Characterization of genetic diversity of Bacillus anthracis in France by using high-resolution melting assays and multilocus variable-number tandem-repeat analysis.

Using high-resolution melting (HRM) analysis, we developed a cost-effective method to genotype a set of 13 phylogenetically informative single-nucleotide polymorphisms (SNPs) within the genome of Bacillus anthracis. SNP discrimination assays were performed in monoplex or duplex and applied to 100 B. anthracis isolates collected in France from 1953 to 2009 and a few reference strains. HRM provided a reliable and cheap alternative to subtype B. anthracis into one of the 12 major sublineages or subgroups. All strains could be correctly positioned on the canonical SNP (canSNP) phylogenetic tree, except the divergent Pasteur vaccine strain ATCC 4229. We detected the cooccurrence of three canSNP subgroups in France. The dominant B.Br.CNEVA sublineage was found to be prevalent in the Alps, the Pyrenees, the Auvergne region, and the Saône-et-Loire department. Strains affiliated with the A.Br.008/009 subgroup were observed throughout most of the country. The minor A.Br.001/002 subgroup was restricted to northeastern France. Multiple-locus variable-number tandem-repeat analysis using 24 markers further resolved French strains into 60 unique profiles and identified some regional patterns. Diversity found within the A.Br.008/009 and B.Br.CNEVA subgroups suggests that these represent old, ecologically established clades in France. Phylogenetic relationships with strains from other parts of the world are discussed.

Outbreak of tularaemia in brown hares (Lepus europaeus) in France, January to March 2011.

We report an outbreak of tularaemia in brown hares (Lepus europaeus) in France, which occurred from January to March 2011 and was characterised by a high mortality rate in the local hare population. In France, hare tularaemia is usually sporadic and does not significantly affect hare populations. The epizootic form of the outbreak reported here led us to reconsider the potential associated risks for hare populations and public health.

[Effects of corticosteroids on adults with tuberculous meningitis admitted to intensive care unit: a propensity score analysis]. / Effets de la corticothérapie chez les adultes admis en réanimation pour méningite tuberculeuse: analyse par le score de propension.

INTRODUCTION: The beneficial effect of corticosteroids has been well established, particularly in patients free of infection with the human immunodeficiency virus. In intensive care units, the high risks of infection to which patients are exposed specifically could offset the neurological benefit of corticosteroids. The purpose of the study was to assess the effects of corticosteroids in adult patients with tuberculous meningitis admitted to intensive care unit. METHODS: Retrospective cohort study including all adult patients admitted to intensive care unit for tuberculous meningitis between January 1993 and December 2005. A propensity score case matching was performed using a multivariable logistic regression model, and matched pairs were examined for baseline characteristics and outcome by using conditional regression model. A multivariate Cox's proportional hazard model was used to assess the effects of corticosteroids in all patients adjusting for propensity score. The primary outcome was mortality at 60 days and the secondary outcome was the density of incidence of nosocomial infections. RESULTS: Two hundred and seventy patients were included. The mean age was 38+/-17 years, and the Glasgow coma scale was 12+/-3. The overall mortality was 43.3%. Ninety-four patients who had received corticosteroids were matched to 94 patients untreated with corticosteroids by the propensity score. The baseline characteristics were similar in the two groups except for hydrocephalus, which was more frequent in the group corticosteroids. The mortality rate was 47.9% in group Corticosteroids and 52.1% in group No corticosteroids (P=0.77). The case fatality rate in stage III patients, according to the British Medical Research Council criteria, was 61.5% in the group Corticosteroids versus 74.1% in the group No corticosteroids (P=0.33). Nosocomial infections were observed in 19.1 by 1000 days patient in group Corticosteroids versus 16.1 by 1000 days patient in group No corticosteroids (P=0.4). The outcome in all patients after adjusting for propensity score showed the same results. CONCLUSION: This study found no significant improvement in survival in adult patients with tuberculous meningitis admitted to intensive care who received dexamethasone. However, the confidence interval was in accordance with the 0.78 relative risk estimated by the meta-analysis Cochrane version 2008. There was no significant difference for nosocomial infections between the group Corticosteroids and the group No corticosteroids. A probable lack of statistical power may explain these results.

