Bed bug infestation in a French university hospital: control strategy, financial impact and perspectives.

BACKGROUND: With the increase in international travel and development of insecticide resistance, a re-emergence of the bed bug has been observed since the 2000s and it is becoming a worldwide public health problem. Hospitals and other medical settings have not been spared, while the cases reported remain limited. However, there are no specific recommendations for the healthcare settings in the literature. AIM: To report our experience of a bed bug infestation in a medical unit, in the French University Hospital Centre of Brest, caused by the admission of a patient carrier in October 2020. We described the practical methods used to control bed bugs infestation, evaluated the cost of this episode and created a specific procedure to take care of at-risk patients or known carriers of bed bugs. FINDINGS: The decision to close the unit for global treatment was taken after the investigations using a sniffer dog revealed that four rooms were infested. The closure lasted 24 days. We estimated the total cost of the infestation to be approximately US$400,000. No other wave of infestation occurred. We created a specific protocol of care for patients who were known carriers or at risk of carriage of bed bugs to graduate a strategy of control. CONCLUSION: Bed bug infestations in health facilities have a major impact on the care of patients and relevant economic consequences. Prevention and education policies are an essential starting point to respond to the scale of the phenomenon.

Assessment and monitoring of water quality of the gulf of Morbihan, a littoral ecosystem under high anthropic pressure.

This field study is intended to propose a global methodology to assess and monitor the water quality of the gulf of Morbihan, a littoral ecosystem under increasing anthropic pressure. To this end, the Locmariaquer site, where Crassostrea gigas is extensively cultivated, was selected to perform a one-year follow-up of tissular glutathione S-transferase and acetylcholinesterase specific activities in this filter feeder organism. Calculation of an integrated index, corresponding to the ratio of the two enzymes activities, allowed to discriminate from the environmental noise, several clusters which could be representative environmental stress, potentially latent pollution. Moreover, the estrogenic activity was assessed in water samples collected at Locmariaquer and other strategic sites of the gulf. The results evidenced a low estrogenic-disrupting compound contamination of waters. Overall, this methodology produced an accurate outlook of a basal state for the gulf and could be developed in the context of a chronic monitoring of this site.

The effect of high indoor temperatures on self-perceived health of elderly persons.

INTRODUCTION: Exposure to high ambient temperatures leads to an increase in mortality and morbidity, especially in the elderly. This relationship is usually assessed with outdoor temperature, even though the elderly spend most of their time indoors. Our study investigated the relationship between indoor temperature and heat-related health problems of elderly individuals. MATERIAL AND METHODS: The study was conducted in the Netherlands between April and August 2012. Temperature and relative humidity were measured continuously in the living rooms and bedrooms of 113 elderly individuals. Respondents were asked to fill out an hourly diary during three weeks with high temperature and one cold reference week, and a questionnaire at the end of these weeks, on health problems that they experienced due to heat. RESULTS: During the warmest week of the study period (14-20 August), average living room and bedroom temperatures were approximately 5°C higher than during the reference week. More than half of the respondents perceived their indoor climate as too warm during this week. The most reported symptoms were thirst (42.7%), sleep disturbance (40.6%) and excessive sweating (39.6%). There was a significant relationship between both indoor and outdoor temperatures with the number of hours that heat-related health problems were reported per day. For an increase of 1°C of indoor temperature, annoyance due to heat and sleep disturbance increased with 33% and 24% respectively. Outdoor temperature was associated with smaller increases: 13% and 11% for annoyance due to heat and sleep disturbance, respectively. The relationship between outdoor temperature and heat-related health problems disappeared when indoor and outdoor temperatures were included in one model. CONCLUSIONS: The relationship with heat-related health problems in the elderly is stronger with indoor (living room and bedroom) temperature than with outdoor temperature. This should be taken into account when looking for measures to reduce heat exposure in this vulnerable group.

Does Brillouin light scattering probe the primary glass transition process at temperatures well above glass transition?

