Costs and resource utilization patterns in surgical site infections: a pre-COVID-19 perspective from France, Germany, Spain, and the UK.

BACKGROUND: Surgical site infections (SSIs), mainly caused by Staphylococcus aureus, pose a significant economic burden in Europe, leading to increased hospitalization duration, mortality, and treatment costs, particularly with drug-resistant strains such as meticillin-resistant S. aureus. AIM: To conduct a case-control study on the economic impact of S. aureus SSI in adult surgical patients across high-volume centres in France, Germany, Spain, and the UK, aiming to assess the overall and procedure-specific burden across Europe. METHODS: The SALT study is a multinational, retrospective cohort study with a nested case-control analysis focused on S. aureus SSI in Europe. The study included participants from France, Germany, Italy, Spain, and the UK who underwent invasive surgery in 2016 and employed a micro-costing approach to evaluate health economic factors, matching S. aureus SSI cases with controls. FINDINGS: In 2016, among 178,904 surgical patients in five European countries, 764 developed S. aureus SSI. Matching 744 cases to controls, the study revealed that S. aureus SSI cases incurred higher immediate hospitalization costs (€8,810), compared to controls (€6,032). Additionally, S. aureus SSI cases exhibited increased costs for readmissions within the first year post surgery (€7,961.6 versus €5,298.6), with significant differences observed. Factors associated with increased surgery-related costs included the cost of hospitalization immediately after surgery, first intensive care unit (ICU) admission within 12 months, and hospital readmission within 12 months, as identified through multivariable analysis. CONCLUSION: The higher rates of hospitalization, ICU admissions, and readmissions among S. aureus SSI cases highlight the severity of these infections and their impact on healthcare costs, emphasizing the potential benefits of evidence-based infection control measures and improved patient care to mitigate the economic burden.

Impact of Finishing and Polishing Procedures on CAD/CAM In Vitro Milled Ceramics Surfaces: A Systematic Review.

INTRODUCTION AND OBJECTIVES: CAD/CAM prostheses may be produced in prosthetic laboratories or directly by practitioners. Quality of ceramic polishing procedures is a controversial topic and it would be interesting for practitioners working with CAD/CAM devices to determine which method is the most efficient regarding finishing and polishing. This systematic review aims to evaluate the impact of different finishing and polishing procedures on the surface of milled ceramics. MATERIALS AND METHODS: A precise request was launched on the PubMed database. Studies included if they met the criteria of a specifically prepared PICO search. A first selection was performed by analysing titles and abstracts: the articles presenting a study conducted on non-CAD/CAM milled ceramics and research not containing comparisons of finishing procedures were not included. Roughness was evaluated in 15 articles. Nine papers recommended mechanical polishing over glazing regardless of the type of ceramic used. However, no significant differences were detected between the surface roughness of glazed and polished ceramics in nine other publications. CONCLUSIONS: there is no scientific evidence demonstrating the superiority of hand polishing over glazing on CAD/CAM-milled ceramics.

Contributory conditions for unexpected COVID-19 cases and nosocomial COVID-19 infection cases identified from systematic investigation in a French University Hospital.

INTRODUCTION: Nosocomial case (NC) of COVID-19 infections is a challenge for hospitals. We report the results of a seven-month prospective cohort study investigating COVID-19 patients to assess unexpected cases (UC) (no COVID-19 precautionary measure application since admission) and NC. PATIENTS AND METHODS: Investigation by an infection control team of 844 patients with COVID-19 infection hospitalized for more than 24 hours (cases). RESULTS: A total of 301 UC were identified (31% after contact tracing) with a total of 129 contact patients, and 27 secondary cases for 59 of them. In geriatric wards, 50% of cases were UC. NC represented 18% of cases (37% in geriatric wards), mainly identified after contact tracing of wandering cases. CONCLUSION: A rapid infection control response is essential to contain nosocomial transmission, along with detailed contact tracing and screening policy. Dealing with wandering elderly patients remain challenging for HCWs.

A bioavailable strontium (87Sr/86Sr) isoscape for Aotearoa New Zealand: Implications for food forensics and biosecurity.

