In inflammatory myopathies, dropped head/bent spine syndrome is associated with scleromyositis: an international case-control study.

BACKGROUND: Some myopathies can lead to dropped head or bent spine syndrome (DH/BS). The significance of this symptom has not been studied in inflammatory myopathies (IM). OBJECTIVES: To assess the significance of DH/BS in patients with IM. METHODS: Practitioners from five IM networks were invited to report patients with IM suffering from DH/BS (without other known cause than IM). IM patients without DH/BS, randomly selected in each participating centre, were included as controls at a ratio of 2 to 1. RESULTS: 49 DH/BS-IM patients (DH: 57.1%, BS: 42.9%) were compared with 98 control-IM patients. DH/BS-IM patients were older (65 years vs 53 years, p<0.0001) and the diagnosis of IM was delayed (6 months vs 3 months, p=0.009). Weakness prevailing in the upper limbs (42.9% vs 15.3%), dysphagia (57.1% vs 25.5%), muscle atrophy (65.3% vs 34.7%), weight loss (61.2% vs 23.5%) and loss of the ability to walk (24.5% vs 5.1%) were hallmarks of DH/BS-IM (p≤0.0005), for which the patients more frequently received intravenous immunoglobulins (65.3% vs 34.7%, p=0.0004). Moreover, DH/BS-IM patients frequently featured signs and/or complications of systemic sclerosis (SSc), fulfilling the American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for this disease in 40.8% of the cases (vs 5.1%, p<0.0001). Distribution of the myopathy, its severity and its association with SSc were independently associated with DH/BS (p<0.05). Mortality was higher in the DH/BS-IM patients and loss of walking ability was independently associated with survival (p<0.05). CONCLUSION: In IM patients, DH/BS is a marker of severity and is associated with SSc (scleromyositis).

Immune Thrombocytopenic Purpura in Patients with COVID-19.

We described three COVID-19-infected patients with profound immune thrombocytopenia causing haemorrhagic mucocutaneous complications. We conclude that an immune mechanism was responsible as common causes were excluded. Since corticoids were considered harmful in the circumstances, the patients were successfully treated with intravenous immunoglobulins without later relapse. LEARNING POINTS: The severity of haemorrhagic syndrome is not correlated with the severity of COVID-19 infection.Thrombocytopenia in mild COVID-19 infection seems to have an autoimmune mechanism.Intravenous immunoglobulins (1 g/kg) should be the first line of treatment.

Compliance with standard precautions: Results of a French national audit.

BACKGROUND: Standard precautions (SPs) aim to reduce the risk of cross-transmission of microorganisms. The objectives of the present study were to assess institutional policies for SPs promotion, available resources for SPs implementation, and education of health care workers (HCWs) and their compliance with SPs. METHODS: A multisite mixed-methods audit was conducted in 2011. Self-assessment questionnaires were administered at institution, ward, and HCW levels in French health care facilities (HCFs). Results were given as percentage of objectives achieved (POA) or percentage of "never or sometimes," "often," and "always" responses for each question. RESULTS: A total of 1599 HCFs participated, including 14,968 wards and 203,840 HCWs. At an institutional level, the POA was 88%, covering SPs promotion (91%), procedures (99%), and SPs evaluation (63%). At the ward level, the POA was 94%, covering procedures (95%) and resources (93%). HCWs reported the best compliance for changing gloves between patients (94.5% "always"), and the worst compliance for the use of gloves for intramuscular injection and the use of eye protection in cases of blood exposure risk (34.5% and 24.4% of "always," respectively). CONCLUSIONS: A literature review found no other study of SPs that included such a large study group. These results led to SPs promotion actions at local and regional levels. Reinforcement of SPs observance will be prioritized in the next national program from the French Ministry of Health.

Control of a regional outbreak of vanA glycopeptide-resistant Enterococcus faecium, Eastern France, 2004-2009.

At the end of 2004, an outbreak of glycopeptide-resistant enterococci (GRE) spread from the Nancy Teaching Hospital to more than 40 facilities in the Lorraine region. Because this outbreak appeared to be uninhibited, a regional task force was set up to organize and co-ordinate the management of the outbreak, visiting the affected facilities to publicize the existing recommendations and take stock of the problems encountered in the field. The task force then proposed control measures specific to the region. The proposed measures included promoting the use of alcohol-based hand-rub solutions, isolation measures, enhanced screening policies, cohorting GRE-colonized patients and contacts in special wards with dedicated staff where possible, or failing that, isolating them in single rooms with additional "contact" precautions, maintaining these precautions for GRE-colonized patients until a negative stool sample was obtained after antibiotic treatment (which is a more restrictive definition of "cleared" than usually employed), regional co-ordination of the follow-up of GRE-colonized patients with the weekly publication of a list of institutions that were or had been affected to allow isolation measures to be adopted as soon as known-GRE-colonized patient were readmitted. It was not possible to determine the efficacy of each individual measure on the course of the outbreak. Nevertheless, we observed that the number of new GRE-colonized patients started to decrease following their implementation. Ultimately, 1077 GRE colonizations were recorded in Lorraine, and the outbreak is now under control.

Factors determining poor practice in alcoholic gel hand rub technique in hospital workers.

BACKGROUND: Hand hygiene of healthcare personnel is one of the most important interventions for reducing transmission of nosocomial pathogens. Previous studies have demonstrated that the use of alcohol-based hand gel increases hand hygiene compliance, but that effective use of this product cannot be taken for granted. OBJECTIVE: Evaluate factors associated with poor hand hygiene effectiveness of hospital workers using an alcohol-based hand gel and the effect of an education program. DESIGN: A direct observational prospective study of hand hygiene effectiveness prior to training and immediately after training. SETTING AND SUBJECTS: 3067 hospital workers of different professional categories in several hospital units in the University Hospital of Nancy (France). RESULTS: Time after program start (OR 0.97, 95%CI 0.96-0.97) and being female (OR 0.37, 0.24-0.58) were highly associated with increased effectiveness of hand hygiene prior to training. Wearing rings other than a wedding ring (OR 1.8, 1.2-2.7), a bracelet (OR 2.0, 1.1-3.6), a watch (OR 1.9, 1.3-2.9) and having long nails were associated with ineffective hand rub use. Professional background was also a strong predictor with nurses and especially senior nurses demonstrating much better effectiveness than all other professional groups. Wearing wedding rings or long sleeves, and having varnished nails, visibly dirty hands prior to washing and cutaneous lesions were not associated with effective gel use. CONCLUSION: These results demonstrate that an educational program can significantly improve the proper practices for using hand rub and hand washing compliance. This study has also demonstrated that wearing rings, bracelets, watches and long nails impair hand gel application but that wedding rings, long sleeves and varnished nails do not. The finding of that hand hygiene effectiveness increased with time even prior to training indicates that knowledge gained by staff trained early diffused into those who had not yet been trained.