Satisfaction and anxiety level during clinical training among nursing students.

BACKGROUND: Quality is a primary concern of health care agencies worldwide. A conducive clinical training environment is essential for nursing students to be capable of enhancing their learning experiences and achieving the desired training outcomes. AIM: This study aimed to examine the satisfaction and anxiety levels during clinical training among nursing students. TYPE OF STUDY: A descriptive -analytical cross-sectional study design was utilized. The research was conducted at the Faculty of Nursing, Assiut University and Colleges of Applied Medical Sciences in Alnamas and Bisha, University of Bisha. Sampling method: A convenience sampling technique was used. SAMPLE SIZE: a sample of 1052 undergraduate nursing students. The data was gathered via a structured questionnaire including the socio-demographic characteristics and nursing students' satisfaction with the hospital and laboratory training. Additionally, Self-Rating Anxiety Scale (SAS) was adopted to measure the anxiety level. RESULTS: The mean age of the studied sample was 21.9 ± 1.83 years, and 56.9% are females. Moreover, 90.1% & 76.4% of the nursing students were satisfied with their hospital and laboratory training. Furthermore, 61.1% & 54.8% of the students had mild levels of anxiety regarding their hospital training and laboratory training, respectively. CONCLUSION: The undergraduate nursing students had a high level of satisfaction with their clinical training at the hospitals and laboratories. Moreover, they had mild anxiety related to hospital and laboratory clinical training. RECOMMENDATIONS: Developing clinical orientation and training programs and improvement strategies to enhance the effectiveness of the clinical training environment. The establishment of a modern, tastefully designed, and fully stocked skill lab for the college's student training should receive more attention. CLINICAL RELEVANCE: Through the provision of ongoing education about different method of practice, nursing was intended to shape future professional nurses who master core competencies of the profession. Organizations may benefit from developing a comprehensive strategy to achieve an effective teaching program.

Identification of clinically relevant Corynebacterium strains by Api Coryne, MALDI-TOF-mass spectrometry and molecular approaches.

We evaluated the Bruker Biotyper matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (MS) for the identification of 97 Corynebacterium clinical in comparison to identification strains by Api Coryne and MALDI-TOF-MS using 16S rRNA gene and hypervariable region of rpoB genes sequencing as a reference method. C. striatum was the predominant species isolated followed by C. amycolatum. There was an agreement between Api Coryne strips and MALDI-TOF-MS identification in 88.65% of cases. MALDI-TOF-MS was unable to differentiate C. aurimucosum from C. minutissimum and C. minutissimum from C. singulare but reliably identify 92 of 97 (94.84%) strains. Two strains remained incompletely identified to the species level by MALDI-TOF-MS and molecular approaches. They belonged to Cellulomonas and Pseudoclavibacter genus. In conclusion, MALDI-TOF-MS is a rapid and reliable method for the identification of Corynebacterium species. However, some limits have been noted and have to be resolved by the application of molecular methods.

Isolation and identification of efficient Egyptian malathion-degrading bacterial isolates.

Bacterial isolates degrading malathion were isolated from the soil and agricultural waste water due to their ability to grow on minimal salt media amended with malathion as a sole carbon source. Efficiencies of native Egyptian bacterial malathion-degrading isolates were investigated and the study generated nine highly effective malathion-degrading bacterial strains among 40. Strains were identified by partial sequencing of 16S rDNA analysis. Comparative analysis of 16S rDNA sequences revealed that these bacteria are similar with the genus Acinetobacter and Bacillus spp. and RFLP based PCR of 16S rDNA gave four different RFLP patterns among strains with enzyme HinfI while with enzyme HaeI they gave two RFLP profiles. The degradation rate of malathion in liquid culture was estimated using gas chromatography. Bacterial strains could degrade more than 90% of the initial malathion concentration (1000 ppm) within 4 days.

The effects of delayed annealing on the luminescent activity of heavy metal cadmium zinc phosphate glasses activated by: Er3+ and Tb3+ ions.