Prognostic factors of acute aluminum phosphide poisoning.

BACKGROUND: In Morocco, acute aluminum phosphide poisoning (AAlPP) is a serious health care problem. It results in high mortality rate despite the progress of critical care. AIMS: The present paper aims at determining the characteristics of AAlPP and evaluating its severity factors. SETTING AND DESIGN: We studied consecutive patients of AAlPP admitted to the medical intensive care unit (ICU) (Ibn Sina Hospital, Rabat, Morocco) between January 1992 and December 2007. MATERIALS AND METHODS: Around 50 parameters were collected, and a comparison was made between survivor and nonsurvivor groups. STATISTICAL ANALYSIS: Data were analyzed using Fisher exact test, Mann-Whitney U test and Cox regression model. RESULTS: Forty-nine patients were enrolled: 31 females and 18 males; their average age was 26+/-11 years. The ingested dose of aluminum phosphide was 1.2+/-0.7 g. Self-poisoning was observed in 47 cases, and the median of delay before admission to the hospital was 5.3 hours (range, 2.9-10 hours). Glasgow coma scale was 14+/-2. Shock was reported in 42.6% of the patients. pH was 7.1+/-0.4, and bicarbonate concentration was 16.3+/-8.8 mmol/L. Electrocardiogram abnormalities were noted in 28 (57%) cases. The mortality rate was 49% (24 cases). The prognostic factors were APACHE II (P=0.01), low Glasgow coma scale (P=0.022), shock (P=0.0003), electrocardiogram abnormalities (P=0.015), acute renal failure (P=0.026), low prothrombin rate (P=0.020), hyperleukocytosis (P=0.004), use of vasoactive drugs (P<0.001), use of mechanical ventilation (P=0.003). Multivariate analysis by logistic regression revealed that mortality in AAlPP correlated with shock (RR=3.82; 95% CI=1.12-13.38; P=0.036) and altered consciousness (RR=3.26; 95% CI=1.18-8.99; P=0.022). CONCLUSION: AAlPP is responsible for a high mortality, which is primarily due to hemodynamic failure.

Pre-admission quality of life as predictor of outcome after acute care: the role of emotional well-being.

PURPOSE: We sought to investigate whether pre-admission quality of life could act as a predictor of mortality among acutely ill patients, and which dimension of QOL has the greater impact on outcomes. METHODS: Prospective cohort study including patients admitted to an acute medical unit of Rabat Ibn Sina University Hospital, Morocco, between June and September 2014. Characteristics of patients were recorded at admission. The primary exposure was pre-admission quality of life recorded using Euroqol five dimensions three level (EQ-5 D-3 L) and the primary outcome was 90-day mortality. We fit a Cox proportional hazards model to assess their association. We constructed six prediction models; each model included either EQ5D index or one of the five dimensions. We allowed all continuous variables to have a non-linear relationship with the primary outcome using restricted cubic spline with three knots. RESULTS: We included 251 patients. The mean EQ5D index was 0.46 ± 0.5. The design of each prediction model was based on the significant findings of the univariate analysis including; bedside EQ5D index or one of the five dimensions of the EQ5D; age, history of chronic disease, Charlson Comorbidity Index and hemoglobinemia. Multi-variate Cox proportional adjusted hazard ratio (HR) derived from the six models, identified that EQ5D index was independently associated with 90-day mortality (HR: 0.48; 95% CI: 0.25; 0.91, P = 0.02), and that anxiety and depression dimension has the greater impact on outcome (HR: 2.97; 95% CI: 1.38; 6.41, P = 0.005). CONCLUSIONS: This study revealed that pre-admission health-related quality of life (HRQoL), and particularly pre-admission psychological HRQoL was associated with outcome of acutely ill patients 90 days after discharge.

First molecular characterisation of a Brazilian Burkholderia mallei strain isolated from a mule in 2016.

We present the first molecular characterisation based on MLVA and SNP analysis of a strain of Burkholderia mallei isolated from a mule found dead in Brazil in 2016.