The primary alpha-relaxation time (tau(alpha)) for molecular and polymeric glass formers probed by dielectric spectroscopy and two light scattering techniques (depolarized light scattering and photon correlation spectroscopy) relates to the decay of the torsional autocorrelation function computed by molecular dynamics simulation. It is well known that Brillouin light scattering spectroscopy (BLS) operating in gigahertz frequencies probes a fast (10-100 ps) relaxation of the longitudinal modulus M*. The characteristic relaxation time, irrespective of the fitting procedure, is faster than the alpha-relaxation which obeys the non-Arrhenius Vogel-Fulcher-Tammann equation. Albeit, this has been noticed, it remains a puzzling finding in glass forming systems. The available knowledge is based only on temperature dependent BLS experiments performed, however, at a single wave vector (frequency). Using a new BLS spectrometer, we studied the phonon dispersion at gigahertz frequencies in molecular [o-terphenyl (OTP)] and polymeric [polyisoprene (PI) and polypropylene (PP)] glass formers. We found that the hypersonic dispersion does relate to the glass transition dynamics but the disparity between the BLS-relaxation times and tau(alpha) is system dependent. In PI and PP, the former is more than one order of magnitude faster than tau(alpha), whereas the two relaxation times become comparable in the case of OTP. The difference between the two relaxation times appears to relate to the "breadth" of the relaxation time distribution function. In OTP the alpha-relaxation process assumes a virtually single exponential decay at high temperatures well above the glass transition temperature, in clear contrast with the case of the amorphous bulk polymers.

Scaling of the structural relaxation in simulated liquid silica.

A scaling law for the alpha relaxation time tau , involving the ratio of a density-dependent energy to the thermal energy, has been found to hold in many fragile glass-forming liquids. This scaling has been recently linked to a local quantity n{loc}(rho,T) relating the variation of tau with density to its variation with temperature. In many fragile liquids, the variation of n{loc}(rho,T) is weak enough to take it as constant over the experimental temperature and density domain. We show that simulated liquid silica has an opposite behavior; close to T{g}, n{loc} is negative for moderate densities and exhibits a significant variation with rho and T, reaching positive values for higher temperature and/or densities. Moreover, those variations linearly correlate to a measure of the bonding properties of the liquid.

Comparison of cardiac output measurements between NICO and the pulmonary artery catheter during repeat surgery for total hip replacement.

OBJECTIVE: The aim of this study was to compare cardiac output measurements of the non-invasive cardiac output and the pulmonary artery catheter during repeat surgery for hip replacement. METHODS: In this prospective observational study, patients undergoing repeat hip surgery who needed a pulmonary artery catheter were included. A standard protocol was followed for induction, endotracheal intubation and maintenance of anaesthesia (sufentanil, etomidate, sevoflurane, cisatracurium). After endotracheal intubation, the non-invasive cardiac output was connected and a pulmonary artery catheter was inserted. Data were collected every 3 min until patients were extubated. RESULTS: Ten patients were included and 2455 points of comparison recorded. Cardiac output from the pulmonary artery catheter varied from 1.7 to 8.9 L min(-1) (mean 4.1 L min(-1)) and the non-invasive cardiac output (using averaging mode) from 1.7 to 8.0 L min(-1) (mean 3.7 L min(-1)). There was a significant correlation between them (P < 0.01; bias 0.3 L min(-1); limits of agreement +1.9 and -2.5 L min(-1)), although these differed between patients. CONCLUSION: The perioperative bias was small and the non-invasive cardiac output slightly underestimated cardiac output intraoperatively compared to the pulmonary artery catheter. The bias was smaller when mean cardiac output was below 3 L min(-1). Core temperature between 34.4 degrees C and 37.6 degrees C had no influence on the differences.

Research in action: the training approach of the Joint Health Systems Research Project for the Southern African Region.

Over the last two decades, capacity-building in health research has been recognized as a priority by the international research community. Since 1987 the Joint Health Systems Research (HSR) Project for the Southern African Region has been making efforts to increase the national expertise for operational health research, starting in ten Southern African countries, in order to strengthen decision-making in health care at all levels. Initially, its targets were health managers and public health staff. Step-by-step, staff of different levels and disciplines have, in small groups, developed and implemented research protocols on problems experienced in their own working environment. The recommendations resulting from over 200 studies could, to a large extent, be implemented by the teams themselves. The Project was characterized by a flexible approach, allowing countries to participate at their own speed and to determine their own activities and the support they needed. As Ministries of Health as well as research institutions, in an increasing number of Southern and Eastern African countries, choose to actively participate in HSR, this has contributed to bridge the gap between the academic world and the health field. Still, sustainability of HSR activities remains a challenge. This paper describes the approach of the Joint HSR Project over the first 10 years of its operation, and its major strengths and limitations.