The luminescent spectra of the RE2O3-doped P2O5-CdO-ZnO glasses (RE = Er, and Tb) were investigated to separate the effects of two studied rare-earth elements and the annealing regime on the emission performance of the prepared glasses. The glasses undergo a series of collective measurements including UV-visible absorption, luminescence, thermal expansion, XRD, TEM, and FTIR. The optical UV-visible spectra of the two doped glasses reveal a UV band due to undoped glass beside and extra extended 11 peaks with the Er3+ ions with high distinct features while the Tb3+ ions samples exhibit peaks within the visible region. These peaks are correlated with transitions from the ground state in each case to specific energy transitions. The overall optical data indicate that the two rare earth ions are present in a stable trivalent state. Under UV excitation, both Er3+ and Tb3+ emit a characteristic green light corresponding to 4S3/2 → 4I15/2 and 5D4 → 7F5 transitions, respectively. The performance of the green light was identified to be enhanced by increasing the concentration of rare earth and the effect of annealing temperature. Moreover, the intensity of the infrared emission of Er3+ at 1532 nm corresponds to the (4I13/2 → 4I15/2) transition which is assumed to be developed with the effect of heating. The resultant IR spectra show distinct vibrational peaks due to phosphate groups that undergo only minor modifications when doped with rare earth elements or over-annealed.

Newly developed CeO2 and Gd2O3-reinforced borosilicate glasses from municipal waste ash and their optical, structural, and gamma-ray shielding properties.

From the useless municipal solid waste (MSW) ashes, CeO2, Gd2O3 and CeO2 + Gd2O3 doped borosilicate glasses were organized via melting-quenching procedure. Various optical, structural, physical and radiation shielding parameters were examined towards the influence of 100 kGy of γ-radiation. UV-visible NIR spectra revealed UV peaks at 351, 348 and 370 nm corresponding to the trivalent states of Ce3+ and Gd3+ ions, while, photoluminescence (PL) spectra displayed asymmetric broad excitations of Ce3+ and Gd3+ ions due to 4f → 5d transitions, and emission intense bands at 412, 434, and 417 nm. CIE chromaticity shows that Gd3+ ions increase the luminescence of Ce3+. FTIR absorption bands revealed an overlapping between tetrahedral groups of silicate (SiO4), with trigonal (BO3) and tetrahedral (BO4) units of borate. The influence of 100 kGy obtains quite reduction in UV-visible NIR and PL peaks, large stability in FTIR and ESR spectra, and stability of thermal expansion coefficient (CTE) as well. The whole data revealed optical, structural and physical stability of glasses after irradiation besides an enhancement in microhardness owing to more structural compactness and high bonding connectivity. Radiation shielding parameters from Phy-X/PSD program showed higher values of mass (MAC) and linear attenuation coefficients (LAC), and effective atomic number (Zeff) in the order of; glass Ce+Gd > glass Ce > glass Gd. Ce + Gd doped glass revealed also the lowest half value layer (HVL) comparing to other shielding commercial concretes. The study recommends the beneficial and economical use of the useless MSW ash to produce CeO2 and/or Gd2O3 borosilicate glasses with hopeful radiation shielding features.

Hypoglycemic and antioxidative effects of fenugreek and termis seeds powder in streptozotocin-diabetic rats.

BACKGROUND AND OBJECTIVES: Diabetes mellitus is a heterogeneous disease characterized by altered cellular metabolism. So, many traditional herbs are being used by diabetic patients to control this disease. In the present study, an attempt has been made to investigate the anti-diabetic and antioxidative effects of water suspension of Fenugreek (F), and Termis (T) seeds powder and their mixture (M) who were studied in Streptozotocin (STZ)-induced diabetic rats. MATERIALS AND METHODS: Experimental diabetes was induced by injection a single dose of STZ (50 mg/kg, i.p.). Adult male albino rats were divided into five groups; normal control, diabetic control, diabetic-F supplement (1 g/kg b.wt.), diabetic-T supplement (1 g/kg b.wt.) and diabetic-M supplement 1 g/kg b.wt. of each seed powder concurrently for 30 days. Serum glucose, insulin, lipid profile, activities of serum marker enzymes of liver function as well as liver and muscle glycogen content were measured. The oxidative stress was assessed by blood reduced glutathione (GSH) content and enzyme activities of glutathione-S-transferase (GST) and catalase (CAT) in plasma. RESULTS: The increase in serum glucose, total lipid, triglycerides, total cholesterol, AST, ALT, ALP and decreased insulin, plasma, GSH, GST, CAT, as well as liver and muscle glycogen content were the salient features recorded in diabetic control rats. The F, T and M supplements significantly reverted the levels of the studied metabolites and enzymes activities to near normal control values. Co-administration of F and T seeds powder was considered as an effective agent in modulating the alterations in total lipid, AST, ALT, GSH and muscle glycogen. CONCLUSIONS: Our data suggest that F, T and M seeds powder supplementation may be beneficial for preventing diabetic complications in this animal model.