High-resolution melting PCR analysis for rapid genotyping of Burkholderia mallei.

Burkholderia (B.) mallei is the causative agent of glanders. A previous work conducted on single-nucleotide polymorphisms (SNP) extracted from the whole genome sequences of 45 B. mallei isolates identified 3 lineages for this species. In this study, we designed a high-resolution melting (HRM) method for the screening of 15 phylogenetically informative SNPs within the genome of B. mallei that subtype the species into 3 lineages and 12 branches/sub-branches/groups. The present results demonstrate that SNP-based genotyping represent an interesting approach for the molecular epidemiology analysis of B. mallei.

Quantitative diagnosis of breast tumors by characterization of viscoelastic behavior of healthy breast tissue.

The main objective of the present study is to propose a model for characterizing the viscoelastic behavior of the healthy breast tissue. The study population consisted of 60 healthy regions of the breast tissue belonged to 9 female cases. To accomplish this, the attending cases were examined by a robot-assisted device and the mechanical stress resulted from an applied compressive strain was measured. Correlation between the experimental stress and the strain data identifies the breast tissue mechanical behavior. The tissue behavior was modeled by a five-element Maxwell-Wiechert model called model E. The model was personalized for every attending case via its coefficients based on a personalized diagnosis idea. The model performance was assessed by measuring the Mean Squared Error (MSE) and the match percentage of the model to the experimental data. Moreover, the model performance was compared with three common spring-dashpot models included the Maxwell model, the Burgers model and Standard Linear Solid model. Results affirmed that model E had the best data match in the whole mechanical loading and the MSE was considerably reduced. Subsequently model E was implemented for the tumor-included regions among the population study. Results showed that with a high match percentage, coefficients had significant deviations from the corresponding healthy regions' values for every individual. Consequently, personalized model E can be used for the healthy tissue characterization and tumor detection.

Anticandidal, antibacterial, cytotoxic and antioxidant activities of Calendula arvensis flowers.

Calendula arvensis (CA) is one of the important plants used in traditional medicine in Morocco, due to its interesting chemical composition. The present study aimed to determine the anticandidal, antioxidant and antibacterial activities, and the effects of extracts of CA flowers on the growth of myeloid cancer cells. Also, to characterize the chemical composition of the plant. Flowers of CA were collected based on ethnopharmacological information from the villages around the region Rabat-Khemisset, Moroccco. The hexane and methanol extracts were obtained by soxhlet extraction, while aqueous extracts was obtained by maceration in cold water. CA extracts were assessed for antioxidant activity using four different methods (DPPH, FRAP, TEAC, ß-carotene bleaching test). Furthermore, the phenolic and flavonoid contents were measured, also the antimicrobial activity has been evaluated by the well diffusion method using several bacterial and fungal strains. Finally, extracts cytotoxicity was assessed using MTT test. Phytochemical quantification of the methanolic and aqueous extracts revealed that they were rich with flavonoid and phenolic content and were found to possess considerable antioxidant activities. MIC values of methanolic extracts were 12.5-25µg/mL. While MIC values of hexanolic extracts were between 6.25-12.5µg/mL and were bacteriostatic for all bacteria while methanolic and aqueous extracts were bactericidal. In addition, the extracts exhibited no activity on Candida species except the methanolic extract, which showed antifungal activity onCandida tropicalis 1 and Candida famata 1. The methanolic and aqueous extracts also exhibited antimyeloid cancer activity (IC50 of 31µg/mL). In our study, we conclude that the methanolic and aqueous extracts were a promising source of antioxidant, antimicrobial and cytotoxic agents.

First Draft Genome for a Burkholderia mallei Isolate Originating from a Glanderous Mule from Brazil.

Burkholderia mallei is the etiological agent of glanders. Here, we present the draft genome sequence of Burkholderia mallei strain 16-2438_BM#8 that was isolated from a mule found dead in Pernambuco, northeast Brazil. It is the first available genomic sequence from a strain isolated on the American continent.