As people, animals and materials are transported across increasingly large distances in a globalized world, threats to our biosecurity and food security are rising. Aotearoa New Zealand is an island nation with many endemic species, a strong local agricultural industry, and a need to protect these from pest threats, as well as the economy from fraudulent commodities. Mitigation of such threats is much more effective if their origins and pathways for entry are understood. We propose that this may be addressed in Aotearoa using strontium isotope analysis of both pests and products. Bioavailable radiogenic isotopes of strontium are ubiquitous markers of provenance that are increasingly used to trace the origin of animals and plants as well as products, but currently a baseline map across Aotearoa is lacking, preventing use of this technique. Here, we have improved an existing methodology to develop a regional bioavailable strontium isoscape using the best available geospatial datasets for Aotearoa. The isoscape explains 53% of the variation (R2 = 0.53 and RMSE = 0.00098) across the region, for which the primary drivers are the underlying geology, soil pH, and aerosol deposition (dust and sea salt). We tested the potential of this model to determine the origin of cow milk produced across Aotearoa. Predictions for cow milk (n = 33) highlighted all potential origin locations that share similar 87Sr/86Sr values, with the closest predictions averaging 7.05 km away from their true place of origin. These results demonstrate that this bioavailable strontium isoscape is effective for tracing locally produced agricultural products in Aotearoa. Accordingly, it could be used to certify the origin of Aotearoa's products, while also helping to determine if new pest detections were of locally breeding populations or not, or to raise awareness of imported illegal agricultural products.

Benefits of a 14-year surgical site infections active surveillance programme in a French teaching hospital.

BACKGROUND: Surgical site infections (SSIs) are the second most common healthcare-associated infection. Active SSI surveillance can help inform preventative measures and assess the impact of these measures. AIM: We aimed to describe the evolution in trends over 14 years of prospective active SSI surveillance and implementations of SSI prevention measures in a French Teaching Hospital. METHODS: We monitored and included in the study all surgical procedures performed from 2003 to 2016 in eight surgical units. The semi-automated surveillance method consisted of weekly collection of SSI declaration forms (pre-filled with patient and procedure administrative data and microbiology laboratory data), filled-in by surgeons and then monitored by the infection control practitioners. FINDINGS: A total of 181,746 procedures were included in our analysis and 3270 SSIs recorded (global SSI rate 1.8%). The SSI rate decreased significantly from 3.0% in 2003 to 1.1% in 2016. This decrease was mainly in superficial SSIs and high infectious risk procedures. Higher SSI rates were observed for procedures associated with the usual risk factors. During this 14-year period, several evolutions in surgical practices occurred that might have contributed to this decrease. CONCLUSIONS: With an overall decrease in SSI rate throughout the surveillance, our results revealed the benefits of an active and comprehensive hospital SSI surveillance programme for understanding the SSI rate trends, analysing local risk factors and assessing the effectiveness of prevention strategies. These findings also highlighted the importance of the collaboration between surgeons and infection control practitioners.

Isotope geochemistry reveals ontogeny of dispersal and exchange between main-river and tributary habitats in smallmouth bass Micropterus dolomieu.

Radiogenic strontium isotope ratios (87 Sr:86 Sr) in otoliths were compared with isotope ratios predicted from models and observed in water sampling to reconstruct the movement histories of smallmouth bass Micropterus dolomieu between main-river and adjacent tributary habitats. A mechanistic model incorporating isotope geochemistry, weathering processes and basin accumulation reasonably predicted observed river 87 Sr:86 Sr across the study area and provided the foundations for experimental design and inferring fish provenance. Exchange between rivers occurred frequently, with nearly half (48%) of the 209 individuals displaying changes in otolith 87 Sr:86 Sr reflecting movement between isotopically distinct rivers. The majority of between-river movements occurred in the first year and often within the first few months of life. Although more individuals were observed moving from the main river into tributaries, this pattern did not necessarily reflect asymmetry in exchange. Several individuals made multiple movements between rivers over their lifetimes; no patterns were found, however, that suggest seasonal or migratory movement. The main-river sport fishery is strongly supported by recruitment from tributary spawning, as 26% of stock size individuals in the main river were spawned in tributaries. The prevailing pattern of early juvenile dispersal documented in this study has not been observed previously for this species and suggests that the process of establishing seasonal home-range areas occurs up to 2 years earlier than originally hypothesized. Extensive exchange between rivers would have substantial implications for management of M. dolomieu populations in river-tributary networks.

FUSARIUM HEAD BLIGHT SYMPTOM DISCRIMINATION: A USEFUL TOOL IN THE FIELD EVALUATION OF FUNGICIDE TREATMENTS.