Evaluation of human monkeypox knowledge and beliefs regarding emerging viral infections among healthcare workers.

OBJECTIVES: The purpose of this study was to evaluate possible factors that might be accompanied by high level of human monkey pox (HMPX) knowledge and to explain the relationship between HMPX knowledge and Beliefs regarding emerging viral infections. STUDY DESIGN: A descriptive cross-sectional study was conducted for the implementation of this study. METHODS: Study was conducted at two general hospitals in Mansoura City (Old General Hospital and International Hospital) El Dakahlia Governorate among 620 healthcare workers (HCWs) using a self-managed questionnaire for 1 week (1 to 7 January 2023). The questionnaire has items adapted from the previously published literature to assess HMPX knowledge and Beliefs regarding emerging viral infections. RESULTS: The mean age of the study sample was 27.97 years and most of them were female (86.1%). Physicians and other HCWs (nurses, laboratory technicians, radiographer technicians, and pharmacists) had significantly different levels of knowledge of monkeypox for the majority of the questions. A higher belief was found among two items: viruses are biological weapons manufactured by the superpowers to take global control and the government is misleading the public about the cause of the virus. CONCLUSION: This study discovered lower levels of knowledge of HMPX among HCWs in Egypt. Beliefs about emerging viral infections were widespread, and future research should look into their potential negative impact on health behavior.

Crystallization effects on the photoluminescence efficiency of SrO-B2O3 glass activated by W6+, Eu3+, Dy3+ or Pr3+ ions.

Binary strontium borate host glass together with samples doped with 0.25 %WO3 and one of the rare - earth ions (0.125% Eu3+, Dy3+ or Pr3+) were prepared by conventional melting - annealing technique. DTA analysis of the host base glass was carried out to derive the proper temperatures which are necessary to convert glasses into their corresponding glass -ceramic through controlled thermal heat -treatment regime. Measurements of optical, FTIR, and PL spectra were carried out with special analysis of the spectral properties. The identity of glass - ceramic derivatives were investigated through x-ray diffraction, and TEM & SEM tools to identify their crystalline morphological features. The absorption spectrum of WO3 - doped glass refers to the existence of dominant hexavalent tungsten ions. The RE- doped glass reveal characteristic visible - NIR absorption peaks due to the respective rare earth ions. FTIR spectra show absorption bands due to both triangular and tetravalent borate groups (BO3, BO4).PL spectra reveal excitation and emission characteristic peaks due to each specific rare earth ions. XRD indicate the preference of the host glass to form strontium pyroborate (SrB4O7) crystalline phase. This facilitates the clear knowledge of the crystallization behavior and hence can justify the effect of the crystallization on the studied properties.

Sperm tendency to agglutinate in motile bundles in relation to sperm competition and fertility duration in chickens.

