The effect of direct admission to acute geriatric units compared to admission after an emergency department visit on length of stay, postacute care transfers and ED return visits.

BACKGROUND: Compared with conventional hospitalization, admission to an acute geriatric care unit (AGU) is associated with better outcomes in elderly patients. In 2012, 50% of the hospitalizations of elderly patients were preceded by an emergency department (ED) visit. Hospital occupancy, access blocks and overcrowding experienced by patients during ED visits are associated with increased morbidity. OBJECTIVE: Our aim was to evaluate the effect of direct admission (DA) to an AGU on both the hospital length of stay and morbidity of elderly patients. DESIGN: This study was a retrospective cohort study conducted using electronic medical records and administrative claims data from the Greater Paris University Hospitals (APHP) health data warehouse involving 19 different AGUs. PARTICIPANTS: We included all patients ≥ 75 years old who were admitted to an AGU for more than 24 h between January 1, 2013, and December 31, 2018. INTERVENTION: Direct admission to the AGU compared to admission after an ED visit. MAIN MEASURES: The main outcome was hospital length of stay. Two outcomes were used to analyse morbidity: postacute care and rehabilitation ward transfer at the end of the index hospitalization and ED return visit within 30 days after the index hospitalization (for those who survived to hospitalization). We used an inverse probability of treatment weighting (IPTW) approach to balance the differences in patient baseline variables between the two groups. Univariate linear and logistic regression models were built to estimate the effect of DA on hospital length of stay and the likelihood of postacute care transfer and ED return visit. KEY RESULTS: Among the 6583 patients included in the study, DA was associated with a lower hospital length of stay (estimate = -1.28; 95% CI = -1.76-0.80), and a lower likelihood of postacute care transfer (OR = 0.87; 95% CI = 0.77-0.97). It was not significantly associated with a lower risk of ED return visits (OR = 0.81; 95% CI = 0.60-1.08) in the following month. CONCLUSION: DA should be prioritized, and reorganization of the geriatric pathway around DA should be encouraged due to the frailty of elderly individuals.

Mitochondrial DNA Suggests a Western Eurasian Origin for Ancient (Proto-) Bulgarians.

Ancient (proto-) Bulgarians have long been thought of as a Turkic population. However, evidence found in the past three decades shows that this is not the case. Until now, this evidence has not included ancient mitochondrial DNA (mtDNA) analysis. To fill this void, we collected human remains from the 8th to the 10th century AD located in three necropolises in Bulgaria: Nojarevo (Silistra region) and Monastery of Mostich (Shumen region), both in northeastern Bulgaria, and Tuhovishte (Satovcha region) in southwestern Bulgaria. The phylogenetic analysis of 13 ancient DNA samples (extracted from teeth) identified 12 independent haplotypes, which we further classified into mtDNA haplogroups found in present-day European and western Eurasian populations. Our results suggest a western Eurasian matrilineal origin for proto-Bulgarians, as well as a genetic similarity between proto- and modern Bulgarians. Our future work will provide additional data that will further clarify proto-Bulgarian origins, thereby adding new clues to the current understanding of European genetic evolution.

[Breast metastasis of a squamous cell carcinoma of the uterine cervix. A case report].

The breast is an extremely rare target organ for metastasis of extramammary neoplasms. The occurence varies between 1.7% to 6.6% in autopsies; between 1.2% and 2% in clinical cases; and around 2.7% in sputum series. In accordance with the primary tumor localization, it is more common to find metastases of lymphoma, melanoma, rhabdomyosarcoma, tumors of the lung and ovarian tumors. Breast metastasis of the uterine cervix is a very seldomly found. According to the published literature so far there have been around 30 documented cases with such pathology. This study presents the case of a 48-year-old female with a squamous cell carcinoma of the uterine cervix, which was histologically verified in 2010. Three years after the initial tumor diagnosis, radiotherapy and chemotherapy, the patient was found to have a cystic tumor formation in one of her breasts. The formation was painful to pressure. Quadrantectomy with an open bisopsy was performed to the patient. Histological and immunohistochemical diagnosis rejected primary squamous cell carcinoma of the breast. The differential diagnosis of metastatic lesions in the breast is problematic and requires careful clinical history, immunohistochemical study and multidisciplinary approach in the management. Mammary metastases are a bad predictor and they serve as an indicator of generalized dissemination of the primary tumor process.

