clara preferência por ovos em comparação com larvas de 1º instar de T. absoluta. Os resultados mostram que mais presas foram consumidas conforme a temperatura aumentou de 22°C para 32°C. A taxa máxima de consumo diário ocorreu durante o período de oviposição, quando as fêmeas consumiram em média 4,26 ovos e 2,44 larvas de 1º instar de T. absoluta. Em geral, a fecundidade total foi maior com ovos de T. absoluta como fonte alimentar e com o aumento da temperatura. A maior taxa de fecundidade (42,92 e 20,97 ovos por fêmea) foi registrada a 32°C, enquanto a mais baixa (26,77 e 10,12 ovos por fêmea) foi a 22°C, quando N. cucumeris se alimentou de ovos e larvas de 1º instar de T. absoluta, respectivamente. Os resultados deste estudo indicam que o ácaro predador N. cucumeris pode ser considerado um potencial candidato para o controle da traça-do-tomateiro T. absoluta, e mais pesquisas são necessárias para avaliar sua eficácia em condições de estufa.

The 2020 Beirut Explosion: A Healthcare Perspective.

On August 4th, 2020, at 6:07pm local time, an explosion took place in Beirut's port near the central district. This tragic event reportedly left more than 204 victims dead, more than 6,500 wounded, and displaced around 300,000 from their homes. Patients were transported to several hospitals, which became quickly overwhelmed within minutes by the large number of patient admissions. This is a retrospective chart review conducted on 292 patients, who presented to the American University of Beirut Medical Center (AUBMC) after sustaining blast-related injuries during the Beirut port explosion on August 4th, 2020. Measures including age, gender, location of the injury, mechanism of blast injury (primary, secondary, tertiary, and quaternary) and outcomes were collected. Time of arrival of the first victim was 10 minutes after the explosion. Patients across all ages presented to the medical center (age range from 3 months to 86 years) and the majority of injuries were in the upper extremity (45.6%), and head and neck region (43.2%). Most blast-related injuries were due to secondary and tertiary types, 78.4% and 24.1% respectively. This study aims to expand the literature and widen the knowledge regarding the mechanism of injury associated with the Beirut port explosion. Moreover, it could be helpful in preparing medical staff, healthcare centers and other communities to work under difficult conditions in similar disasters and improve the global response to devastating events.

Le 4 août 2020 à 18 h 07 locales, une explosion s'est produite dans le port de Beyrouth, à proximité du centre- ville. Cette explosion a tué 204 personnes, en a blessé plus de 6 500 et en a laissé environ 300 000 sans abri. Les blessés ont été acheminés dans plusieurs hôpitaux, vite débordés par cet afflux massif. Cet article est une revue sur dossier de 292 cas de patients blastés lors de cette catastrophe pris en charge à l'Hôpital Universitaire Américain de Beyrouth, la première étant arrivée 10 mn après l'explosion. Nous avons répertorié l'âge, le sexe, la localisation des blessure et le type de lésions de blast (primaire, secondaire, tertiaire ou quaternaire), les plus fréquents étant les blasts secondaires (78,4%) et tertiaires (24,1%) et l'évolution. Les patients étaient âgés de 3 mois à 86 ans et leurs blessures se situaient plus fréquemment au niveau de la partie supérieure du corps (45,6%) ou de la région cervico- céphalique (43,2%). Cette étude permet d'abonder la littérature sur les mécanismes lésionnels après une explosion comme celle du port de Beyrouth. Elle pourrait en outre permettre d'améliorer les réponses médicale, hospitalière et générale après une catastrophe.

An in vitro simulation model to assess the severity of edge loading and wear, due to variations in component positioning in hip joint replacements.

The aim of this study was to develop a preclinical in vitro method to predict the occurrence and severity of edge loading condition associated with the dynamic separation of the centres of the head and cup (in the absence of impingement) for variations in surgical positioning of the cup. Specifically, this study investigated the effect of both the variations in the medial-lateral translational mismatch between the centres of the femoral head and acetabular cup and the variations in the cup inclination angles on the occurrence and magnitude of the dynamic separation, the severity of edge loading, and the wear rate of ceramic-on-ceramic hip replacement bearings in a multi-station hip joint simulator during a walking gait cycle. An increased mismatch between the centres of rotation of the femoral head and acetabular cup resulted in an increased level of dynamic separation and an increase in the severity of edge loading condition which led to increased wear rate in ceramic-on-ceramic bearings. Additionally for a given translational mismatch, an increase in the cup inclination angle gave rise to increased dynamic separation, worst edge loading conditions, and increased wear. To reduce the occurrence and severity of edge loading, the relative positions (the mismatch) of the centres of rotation of the head and the cup should be considered alongside the rotational position of the acetabular cup. This study has considered the combination of mechanical and tribological factors for the first time in the medial-lateral axis only, involving one rotational angle (inclination) and one translational mismatch. © 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1897-1906, 2018.