A unique sperm behavior was observed in Egyptian chickens. Sperm showed a tendency to agglutinate forming motile thread-like bundles. Sperm agglutination behavior, kinematics, and some morphometric measures were studied in relation to sperm competition and fertility duration in Sharkasi and Dandarawi chickens. Sperm tendency to agglutinate was assessed by examining sperm morphology using scanning electron microscopy, Acridine orange-stained semen smears using fluorescence microscopy, and recording videos of sperm under phase contrast microscope. Sperm velocity and morphometric measures were evaluated using image-J software. To assess sperm competition, Sharkasi and Dandarawi hens were artificially inseminated by semen pools possessing equal number of Sharaksi and Dandarawi sperm. Artificial insemination was repeated ten times. The eggs obtained were incubated, and the hatchlings were discriminated as descending from Sharkasi or Dandarawi fathers according to their phenotype. To assess the fertility duration, Sharkasi and Dandarawi hens were inseminated by semen collected from roosters of the same strain. Eggs were collected for a period of 28 days post-insemination and incubated. Sharkasi spermatozoa showed higher tendency to agglutinate forming longer and thicker motile bundles. No significant differences were observed in sperm curvilinear and straight line velocity and in sperm morphometric measures between Sharkasi and Dandarawi chickens. Sharkasi roosters fathered 81.6% and 67.7% of the hatchlings produced by Sharkasi and Dandarawi mothers, respectively. The fertility period in Sharkasi and Dandarawi was 22 and 14 days, respectively. We suggest that the differences seen in sperm competitiveness and fertility duration can be attributed to sperm agglutination behavior.

Evaluation of a simplified IS6110 PCR for the rapid diagnosis of Mycobacterium tuberculosis in an area with high tuberculosis incidence.

PURPOSE: To assess the diagnostic yield of a simplified IS6110-PCR in an area with high tuberculosis incidence. METHODS: Pulmonary (218) and extrapulmonary (121) samples were collected from 236 patients including smearpositive leprosy patients. All samples were processed to detect acidfast bacilli by microscopy, culture on solid media and PCR. To remove PCR inhibitors, three washing steps of the decontaminated pellet were included before mycobacterial cell lysis by heat treatment. No detergents, enzymes, or chelating agents were used. From the 339 samples, 34 were selected basing on their large volume and were tested by the commercial kit GenoType Mycobacteria Direct (GTMD) (VER 4, Hain Lifescience, Germany) in addition to the tests cited above. RESULTS: The overall sensitivity and specificity of PCR were 93.8 and 98.6% for pulmonary samples, 63.6 and 100% for extrapulmonary samples, respectively. The assay detected MTC in 94.2% of smear positive samples with a positive predictive value of 100%. No inhibition was found among seven samples that were PCR negative but bacteriological confirmed as containing Mycobacterium tuberculosis. No false positive result occurred with samples from leprosy patients. The sensitivities for PCR and GTMD were 81.8 and 75%, respectively. CONCLUSION: PCR could efficiently complement conventional bacteriological tools for the rapid diagnosis of tuberculosis but cannot replace them.

[Seroprevalence and risk factors of hepatitis E among pregnant women in central Tunisia]. / Séroprévalence et facteurs de risque de l'hépatite virale E chez la femme enceinte dans le centre tunisien.

OBJECTIVES: The study was conducted to investigate the prevalence and risk factors for hepatitis E virus (HEV) infection in Tunisian pregnant women. METHODS: A total of 404 pregnant women were enrolled. Data were collected through a standard questionnaire which covered sociodemographic characteristics and risk factors. Blood samples were collected and were tested for HEV IgM and IgG antibodies, IgG against hepatitis A (anti-HAV IgG), hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV). Risk factors were analyzed using univariate and multivariate logistic regression models. RESULTS: Prevalence of anti-HEV IgG, anti-HEV IgM, anti-HAV IgG, HBs Ag and anti-HCV was 12.1 %, 0 %, 97 %, 3 % and 0,5 %, respectively. In multivariate analysis age (>30 years) and the number of persons per room (>2) in the house were independent factors predicting HEV infection. History of agricultural work, kind of water, sewage treatment, use detergent to wash vegetables, contact with animals and parenteral risk factors were not correlated with the presence of anti-HEV IgG. CONCLUSION: The important seropositive rate among pregnant women is compatible with endemicity of HEV in Tunisia. Hepatitis E should be considered in the diagnosis of acute hepatitis during pregnancy. Our result suggests that infection occurs sporadically by person-to-person transmission route but further investigations are needed to determine the natural reservoir of infection.