[Neuroimaging findings in eclamptic patients still symptomatic after 24 hours: a descriptive study about 19 cases]. / Apport de l'imagerie neurologique chez les éclamptiques encore symptomatiques après 24 heures: étude descriptive à propos de 19 cas.

OBJECTIVE: To describe the neuroimaging findings in eclamptic patients still symptomatic after 24 hours. PATIENTS AND METHODS: All parturients consecutively admitted over a 12-month period for eclampsia and presenting with neurological disorders (coma, focal neurological abnormalities, and eye sight disturbance) underwent cerebral CT-scan and/or MRI. RESULTS: Nineteen women were studied, and all had abnormal neuroradiological findings. The CT-scan was normal in three cases. Cerebral oedema was the predominant lesion (14 cases). It was localized in the parietal or occipital area (12 cases), paraventricular area (1 case), or was diffuse (1 case). Diffusion weighted MRI was performed in four cases and showed cytotoxic cerebral oedema in one case. There were three cases of cerebral venous thrombosis and two cases of intracerebral haemorrhage. CONCLUSION: Various neuroradiological lesions can be observed in eclamptic patients. A localized cerebral oedema is the most frequent. Diffusion weighted MRI should be systematically done when neurological disorders persist.

Protein metabolism during weight reduction with very-low-energy diets: evaluation of the independent effects of protein and carbohydrate on protein sparing.

The aim of this study was to assess the independent effects of carbohydrate and protein intakes in protein sparing during weight reduction. Forty-eight obese women were randomly assigned to consume isoenergetic (2500 kJ/d) liquid diets that provided the following amounts (g/d) of protein and carbohydrate, respectively, for 28 d: 50 and 10, 50 and 76, 70 and 10, and 70 and 86. The effects of carbohydrate and protein were analyzed by repeated-measures analysis of variance (ANOVA). Carbohydrate significantly affected daily urinary ammonia and total nitrogen excretion, stool nitrogen, and nitrogen balance. Protein, independently of carbohydrate, significantly affected daily urinary ammonia, urea, and total nitrogen excretion but had no effect on nitrogen balance. Cumulative nitrogen losses (mmol/28 d) were lower in the high-carbohydrate groups than in the low-carbohydrate groups (1869 +/- 392 and 3611 +/- 328, P = 0.003) but were similar in the groups receiving 50 and 70 g protein/d (3171 +/- 327 and 2326 +/- 430, respectively, P = NS). These results indicate that carbohydrate and protein have independent but additive protein-sparing effects during weight reduction.

Weaning from mechanical ventilation: a model for extubation.

OBJECTIVE: To develop a model able to determine the right time for extubation and to validate its performance. paragraph sign DESIGN: A prospective clinical study. SETTING: 14-bed medical intensive care unit in a university hospital. PATIENTS: 101 patients (37 women/64 men) ventilated over more than 48 h (mean 10.4 +/- 10.3 days) and considered ready to be weaned by the medical team (February 1996-February 1998). METHODS: This study included two series: a development series with 53 patients and a validation series with 48 patients. Before extubation, a weaning test was performed measuring tidal volume (V(T)), respiratory rate (f), f/V(T) ratio, minute ventilation, vital capacity (VC) and maximum inspiratory and expiratory pressures (MIP and MEP). The success of extubation was assessed after 48 h. Receiver operating characteristic (ROC) curves allowed the analysis of the discriminating power of each parameter. Threshold values were determined using the Youden's index. To create the best predictive model, we performed a multiple logistic regression analysis. To assess the calibration and the discrimination of the model, the Hosmer- Lemeshow goodness-of-fit test and area under ROC curves (AUC) were adopted. MEASUREMENTS AND RESULTS: In a development series, 60 tests were carried out with 38 successful extubations and 22 extubation failures. The multivariate analysis found three significant variables: VC (threshold value = 635 ml), f/V(T) ratio (threshold value = 88 breaths/min.l) and MEP (threshold value = 28 cmH(2)O). The validation cohort included 59 tests (38 successes and 21 failures). The validation series shows a good discrimination (AUC = 0.855 +/- 0.059) and calibration (goodness-of-fit test C: p = 0.224) of the model. CONCLUSION: VC together with the f/V(T) ratio and MEP offer accurate prediction of early extubation.