Organochlorine pesticide residues in human milk and estimated daily intake (EDI) for the infants from eastern region of Saudi Arabia.

This study presents the level of organochlorine pesticide (OC) residues in human milk samples collected from donor mothers aged from 18 to 30 years old, from four cities in Eastern district of Saudi Arabia (Al-Hassa, Al- Khobar, Al-Jubail, and Al-Dammam). Pesticides residues were extracted from the samples and analyzed using GC-MS. The results showed that, only pp'DDE and p,pDDD, were found in 82.5% and 70% of analyzed samples respectively, the total DDT were at level of 0.37, 0.32, 0.30 and 0.46 µg/L in the four cities respectively and were far below the MRL of 50 µg/L (FAO/WHO). The estimated daily intake (EDI) of DDT ingested by infant weight 3.5 kg ranged between 0.06 and 0.10 µg/kg, which is less than the ADI issued by (EFSA, 2014). Lindane (γ-HCH) found in 91.25% of the analyzed samples at level of 0.37, 0.35, 0.35 and 0.29 µg/L. The EDIs of Lindane by infant were far below the ADI of 5 µg/kg bw/day. Dieldrin and Enderin were found in 27.5% and 58.8% of samples respectively and were lower than MRL issued by FAO/WHO, but the (EDI) was higher than the ADI issued by EFSA. The isomer A-heptachlor was detected in 51% of the samples, at levels were 15 times lower than the MRL issued by FAO/WHO, but EDIs by infants were 2-4 times higher than the ADI issued by EFSA. However, the results of the four studied areas in Saudi Arabia showed no statistically different among locations (p > 0.05).

Evaluation of Nd:YAG laser device efficacy on onychomycosis: a case series of 30 patients.

Until recently, pharmacologic molecules have been the only available treatments for onychomycosis. Laser treatments were introduced for recurrent or resistant cases or in patients in whom oral treatments are contra-indicated. Some devices were approved by the Food and Drug Administration (FDA). Neodymium yttrium aluminium garnet (Nd:YAG) is used for onychomycosis as a short-pulse or a long-pulse system. We aim to evaluate the efficacy of the short-pulse Nd:YAG in treating onychomycosis, its side effects, cure rates, and 12-month recurrence rates. Efficacy was evaluated based on a subjective measure of patient satisfaction on a scale from 1 to 10, and an objective measure based on the results of the mycologic cultures. Medical records of 30 patients were reviewed. Ages ranged from 22 to 85, with a mean of 44. Mycologic cure at 12 months was not achieved in 5 patients (16.67%) who had received laser treatment. None of these patients showed any signs of clinical improvement. Twenty patients (66.67%) were completely cured at 12 months, with corroborating negative mycologic cultures. The remaining five patients (16.67%) had discordance between their clinical cure status and their mycologic cultures. Side effects were reported by 7 patients out of 30 (33%): pain within 48 hours of the treatment session, burning sensation in the treated nail bed area. Our primary end point of negative mycologic cultures at 12 months was seen in 24 out of 30 (80%) of our patients. Similar culture cure rates have not been reported before, not even with systemic treatments with oral antifungals. However, few limitations should warrant us (False-negative results in fungal cultures; time limitation; sample size…). Still, we propose that this alternative should be offered for patients in whom antifungals are contraindicated or for patients previously treated, but not cured by oral antifungals, and in elderly and polymedicated patients.

New Approach of Beauveria bassiana to Control the Red Palm Weevil (Coleoptera: Curculionidae) by Trapping Technique.

This work is the first study to investigate the efficacy of the commercial formulation of Beauveria bassiana (Broadband) to control adults of red palm weevil (Rhynchophorus ferrugineus (Olivier)). This fungus could be applied as one of the biological tactics in controlling red palm weevil. Bioassay experiments for medium lethal concentrate and medium time to cause death of 50% of red palm weevil adults were carried out. The result showed that the LC50 of B. bassiana (Broadband) was 2.19×10(7) and 2.76×10(6) spores/ml at 9 and 23 d of treatment, respectively. The LT50 was 13.95 and 4.15 d for concentration of 1×10(7) and 1×10(8) spores/ml, respectively, whereas 1×10(9) spores/ml caused 100% mortality after 24 h. Additionally, a red palm weevil pheromone trap was designed to attract the adults to be contaminated with spores of Broadband, which was applied to the sackcloth fabric that coated the internal surfaces of the bucket trap. The mating behavior was studied to determine direct and indirect infection of the spores from male to female and vice versa. The results showed a high efficacy of Broadband suspension at 1×10(9) spores/ml; 40 ml of suspension at this concentration treated to cloth in a trap caused death of contaminated adults with B. bassiana spores directly and indirectly. The 100% mortality was obtained even after 13 d of traps treatment with 40 ml of the suspension at 1×10(9) spores/ml.