[Viral infection risk in polytransfused adults: seroprevalence of seven viruses in central Tunisia]. / Le risque infectieux viral chez le polytransfusé : séroprévalence de sept agents viraux dans le centre tunisien.

The aim of this study is to evaluate the prevalence of seven transfusion-transmitted viruses in polytransfused adults and children comparatively with a group of healthy control subjects. We studied 107 polytransfused patients (59 adults and 48 children) and 160 control subjects (100 blood donors and 60 children). Immunoenzymatic tests were used for detection of HBs antigen (HBs Ag), antibodies against hepatitis C Virus (anti-HCV), and human immunodeficiency virus (anti-HIV), and IgG antibodies against human cytomegalovirus (IgG anti-CMV), human parvovirus B19 (IgG anti-PB19), and hepatitis E virus (IgG anti-HEV). An immunofluorescent assay was performed for the detection of human herpesvirus 8 antibodies (anti-HHV8). Prevalence of HBs Ag, anti-HCV, anti-HIV, IgG anti-CMV, IgG anti-PB19, IgG anti-HEV, and anti-HHV8 in polytransfused group was 8.4, 4.7, 0, 86.9, 60.7, 28.9, and 47.6%, respectively, and 1.8, 0.6, 0, 86.2, 53.1, 10, and 12.5%, respectively, in the control group. The difference in prevalence between the two groups was statistically significant for HBs Ag (P = 0.01), anti-HCV (P = 0.03), IgG anti-HEV (P < 10(-4)), and IgG anti-HHV8 (P < 10(-4)). Categorization according to age showed that hepatitis B and C risk was limited in adult polytransfused group. HHV8 infection was higher in polytransfused subjects born before the use of leucocyte-depleted blood components. Our results corroborate literature data on the risk of HEV and HHV8 infection by blood transfusion. Hepatitis B vaccination and improvement in screening tests have an important role in reduction of hepatitis B and C risk in transfusion, especially in young polytransfused persons. However, a residual risk of transmitting viral infections persists, and efforts are needed to improve transfusion safety.

[Seroprevalence of rubella virus, varicella zoster virus, cytomegalovirus and parvovirus B19 among pregnant women in the Sousse region, Tunisia]. / Séroépidémiologie de la rubéole, de la varicelle et des infections par le cytomégalovirus et le parvovirus B19 chez les femmes enceintes dans la région de Sousse, Tunisie.

The aim of the study is to evaluate seroprevalence of rubella virus (RV), cytomegalovirus (CMV), varicella zoster virus (VZV), and parvovirus B19 (PB19) in 404 Tunisian pregnant women, and to determine reliability of maternal past history of eruption. Sociodemographic characteristics, risk factors, and past history of eruption were collected through a questionnaire. Serologic tests were performed using enzyme immunoassays. Risk factors were analyzed using univariate and multivariate logistic regression models. Seroprevalences were 79.7% for rubella, 96.3% for CMV, 80.9% for VZV, and 76.2% for PB19. In multivariate analysis, the number of persons per room (> 2) in the house during childhood was associated with CMV infection (P = 0.004), irregular professional husband's activity was correlated with VZV infection (P = 0.04), and an age of more than 30 years was associated with PB19 infection (P = 0.02). History of rubella, varicella, and PB19 infection was unknown for, respectively, 55.8%, 20%, and 100% of women. False history of rubella and varicella were found for 7.4% and 15% of women, respectively. The positive and negative predictive values (PPV and NPV) of rubella history were, respectively, 92.6% and 17.2%, and were, respectively, 84.9% and 20.9% for varicella history. Susceptibility to RV, VZV, and PB19 infection remains high in pregnancy in our population. Preventive strategies against congenital rubella must be reinforced. Vaccination against VZV should be considered in seronegative women. Systemic CMV screening is not warranted in our country where high immunity is acquired probably in childhood. Since maternal history of eruption is not reliable, we recommend serologic testing to determine immune status of women.

Campylobacter fetus Meningitis: A diagnosis to suggest in immunocompromised patients.

