Extravasation of Noncytotoxic Drugs.

Objective: Commonly used drugs may be dangerous in case of extravasation. The lack of information from health care teams can lead to delays in both diagnosis and treatments. This review aims at alerting health care professionals about drugs and risk factors for extravasation and outlines recommendations for the diagnosis and treatment of extravasation. Data Source: A literature search of MEDLINE/PubMed, Scopus, the Cochrane Library, and Google Scholar was performed from 2000 to December 2019 using the following terms: extravasation, central venous line, peripheral venous line, irritant, and vesicant. Study Selection and Data Extraction: Overall, 140 articles dealing with drug extravasation were considered potentially relevant. Each article was critically appraised independently by 2 authors, leading to the inclusion of 80 relevant studies, guidelines, and reviews. Articles discussing incidents of extravasation in the neonatal and pediatric population of patients were excluded. Data Synthesis: Training of health care teams and writing care protocols are important for an optimal management of extravasations. A prompt consultation should be achieved by a specialist surgeon. The surgical procedure, if necessary, will consist of wound debridement followed by an abundant lavage. Relevance to Patient Care and Clinical Practice: This review discusses the management of drug extravasations according to their mechanism(s) of toxicity on tissues. It highlights the importance of a close monitoring of patients and the training of health care teams likely to face this type of adverse event. Conclusions: Extravasations still contribute to significant morbidity and mortality. A good knowledge of risk factors and the implementation of easily and quickly accessible standardized care protocols are 2 key elements in both prevention and treatment of extravasations.

Differential learning processes for laparoscopic and open supraumbilical pyloromyotomy.

PURPOSE: To compare the learning curves for mastering OP and LP surgical techniques, in terms of effects on completion times and postoperative outcomes/complications. METHODS: A retrospective analysis was performed for 198 patients with hypertrophic pyloric stenosis. The learning curves were in regard to two groups of surgeons: three of whom performed 106 OPs while three others performed 92 LPs. Treatment-related complications were divided into two categories: specific complications relating to the pyloromyotomy and non-specific complications. A logistic regression model with repeated data was used to explore the occurrence of complications. RESULTS: The overall postoperative complication rates were not significantly different between the OP (15.1 %) and the LP (11.8 %) groups. Specific complications were more frequent in the LP group (6.4 versus 2.8 %), while non-specific complications were more frequent in the OP group (12.1 versus 5.3 %). The occurrence of complications exhibited a statistically decreasing risk with each supplementary procedure that was performed (p = 0.0067) in the LP group, but not in the OP group (p = 0.9665). CONCLUSION: From a learning process perspective, laparoscopy is mainly associated with a significantly higher risk of specific complications. This risk decreases in line with the surgeon's level of experience, whereas non-specific complications remain stable in open procedures.

Cognitive Profiles are Better Predictors of Literacy Attainment Than Diagnostic Outcomes in Children with High ADHD Symptoms.

We examined whether cognitive profiles or diagnostic outcomes are better predictors of literacy performance for children being considered for an ADHD diagnosis. Fifty-five drug naïve children (Mage = 103.13 months, SD = 18.65; 29.09% girls) were recruited from an ADHD clinical referral waiting list. Children underwent assessment of IQ, Executive Functions (EF) and literacy attainment. Hierarchical cluster analysis was used to generate subgroups of children using EF scores. Data were then grouped based on presence of a clinical ADHD diagnosis and the results compared. Grouping participants by profiles of cognitive test scores led to groups which also differed on literacy scores. However, categorising by whether children had received an ADHD diagnosis or not did not differentiate either cognitive tests scores or literacy scores. Cognitive performance, rather than children's diagnostic outcomes, is more informative for identifying groups who differ in their literacy attainment which has important implications for remedial support.

[ACACIAS 3: Learning about announcement consultations in the second cycle of medical studies]. / ACACIAS 3 : Apprentissage des consultations d'annonce dans le deuxième cycle d'études médicales.

INTRODUCTION: The second cycle of medical studies is a key time for developing interpersonal skills and the doctor-patient relationship. High-fidelity simulation is an initial learning option that enables learners to confront situations involving empathy. METHODS: This is a feedback report from May 2023 on the implementation of simulation as a training tool for 2nd cycle medical students in the announcement consultation. The training consists of two parts: theoretical teaching via a digital platform with an assessment of theoretical knowledge and a practical part with a simulation session with an actress playing a standardized patient. The acquisition of skills and the reflexivity of learners are assessed by means of a pre- and post-test. RESULTS: Twenty-nine externs took part in this project. Student satisfaction was 96 %. The feedback was very positive, both in terms of the quality of the sessions and the briefings/debriefings. Almost all the students wanted to repeat the experience. The simulation exercise was beneficial for the students in terms of the development (before vs. after) of their skills (verbal, emotional and relational) (1.05±0.25 vs. 1.22±0.19, P=0.047) and appeared to be relevant to the development of reflexivity (3.29±0.72 vs. 3.48±0.9, P=0.134). CONCLUSION: This first published French study demonstrates the feasibility and value of training in announcing a diagnosis, combining teaching via a digital platform and high-fidelity simulation for second cycle medical students.

