Budget impact of next-generation sequencing for diagnosis of TB drug resistance in Moldova.

BACKGROUND Diagnosing drug resistance is critical for choosing effective TB treatment regimens. Next-generation sequencing (NGS) represents an alternative approach to conventional phenotypic drug susceptibility testing (pDST) for diagnosing TB drug resistance.METHODS We undertook a budget impact analysis estimating the costs of introduction and routine use of NGS in the Moldovan National TB Programme. We conducted an empirical costing study and collated price and operating characteristics for NGS platforms. We examined multiple NGS scenarios in comparison to the current approach (pDST) for pre-treatment drug resistance testing over 2021-2025.RESULTS Annual testing volume ranged from 912 to 1,926 patients. For the pDST scenario, we estimated total costs of US$362,000 (2021 USD) over the 5-year study period. Total costs for NGS scenarios ranged from US$475,000 to US$1,486,000. Lowest cost NGS options involved targeted sequencing as a replacement for pDST, and excluded individuals diagnosed as RIF-susceptible on Xpert® MTB/RIF. For all NGS scenarios, the majority (55-80%) of costs were devoted to reagent kits. Start-up costs of NGS were small relative to routine costs borne each year.CONCLUSION NGS adoption will require expanded resources compared to conventional pDST. Further work is required to better understand the feasibility of NGS in settings such as Moldova.

[Prevention of chronic venous disease: which advice for our patients?]. / Prévention de la maladie veineuse chronique: quels conseils donner à nos patients?

Chronic venous disease (CVD) is a major public health problem due to its high prevalence and socioeconomic costs. In absence of adequate care, it can lead to chronic venous insufficiency (CVI). Disturbed venous-flow patterns lead to venous hypertension. Therefore, prevention of CVD involves venous hypertension reduction. In primary prevention, it is essential to inform the patient about necessary lifestyle changes. In case of CVD, it is essential to propose treatment (compression, venoactive drugs, and interventional treatments) to avoid CVI appearance and eventually offer the best therapy solutions for CVI complications.

[Vascular follow up in patients suffering from peripheral arterial disease and undergoing revascularization]. / Suivi angiologique des patients artériopathes après geste de revascularisation.

The rapid evolution of revascularization techniques has allowed an improvement in quality of life of patients with peripheral artery disease. The angiological follow-up aims to insure durable results of revascularization, to diminish risk of amputation and to limit progression of atheroma plaques. The patient history and physical examination are essential in evaluating impact of peripheral artery disease upon quality of life and insuring the appropriate control of cardiovascular risk factors.

Motion compensated generalized reconstruction for free-breathing dynamic contrast-enhanced MRI.

The analysis of abdominal and thoracic dynamic contrast-enhanced MRI is often impaired by artifacts and misregistration caused by physiological motion. Breath-hold is too short to cover long acquisitions. A novel multipurpose reconstruction technique, entitled dynamic contrast-enhanced generalized reconstruction by inversion of coupled systems, is presented. It performs respiratory motion compensation in terms of both motion artefact correction and registration. It comprises motion modeling and contrast-change modeling. The method feeds on physiological signals and x-f space properties of dynamic series to invert a coupled system of linear equations. The unknowns solved for represent the parameters for a linear nonrigid motion model and the parameters for a linear contrast-change model based on B-splines. Performance is demonstrated on myocardial perfusion imaging, on six simulated data sets and six clinical exams. The main purpose consists in removing motion-induced errors from time-intensity curves, thus improving curve analysis and postprocessing in general. This method alleviates postprocessing difficulties in dynamic contrast-enhanced MRI and opens new possibilities for dynamic contrast-enhanced MRI analysis.

[Measurement of ventricular twist by 2D speckle tracking early after acute myocardial infarction. Comparison between anterior and inferior infarction]. / Mesure du twist ventriculaire par 2D speckle tracking dans la phase précoce de l'infarctus du myocarde. Comparaison entre l'infarctus antérieur, l'infarctus inférieur et un groupe contrôle.

INTRODUCTION: Left Ventricular twist (LV twist) is defined as the apical counter-clockwise rotation relative to the clockwise basal rotation. It has been shown that LV twist decreases after myocardial infarction (MI) and that it is well correlated with left ventricular ejection fraction. Most studies have only evaluated anterior wall MI. The aim of our study was to determine whether LV twist is dependent on the infarct territory (anterior vs. inferior) and whether there is a correlation between LV twist and matrix metalloproteinase-9, a marker of LV remodeling. METHODS: We measured LV twist using echocardiography with 2D speckle tracking in patients with acute MI and in a control group. RESULTS: We evaluated 27 controls and 35 patients with acute MI, 15 with anterior wall and 20 with inferior wall MI. LV twist was significantly decreased after MI, compared to the control group (10.93 +/- 2.05 vs 15.5 +/- 2.29; p = 0.003). There was no difference between anterior and inferior MI. LV rotation was decreased in the infarct area. We did not observe a correlation between LV twist and MMP-9, or creatine phosphokinase. CONCLUSION: With this study we confirm that LV twist decreases after acute MI. Moreover, we show that LV apical rotation is mostly decreased after large anterior MI. As apical rotation is important for ejection and aspiration (untwisting), this could be a possible mechanism of LV dysfunction after MI.