Campylobacter fetus causes in humans mostly gastroenteritis. Systemic infection occurs almost exclusively in immunocompromised patients with chronic debilitating diseases. We report the case of a Campylobacter fetus meningitis in a woman aged 48 years with a history of systemic lupus erythematosus treated with corticosteroids and immunosuppressive drugs. Cerebrospinal fluid culture was positive for Campylobacter fetus. The evolution was favorable using imipenem and ciprofloxacin.

The phlebotomine fauna (Diptera: Psychodidae) of the eastern coast of Tunisia.

To identify the phlebotomine sand fly populations of the eastern coast of Tunisia, an entomological survey was carried out between September and October 2005 at 71 sites located in three districts. CDC light traps and sticky papers were used to collect a total of 2,138 phlebotomine sand flies representing nine species. The predominant species occurring on the eastern coast of Tunisia are, in order of abundance, Phlebotomus longicuspis Nitzulescu, 1930 (40%); Phlebotomus papatasi Scopoli, 1786 (21%); Sergentomyia minuta Parroti Adler & Theodor, 1927 (19%); Phlebotomus perniciosus Newstead, 1911 (9.5%); Phlebotomus chabaudi Croset, Abonnenc & Rioux, 1970 (9%); Sergentomyia fallax Parrot, 1921 (1.5%); Sergentomyia dreyfussi Parrot, 1933 (0.23%); Phlebotomus langeroni Nitzulescu, 1930 (0.05%); and Phlebotomus perfiliewi Parrot, 1930 (0.05%). Species involved in the transmission of Leishmania, namely P. papatasi and P. perniciosus, represent 31% of the total number of flies captured. In the central sites (district of Monastir), P. longicuspis predominates, P. perniciosus predominates in the northern sites (district of Sousse) and P. papatasi in the southern sites (district of Mahdia), which is consistent with the distribution of Leishmania infantum and L. major in this region. Analysis of the degree of presence (D) revealed that Phlebotomus papatasi was the most common species and showed the broadest distribution (D = 95%), followed by P. longicuspis and S. minuta parroti (D = 90%) and P. perniciosus and P. chabaudi (D = 86% and 68% respectively).

A three-year surveillance of nosocomial infections by methicillin-resistant Staphylococcus haemolyticus in newborns reveals the disinfectant as a possible reservoir.

OBJECTIVE: Study of the clonality of methicillin-resistant Staphylococcus haemolyticus responsible of epidemic infections in a neonatal intensive care unit. PATIENTS AND METHODS: Methicillin-resistant Staphylococcus haemolyticus isolates were collected during the period from March 2004 to November 2006, from newborns, the clean hands of nurses and from disinfectant bottles used in the unit. Molecular typing by pulsed-field gel electrophoresis (PFGE) was achieved for all isolates. RESULTS: Forty-six isolates of S. haemolyticus resistant to methicillin were collected from 42 newborns, the hand of two nurses and from two disinfectant bottles used in the unit. PFGE analysis revealed five types (A, B, C, D and E) among newborns isolates. Types A and B were predominant. Nurses' isolates revealed PFGE types similar to types A and B. Disinfectant isolates were of type B. qacA/B PCR analysis revealed that the majority of type B isolates contain the disinfectant resistance gene qacA/B. No isolate of type A possessed this gene. CONCLUSION: These results suggest that MRSH neonatal infections are caused by a limited number of clones. Clone B was able to survive in disinfectant bottles and to conserve its ability to infect newborns. We therefore conclude that the disinfectant can serve as a reservoir for MRSH and point out the need to control all disinfectants used in a neonatal intensive care unit.

[Hepatitis B virus infection in Tunisian pregnant women: risk factors and viral DNA levels in HBe antigen negative women]. / Hépatite virale B chez les femmes enceintes tunisiennes: facteurs de risque et intérêt de l'étude de la réplication virale en cas d'antigène HBe négatif.