Fusarium head blight (FHB) is one of the major diseases affecting wheat. It is caused by a complex of fungal species, resulting in yield losses and health problems due to mycotoxin production. The presence of multiple fungal species on wheat ears, with varying responses to active fungicide ingredients used in the field, makes the disease difficult to manage. In order to evaluate the efficacy of the timing of applications (at GS 39, GS 61 and GS 39+61) of a prothioconazole + fluoxastrobin-based fungicide, a 2-year field trial was conducted in Belgium. In both years, applications at GS 61 and GS 39+61 resulted in a significant reduction in symptom severity on ears and in deoxynivalenol (DON) content compared with the untreated control in 2013. In 2012, when Microdochium spp. were the most prevalent species, the treatment at GS 39 significantly reduced ear symptoms. Fusarium graminearum was predominant in the second year (2013) and caused significant DON accumulation in the grain after a single foliar spraying. The two genera were characterized by distinct types of symptoms: grouped bleached spikelet's for F. graminearum and isolated bleached spikelet's for Microdochium spp. This difference enabled the significant effect of the double treatments on symptoms caused by Microdochium spp. to be determined in the second year. This effect, which was also visible on leaf symptoms, suggests that Microdochium spp. epidemics in wheat might be polycyclic. Discrimination between symptoms caused by F. graminearum and Microdochium spp. could be a useful tool to study FHB management using fungicide treatments.

[The psychological disorders of children whose parents are without residence permits]. / Troubles psychiques des enfants de parents sans papiers.

The authors and child psychiatrists are concerned about the psychological effects on children who are victim of the current policy on families without regular residence permits (regularization is increasingly restricted). These children often live for many years in hotels; they lead a life of insecurity and promiscuity, which is prejudicial to their development. The risk of expulsion makes their future uncertain. The authors denounce a form of abuse that has traumatic social and political effects on the parents and children; the symptoms are not specific, but are of concern due to their frequency and intensity. The treatment of these families requires social networking, which can be mentally exhausting due to a lack of financial and human resources. However, it is a public health issue and an ethical obligation concerning children's rights.

Hepatitis C of genotype 2: the role of medical invasive exams.

BACKGROUND AND AIM: Hepatitis C virus genotype 2 is the third in order of frequency in Belgium. The aim of this study was to better define the genotype 2 carriers' epidemiology characteristics. METHODS: In a database comprising 1726 viremic hepatitis C virus patient from the south part of Belgium, the files of 98 genotype 2 carriers were reviewed. RESULTS: There was a strong association between genotype 2 and the mode of transmission. The rate of contamination by invasive medical exams was very high (23%), and statistically different from the one of the others genotypes. Eligibility for antiviral therapies and the rate of sustained viral response were high. CONCLUSION: HCV genotype 2 was highly associated with transmission by invasive medical exams.

Learning from radiation incidents: the new OTHEA website.

OTHEA is the name of a new website (www.othea.net), created by the Health Protection Agency (UK) and the Centre d'étude sur l'évaluation de la protection dans le domaine nucléaire (CEPN, France), and supported by several other stakeholders including national societies and associations. The website is bi-lingual (French and English) and the purpose is to share the lessons learnt from radiological incidents that have occurred in the industrial, medical, research and teaching, and other non-nuclear sectors. OTHEA contains a collection of incident reports, categorised according to the sector and the type of application, and a search facility. The reports can be freely downloaded and printed, for example for use in radiation protection training activities. To encourage dissemination, the incident reports have been made anonymous, i.e. any information that could identify a particular individual, organisation or site has been removed. Each report contains a brief summary of the incident, the radiological consequences, and the lessons learnt. The aim is not to capture every single incident, but to provide a range of reports selected according to the value of the lessons learnt. For OTHEA to be a long-term success, it needs to be sustained with new reports. Therefore users are encouraged to submit incident reports that can be considered for inclusion in OTHEA. This note summarises the background to OTHEA, and provides a description of the operating features and content at its launch in summer 2010.

Black pigments in the liver related to gold and titanium deposits. A report of four cases.

Black pigments are rarely described in the liver. We report four patients with chronic cholestasis and black pigments described on liver histological examination. Energy-dispersive X-ray analysis identified these black pigments as gold particles in the first three patients and titanium particles in the fourth. The origin of the gold deposits was unknown in this first patient and related to gold salts therapy in the two others. Titanium deposits was associated with hepatic granulomas and related to total knee replacement.

[Clinical case of the month: clostridium difficile colitis]. / Le cas clinique du mois. Colite à clostridium difficile.