Genetic variation of the East Balkan Swine (Sus scrofa) in Bulgaria, revealed by mitochondrial DNA and Y chromosomal DNA.

East Balkan Swine (EBS) Sus scrofa is the only aboriginal domesticated pig breed in Bulgaria and is distributed on the western coast of the Black Sea in Bulgaria. To reveal the breed's genetic characteristics, we analysed mitochondrial DNA (mtDNA) and Y chromosomal DNA sequences of EBS in Bulgaria. Nucleotide diversity (πn ) of the mtDNA control region, including two newly found haplotypes, in 54 EBS was higher (0.014 ± 0.007) compared with that of European (0.005 ± 0.003) and Asian (0.006 ± 0.003) domestic pigs and wild boar. The median-joining network based on the mtDNA control region showed that the EBS and wild boar in Bulgaria comprised mainly two major mtDNA clades, European clade E1 (61.3%) and Asian clade A (38.7%). The coexistence of two mtDNA clades in EBS in Bulgaria may be the relict of historical pig translocation. Among the Bulgarian EBS colonies, the geographical differences in distribution of two mtDNA clades (E1 and A) could be attributed to the source pig populations and/or historical crossbreeding with imported pigs. In addition, analysis of the Y chromosomal DNA sequences for the EBS revealed that all of the EBS had haplotype HY1, which is dominant in European domestic pigs.

Variations in the squamous part of the occipital bone in medieval and contemporary cranial series from Bulgaria.

The squamous part of the occipital bone is a place of many different variations. They are a result of faulty ossification in the occipital squama or due to the presence of sutural bones in the lambda region. As their differentiation is intricate because of the various criteria used, the issue of their recognition in the adult skull still remains difficult even though they can be clearly distinguished at a younger age. The aim of the present study was to compare the frequency of interparietal, preinterparietal and sutural bones in the lambda region in medieval male and female cranial series as well as between medieval and contemporary male series from Bulgaria. We also discuss the development of the occipital squama in order to set clearer criteria for further differentiation of such variations in the adult skull. In the reviewed 3 cranial series, the variations in the squamous portion of the occipital bone were observed with a low frequency. The incidence of preinterparietal bones was more common than the interparietal ones. The sutural bones in the lambda region were numerous in the series. No statistically significant sex or intergroup differences were established. So even if these anatomical variations are relatively rare, the understanding of them is of significance for many disciplines like anthropology, comparative and developmental anatomy, clinical and forensic medicine.

[Visceral metastases of triple negative breast cancers with contribution of cases and review of the literature].

Breast carcinoma is a heterogeneous disease. Clinical treatment of metastases from triple negative-Estrogen receptor-(ER(-), Progesterone receptor (PgR)(-), Human epidermal growth factor receptor 2(HER2)(-)) primary breast cancer and metachronous second cancer in visceral organs is different. In this article we report two cases of visceral metastases from two patients with Stage IV triple negative primary breast cancer. We presented morphology findings and immunophenotype of all lesions and we offered a practical recommendation for diagnosis of similar cases.

Vaccination coverage among medical residents in Paris, France.

Medical residents are particularly exposed to the risk of occupational infection. We aimed to determine the vaccination coverage in residents with an anonymous self-reporting electronic questionnaire. A total of 250 residents took part in this survey. Vaccination rates were particularly high for mandatory vaccinations (diphtheria, tetanus, poliomyelitis, hepatitis B virus and tuberculosis). Regarding recommended vaccinations (influenza, 45.6%; pertussis, 65.2%; measles, 62.8%; varicella, 62.8%), rates were insufficient to prevent hospital epidemics, but higher than those reported in other healthcare workers. Further immunization programmes should target residents, and not only senior healthcare workers, with a critical role for occupational medicine departments.

Accidental blood exposures among medical residents in Paris, France.