Intervention research in rational use of drugs: a review.

Many studies have been done to document drug use patterns, and indicate that overprescribing, multi-drug prescribing, misuse of drugs, use of unnecessary expensive drugs and overuse of antibiotics and injections are the most common problems of irrational drug use by prescribers as well as consumers. Improving drug use would have important financial and public health benefits. Many efforts have been undertaken to improve drug use, but few evaluations have been done in this field. This article provides an overview of 50 intervention studies to improve drug use in developing countries. It highlights what type of interventions exist and what is known about their impact. It reveals that commonly used interventions, such as an essential drug list and standard treatment guidelines, have rarely been systematically evaluated so far. The majority of intervention studies are focused on prescribers in a public health setting, while irrational use of drugs is also widespread in the private sector. Furthermore, the magnitude of inappropriate drug use at community level is often overlooked and few interventions address drug use from a consumer's perspective. More research on different types of intervention strategies in various health care settings is needed to draw conclusions on the effectiveness of a specific intervention strategy. Also more research is needed on socio-cultural factors influencing the impact of drug use interventions, particularly from a user perspective. To enhance evaluative research, more technical support will be needed for researchers in developing countries. The design of available studies from developing countries is generally weak, only six of the 50 studies included in this overview were randomized controlled studies. In order to provide technical support and coordination of future intervention research the establishment of an international resource centre for drug use intervention research is recommended.

Effect of arsenic trioxide on viability, proliferation, and apoptosis in human megakaryocytic leukemia cell lines.

Arsenic trioxide (As2O3) has been demonstrated to be effective for the treatment of acute promyelocytic leukemia (APL) and to inhibit proliferation and produce apoptosis in the APL cell line NB4. To determine if As2O3 might be useful for the treatment of other lineages, we investigated the effects of As2O3 on viability, proliferation, and induction of apoptosis in the megakaryocytic leukemia cell lines HEL, Meg-01, UT7, and M07e. Our results showed that As2O3, at concentrations of 0.1-2.0 microM, causes a dose- and time-dependent inhibition of survival and growth in all four megakaryocytic leukemia cell lines studied. In contrast, As2O3 at similar concentrations had no effects on either viability or growth of the nonmegakaryocytic leukemia cell line HL60 and two human breast cancer cell lines, ZR75 and MCF7. In situ end-labeling of DNA fragments (TUNEL assay) indicated that As2O3, at concentrations of 0.5-2 microM, could significantly induce apoptosis in the aforementioned four megakaryocytic leukemia cell lines, but not in the nonmegakaryocytic HL60, ZR75, and MCF7 cell lines. These results were confirmed using conventional morphologic assessment and the DNA ladder assay. Induction of apoptosis in arsenic-treated Meg-01 and UT7 cells was accompanied by a dose-response decrease of Bcl-2 protein, whereas As2O3 had no effect on this measurement in HL60, ZR75, and MCF7 cell lines. Pertinently, these concentrations of As2O3 produced identical changes in the characteristics of the APL cell line NB4. Collectively, these data demonstrate that As2O3 can selectively inhibit growth and induce apoptosis in megakaryocytic leukemia cell lines. The use of As2O3 for the treatment of malignant megakaryocytic disorders should be considered.

New insights into the negative regulation of hematopoiesis by chemokine platelet factor 4 and related peptides.