A 55-year-old patient with mant e cels underwent a cytotoxic chemotherapy (D.H.A.P. + Rituximab). During the medullar aplasia related to the third cycle, diarrhoea due to Clostridium difficile arised and relapsed 15 days later despite normal blood counts. This colitis was very severe with pluribacterial peritonitis, but resolved with intensive medical treatment. The incidence, the patient's risk factors, the iatrogenic and nosocomial characters of cl. difficile colitis are discussed.

C-H insertion approach to the synthesis of endo,exo-furofuranones: synthesis of (+/-)-asarinin, (+/-)-epimagnolin A, and (+/-)-fargesin.

A series of novel 5-aryl-4-aryloxymethyl-3-diazotetrahydrofuran-2-ones (12, 24, and 35a/b) have been prepared and found to undergo regio- and stereoselective C-H insertion reactions to afford 2,6-diaryl-3,7-dioxabicyclo[3.3.0]octane-8-ones (18, 26, and 36a/b) with endo,exo stereochemistry. Subsequent reduction of the lactone ring and cyclization of the resulting diols 27 and 37a/b permitted the synthesis of three endo,exo-furofuran lignans: asarinin (2), fargesin (3), and epimagnolin A (4). En route to the key diazo compounds 24 and 35a/b, a modified procedure for the Ghosez keteniminium-olefin cyclization was developed, which was required to minimize the decomposition of acid-sensitive functional groups such as electron-rich benzylic ethers that were present in the target compounds 2-4.

Acute effects of captopril on systemic and renal hemodynamics and on renal function in cirrhotic patients with ascites.

The reduction of angiotensin II production by captopril--an angiotensin-converting enzyme inhibitor--could suppress hyperaldosteronism without impairment of renal function and could thereby be useful in the treatment of ascites in patients with cirrhosis. Systemic and renal hemodynamics and renal function were studied in 6 nonazotemic patients with cirrhosis and ascites with a low-sodium diet before and after oral administration of 25 mg of captopril. Cardiac output and renal blood flow did not change significantly after administration of captopril, whereas mean arterial pressure significantly decreased. Systemic and renal vascular resistances were significantly reduced. There was a statistically significant reduction of glomerular filtration rate, filtration fraction, and urinary output. Plasma renin activity significantly increased in all patients after administration of captopril. A statistically significant correlation was found between the decrease in mean arterial pressure and the reduction of glomerular filtration, but no relationship was found between basal values of plasma renin activity and the other observed variations. We concluded that captopril mainly induces hypotension due to an increase in renal vasodilatation in ascitic patients with cirrhosis.

Oral zinc supplementation improves hepatic encephalopathy. Results of a randomised controlled trial.

22 cirrhotic patients with chronic encephalopathy were given oral zinc supplementation or placebo in a double-blind randomised trial. In the group which received zinc acetate 600 mg a day for 7 days, serum zinc had been restored to normal by day 8. On day 8 hepatic encephalopathy, as assessed by a trailmaking test, was improved in the supplemented group but not in the placebo group. There was also a significant increase in blood urea nitrogen in the supplemented group. Short-term oral zinc supplementation probably improved hepatic encephalopathy by correcting the zinc deficiency that compromises conversion of ammonia to urea. The duration of this improvement requires further investigation.

Discrepancy between wedged hepatic venous pressure and portal venous pressure after acute propranolol administration in patients with alcoholic cirrhosis.

In patients with alcoholic cirrhosis, wedged hepatic venous pressure closely reflects portal venous pressure. This study was carried out to determine if propranolol-induced reductions in portal venous pressure are accurately evaluated by the measurement of wedged hepatic venous pressure. Hepatic venous cannulation and percutaneous transhepatic catheterization of the portal vein were simultaneously performed in 7 patients with alcoholic cirrhosis. One hour after oral administration of 40 mg of propranolol, wedged hepatic and portal venous pressures significantly decreased from 24.3 +/- 3.5 (mean +/- SD) to 19.0 +/- 3.0 mmHg, and from 24.7 +/- 3.9 to 22.4 +/- 3.6 mmHg, respectively. Although no significant difference was found between baseline wedged hepatic and portal venous pressures, a significant difference was found between these pressures after propranolol administration. We concluded that during acute administration of a drug acting on the splanchnic circulation, the measurement of wedged hepatic venous pressure may not provide a reliable estimation of the magnitude of the changes in portal venous pressure. There is, however, no evidence that the direction of the changes might not be adequately assessed by wedged hepatic venous pressure measurement.