First Case of Abdominal and Tunica Vaginalis Multicystic Benign Mesothelioma: Management and Review of Literature.

Multicystic benign mesothelioma is a rare tumor that affects the serosa. Most cases present with peritoneal lesions exclusively. Some identified risk factors are chronic abdominal inflammation, woman of childbearing age, and asbestos exposure. The symptomatology is not specific and can delay the diagnosis. There are no guidelines for the treatment of this pathology. We describe one male patient with abdominal and tunica vaginalis localizations of multicystic benign mesothelioma. The diagnosis was suspected on imaging and confirmed with histological examination. The treatment on an expert center was complete cytoreduction surgery and HIPEC, but the patient had two recurrences during the 2-year of follow-up. This is the first case of simultaneous rare localizations of multicystic benign mesothelioma. No new risk factors were identified. The case underlines the importance of regular examination of all serosa localizations.

Predictive value of C-reactive protein levels for the early and later detection of postoperative complications after cytoreductive surgery and HIPEC.

Synopsis: C-reactive protein (CRP), white blood cells and procalcitonin (PCT) participate in the systemic response to inflammation and increase after postoperative infective complications. Postoperative complications after CRS and HIPEC could be predicted using the CRP cut-off value (169 mg/L at PODs 3-5 and 62 mg/L at PODs 7-10). Background: Postoperative elevation of C-reactive protein (CRP) can be used in order to predict the postoperative complications in many indications. Cytoreduction surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with high morbidity. Objectives: The aim of the study was to demonstrate the CRP predictive value for the occurrence of complications. Methods: All patients who had CRS and HIPEC, regardless of the origin of peritoneal metastasis, were included in this retrospective study. Postoperative complications and CRP and white blood cell (WBC) counts were recorded from postoperative day (POD) 1 through 10. Results: Among the 127 patients included, 58 (45.7%) had no complications (NCs), 53 (41.7%) had infective complications (ICs), and 16 (12.6%) had non-infective complications (NICs). The IC group had a higher CRP value than the NC group, which was statistically significant from POD7 to POD10 (41.1 versus 107.5 p = 0.023 and 77.8 versus 140 p = 0.047, respectively). A cut-off CRP value was 169 mg/L at PODs 3-5 and 62 mg/L at PODs 7-10. The area under the curve (AUC) at POD5 was 0.56 versus 0.76 at POD7, p=0.007. The sensibility, specificity, positive and negative predictive values of these cut-offs were 55%, 83%, 74% and 67%, respectively. Moreover, 17 patients (32%) with ICs had a CRP value higher than these cut-offs before the diagnosis was made by the medical team. Conclusion: This study suggested that postoperative complications could be predicted using the CRP cut-off value on PODs 3-5 (169 mg/l) and PODs 7-10 (62 mg/l) after CRS and HIPEC.

Captive Psittacines with Chlamydia avium Infection.

Avian chlamydiosis is an infection caused by obligate intracellular, gram-negative bacteria belonging to the Chlamydiaceae family. Birds can be hosts of several Chlamydia species, including Chlamydia avium, which has only been detected in pigeons and psittacine birds. In this study, depression, respiratory distress, and mortality were noted among psittacines belonging to a large aviary with 35 different avian species. On the basis of immunohistochemistry and PCR testing, chlamydiosis was diagnosed in affected birds. Gross and histopathologic lesions were mainly observed in the spleen and gastrointestinal tract. Chlamydia avium was detected in four psittacines by PCR, including two dead birds and two individuals exhibiting respiratory distress. Increased aspartate aminotransferase and lactate dehydrogenase values and anemia were consistently identified in affected birds. Administration of doxycycline, combined with hepatoprotectors and vitamins, was effective in stopping mortality and bacterial shedding.

Differentiation in prefrontal cortex recruitment during childhood: Evidence from cognitive control demands and social contexts.

Emerging cognitive control during childhood is largely supported by the development of distributed neural networks in which the prefrontal cortex (PFC) is central. The present study used fNIRS to examine how PFC is recruited to support cognitive control in 5-6 and 8-9-year-old children, by (a) progressively increasing cognitive control demands within the same task, and (b) manipulating the social context in which the task was performed (neutral, cooperative, or competitive), a factor that has been shown to influence cognitive control. Activation increased more in left than right PFC with cognitive control demands, a pattern which was more pronounced in older than younger children. In addition, activation was higher in left PFC in competitive than cooperative contexts, and higher in right PFC in cooperative and neutral than competitive contexts. These findings suggest that increasingly efficient cognitive control during childhood is supported by more differentiated recruitment of PFC as a function of cognitive control demands with age.