OBJECTIVE: To evaluate the seroprevalence and the risk factors of hepatitis B virus (HBV) infection in 2303 Tunisian pregnant women and to estimate the risk of perinatal transmission in women positive for hepatitis B surface antigen (HBsAg) but negative for hepatitis B e-antigen (HBeAg). MATERIAL AND METHODS: Positive samples were tested for HBeAg and anti-HBe antibody using enzyme immunoassays. Serum HBV-DNA was determined by real time PCR assay. RESULTS: Overall, 4% of women were HBsAg positive and for the majority of them (96.8%) this status was unknown. Only 1.4% of studied population were vaccinated previously against hepatitis B. Study of risk factors revealed association between the HBsAg status and presence of intrafamilial hepatitis cases (p<0.05). Only four women were positive for HBeAg. Among patients with HBeAg negative status, only 11% were negative for HBV DNA. For the others, DNA level ranged from 34 to 10(8)copies/ml; it was greater than 10(4)copies/ml in 26.5% of them. CONCLUSION: Hepatitis B virus (HBV) prevalence in pregnant women is of intermediate endemicity in Tunisia. Universal vaccination before pregnancy and antenatal screening is recommended. Pregnant women who are found to be HBsAg positive and HBeAg negative should be tested systematically for DNA level to evaluate the risk of perinatal infection and to prevent it by sero-prophylactic for babies or by treatment during the third trimester of pregnancy.

Lymphatic spread in an immunocompetent adult.

Cutaneous tuberculosis with lymphatic spread is rarely described. We report the case of a woman aged 38, immunocompetent, working in a fruit sorting center, who consulted us for ulceration of the left third finger that had persisted for four months, following a prick from a prickly pear. Physical examination revealed a nodular, erythematous, and ulcerative lesion of the left third finger, associated with inflammatory subcutaneous nodules arranged in a line along the ipsilateral upper extremity and an ipsilateral axillary lymph node. Laboratory tests and chest X-ray were normal. Pathological examination revealed granulomatous chronic inflammation without necrosis. PCR detected DNA from Mycobacterium tuberculosis. No extracutaneous tuberculosis locations were detected. A tuberculous chancre by direct inoculation was therefore diagnosed. The patient received quadruple therapy (rifampicin + isoniazid + pyrazinamide + ethambutol) for 2 months, followed by a combination therapy based on isoniazid and rifampicin for 6 months. Marked regression of the cutaneous lesions occurred after 1 month of first-line therapy. A tuberculous chancre is a rare form of cutaneous tuberculosis, with possible lymphatic spread, in immunocompromised patients but also in immunocompetent children and young adults.

[A case of hypernatremic dehydration due to breast-feeding]. / Déshydratation hypernatrémique au cours d'un allaitement maternel.

The authors report an 11-day-old exclusively breast-fed female, with a birth weight of 3 300 g, who had suffered from dehydration stage I, with acute renal failure and metabolic acidosis, with 170 mmol/L of serum sodium. Renal ultrasounds were normal but the rate of sodium in mother's milk was three times higher than controls (87 versus 21 mmol/L). Intravenous rehydration allowed the correction of hydroelectrolytic disorders.

NASA's Satellite Laser Ranging Systems for the 21st Century.

For over 40 years, NASA's global network of satellite laser ranging (SLR) stations has provided a significant percentage of the global orbital data used to define the International Terrestrial Reference Frame (ITRF). The current NASA legacy network is reaching its end-of-life and a new generation of systems must be ready to take its place. Scientific demands of sub-millimeter precision ranging and the ever-increasing number of tracking targets give aggressive performance requirements to this new generation of systems. Using lessons learned from the legacy systems and the successful development of a prototype station, a new network of SLR stations, called the Space Geodesy Satellite Laser Ranging (SGSLR) systems, is being developed. These will be the state-of-the-art SLR component of NASA's Space Geodesy Project (SGP). Each of SGSLR's nine subsystems has been designed to produce a robust, kilohertz laser ranging system with 24/7 operational capability and with minimal human intervention. SGSLR's data must support the aggressive goals of the Global Geodetic Observing System (GGOS), which are 1 millimeter (mm) position accuracy and 0.1 mm per year stability of the ITRF. This paper will describe the major requirements and accompanying design of the new SGSLR systems, how the systems will be tested, and the expected system performance.