Ferritin synthesis on polyribosomes attached to the endoplasmic reticulum.

The evidence that ferritin is synthesized both on free polyribosomes and on polyribosomes attached to the endoplasmic reticulum is reviewed. Evidence that some ferritin is secreted from cells after synthesis on bound polyribosomes was found to be inconclusive.

Exoprotein and slime production by coagulase-negative staphylococci isolated from goats' milk.

Milk from mastitis-free goats from French herds was examined for the presence of coagulase-negative staphylococci (CNS), and 165 positive isolates were evaluated for their capacity to produce exoproteins. Most isolates were identified as Staphylococcus caprae (N = 91) or S. xylosus (N = 36), but members of at least nine other species were present. Overall, some 57% of isolates produced toxins with phenotypic properties of alpha-hemolysin, and 75% produced toxins resembling S. aureus beta and/or delta-hemolysins. Thermostable desoxyribonuclease (TNAse) was secreted by 29% of isolates and thermolabile DNAse by 66%. Slime was produced by 42% of our cultures and, although none of them showed activity to insoluble elastase, over 70% lysed the soluble substrate. No clinical consequences were observed to correlate with exoprotein production, which proved to be inconstant within individual CNS species.

[Resistance spectrum of staphylococci at the Vienna general hospital (July to December 1991)]. / Resistenzverhalten von Staphylokokken am Allgemeinen Krankenhaus der Stadt Wien (Juli bis Dezember 1991).

This study describes the antibiotic resistance of 1961 staphylococcal strains that were isolated at the University Hospital of Vienna from July to December 1991. Staphylococcus aureus (SA) represented 43.2%; coagulase-negative (CNS) staphylococci 56.8%, three quarters of which were Staphylococcus epidermidis. Excepting netilmicin, the proportion of resistant strains to all antibiotics was higher with CNS than SA. Methicillin resistance (M(r)) was found in 11.8% of SA and 30.3% of CNS. Borderline oxacillin resistance (BOR) was noted in 7.4% of SA and 32.5% of CNS. It is important to note that severe or generalized infections due to M(r) staphylococci should be treated with glycopeptide antibiotics such as vancomycin or teicoplanin from the very beginning, whereas chemotherapy of those with BOR strains may also be carried out with beta lactamase-stable beta lactam antibiotics. Comparing the results of this study with those of the first half of 1991, the respective proportion of M(r) staphylococci was significantly lower than 23.6% for SA and 47.6% for CNS recorded then. As compared with the foregoing period, however, these strains demonstrated increased resistance frequencies to gentamicin (from 81.3 to 90%), amikacin (from 35.4 to 69%), netilmicin (35.4 to 55%), and ciprofloxacin (56.2 to 64%). This is taken as an indication for the epidemic spread of a clone of resistant strains.

[Incidence, causes and prognostic factors of hyponatremia in intensive care]. / Incidence, étiologies et facteurs pronostiques de l'hyponatrémie en réanimation.

PURPOSE: The incidence of hyponatremia is unknown, their causes are multiple. The higher mortality, especially in intensive care units, is currently unexplained. The objective of this article is to evaluate the incidence of hyponatremia, to assess their causes and to identify predictors of prognosis in intensive care units. METHODS: We included retrospectively all patients admitted at department of medical intensive care unit between January 1996 and February 2001, who presented at the admission, an hyponatremia (< 130 mmol/l). We excluded all patients who presented a hospital acquired hyponatremia, or hyponatremia associated with hyperglycemia > 13 mmol/l or with mannitol administration. Data were analysed by univariate methods, then by multivariate analysis. RESULTS: During the study period, 300 patients were identified among 2188: the incidence was 13.7% with 95% confidence interval (95% CI) between 9.8 % and 16.7%. Hypovolemic hyponatremia was observed in 25.7%, hypervolemic in 23.7% and normovolemic in 50.6%. In-hospital mortality was 37.7% (95% CI: 31.8% - 42.3%). Nine data were significantly associated with higher mortality in univariate analysis, but only 5 were identified as independant predictors of hospital mortality in multivariate analysis: hyponatremia < 125 mmol/l with a significant relative risk (RR) (RR = 2.10; 95% CI: 1.43-3.08; p < 0.001), Glasgow score < 9 (RR = 2.66; 95% CI: 1.25-5.66; p = 0.01), Glasgow score between 9 and 14 (RR = 1.94; 95% CI: 1.31-2.88; p < 0.001), shock (RR = 1.80; 95% CI: 1.10-3.05; p = 0.02) and blood urea concentration > 10 mmol/l (RR = 1.59; 95% CI : 1.08-2.34; p = 0.02). CONCLUSION: The frequency of hyponatremia is high; the normovolemic type represented 50%. Mortality is linked, in greater part, to organs dysfunction, but the severity of hyponatremia remained a significant predictor of mortality.