Severity of the ductal shunt: a comparison of different markers.

BACKGROUND: When the ductus arteriosus (DA) is patent, the ductal shunt is proportional to the ratio of left ventricular output (LVO) to systemic blood flow. Systemic blood flow can be estimated by measuring flow in the superior vena cava (SVC). OBJECTIVE: To re-evaluate the accuracy of standard echocardiographic markers of patent ductus arteriosus (PDA) using LVO/SVC flow ratio. METHODS: Prospective study. Preterm infants of 24-30 weeks gestational age and postnatal age less than 48 hours. The following echocardiographic criteria were measured: left atrial to aortic root ratio (LA/Ao); DA diameter by B mode and colour Doppler; mean and end diastolic flow velocity of the left pulmonary artery (LPA); LVO; SVC flow. RESULTS: Twenty three preterm infants were enrolled (median gestational age 28 weeks (range 24-30), median birth weight 840 g (500-1440)). The DA was closed in eight (mean (SD) LVO/SVC 2.4 (0.3)) and open in 15 (mean (SD) LVO/SVC 4.5 (0.6)). An LA/Ao ratio > or =1.4, a DA diameter > or =1.4 mm/kg, and a mean and end diastolic flow velocity of LPA respectively > or =0.42 and > or =0.20 m/s identified an LVO/SVC > or =4 with a sensitivity and a specificity above 90%. CONCLUSION: This study indicates that LA/Ao ratio, DA diameter, and mean and end diastolic flow velocity of the LPA are accurate markers of PDA. These standard echocardiographic variables are easy to measure and need less skill and resources than direct measurements of ductal shunt.

[Survey of cardiovascular risk assessment and the behaviour of a sporting population]. / Enquête sur les comportements et l'évaluation du risque cardiovasculaire dans une population de sportifs.

In order to better understand the risk factors and behaviour of a general sports population, a questionnaire was handed to 603 consecutive sportsmen of various disciplines during a specific sports medicine consultation and a half-marathon. Among the discovered risk factors, smoking was the most common (19.3% for the entire study population), predominantly in the youngest group (26%). A resting ECG had been performed very frequently within the previous year in those over 40 years (86.5%), but less often in the younger sportsmen (44.8%). An exercise test had also very often been performed in those aged over 40 years (69.2 vs 10.6%). Behaviour associated with cardiovascular risk was common. Undertaking physical activity while febrile (58%) and smoking just before or after exertion (13.1%) were widespread behaviours. This population appeared casual in its approach to possibly suspicious cardiac symptoms of exercise, particularly the females and paradoxically the subjects doing the most sport. Lastly, only a minority of sportsmen knew the telephone number for the emergency medical service (45%) or claimed to be competent at first aid (32%). This survey underlines a practice relatively in accordance with the recommendations for detecting cardiovascular pathology, but shows a failure of preventive education.

[Tachycardia-induced cardiomyopathy in children: a difficult diagnosis but a reversible form of left ventricular dysfunction]. / Myocardiopathie rythmique de l'enfant : un diagnostic difficile mais une forme curable de dysfonction ventriculaire gauche.

UNLABELLED: Tachycardia-induced cardiomyopathy is a reversible left ventricular dysfunction caused by cardiac arrhythmia. Because of its reversibility, a correct diagnosis and treatment are necessary. The aim of our study was to precise the diagnostic procedures of the tachycardia-induced cardiomyopathy and to study the left ventricular function after the correction of the arrhythmia. PATIENTS AND METHODS: A retrospective study done between 1992 and 2001. Children studied were followed-up for: an idiopathic form of cardiomyopathy, in which the etiological research showed a cardiac arrhythmia; a cardiac arrhythmia associated to a cardiomyopathy. An electrocardiogram recorded the cardiac arrhythmia. The left ventricular function was evaluated by an echocardiography before and every month after the correction of the cardiac arrhythmia. RESULTS: Twelve children were included, ages ranged from 2 months to 15 years (median 11 years). Four patients presented a cardiac insufficiency associated to arrhythmia; three followed-up for an arrhythmia developed a cardiomyopathy; five whose cardiac arrhythmia was not easy to demonstrate had an idiopathic form of cardiomyopathy. The Wilcoxon test showed a significant amelioration (P < 0.01) of the left ventricular function after the correction of the cardiac arrhythmia. CONCLUSIONS: Tachycardia-induced cardiomyopathy in children is curable and the diagnosis is quite difficult. Pediatricians and family doctors should try to look for specific signs of cardiac insufficiency or arrhythmia. Pediatric cardiologists should search a tachycardia-induced cardiomyopathy in every idiopathic form of cardiomyopathy.