Platelet factor 4 (PF4) has been recognized as an inhibitor of myeloid progenitors. However, the mechanism of action of this chemokine remains poorly understood. The present study was designed to determine its structure/function relationship. A series of peptides overlapping the C-terminal and central regions of PF4 were analyzed in vitro for their action on murine hematopoietic progenitor growth to assess the minimal sequence length required for activity. The peptides p17-58 and p34-58 possessed an increased hematopoietic inhibitory activity when compared with PF4, whereas the shorter peptides p47-58 and p47-70 were equivalent to the native molecule and the peptide p58-70 was inactive. The PF4 functional motif DLQ located in 54-56 was required for the activity of these peptides. The peptide p34-58 impaired to a similar extent the growth of colony-forming unit-megakaryocyte (CFU-MK) as well as burst-forming unit-erythroid (BFU-E) and colony-forming unit-granulocyte-macrophage (CFU-GM), whereas PF4 was more active on CFU-MK. In the experiments using purified murine CD34(+) marrow cells, statistically significant inhibition induced by p34-58 was shown at concentrations of 2.2 nmol/L or greater for progenitors of the three lineages, whereas that induced by PF4 was seen at 130 nmol/L for CFU-MK and 650 nmol/L for CFU-GM and BFU-E, indicating that the p34-58 acts directly on hematopoietic progenitors and its activity is approximately 60- to 300-fold higher than PF4. The p34-58, unlike PF4, lacked affinity for heparin and its inhibitory activity could not be abrogated by the addition of heparin. In addition, an antibody recognizing p34-58 neutralized the activity of p34-58 but not whole PF4 molecule. These results demonstrate that PF4 contains a functional domain in its central region, which is independent of the heparin binding properties, and provide evidence for a model of heparin-dependent and independent pathways of PF4 in inhibiting hematopoiesis.

Women and leprosy: a review.

Gender inequalities in health have a significant impact on women's health. In leprosy gender inequalities could be even more serious, as it is a highly stigmatized disease. A review has been made of the most recent literature dealing with gender and leprosy. First some data are presented on gender inequalities in rates of case detection, deformities and reversal reactions among leprosy patients. Then the major factors contributing to those differences are discussed. The paper ends with some recommendations for further research on gender and leprosy.

[Block of the lateral perforant branches of the subcostal and iliohypogastric nerves for proximal femur surgery]. / Bloc des branches perforantes latérales des nerfs sous-costal et iliohypogastrique pour la chirurgie proximale du fémur.

We describe an original method to block the lateral cutaneous rami of the subcostal and iliohypogastric nerves or'iliac crest point block'to complete plexular block of the lower limb for hip surgery. The local anaesthetic is injected in front of an osterofibrous orifice of the iliac crest. In nine cases out of ten, the lateral cutaneous rami of the iliohypogastric nerve pass through this orifice and in one case out of ten, it is the one arising from the subcostal nerve. This complementary block allows the surgical incision at the level of the great trochanter.

[Comparison of the use of a vaccine and sequential antibiotic treatment in a herd infected with Mycoplasma hyopneumoniae]. / Comparaison de l'utilisation d'un vaccin et d'un traitement antibiotique séquentiel dans un élevage infecté par Mycoplasma hyopneumoniae.

The purpose of this study was to compare the efficacy of Mycoplasma hyopneumoniae vaccination with pulse medication in a pig herd chronically infected with Mycoplasma hyopneumoniae. Control groups of pigs were compared to vaccinated or treated groups. Medication and vaccination induced a significant reduction of pneumonia score (46.37% and 29.8% respectively, compared to 53.85% for control groups, p < 0.05). The treatment did not induce a significant reduction of the mean range of lung lesions (3.75) compared to the control groups (4.25). The mean range of lung lesions was significantly reduced by vaccine (3.06, p < 0.005) but not by treatment. Neither the medication nor the vaccination were able to clear M hyopneumoniae or Pasteurella multocida from lung tissue. In this herd, the vaccination had a beneficial effect on daily weight gain of pigs (695.9 g/day compared to 683.1 g/day for the control groups). The improvement of the age at slaughtering was 1.3 days for treated groups and 2.4 days for vaccinated groups compared to control groups. The vaccination induced a significant improvement in muscle rate (57.05%) compared to control groups (56.41%, p < 0.05) and to treated groups (56.21%, p < 0.001). In this herd infected with M hyopneumoniae, after allowing for treatment cost, manpower excepted, the increase in value was from -3 FF to -11 FF for the antibiotic treatment and +10.4 FF for the vaccination. From economical and medical points of view, the vaccination was preferable to the treatment under the conditions described in this study.

Enhancing appropriate drug use: the contribution of herbal medicine promotion. A case study in rural Thailand.