Accidental blood exposure (ABE) exposes healthcare workers, including medical residents, to the risk of occupational infection. We aimed to determine the characteristics of ABEs in residents with an anonymous self-reporting electronic questionnaire. A total of 350 residents (33% from surgical disciplines) entered this survey. One hundred and eighty-five residents (52%) reported at least one ABE during their residency (median, 2; range, 1-25), 53% of which occurred in operating theatres. Sixty-nine per cent of residents followed the current procedures for local disinfection. ABEs were notified to the hospital administration by 62% of residents, but only 51% of residents were referred to the occupational medicine department. The most frequently reported concerns following ABEs were human immunodeficiency virus (52%) and hepatitis C virus infection (39%). In 74% of cases, the serological status of the index patient was investigated. Only 54% of residents were aware of their hepatitis B surface antibody titres. Medical residents behaved inappropriately in 33% of cases in this survey. Further educational programmes should include residents, and not only senior healthcare workers, in order to improve individual behaviours.

[Metal fume fever, an almost forgotten disease]. / La fièvre des fondeurs, une pathologie presque oubliée.

Metal fume fever is an ancient and almost forgotten occupational disease found among welders. Diagnosis is made difficult by the frequency and the non-specific flue-like symptomatology. We present the cases of three patients admitted for developing the symptoms after being exposed to welding fumes. Treatment was symptom based. Severe cases have been described after exposure to military fumes.

Stature estimation from long bone lengths in Bulgarians.

The purpose of the present study is to develop a new regression procedure for predicting the stature from the length of the limb long bones taking into account sex- and age-related changes. The statures and lengths of humerus (H), tibia (T) and fibula (Fi) were measured in 416 forensic cases (286 male and 130 female adult Bulgarians). The measurements of the bones and the stature were made on cadavers before autopsy. Stature regression analysis is performed for each of the three bones, as well as for a combination of humerus and tibia. There is a possibility of applying five different procedures with regard of the effect of aging on stature decrease. Resulting models are tested for outliers and heteroskedasticity. Regression parameters, their standard deviations, standard error of the regression. Anova test for model adequacy and the covariance matrix of regression parameters are calculated. The confidence intervals of the error term are determined. Nomograms for a direct application of the results are constructed where it is convenient. The method provides better and more reliable results of stature estimation for the Bulgarian population than other formulae.

HLA-DRB1, DQA1, DQB1 DNA polymorphism in the Bulgarian population.

We describe for the first time the use of PCR based techniques to analyze the MHC class II polymorphism of the Bulgarian population. The present study provides the HLA-DRB, DQB1 allele frequencies in 116 Bulgarian individuals and DQA1 alleles frequencies in 100 subjects. DNA from these individuals was typed for DRB and DQB1 typed by the PCR-Allele Specific Amplification (PCR-ASA) method and DQA1 by PCR followed by hybridization using Sequence Specific Oligonucleotides (PCR-SSO). Allele and haplotype frequencies and linkage disequilibria are computed by the standard methods used for the XIth International Histocompatibility Workshop. The highest frequencies are 0.159, 0.109 and 0.085 for DRB1*1101, DRB1*1601 and DRB1*1301 respectively. Among the eight DQA1 alleles detected, DQA1*0501 (0.344) is found to be much more frequent than the two most frequent alleles DQA1*0102 (0.225) and DQA1*0101 (0.151). Twelve DQB1 alleles are found and three of them, DQB1*0301 (0.280), DQB1*0502 (0.153) and DQB1*0201 (0.133) showed the highest frequencies. The haplotype DRB1*1101-DQA1*0501-DQB1*0301 (0.079) predominate clearly, followed by DRB1*1601-DQA1*0102-DDQB1*0502 (0.055) and DRB1*0101-DQA1*0101-DQB1*0501. These results indicate that the Bulgarian population is characterized by features representative of the European anthropological type with a substantial contribution from the Southern Belt of Europe.

One hundred years of anthropological studies in Bulgaria.

The anthropological studies are divided into three distinct periods: initial--covering the last decades of the 19th century, classical--mirroring the results of studies carried out in the first half of the 20th century, and contemporary--marked by the organization of the Section of Anthropology and Human Anatomy in the Institute of Morphology at the Bulgarian Academy of Sciences (actually the Institute of Cell Biology and Morphology) in 1953, and by the research done during the second half of the current century. The roles and contributions of Dr. Jonas Basanovichjus, Prof. Stefan Vatev, D. Sc., Dr. Krum Dronchilov, Prof. Milko Balan, D. Sc., Prof. Dimitar Kadanov, D. Sc. and others to the development of Bulgarian anthropology is underscored.