[Power Doppler sonography and acute pyelonephritis in children: comparison with Tc-DMSA scintigraphy]. / Echographie doppler énergie et pyélonéphrite aiguë de l'enfant: comparaison avec la scintigraphie au DMSA-Tc.

UNLABELLED: Acute pyelonephritis is a common infection in children. The clinical and biological diagnosis is still sometimes difficult. For most authors, Technecium 99m dimercaptosuccinic acid scintigraphy is considered as the gold standard tool for diagnosis but it is invasive and expensive. The aim of our study was to compare the sensitivity and the specificity of B-mode sonography and power doppler to DMSA-Tc scintigraphy in acute pyelonephritis. PATIENTS AND METHODS: Forty-nine children were enrolled in this study with suspicion of pyelonephritis. All infants underwent doppler sonography and scintigraphy within 48 hours after their hospitalization. Doppler sonography criteria were increased kidney size, thickness of sinus wall, vascular defect, and various echogenicity of the kidneys (focal or diffuse hyperechogenicity or focal hypoechogenicity). RESULTS: Among 28 children with a positive scintigraphy, 15 had a positive doppler sonography (sensitivity 54%) and 13 had a negative doppler sonography. Among 21 children with a negative scintigraphy, 20 had a negative doppler sonography (specificity 95%) and one had a positive doppler sonography. CONCLUSION: In clinically suspected acute pyelonephritis, doppler sonography has a high specificity. A positive doppler sonography should avoid the use of scintigraphy.

Measurement of sarcomere length during fast contraction of muscle fibers by digital image analysis.

A low-cost, high-resolution (spatial and temporal) image analysis system was developed to measure sarcomere length (Sl) during fast twitch of isolated striated muscle fibers at different temperatures. Fiber images were examined during twitch with an imaging rate of 220 Hz. To increase temporal resolution beyond 220 Hz, consecutive temporally shifted image sequences (N sequences) were acquired. Individual or average Sl was directly measured from a horizontal profile without spatial-frequency assessment. Measurement precision (E) was determined and expressed as: E(%) = 100xPs/(IsxSl), where Ps is the pixel size and Is the involved sarcomere number. At 18 degrees C during isometric twitch, Sls were measured with 220 Hz temporal and 0.2% spatial resolutions. Sl shortened in the central region (0.21+/-0.12 microm) as tension developed, reaching a maximal shortening of 8.09 + 2.05% (at rest, Sl = 2.59+/-0.05 microm, n = 4) in 32.5+/-1.96 ms. At 30 degrees C, Sl variations were examined with 880 Hz temporal resolution, in which case maximal S1 shortening was reached in 15.74+/-1.99 ms, and then decreased to 5.19+/-1.97% (at rest, S1 = 2.6+/-0.06 microm). The twitch tension developed by the whole fiber was recorded and compared with sarcomere length behavior. Sarcomere length variations in the central region were representative of overall developed tensions at 18 and 30 degrees C.

[Major statistical software usable in epidemiology]. / Principaux logiciels statistiques utilisables en épidémiologie.

Quality assurance of biostatistical data analysis is becoming mandatory. The aim of this review of statistical software was to guide uses who are faced with the increasing number of these tools. A list of softwares was obtained from statisticians and computer scientists, computerized databases, computer science lay press, and commercial documents. The softwares were described and their possibilities measured. The following functions were studied: functions considered as essential (descriptive analysis, Student's t, Mann-Whitney or Wilcoxon, ANOVA, Kruskall-Wallis, Pearson's chi 2, Fisher's exact test, Pearson's r), survival and multivariate analysis (logistic regression, proportional hazards modelling, times series). User-friendliness and quality of graphs were also studied. Among the 220 listed softwares, 26 could be considered as general softwares and were extensively analyzed. Statistical softwares may be classified into four categories: easy-to-use general public softwares with limited functions, such as EPI INFO; simple reference softwares with satisfactory user-friendliness and performing most of the statistical analyses, such as PCSM, STATISTICA or STATA; complex reference softwares intended for statisticians (EPILOG PLUS, SAS); specific cases such as EGRET performing only multivariate analysis or SUPERANOVA performing only analysis of variance. Such a review should be regularly updated.