The article presents the results of an exploratory study conducted in Thailand in 1988, comparing the results of two approaches to encourage the use of herbal medicine as a safe and cheap alternative to pharmaceuticals. The study included one government programme using a clinic-oriented approach and one non-governmental programme using a community-oriented approach. Drug use in response to illness episodes was surveyed among households in two villages covered by each programme and hospital out-patient prescription records were sampled. Herbal medicines were used to treat 14.8% and 14.0% of the illness-episodes in the villages taking part in the clinic-oriented programme and to treat 62.1% and 29.7% of the episodes in the villages covered by the community-oriented programme. Herbs are mostly used after a prior treatment with pharmaceuticals has failed. Only 12.4% of out-patient prescriptions from the hospital in the government programme included herbal drugs, compared to 47.3% of prescriptions from the hospital in the non-governmental programme. The results of the study suggest that a community-oriented approach can most effectively influence the pattern of drug use in self-care. Complementary to the community-oriented approach, the government should support efforts to change the prescribing attitude of physicians and include training in traditional medicine in medical curricula.

[Anti-infective phytotherapies of the tree-savannah, Senegal (occidental Africa). III: A review of phytochemical substances and the antimicrobial activity of 43 species]. / Les phytotherapies anti-infectieuses de la foret-savane, Senegal (Afrique occidentale) III: Un resume des substances phytochimiques et l'activite anti-microbienne de 43 species.

A review has been made of the ethnobotanical and pharmacological data of 43 medicinal plants of the tree-savannah used by the Diola against infectious diseases. The traditional use of ten plants can be explained by pharmacologically active principles: Adansonia digitata, Azadirachta indica, Carica papaya, Cassia tora, Fagara leprieurii, Guiera senegalensis, Khaya senegalensis, Mangifera indica, Psidium guajava and Voacanga africana. Four of these herbs are recommended for use in Primary Health Care. The therapeutic value of the other plants discussed is not absolutely clear. It is, however, obvious that herbal medicine has a large potential, which is still insufficiently explored, for utilization in Primary Health Care.

Anti-infectious phytotherapies of the tree-savannah of Senegal (West-Africa) II. Antimicrobial activity of 33 species.

The screening of the antimicrobial activity of 33 medicinal plants from Senegal is reported. None of these plants showed activity against the gram-negative test bacteria and against Candida albicans. Extracts of Cnestis ferruginea and Voacanga africana showed strong activity against Aspergillus niger. The former plant was also active against dermatophytes. Twenty-five of the plants tested showed activity against gram-positive bacteria.

[Anti-infectious plant therapies of the forest and savanna regions of Senegal (western Africa). I. A listing]. / Les phytothérapies anti-infectieuses de la fôret-savane, Sénégal (Afrique occidentale). I. Un inventaire.

The use of medicinal plants for the treatment of infectious diseases, by the Diola-boulouf in the Basse Casamance, the South of Senegal, has been studied. The preparation and the indications of 50 plants are described. These data are supplemented with previous reports on the anti-infectious use of these plants.

Pituitary function in idiopathic haemochromatosis: hormonal study in 36 male patients.

Thirty-six male patients with idiopathic haemochromatosis were subjected to measurements of basal plasma values of testosterone, LH and FSH and to an LRH test. Nineteen were also subjected to basal plasma determinations of T3, T4, cortisol, TSH and prolactin and to a TRH test. In 11 cases GH values were measured before, during and after an arginine infusion. Seventeen patients were found to hae low levels of testosterone, LH and FSH, and no gonadotrophin responses to LRH. Seventeen others had normal levels of these three hormones, with normal responses to LRH. The two remaining patients had normal testosterone values but very increased gonadotrophin values: a fact which remains unexplained. Basal levels of prolactin, GH, T3, T4, and TSH were normal: cortisol levels were either normal or increased in cases of poorly controlled diabetes. Prolactin responses to TRH were always normal. TSH responses to TRH were impaired in 2 cases, and GH responses to arginine in 3 cases. Considering that other factors may be involved in the few impairments found in TSH and GH stimulations, it is concluded that the only indisputable pituitary insufficiency in about half of the cases of idiopathic haemochromatosis is gonadotrophic.