[Left ventricular thrombus and myocarditis induced by paraphenylenediamine poisoning]. / Thrombus ventriculaire gauche et myocardite toxique induite par la paraphénylène diamine.

We showed that the paraphenylenediamine (PPD) poisoning caused myocarditis but there is no data on the echocardiographic features. We report a case of myocarditis induced by PPD poisoning with echographic data. After ingestion of 5 g of PPD, a 18-year-old woman was admitted to the hospital with asphyxia and rhabdomyolysis. An electrocardiogram showed ventricular extrasystoles and negative T waves. The serum concentration of CK was 28,020 UI l(-1) (iso-enzyme MB = 840 UI l(-1)). A transthoracic echocardiography showed significant left and right ventricular hypokinesis (shortening fraction = 20% and left ventricular ejection fraction = 35%) and a left ventricular apical thrombus. Anticoagulation treatment with heparin was initiated. A follow-up echocardiogram performed on the 15th day showed normalization of ventricular function and disappearance of the thrombus. No embolic event was noted. Echocardiography is indicated in the myocarditis induced by PPD poisoning to prove the ventricular function as well as the presence of a thrombus.

[Comparative efficiency of nebulized adrenaline and salbutamol in severe acute asthma. A randomized, controlled prospective study]. / Efficacité comparée de l'adrénaline et du salbutamol en nébulisation dans l'asthme aigu grave. Essai clinique contrôlé prospectif randomisé.

OBJECTIVE: To compare nebulized salbutamol and nebulized adrenaline in acute severe asthma (ASA). STUDY DESIGN: Prospective controlled study. PATIENTS AND METHODS: October 1998 at May 99, 44 patients (31 women and 13 men, 35 +/- 11 yrs) with ASA (defined as peak expiratory flow rate (PEF) < 150 l min-1 and normo- or hypercapnia) were randomized to receive either nebulized salbutamol (n = 22), 10 mg/h-1 during 2 h then 5 mg every 4 h or nebulized adrenaline (n = 22), 6 mg/h-1 during 2 h then 3 mg every 4 h. The efficacy was assessed by PEF, forced expiratory volume in one second (FEV1) and Fischl's score during eight hours and by arterial blood gases during the first hour. Side-effects were evaluated by heart rate, systolic blood pressure, serum potassium and blood glucose. Statistical tests: Wilcoxon, Fischer exact, ANOVA and Scheffe's test. RESULTS: Both groups were similar with respect to age, sex, severity, duration of asthma and length of crisis. With the two treatments, PEF increased significantly but no statistical difference were observed between the two groups during the eight hours: 117.7 +/- 41.6 l min-1 to 203.3 +/- 56.9 l min-1 in the salbutamol group; 116.4 +/- 36.8 l min-1 to 217.3 +/- 188.8 l min-1 in the adrenaline group; p = 0.77. FEV1, Fischl's score and arterial blood gases did not differ significantly between treatments at every time interval. There were no significant difference between the two groups in terms of side-effects. The intravenous way was necessary at 3 cases of the salbutamol group and 4 cases of adrenaline group (NS). CONCLUSION: The results suggest that nebulized adrenaline is as effective as nebulized salbutamol in the ASA without significant side-effects. The nebulization could reduce systemic effects of adrenaline.