[Association of Wolff-Parkinson-White syndrome with isolated non-compaction of the left ventricle: a case report]. / Association du syndrome de Wolff-Parkinson-White a une non-compaction isolée du ventricule gauche. A propos d'un cas.

The Wolff-Parkinson-White syndrome (WPW) may be associated with a number of cardiac pathologies, especially congenital disease, in 7.5 to 17% of cases. The authors report a rare association of the WPW syndrome with two Kent bundles, right and left septal, with non-compaction of the left ventricle in a 52 year old man. This was a chance finding during systematic echocardiography after ablation, and confirmed by cardiac MRI. The patient was asymptomatic.

Long QT syndrome in a patient with allergic rhinoconjunctivitis and auto-immune diabetes: focus on the choice of anti-H1 drugs.

The long QT syndrome is a rare disease. The prevalence is estimated at 1/5 000 to 1/20,000. Numerous drugs are contra-indicated because they can lengthen the QT interval. A case of pollen allergy in an adolescent with LQTS is described. The possibility to prescribe anti-H1 drugs is reviewed since cases of torsades de pointe and even deaths have been reported for terfenadine and astemizole. Diphenhydramine, orphenadrine and hydroxyzine are contra-indicated. No accidents and no effects on the QT interval have been published for ebastine, fexofenadine, desloratadine and levocetirizine. These anti-H1 drugs could be used with great care, without any association with drugs resulting in low serum potassium level. Azelastine eye drops have been authorized and a routine protection by inhaled corticosteroids during the pollinic period has been advised in this adolescent treated by betablockers.

[Contribution of EKG-gated multislice CT in the diagnosis of arrhythmogenic right ventricle dysplasia: report of two selected cases]. / Apport du scanner volumique avec synchronisation ECG dans le diagnostic de cardiomyopathie arythmogène du ventricule droit: à propos de deux cas choisis.

Arrhythmogenic cardiomyopathy of the right ventricle is characterized by replacement of right myocardial cells by fibro-fatty tissue and arrhythmias. The authors present two cases where EKG gated multislice CT was valuable. In one case, comprehensive evaluation of extensive ventricular dysplasia complicated by intraventricular thrombus was achieved whereas accurate evaluation of the ventricular wall process was possible in another case.

[Evaluation of ventricular asynchronism by Doppler tissue imaging in patients with idiopathic dilated cardiomyopathy]. / Evaluation de l'asynchronisme ventriculaire par échocardiographie Doppler tissulaire chez les patients atteints d'une cardiomyopathie dilatée idiopathique à QRS fins.

OBJECTIVES: To study ventricular asynchronism with tissue Doppler imaging in patients with primitive dilated cardiomyopathy and narrow QRS. PATIENTS AND METHODS: We compared a group of patients with DCM and QRS < 120 ms (gr 1, n=25, 52+/-14 yrs, LVEF: 25+/-9%) with a group of normal patients (gr 2, n=16, 36+/-20 yrs). We measured the delays between the beginning of QRS and the beginnings of aortic (QA), mitral (QM), tricuspid (QT) and pulmonary (QP) flows, and of systolic (QSm) and protodiastolic (QEm) wall motion waves recorded with TDI in the basal portion of interventricular septum (IVS) and LV and RV free walls. We then calculated the differences QA-QP, QM-QT, the interparietal differences for QSm and QEm, and the maximal interparietal systolic (QSm max) and diastolic (QEm max) delays. RESULTS: QA, QP, QM and QT were significantly lengthened in group 1 patients but there were no difference between both groups for QA-QP and QM-QT. There was a trend toward a lengthening of QSm and QEm in group 1 patients. Interparietal differences of QSm and QEm were similar in both groups; however, QSm max and QEm max were significantly longer in group 1 patients than in group 2. CONCLUSION: Doppler study of patients with DCM and narrow QRS shows a lengthening of all electromechanical delays and suggests some degree of ventricular asynchronism by showing a significant increase in maximal interparietal systolic and diastolic delays.

[Cardiac stimulation in the infant and young child]. / Stimulation cardiaque chez le nourrisson et le jeune enfant. Avantages et inconvénients respectifs de la voie endocavitaire et de la voie épicardique.

This study evaluates the problems and the evolution of cardiac stimulation in infants (aged < 3.5 years) by comparing the endocavity and epicardial routes in a retrospective series of 37 patients. Thirty seven patients aged 1.2 +/- 0.9 years treated with epicardial (n = 19) or endocavity (n = 18) stimulation were followed for 10.9 +/- 6.4 years (0.75-24). The 2 patient groups did not differ in age or weight. Four patients were lost to follow up, and 1 died. The functional duration of the first stimulator was not significantly different if the initial approach was epicardial or endocavity. The endocavity probes were introduced by venous denudation in 15 cases and by subclavian puncture in 3 cases. Fourteen of the 19 children fitted by the epicardial route went on to endocavity stimulation, of which 10 were at the first replacement. None of the 18 patients fitted by the endocavity route went on to epicardial stimulation. Out of 11 endocavity probe replacements and 9 atrialisations, the homolateral venous approach was always possible except in 2 cases. In conclusion, the results for the epicardial and endocavity routes are comparable. For technical reasons (calibre of the veins, size of the stimulator) it would appear reasonable if the endocavity route was used, making do initially with a mono chamber stimulation. The advances in the epicardial electrodes abolishes the major handicap (threshold elevation) of this approach which can be advocated when double chamber stimulation seems preferable.